HIV and ID Observations

October 8th, 2024

Why We Have Antibiotic Shortages and Price Hikes — And What One Very Enterprising Doctor Did in Response

At the start of our weekly case conference, we get announcements from one of our ID pharmacists. New drug approvals, hospital policies, updated guidelines — that kind of thing. But over the last decade or so, the most common topic they’ll comment on is the latest important antibiotic shortage. For those not in medicine, you […]

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September 19th, 2024

How Electronic Health Records Tyrannize Doctors — ID Doctors in Particular

A paper just appeared in the Journal of General Internal Medicine entitled “National Comparison of Ambulatory Physician Electronic Health Record Use Across Specialties.” The goal of the study was to track clinician workload by specialty, divided into various functions — documentation, chart review, orders, inbox. Importantly, there was no gaming the system. By using Epic’s built-in […]

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September 6th, 2024

Five Reflections after Attending on General Medicine This Year

Here are five things that occurred to me after a stint on General Medicine this year, where (per our department’s wise policy), I was paired with an experienced and excellent hospitalist to oversee two medical residents, three interns, and two medical students. #1:  Energy. Medical house officers radiate positive energy. Yes, it was summertime, and motivations […]

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July 14th, 2024

Should We Continue to Use Contact Precautions for Patients with MRSA?

Back in the early 2000s, I heard about a local hospital that eliminated contact precautions while caring for patients with methicillin-resistant Staphylococcus aureus (MRSA). No more required gowns and gloves, or warning signs on the doors, or private rooms for patients known to have MRSA. They planned to track MRSA cases carefully over the next […]

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June 9th, 2024

The Mysteries and Challenges of the RPR — and a Proposed Clinical Trial

Last week, we had a real treat for our weekly ID/HIV clinical conference — a review of controversies in the management of syphilis in adults by Dr. Khalil Ghanem, from Johns Hopkins. He’s a well-known expert in the field of sexually transmitted infections, syphilis in particular. A highlight of the talk was his dismantling of a […]

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May 28th, 2024

More on ID Doctors and Primary Care for People with HIV

A recently published study suggested that “non-ID doctors do better” when it comes to providing primary care to people with HIV. At least that was the attention-grabbing subject line of an email summary distributed by a local primary care doctor, Dr. Geoffrey Modest. He periodically sends around detailed descriptions of studies he finds interesting, then […]

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May 11th, 2024

Just in Time for Mother’s Day, Some Admiration and Gratitude

As I’ve written here before, I’m in awe of my mother — a smart woman who doesn’t celebrate Mother’s Day. So in place of celebrating, I’m going to use the holiday anyway as an excuse to share an event that highlights her strengths and resourcefulness. It has an ID theme eventually, so stick around to the end. […]

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April 26th, 2024

Hey, Insurance Companies and Pharmacies — Stop Messing Around with the Price of Cheap Generic Drugs

If you’re practicing medicine these days, you’ve likely experienced some version of this painfully annoying scenario. You prescribe a generic medication, one that’s inexpensive. Your patient goes to the pharmacy, and the pharmacist says that it requires a prior approval. They leave without getting their meds. Here’s a recent example from one of my patients (details […]

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March 27th, 2024

Think Again Before Sending Your Patient Home on Intravenous Vancomycin

I took care of a patient many years ago with MRSA. The severity of the infection required a prolonged treatment course, and vancomycin was the default option. Cripes, it was the only option. He ultimately was discharged on home IV therapy, and as usual we had a plan to monitor his renal function and vancomycin […]

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March 2nd, 2024

Just as CROI Gets Ready to Start, an Important Change to the IAS-USA HIV Treatment Guidelines

One of the top experiences of my ID career has been working with a research group that does HIV disease modeling. The people involved are without exception smart, collaborative, generous, funny, and hard-working — an amazing combination of positive traits. They get this, I believe, from their leader and founder, Dr. Ken Freedberg, who sets a […]

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