Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
Are you recommending the mRNA COVID-19 vaccines to your patients with immune mediated inflammatory diseases?
This is THE question at the moment for providers of patients with immune mediated inflammatory diseases. For now, we are merely extrapolating as patients with active IMIDS were censored from trials (Pfizer & Moderna). Organizations like the American College of Rheumatology are moving quickly to clos...
How soon after a VTE would you feel comfortable with a patient undergoing an elective surgery?
Here is my approach: Many factors play a role in decision making such as type of venous thromboembolic event, clot burden, provoked versus unprovoked nature of the event, patient's bleeding and clotting phenotype, associated risk factor such as cancer, etc, type of anticipated surgery, and risk for ...
What is your strategy for having COVID positive patients resume infusions after they have recovered from the infection?
If they are asymptomatic and doing well, we may resume systemic therapy as clinically indicated. I have used either chemotherapy or IO, depending on the case. We follow institutional guidelines but retesting for Covid19 is not required at our center if the patient has recovered and has been asymptom...
Is a comprehensive physical exam with vital signs warranted for routine follow-up visits in well-controlled uncomplicated RA patients?
This is an important question for which we don't have an evidence-based answer yet, but it is likely that our practice will change with these new guidelines, and with the expansion of telemedicine. I think we cannot have a one size fits all recommendation. Many factors may influence the need for a f...
Do you recommend long term anticoagulation for all patients with first time unprovoked VTE?
I consider long term anticoagulation after a first unprovoked proximal DVT or PE in patients with low bleeding risk, especially if they are male. Risk/benefit discussion is employed for patients who have a higher bleeding risk after a first unprovoked VTE event.
What type of surveillance would you recommend following resection of primary mucinous carcinoma of the skin?
A full skin examination every 6 to 12 months. Reminding the patient to call the clinic immediately for any symptoms that are unusual, or for a new skin lesion and perform a symptoms directed work-up.
Do you switch to certolizumab in RA patients who are doing well on other TNFis and planning to become pregnant?
I have not “switched” any patients who are stable and doing well on an anti-TNF agent when the issue of pregnancy arises. The risk of flare remains a concern in this situation. There is enough data-base derived information (such as the OTIS registry) to suggest safety to continue an established anti...
How would you approach localized lymphadenopathy in a patient with lupus whose symptoms are otherwise well-controlled?
Localized adenopathy in lupus is infrequent and the differential is broad including nonspecific reactive hyperplasia as part of underlying illness or local trigger, infectious (e.g., suppurative in association with staph or strep, MTB, atypical mycobacterium, fungal, etc), lymphoma (e.g., Hodgkin's ...
How many years of oral antibiotics prophylaxis do you recommend for a teenager with hereditary spherocytosis post-splenectomy?
If older than 5 and vaccinated, no proph.
For patients on a bone-modifying agent for osteoporosis/severe osteopenia in the context of adjuvant AI therapy, how do you manage the bone-modifying agent once their AI course is complete?
In this case, I would be guided by the bone density (DXA) scan, if there is still osteoporosis or severe osteopenia, I would continue the BMA and repeat the DXA scan in one or two years. If the DXA shows improvement, I would discontinue the BMA, knowing that one can re-institute at a later date. Sev...