Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
What are your thoughts about becoming active with national societies related to geriatric medicine and/or gerontology?
There are so many benefits to this investment. Beyond becoming part of a community and keeping up with changes in the field, it also provides opportunities for career advancement and peer mentorship. It is so valuable to know what is happening at other institutions, and so many chance meetings with ...
What is your approach to managing incidental hypertension without evidence of end-organ damage in hospitalized patients?
Approaches to managing inpatient HTN without evidence of end-organ dysfunction have evolved over the years. I worked with some attendings who felt strongly about treating. There was a great JAMA IM article that explored this very question for non-cardiac patients. Link here: Rastogi et al., PMID 333...
Are you more likely to use cefazolin over antistaphylococcal penicillins for MSSA bacteremia in light of the recent publication of the SNAP trial?
I had already mostly transitioned to using cefazolin; while I occasionally use oxacillin for CRRT patients, I have found that oxacillin is a very difficult drug for patients to tolerate (in my experience), with AIN happening with relatively alarming frequency considering how infrequently I use it. A...
What strategies do you recommend for new primary care providers to help create boundaries with patients on their virtual portals (I.e., MyChart)?
I recommend creating a dot phrase that can be added to all of your replies as a form of signature to help educate your patients. I also suggest printing the same at each visit along with the patient’s visit instructions. ***Patient Virtual Communication Best Practices for Optimal Results*** MyChart ...
What was the rationale for abrupt discontinuation of etanercept rather than gradual tapering in the SEAM-RA trial?
The main goal of this trial was to get RA patients off of therapy and to see whether they would flare or maintain remission. We didn’t expect that the ultimate likelihood of success or failure was going to be primarily related to how long it took to do that. While a gradual withdrawal of the drug ma...
How do you present the trade off between a small chance of a sustained response for a new drug at the expense of potential worsening quality of life?
Since we now have an increasing number of treatments at our disposal, this becomes an ever more frequent conversation in oncology. This question gets at several Shared Decision Making (SDM) model steps. Usually in this scenario, there are not routine standard of care options and highlighting the pat...
What is your treatment paradigm for rectal cancer in the setting of COVID-19?
We haven't changed our standard recommendation: short course radiation -> 3-4 months of FOLFOX. In a very timely manner, the RAPIDO ASCO abstract was released here in May. It showed that the patients who received short course radiation -> FOLFOX had improved pCR, less disease related treatment failu...
How do you assess the pros and cons of discontinuing a selective alpha blocker such as tamsulosin or alfuzosin in an older adult male with orthostatic hypotension and established urinary retention?
Discontinuing alpha blockers in older adults with orthostatic hypotension (OH) and urinary retention is rarely straightforward, and the decision hinges on several key points. First, it is important to understand that selective alpha-blockers (tamsulosin, alfluzosin) work by relaxing the smooth muscl...
When do you consider switching a generic formulation of an antiseizure medication to the brand formulation?
This rarely, if ever, happens. The easiest way to think of the difference is not to think of brand versus generic. Think of brand as the first generic (G1), and all the rest are later generics (G1, G2, etc.). Since the active ingredient is identical amongst all formulations, the only difference is w...
How should you manage a COVID-19 infected/suspected patient who is receiving chemotherapy and cannot interrupt or delay their cancer treatment?
This is difficult to answer specifically without further details. There certainly is accumulating evidence that patients with cancer, especially those receiving immunosuppressive chemotherapy, are at greater risk of COVID-19 infection if exposed, and a greater risk of serious and life-threatening co...