Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
How do you decide whether to reinitiate a GLP-1 agonist after a patient has experienced acute pancreatitis while on this therapy?
Will not try it again, given the seriousness of the side effect, and in most cases, there are alternatives.
How do you counsel patients on GLP-1 agonists for weight loss who wish to space out their medication or take a "drug holiday" to temporarily increase their appetite?
Will not try it again, given the seriousness of the SE and given that alternatives are available.
Would you recommend against starting SGLT2 inhibitors in patients with a history of struvite nephrolithiasis who also have proteinuria and chronic kidney disease?
Yes! Although SGLT2 inhibitors are helpful in most patients with proteinuric chronic kidney disease, they can also exacerbate some coexistent conditions. Increasing glycosuria predisposes patients to UTIs. For patients with struvite stones, SGLT2s would likely exacerbate the infection and increase s...
How would you prioritize physiotherapy and cognitive behavioral therapy for functional movement disorders in a resource-limited setting where access to both might be constrained?
I have a dedicated clinic for people with functional movement disorder/functional neurologic disorder (FMD/FND) in New York City and even in a city like New York, it is difficult or actually impossible to refer patients for appropriate therapy.For some people with rather straightforward cases, a ref...
What are some practical tips for caring for resource-limited patients with severe, Hurley Stage III hidradenitis suppurativa?
HS can be a really expensive disease, so this is a great topic. For wound care, ordering gauze and supplies through Amazon can be a big savings. Hidrawear, clothing made to hold bandages for HS, can also be covered by insurance. If you need order forms, you can reach out to the company www.hidrawear...
What is the clinical significance of positive anti-thyroid antibodies in a patient that is post-thyroidectomy?
Ordinarily, the persistence of anti thyroperoxidase antibodies (antiTPO) or antithyrogloblin (antiTG) antibodies is of no concern or clinical relevance. However, in the case of patients with differentiated thyroid cancer, in whom thyroglobulin (TG) testing is a cornerstone of follow up, persistent a...
How do you handle elevated blood calcium levels from lithium?
Lithium in the past would often show up as calcium on blood tests, leading to an artificially elevated level. I don’t know if the modern tests have fixed that. Usually, I will watch it if over time the calcium is only mildly elevated, or refer for further workup (such as parathyroid issues, bone iss...
What is the maximum dose or treatment course of topical steroids that you generally recommend to avoid causing systemic adverse effects?
Topical steroids cause essentially no systemic AEs. Dosing is limited by local AEs.
What unique factors do you take into consideration for geriatric patients with a first lifetime episode depression?
Late-onset depression can also be the earliest symptom of dementia, particularly Alzheimer's, in some cases!
In light of recent measles outbreaks, have you adjusted your vaccination counseling or preventive strategies for adult immunocompromised patients?
Check measles antibody (once) in individuals working in public places, especially when working with kids.