HIV and ID Observations

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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December 8th, 2023

Clinician-to-Clinician Advice Is Great for Everyone but Still Horribly Undervalued

One of the best things about being an ID doctor is that you get to interact with all the medical and surgical specialties. This is one of the most common answers to the question, “Why did you choose to specialize in ID?” and it certainly resonates with me. As a result, we’re frequently in the position […]

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November 16th, 2023

Being a Good Doctor — Why Are the Simple Things So Hard?

The simple things that make someone not just a doctor — but a good doctor — can slip away from us when we’re too busy, or tired, or preoccupied, or hungry. That’s why it’s wise periodically to be reminded of the “soft skills” that, while individually not tricky, together make a huge difference in how […]

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October 17th, 2023

A Brilliant Strategy for Conducting Clinical Trials — The ACORN Study

The secret to doing a great clinical trial is quite simple. Here, I’ll share it with you: Come up with an important clinical question for which there’s true equipoise. Choose primary and secondary endpoints that people care about. Make the inclusion and exclusion criteria easy to understand and chosen so that they define a readily available […]

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