Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
How do you approach a situation where you disagree with a consultant's recommendation for your patient, particularly when the consultant has more disease-specific expertise, but you have a fuller picture of the patient's overall clinical trajectory?
Thank you for this question. If a consultant provides a recommendation that I disagree with, I try to understand their perspective and rationale. Most of the time, it ends up in a direct phone call to talk through the clinical scenario, listen with intention to understand their perspective, and shar...
How do you approach a situation where you disagree with a consultant's recommendation for your patient, particularly when the consultant has more disease-specific expertise, but you have a fuller picture of the patient's overall clinical trajectory?
Thank you for this question. If a consultant provides a recommendation that I disagree with, I try to understand their perspective and rationale. Most of the time, it ends up in a direct phone call to talk through the clinical scenario, listen with intention to understand their perspective, and shar...
What is your approach to patients with persistent low libido despite normal testosterone levels after use of exogenous testosterone replacement therapy?
The key point is understanding a man’s mental health and relationship status. I will always screen for depression and strongly encourage sex therapy. My unvalidated but effective screening question is asking when their last vacation was and how their libido and erections were. It’s surprising how ma...
Are there still clinical situations in which you deliberately treat patients with a DOAC besides apixaban?
Thank you for your question. Apixaban has been my preferred agent for a long time for patients requiring therapeutic anticoagulation. Apixaban’s lower bleeding risk was shown prior to and now has additional evidence to support this with the COBRRA trial. The risk is also ameliorated by the safety in...
Are there still clinical situations in which you deliberately treat patients with a DOAC besides apixaban?
Thank you for your question. Apixaban has been my preferred agent for a long time for patients requiring therapeutic anticoagulation. Apixaban’s lower bleeding risk was shown prior to and now has additional evidence to support this with the COBRRA trial. The risk is also ameliorated by the safety in...
Do you add empiric anti-MRSA coverage to the initial antibiotic regimen for a patient admitted with community-acquired pneumonia who has risk factors for MRSA but a negative MRSA nasal screen?
Thank you for this excellent and highly relevant clinical question. I approach this scenario by blending robust evidence-based medicine with fundamental principles of diagnostic reasoning. The short answer is generally no, you probably do not need to add empiric anti-MRSA coverage for a standard CAP...
What advice would you give a hospitalist in their first few years of practice who wants to develop a focused area of expertise, such as perioperative medicine, quality improvement, or medical education, while maintaining a full clinical load?
I think my two big pieces of advice are: Pick one thing; you don't have to stay with it your entire career, so whatever seems interesting right now is just fine. I have moved from education to QI to even some basic science work, which I would never have predicted. Part of the fun is figuring out wh...
What advice would you give a hospitalist in their first few years of practice who wants to develop a focused area of expertise, such as perioperative medicine, quality improvement, or medical education, while maintaining a full clinical load?
I think my two big pieces of advice are: Pick one thing; you don't have to stay with it your entire career, so whatever seems interesting right now is just fine. I have moved from education to QI to even some basic science work, which I would never have predicted. Part of the fun is figuring out wh...
What screening tools or signs do you use to predict if a cancer patient is near end-of-life?
For most of us, long-time practicing oncologists, all we have to do to determine that one of our patients is at the end of their life is to be in the same room with them. No special computer programs or calculators are needed. Just look closely at the patient's current weight, their level of conscio...
What would you tell a trainee who is interested in pursuing a career in geriatric medicine but is concerned about the relatively low number of people who enter/match into the field?
A trainee who is interested in pursuing a career in geriatric medicine should consider the long-term potential of contributing meaningfully to the field and to the lives of their patients. Although there are concerns from trainees about the relatively low number of people who enter/match into the fi...