December 12th, 2018

Two Weeks of Attending on the ID Consult Service, with One-A-Day ID Learning Units

Ellis Island, Contagious Disease Hospital Isolation Ward I; Library of Congress

For those of us who don’t do inpatient medicine all the time, the “blocks” doing inpatient Infectious Diseases consults are a stark reminder of just how complex and challenging the case material can be.

Think about it — if a hospitalized patient has a straightforward ID problem, we are not getting involved. No one consults ID for cellulitis that rapidly improves, for community-acquired pneumonia responsive to antibiotics, or for the post-op infectious complication easily amenable to incision and drainage.

I’ve said it before — you know that randomized study of short-course antibiotic therapy for abdominal fluid collections? The one where the entry criteria included “adequate source control”?

We’re never consulted on those cases. Just these.

That’s why it was no surprise to read this recent paper, which showed that among 2.5 million patients in Canada, those seen by ID ranked second in complexity among all the sub-specialists. We trailed only nephrology — who, by taking care of all those people on dialysis, certainly have their hefty share of complex patients.

In order to provide some structure to this on-service experience, I try to find at least one item daily to for us to learn.

My “criteria” for inclusion:

  1. Has to be related to a case.
  2. Has to have a reference.
  3. Has to be interesting.
  4. Has to have no patient confidentiality issues.

Unlike previous rotations, this time I did it on the fly (so to speak) using Twitter. While some stay away from Twitter since it is (to certain individuals) an irresistible way to say something stupid, medical Twitter can also elicit fascinating responses and dialogue from an incredibly diverse group of clinicians. Thank you for that!

So here are the daily ID Learning Units from two weeks on service — a truly enjoyable time spent with an outstanding first-year fellow and a great second-year medical resident, someone I’m hoping will one day go into ID!


2 Responses to “Two Weeks of Attending on the ID Consult Service, with One-A-Day ID Learning Units”

  1. Gerald says:

    These are terrific pearls! Please keep them coming!

  2. Bart says:

    Would you stop PCP prophylaxis in a patient with viral suppression and CD4 < 200 but also with a previous history of PCP? (diagnosed by BAL)

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

Biography | Disclosures | Summaries

Learn more about HIV and ID Observations.