Expertise in clinical problem-solving defines and distinguishes infectious diseases as a specialty. A new, ongoing series of articles in Clinical Infectious Diseases — “Clinical Dilemmas in Infectious Diseases” — highlights how experienced clinicians deploy these reasoning skills to navigate complex cases.
The series editors, Varun Phadke, MD, and Daniel Minter, MD, recently shared how the series came together, key takeaways from the articles published so far and advice for potential authors looking to submit their own challenging diagnostic or management dilemmas.
What was the inspiration behind this new article series? How was it developed?
Like many of our ID colleagues, we were drawn to ID because we are passionate about problem-solving — this includes thinking through diagnostic mysteries as well as navigating challenging management dilemmas. Indeed, trainees, non-ID colleagues and patients often associate our specialty with expertise in these domains. Yet, before this new article series, there had been no venue specifically for ID clinicians to showcase and celebrate the complex reasoning skills that we deploy in everyday practice. And so, we developed the idea for “Clinical Dilemmas in Infectious Diseases,” or CDID.
Before launching CDID we drew inspiration from a variety of non-ID journals (for example, the New England Journal of Medicine, the Journal of General Internal Medicine, and the Journal of Hospital Medicine, to name a few), which have featured a clinical problem-solving article format for many years. Importantly, while the focus of many of those articles is on an expert clinician reaching a difficult diagnosis — certainly an important aspect of infectious diseases — we also wanted to distinguish our series by emphasizing the management dilemmas that are routine in our clinical work. Finally, because we have a shared educational interest in teaching about clinical reasoning, we wanted each case in our series to highlight clinical reasoning concepts that underpin the complex diagnostic thinking and decision-making that define our specialty.
The series launched in 2025, and 10 articles have published so far. What are some key takeaways and lessons — or surprises — from the articles to date?
It has been exciting to see submissions spanning the entire breadth of our specialty, from bread-and-butter bacterial and fungal infections to HIV medicine, sexually transmitted diseases, tuberculosis, immunocompromised host ID, travel medicine and beyond. As you might expect, many of the most common diagnostic puzzles in ID have made an appearance, such as fever of unknown origin, undifferentiated CNS lesions or pulmonary infiltrates, and of course, rashes! And, as we had hoped, many cases highlight some of the toughest management problems that we face in ID, including interpreting discordant test results, choosing therapy in the face of diagnostic uncertainty, managing treatment-related toxicities or treatment failure, and navigating social and logistical barriers to care.
One important takeaway for us has been renewed appreciation for the myriad approaches to thinking about diagnosis and management that exist within our specialty. As readers will surely appreciate, in each of our individual practices it is sometimes easy to assume that there are limited ways to organize how to approach a particular clinical dilemma — learning from the many unique and refined scripts and schemas that are on display in the discussant commentary of our submitted cases has been humbling and inspiring.
What kind of feedback have you gotten from readers about the series and the approach it uses to highlight clinical reasoning in ID?
We have been delighted to hear from readers who have enjoyed engaging with the cases themselves, and those who have been deploying them for teaching purposes. We have heard about colleagues pulling up CDID cases to stimulate reasoning discussions in real-time, and others who share them for asynchronous deliberate practice of clinical decision-making skills. This is precisely the kind of resource we set out to build in our mission to showcase the clinical reasoning ID clinicians are doing all the time.
All that said, we are eager to expand the reach of CDID and hear from our readers, including specifically what they’d like to see more of, in terms of cases, clinical reasoning themes, supplemental educational materials to support teaching, or additional venues to engage in clinical problem-solving.
What advice do you have for potential authors? What types of cases are good candidates for a “Clinical Dilemmas in Infectious Diseases” submission?
There is an old adage that trainees often hear on the wards that “there is something to learn from every case” — when viewed specifically through the lens of clinical reasoning, one can see why this holds true. Cases that highlight the iterative cognitive steps in a difficult problem are good candidates for CDID — this might mean a diagnostic mystery where pivotal elements of the patient’s presentation unfolded gradually over time, an undifferentiated clinical syndrome whose workup and management required careful weighing of risks and benefits, or an established infection where the usual therapeutic approach was complicated by one or more obstacles.
Importantly, the unusualness of the diagnosis or treatment is often not the most interesting aspect of a successful CDID submission. Many of our most fascinating submissions have been about relatively common syndromes or infections whose story was nonetheless compelling because of the difficult decisions that confronted the treating clinicians along the way. Put another way, in contrast with other clinical problem-solving series where the central question for each case is “What is the diagnosis?”, the suitability of a case for CDID is largely dependent on if there is no single answer to the question “What would you do?”
Check out previously published articles in the CDID series on the CID website. To learn more about how to submit a CDID article, see the author guidelines.
