October 18th, 2008

Back to School, Day 2

During the course, often the best questions and anecdotes come during the breaks.  Here are a few:

  1. Tons of questions about our favorite nemesis, MRSA.  What works for chronic carriers?  How do you manage family members who you suspect would be culture-positive (and the source of recurrences), but are not your patient?  What if the vet won’t culture the family dog?  What are the guidelines for infection control in the outpatient setting?  What is the best non-linezolid (which still costs > $150/day) oral antibiotic?  What’s the right dose of trimethoprim-sulfa?  (Many advocates for two double-strength tablets twice daily.)  Number of definitive answers to any of the above questions?  None. I guess misery loves company.
  2. A primary care MD working at a college health clinic gave me some insight into just how far we still have to go to make those revised HIV testing guidelines a reality.  In this campus-based practice, if one of the students requests an HIV test, or the clinician thinks an HIV test is indicated, several restrictions are in place that go way beyond the state-mandated requirement for written informed consent.  First, extensive pre-test counseling is required; second, only one of the providers is allowed to order the test (so the student must return to see that clinician if he is not available that day); third, mention of HIV testing in the medical record is forbidden; and fourth, the results of the test do not appear in the student’s chart.  (They are kept in some locked remote location, no doubt.)  Hey, can we stop this madness already?  Is there any evidence that such policies help anyone?  (The MD at our course was complaining about them, not surprisingly.)  Of note, the revised HIV testing recommendations — explicitly outlining the rationale for eliminating barriers to testing — are now over two years old.
  3. Only two course participants thought I was Paul Farmer.  Interestingly, one of them thought I was Paul Farmer immediately after he gave his lecture, during the coffee break, when the real thing was standing right across the room. My clue she had the wrong Paul Edward was when she told me my work inspired her to apply to medical school when she was growing up in Port-au-Prince.  There are definitely worse people one could be mistaken for — back when I had more hair (lots more hair), someone thought I was a dead ringer for this guy. Yikes.

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

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Infectious Diseases

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