Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
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 patient factors are most important when considering who needs a broader workup for osteoporosis prior to starting therapy?
A workup to rule out secondary causes must be done prior to starting therapy for osteoporosis. A good history and exam are recommended to look for any clues for modifiable factors. At a minimum, one should do CMP, 25-OH vitamin D, TSH, and a 24-hour urinary calcium or calcium/creatinine ratio should...
What are the current official guidelines regarding managing patients during COVID-19?
Here are some guidelines and FAQ from professional societies: NCCN: https://www.nccn.org/covid-19/default.aspx ASTRO FAQ: https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information/COVID-19-FAQs ASCO Coronavirus Resources: https://www.asco.org/asco-coronavirus-information
What criteria do you use to decide when to perform a BAL in hypersensitivity pneumonitis?
Short answer: When the vibes are right. I know that's a flippant answer, but that's an honest-to-God real answer. Long answer: This is really complicated and personally, I'm frustrated by our guidelines and the level of evidence we have for diagnosing HP. To answer the question, it's worth delineati...
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...
When do you use a carbapenem empirically to treat a patient with Acinetobacter infection?
Significant rates of Acinetobacter resistance to multiple classes of antimicrobial agents are a global concern. Mechanisms of resistance include bacterial production of beta-lactamases (i.e., carbapenemases), changes in porin channels, and alterations of target or cellular function due to mutations ...
Are there any specific scenarios in which you calculate estimated creatinine clearance over eGFR in an older adult patient?
This would be something to consider for patients in whom there is a discrepancy between clinical manifestations and creatinine estimated eGFR, for patients at the borderline of CKD stages, and for patients with extremes of muscle mass (which would lead you to think that the eGFR is less accurate). T...
Are there any specific scenarios in which you calculate estimated creatinine clearance over eGFR in an older adult patient?
This would be something to consider for patients in whom there is a discrepancy between clinical manifestations and creatinine estimated eGFR, for patients at the borderline of CKD stages, and for patients with extremes of muscle mass (which would lead you to think that the eGFR is less accurate). T...
For patients admitted while taking chronic outpatient opioids, how do you decide whether to resume their baseline opioid regimen at discharge versus tapering or modifying therapy during hospitalization?
I'm not sure there's a single right answer here. My only recommendation is for patients who are on chronic outpatient opiates: please talk to their ambulatory clinician before making any significant changes. Their ambulatory doctor knows them over time and can give you advice regarding what's happen...
Do you have a standard approach to using POCUS to evaluate acute abdominal pain?
I don't have a standard framework for evaluating acute abdominal pain because my approach as a hospitalist depends very much on the history and available data. This is usually very different from the ED context, though we not infrequently have patients develop acute abdominal pain during hospitaliza...