Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
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...
How do you approach using fecal microbiota therapy for recurrent Clostridioides difficile infection in immunocompromised patients?
We generally do not do the single donor FMT via colonoscopy, that was popular 5-10 years ago. We do offer both the oral and enema-based products, with a slight preference for the oral-based product due to ease of use.
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...
How do you manage resistant infections that persist after stopping antibiotic therapy in patients with non-CF bronchiectasis?
In patients with non-CF bronchiectasis who continue to have infections after completing antibiotics, I first obtain repeat sputum cultures to identify the organism and check for any resistance patterns. I also review adherence to airway clearance techniques, as inadequate mucus clearance often contr...
How do you manage resistant infections that persist after stopping antibiotic therapy in patients with non-CF bronchiectasis?
In patients with non-CF bronchiectasis who continue to have infections after completing antibiotics, I first obtain repeat sputum cultures to identify the organism and check for any resistance patterns. I also review adherence to airway clearance techniques, as inadequate mucus clearance often contr...
Are recurrent UTIs a contraindication to SGLT2i use?
I don't view UTIs as a contraindication to SGLT2i use, but I make a risk and benefit analysis with each patient. Bacterial UTI as well as mycotic vaginal infections may be a sign that the patient has excessive glycosuria from hyperglycemia. In general, treating hyperglycemia should lessen the freque...
How do you counsel patients regarding using stimulants for attention-deficit/hyperactivity disorder during pregnancy?
There is limited research evaluating the course of ADHD across pregnancy and postpartum. The individual woman’s severity of illness and impairment inform treatment decisions across pregnancy. As with the treatment of all disorders during pregnancy, the risks and benefits of medications need to be ca...
What patients with food allergies do you screen for EoE?
If a patient has symptoms of esophageal dysfunction, they should be screened for EoE. Because symptoms can be ill-defined in children, this may be more challenging. Growth failure, unexplained abdominal pain, or vomiting are indications for GI referral with consideration for endoscopy. Indiscriminat...
How do you assess and counsel women with chronic post-lumpectomy or mastectomy pain?
Post-surgical breast pain is not uncommon. Estimates suggest that 25-60% of patients having breast surgery experience persistent pain, with symptoms lasting from months to years following breast cancer diagnosis and treatment (Langford et al., PMID 25439318; Gartner et al., PMID 19903919).Initial as...