Learning Objectives

1.How does my clinical decision making on interesting and unusual cases compare with that of other physicians?

2.Can the practice of medicine really be this much fun?

3.How can the most interesting case that I have ever diagnosed become a teaching tool for physicians everywhere?

The History of Thieves’ Market

The Internal Medicine version of Thieves’ Market has been in existence since the late 1980s, when David Scrase, M.D. began collecting interesting cases and presenting them at the annual meeting of the Michigan Chapter, American College of Physicians.  The Audience Response System was quickly added to the entertaining format and the sessions immediately became the most popular sessions at the meetings.  Jan Rival, M.D., the Governor of the Michigan Chapter at the time, successfully campaigned to have Thieves’ Market become part of the annual ACP national meetings, and they have likewise been among the highest rated sessions there since 2000.  In 2011, over 1000 people attended Dr. Scrase’s Thieves’ Market session in San Diego.  It was sheer pandemonium, exactly the atmosphere required for a successful Thieves’ Market conference session.  Dr. Scrase also now regularly presents the Thieves’ Market format in New Mexico, where he currently lives and practices medicine, and, on invitation, in various other medical settings across the United States.

How the Cases Work

Typically, Dr. Scrase will begin by describing the patient’s chief complaint and history of present illness.  Next, important physical examination findings are offered, followed by basic lab and imaging studies.  The audience is given opportunities to use the Audience Response System to vote at key points during the case presentation.  Typically, a diagnostic test is performed near the end of the case presentation.  This usually represents the audience’s last opportunity to “steal” the diagnosis.  Once the diagnosis is revealed, a summary of the disease state is presented, along with relevant medical history, pathophysiology, diagnostic approach, and treatment.

The Role of the Audience

Thieves’ Market sessions are unique in that audience participation is mandatory!  Audience members are expected to interrupt frequently, ask questions, shout out diagnoses, challenge the speaker, and ultimately to try to steal the diagnosis (you are the thieves) before it appears on the screen.  The first audience member to correctly call out the diagnosis before it is revealed on screen is a “winner,” and will be immortalized via photo with all prior Thieves’ Market winners.  Note that you must say exact diagnosis out loud, the speaker must hear it, and then repeat it, to “win.”

The Role of the Presenter

Dr. Scrase pledges that he will not lie to the audience.  However, just like a typical patient history, he may not always report all of the facts right up front.  He will never withhold information when asked a direct question.  Occasionally, there may be one case which has either a significant psychological component or is a “spoof” case, just to keep the audience on its toes.

At Thieves’ Market, fun is mandatory.  Those who prefer a more droll and sedate elucidation of the pathophysiology of rare diseases to the thrill of diagnosing a rare and unusual case might be better served by spending time in the medical library during this session.

Submit your own Great Case!

Once you experience the format of the session, you will likely recall one of the “Great Cases” of your own medical career.  Please take a moment to fill out the attached form and pass it on to David after the conference.  You may see your own “name in lights” (of the PowerPoint projector) at a future national meeting!

Click here for the form you can use to submit your great case!