A long time ago, I was very close to becoming a cardiologist. Really.Even though my fascination with ID and microbiology started in medical school — and believe me, not much fascinated me in medical school — the fact that all the top residents in my program were going into cardiology made me feel that somehow I should be doing this too. Plus, the guy who was Chief ...
Paul Sax, MD
How switching from brand name drugs to generics is sometimes absurd
I had an interesting exchange with one of our nurses recently about a long-term patient of ours.The e-mails went something like this:
Got a fax from —-’s insurance that his Lipitor won’t be covered anymore. They will cover simvastatin, lovastatin, and pravastatin. Let me know what you want to do. Charlie
He’s on darunavir, and all three of those statins are contraindicated because of drug-drug interactions. Rosuvastatin? Paul
Checked with them — rosuvastatin needs ...
How an EMR can be shockingly inconvenient for prescription refills
Let me start by confessing I’m something of a gadget freak. I was an early Palm Pilot adoptor, loved the iPod from the get-go, and need to avoid CNET, Engadget, Gizmodo, and David Pogue’s columns for the New York Times when deadlines loom.Not surprisingly, I embraced the shift to electronic medical records (EMRs) enthusiastically. While I acknowledge that sometimes EMRs ...
Adherence to HIV treatment in Africa
There has been an irresistible urge for people — doctors, public health officers, politicians, journalists, the usual pundits — to compare adherence to HIV treatment in resource-rich vs. resource-limited setting.I suspect this is because the whole issue got off to a famously bad start in 2001, when then-head of the U.S. Agency for International Development (USAID) Andrew Natsios said in an interview with the Boston Globe that Africans,
don’t know what Western time ...
Pregabalin for HIV related distal sensory peripheral neuropathy
Published earlier this year in the journal Neurology – not typically on my radar screen — is this remarkable study comparing pregabalin to placebo for HIV-related distal sensory peripheral neuropathy.Here are the results:
At endpoint, pregabalin and placebo showed substantial reductions in mean Numeric Pain Rating Scale (NPRS) score from baseline: -2.88 vs -2.63, p = 0.3941 ...... Individuals with HIV-associated neuropathy achieved NPRS treatment effect size similar to those in ...
Why specialists don’t do more curbside consults
One of the simultaneously most enjoyable and exasperating aspects of being an infectious disease specialist is the large volume of “curbside” consultations we get from colleagues.For example, here’s this week’s tally — and it’s only Tuesday — done from memory and without systematically keeping track of emails, pages, phone calls, etc.:
- Duration of antibiotics after urosepsis, organism resistant to TMP/SMX and quinolones
- Need for repeat immunizations in splenectomized adults (got that one ...
Empiric antibiotics in the ICU
Last year, I commented on the ironic sameness of ICU infectious diseases — that incredibly sick, complex patients entered the ICU with vastly different problems, then over time, seemed to converge, presenting similar kinds of clinical issues and management challenges for the ID doc.Or, as a visiting medical student said to me, “My ICU attending said that every patient in the ICU should be on vancomycin and Zosyn.”Which brings up ...
Notes in the chart are helping patients less
What is the purpose of the note in the patient chart?Depends who you’re asking.The best guidance I ever received on how to write a good note came from my residency program director, who told us that a note needn’t be encyclopedic to be excellent; in fact, he urged us to get away from the “second-year medical student” style, which typically includes absolutely everything.Instead, he urged us to write, as concisely ...
Anal cancer screening in HIV+ men
In Journal Watch AIDS Clinical Care, we published a simple case: Clinically stable HIV+ gay man, on HIV treatment; anal pap comes back with “atypical squamous cells of undetermined significance” (ASCUS).What to do with this result? Two experts weighed in, Howard Libman and Joel Gallant. In Howard’s thoughtful response, he acknowledges the limitations of the data thus far, but said he would refer the patient for high-resolution anoscopy (HRA) and ...
Electronic medical records and detail obsessed doctors
When it comes to writing consult notes, it often seems as if we ID specialists have a blatant form of obsessive-compulsive disorder. Every detail is fair game — travel history, dietary habits, all sorts of seemingly trivial exposures, and of course microbiologic data stretching back to the Cretaceous period.I’ll never forget receiving sign-out from the graduating first-year ID fellow when I started my fellowship. It included a photocopy of a ...
Official state microbe of Wisconsin
Wisconsin has selected Lactococcus lactis as its official state microbe:
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows: SECTION 1. 1.10 (3) (t) of the statutes is created to read: 1.10 (3) (t) The bacterium Lactococcus lactis is the state microbe. SECTION 2. 1.10 (4) of the statutes is amended to read: 1.10 (4) The Wisconsin Blue Book shall include the information contained in this section ...
