Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
Has the TRAVERSE trial, which showed testosterone therapy was noninferior to placebo for MACE but raised signals for pulmonary embolism and atrial fibrillation, changed how you counsel middle-aged men who specifically cite cardiovascular safety when requesting TRT?
Results from the TRAVERSE trial have made my discussions a bit more streamlined, but I have always used a handout discussing known risks of TRT, such as infertility, testis atrophy, and erythrocytosis, and associated risks based on poor literature dating back to 2011. This trial confirmed what most ...
How have you integrated the new HPV self-swab collection into your routine cervical cancer screening, particularly in those with prior abnormal results?
Unfortunately, the new HPV self-swab collection is not currently available in my institution, but I would definitely incorporate this into my routine cervical cancer screening if it were an option! I think the HPV self-swab option is ideal for patients who are either not amenable to a pelvic exam or...
How have you integrated the new HPV self-swab collection into your routine cervical cancer screening, particularly in those with prior abnormal results?
Unfortunately, the new HPV self-swab collection is not currently available in my institution, but I would definitely incorporate this into my routine cervical cancer screening if it were an option! I think the HPV self-swab option is ideal for patients who are either not amenable to a pelvic exam or...
With data suggesting that menopause contributes to major cardiovascular, bone, and cognitive outcomes, what changes should internal medicine clinicians make in risk assessment, HRT counseling, and long‑term monitoring for midlife women?
This is an interesting question because there are no new data about menopause as a risk factor for CV, bone, or brain health. These BMJ guidelines are very helpful and reflect a new approach to the treatment of menopausal symptoms, which is hormone therapy first. My patients usually want to try alte...
How do you choose between various nonpharmacological strategies for prevention of behavioral and psychological symptoms of dementia such as bright light therapy, pet therapy, robot therapy, exercise, massage?
Non pharmacological strategies are most effective strategies with no potential side effects, but they are resource heavy. So it is crucial to assess specific symptoms, access to resources and the enviornment.A 3-Step Approach to ChoosingIdentify the Target Symptom: Are you treating agitation, apathy...
How do you evaluate for an ascending UTI in a patient with a urostomy?
Evaluating for ascending UTI in a patient with a urostomy UA Generally low value; chronic pyuria/mucus makes results unreliable. Urine culture Essential; must be collected from a clean stoma catheterization or a fresh pouch, and not from the urostomy bag. Imaging (CT abdomen and pelvis wit...
How do you evaluate for an ascending UTI in a patient with a urostomy?
Evaluating for ascending UTI in a patient with a urostomy UA Generally low value; chronic pyuria/mucus makes results unreliable. Urine culture Essential; must be collected from a clean stoma catheterization or a fresh pouch, and not from the urostomy bag. Imaging (CT abdomen and pelvis wit...
How do you pragmatically approach a conversation about "liver detox"/"liver cleansers" when patients bring up this topic?
It's important to keep an open mind with the use of these products, as often people will want to take them despite what you might say. Having some experience with the use of these products (or at least their ingredients) will give the patient a comfort level with freely discussing their use with you...
How do you approach a patient maintained on chronic methadone incidentally found to have a prolonged QTc?
If a patient without OUD on chronic methadone who has not previously had QTc issues, suddenly has a prolonged QTc, I look for other reversible causes such as hypokalemia, hypomagnesemia, new medications (such as recent antibiotics, Zofran), etc. From there, it's a nuanced and patient-centered risk/b...
How do you approach a patient maintained on chronic methadone incidentally found to have a prolonged QTc?
If a patient without OUD on chronic methadone who has not previously had QTc issues, suddenly has a prolonged QTc, I look for other reversible causes such as hypokalemia, hypomagnesemia, new medications (such as recent antibiotics, Zofran), etc. From there, it's a nuanced and patient-centered risk/b...