Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
Would you consider using DOACs as a bridge to warfarin instead of heparin or LMWH?
I would feel very comfortable bridging with apixaban, given its relatively short half-life and fairly quick absorption. I think it is very similar to bridging with Lovenox. More importantly, it usually takes at least 24 hours until heparin IV gets to therapeutic levels - it is often too high or too ...
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 ...
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...
What treatment modalities have you had success with for treating recalcitrant warts?
More than digital warts, I find plantar warts challenging to treat. This is my usual approach: Paring down warts on feet. Multiple rounds of cryotherapy every 4-6 weeks. Between cryotherapy sessions- use of topical 5-FU with 40-70% salicylic acid After 3 rounds of cryo- if still persistent- IL Cand...
Do you prefer formal testing to establish a diagnosis of SIBO/IMO over empiric treatment?
Great practical question. I prefer formal testing for several reasons: Even though postprandial bloating and distention along with change in bowel habits are the hallmarks of SIBO/IMO, they are non-specific and can be caused by myriad of other organic causes. A normal breath test would direct the a...
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...