HIV and ID Observations

This doggy has an infectious disease.

Curbside consults are much on my mind this week for several reasons.

First: I received an extremely complex curbside — a case of an HIV patient (from another state) who experienced treatment failure, had developed multi-class resistance, including integrase resistance (hate that), and now faced a tricky treatment regimen.

The email was a good 300 words long and included 4 resistance reports. Phew.

But what an interesting case! The requester was, to their credit, extremely polite and grateful, which is always appreciated.

Second:  Another clinician sent me a curbside that was completely the opposite — something relatively concise, and straightforward, but alas I couldn’t be of much help given the unusual patient profile.

Doubt there will be a HIPAA violation here if I share:

Third:  Medscape recently reviewed the medicolegal aspects of curbside consults, an area of significant concern among ID doctors who lead the world in this activity. It’s an excellent, authoritative piece, though unfortunately the net effect could be to make one terrified of providing informal advice to our colleagues — something quite useful both to them and their patients.

Take a look at this definition of a legally safe curbside consult:

A curbside consultation refers to a consultation where the patient isn’t identified; where the specialty physician typically doesn’t review the chart, doesn’t meet with the patient, doesn’t talk to the patient, and doesn’t examine the patient; where the specialty physician doesn’t have any direct or contractual agreement with the treating physician or the hospital where the treating physician is working; where the specialist physician doesn’t bill for his services; and where the treating physician is free to accept or reject the specialty physician’s advice.

Yikes, those are a lot of criteria! Oh well.

Fourth: These general internists do a whole podcast of curbsides, on multiple medical topics — so much so that they call themselves The Curbsiders! No actual patients are discussed, of course, just imaginary ones (and no golden retrievers either).

It’s a terrific show for people in both hospital- and outpatient-based practice, and they invited me on recently to do one on ID Pearls. We covered cellulitis, Lyme, C. diff, flu vaccine, travel medicine, antibiotic allergies — in short, the very stuff we ID docs are curbsided about all the time.

Highly recommended.

Have you listened to our latest episode? ID virtuoso @PaulSaxMD takes us through a wide aria of infectious disease topics.https://t.co/58qrfTHOU0 #FOAMed #infectiousdiseases #puns pic.twitter.com/UL2cPiBiTC

— The Curbsiders (@thecurbsiders) January 16, 2018

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