Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
Are there scenarios that new visits/consults with patients can be done virtually amidst the COVID-19 outbreak?
Starting 3/16, we began offering lower-complexity / lower-risk patients the option of having a Tele-medicine consult vs re-scheduling to a later date. This offer has been extended broadly to all new consults at our facility when the provider indicates that s/he can extend comparable service virtuall...
Do you taper memantine after completion of 24 weeks of therapy?
Tapering is recommended when discontinuing some medications used in the management of dementia such as cholinesterase inhibitors. There are anecdotal cases of “discontinuation syndrome” after abrupt cessation of memantine in patients with dementia. However, this alone does not prove that a slow tape...
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...
In older adults with mild cognitive impairment, do you ever prescribe cholinesterase inhibitors and/or memantine?
This is a great question, and of course, "do you ever" will get you in trouble every time! Let me start by saying that, in general, I do not prescribe these drugs for MCI. Cholinesterase inhibitors are clearly indicated for the mild-moderate stage of some kinds of dementia (some people would include...
In older adults with mild cognitive impairment, do you ever prescribe cholinesterase inhibitors and/or memantine?
This is a great question, and of course, "do you ever" will get you in trouble every time! Let me start by saying that, in general, I do not prescribe these drugs for MCI. Cholinesterase inhibitors are clearly indicated for the mild-moderate stage of some kinds of dementia (some people would include...
What measures should we take regarding routine follow-up visits for well patients in surveillance during the coronavirus pandemic?
3-6 months.
How do you counsel patients with osteoporosis and cervical spine osteoarthritis who are considering chiropractic cervical manipulation or traction?
I am concerned with the risks of actually causing a fracture or nerve impingement/damage. So, I would recommend against.
Should we be utilizing prophylactic G-CSF in our patients with intermediate risk of febrile neutropenia due to the COVID-19 pandemic?
There are many functions of G-CSF, including repression of T-cell and NK cell function. Unless you are certain that growth factors are not modifying the immune network to the detriment of viral clearance—there is no data that growth factors help clear viral infections.
Do you recommend vitamin K2 supplements in patients with osteoporosis?
The answer, as with most vitamin supplementations, cannot be answered with high-level evidence to support a "yes or no". A bit of background and then a brief review of available evidence.Vitamin K is thought to be important for bone health because it activates several proteins involved in bone forma...