HIV and ID Observations

July 9th, 2017

Should You Answer Medical Questions from Clinicians You Don’t Know About Patients You’ve Never Seen?

This email popped into my inbox the other day from a person I’ve never met: Hi Dr. Sax, I do mostly hospital-based ID in Pennsylvania, and was consulted on a newly diagnosed HIV patient with CD4 10, viral load 210,000, and lymphoma. I started him on Truvada and dolutegravir, which is going well so far. Because he complained […]

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July 2nd, 2017

Delafloxacin, a New Quinolone, Is Approved for Skin Infections — But That’s Not Where It’s Really Needed

The history of the fluoroquinolone antibiotics can be divided into four eras, alternating good news and bad: Ciprofloxacin is approved — it covers everything, and is miraculous. We’re talking some tough customers here. Pseudomonas aeruginosa! Staphylococcus aureus! Neisseria gonorrhoeae! Plus, pretty much every gram negative causing urinary tract infections. There was no intravenous formulation initially, but that hardly mattered since it had […]

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June 10th, 2017

What’s Your Favorite Antibiotic? A Fantasy Draft

Over on the journal Open Forum Infectious Diseases (that’s “O-F-I-D”, not “Oh-FID”), the generous people from IDSA and Oxford University Press have allowed me to record a series of podcasts, interviewing various interesting people in the ID field. This time, however, I strayed from the usual format and asked my colleague Rebeca Plank to join me in a […]

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May 29th, 2017

Healthcare Providers Shouldn’t Come to Work While Sick, but They Do — Here’s Why

Let’s start with two questions: Have you ever seen a doctor, nurse, PA, pharmacist or other person directly involved in patient care wearing a surgical mask because they have a respiratory tract infection? Has this mask-wearing person ever been you? Bold prediction: Virtually every reader who works in a hospital or large office practice answered “Yes” to #1. Some […]

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May 14th, 2017

Poll: Which Feature of Electronic Health Records is Most Important to Patient Care?

The first electronic medical record I used regularly — called “BICS” — initially had one purpose. It was a tool to look up a patient’s lab results. Simple, reliable, and blazingly fast, it did one thing remarkably well. Later, one of our Emergency Department doctors, who happens to have impressive coding skills, worked with a team to add a simple ambulatory medical […]

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April 30th, 2017

Celebrating the Invaluable Knowledge and Expertise of ID Specialist PharmD’s

Since expression of gratitude makes you happier — hey, I read it on the internet — and whining does the reverse, I’ve decided to turn what was going to be a typical rant about dealing with insurance companies into an expression of thanks to a remarkable group of professionals. Namely, the Doctors of Pharmacy (PharmD’s) who specialize in Infectious […]

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March 14th, 2017

Poll: Should We Allow 24-Hour Shifts Again For Interns?

Over on Boston’s NPR site, I wrote a piece about the decision by the Accreditation Council for Graduate Medical Education (ACGME) to allow 24 hour (or longer) work shifts again for interns. My goal in writing the piece was to relay what I experienced doing these long shifts way back when during my internship — the good […]

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November 6th, 2016

Do ID Clinicians Perpetuate Our Own Stigma?

Infectious Diseases doctors will find this exchange familiar: New person you’re meeting:  What to do you do? ID Doc:  I’m a doctor. New person:  Oh — what kind? ID Doc:  A specialist in Infectious Diseases. New person (making a face, or moving a few feet back, either to be humorous or truly frightened, or both):  Yuck! […]

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July 14th, 2016

Must-Read Item: This Year’s JAMA HIV/AIDS Issue

The folks over at the Journal of the American Medical Association have been doing a periodic HIV/AIDS themed issue for years, generally around the time of the International AIDS Conference. The latest issue is out this week, and it’s terrific. Here are some highlights: In serodiscordant couples practicing “condomless sex”, there were zero transmissions if the infected partner […]

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July 3rd, 2016

Velpatasvir/Sofosbuvir Makes HCV Treatment Simpler, Especially For Genotypes 2 and 3

One of the ways ID and hepatology hepatitis C experts like to show off is by discoursing on the nuances of cleverly named clinical trials, and how these impact treatment guidelines. It usually goes something like this: “In the EP-CILEON [I made that up] study of [insert HCV regimen here], treatment-experienced patients with genotype [insert non-genotype 1 patients here, […]

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