Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
Do you recommend checking anti-drug antibodies for patients on TNF inhibitors?
This is a very good question with direct clinical practice implications. I do not check or follow anti-drug antibodies when using TNF inhibitors for the treatment of rheumatoid arthritis or psoriatic arthritis. There are reports that suggest, on a group level, that these antibodies, if present, impa...
What do you recommend as a first-line antidepressant in patients with major depressive disorder and migraines?
In my clinical practice, I have found SNRI medication, particularly extended-release venlafaxine (dosed from 37.5 mg to 225 mg), to be helpful for patients with both comorbidities. Other medication classes I have seen used to good effect include TCAs (amitriptyline, nortriptyline) and some SSRIs (se...
What are your thoughts about becoming active with national societies related to geriatric medicine and/or gerontology?
There are so many benefits to this investment. Beyond becoming part of a community and keeping up with changes in the field, it also provides opportunities for career advancement and peer mentorship. It is so valuable to know what is happening at other institutions, and so many chance meetings with ...
What are your thoughts about becoming active with national societies related to geriatric medicine and/or gerontology?
There are so many benefits to this investment. Beyond becoming part of a community and keeping up with changes in the field, it also provides opportunities for career advancement and peer mentorship. It is so valuable to know what is happening at other institutions, and so many chance meetings with ...
Do patients with a PEG allergy have a contraindication to receiving mRNA vaccines?
While early anecdotal reports suspected that PEG allergy may be linked to allergic reactions to mRNA COVID vaccines, subsequent research disproved this. Therefore, even patients with true IgE-mediated allergy to PEG (which is extremely rare) do not have a contraindication to receiving mRNA vaccines....
What strategies do you recommend for new primary care providers to help create boundaries with patients on their virtual portals (I.e., MyChart)?
I recommend creating a dot phrase that can be added to all of your replies as a form of signature to help educate your patients. I also suggest printing the same at each visit along with the patient’s visit instructions. ***Patient Virtual Communication Best Practices for Optimal Results*** MyChart ...
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...
What is your treatment algorithm for dissecting cellulitis of scalp?
I view dissecting cellulitis as a variant of HS (and we know it's a component of the follicular tetrad along with acne conglobata and pilonidal cysts). Anti-TNFa inhibitors and isotretinoin are preferred therapies for this condition with a high level of efficacy.
How do you assess the pros and cons of discontinuing a selective alpha blocker such as tamsulosin or alfuzosin in an older adult male with orthostatic hypotension and established urinary retention?
Discontinuing alpha blockers in older adults with orthostatic hypotension (OH) and urinary retention is rarely straightforward, and the decision hinges on several key points. First, it is important to understand that selective alpha-blockers (tamsulosin, alfluzosin) work by relaxing the smooth muscl...
How do you assess the pros and cons of discontinuing a selective alpha blocker such as tamsulosin or alfuzosin in an older adult male with orthostatic hypotension and established urinary retention?
Discontinuing alpha blockers in older adults with orthostatic hypotension (OH) and urinary retention is rarely straightforward, and the decision hinges on several key points. First, it is important to understand that selective alpha-blockers (tamsulosin, alfluzosin) work by relaxing the smooth muscl...