Infectious Disease

It was another simmering-hot Texas day, and the AC was faltering in the family-practice clinic where I worked as a family nurse practitioner. Most of our clients were poor and spoke only Spanish. My nurse, Eliza, approached, wide-eyed. "There's a new patient — a woman named Maraby. She seems really angry," she murmured. "She's the color of Dijon mustard, and she's wearing a long, heavy wool cape. She looks like she's nine ...

Read more...

“Get rest and drink plenty of fluids,” might not sound like adequately aggressive medical advice. If you’ve dragged yourself out of bed to visit an urgent care or your doctor’s office, you will probably feel somewhat cheated by an admonition to head right back to bed and stay there until you feel better. Most likely, you’ll want a prescription for an antibiotic. You might even demand it. Don’t. Antibiotics are not the ...

Read more...

Imagine this scenario. Your two-year-old son has had a runny nose for a day or two and an occasional cough, but seemed no worse to you that everyone else in his preschool class. Two hours after you put him to bed you hear him coughing, only this cough is like none you have ever heard from him before. It sounds like a barking seal at the circus -- a brassy, ...

Read more...

I don’t mean to pick on McDonald’s. Insert any other large retail business where customer satisfaction massively trumps every other consideration of the relationship between employee and customer. Telemedicine companies have exploded the past few years. I suspect a lot of my readers have already seen this, but just in case not, a recent study in JAMA Internal Medicine measured the correlation between customers with a cold who called ...

Read more...

I am bad at taking vacations — really bad. It’s not that I don’t take days off or even travel on days off. It’s my near inability to actually unplug and not bring work with me. Despite recovering from a level of burnout a few years ago that left me considering quitting medicine altogether, I still struggle with this. There is a never-ending to-do list related to work — both the items ...

Read more...

A true allergic reaction is one of the most terrifying events in medicine. A child or adult who is highly allergic to bee stings or peanuts, for instance, can die within minutes without a life-saving epinephrine injection. But one of the most commonly reported allergies — to penicillin — often isn’t a true allergy at all. The urgent question that faces physicians every day in emergency rooms and operating rooms is ...

Read more...

During my urgent care shifts, I see 20 to 30 people with viral upper respiratory infections. They are all feeling miserable, and they just want to feel better. They want an impressive-sounding diagnosis to justify their suffering to themselves, their spouses, and their bosses. They want a prescription medication which will immediately cure their illness, so they can get back to their lives. Their faces fall when they receive their ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 30-year-old woman is evaluated for a 2-month history of diarrhea with three to five loose stools per day. She has mild abdominal cramps, bloating, intermittent nausea, and mild anorexia that has resulted in the loss of 2.3 kg (5.0 lb). She has had no fever or blood in ...

Read more...

Influenza is the leading cause of vaccine-preventable deaths in the United States. Influenza also tops the list of the burden of disease and disability-adjusted life years (DALYs) according to a Eurosurveillance article. The flu is more likely to cause severe illness and harm pregnant women as compared to women who are not pregnant. Changes in the immune system, heart, and lungs during pregnancy make pregnant women (including ...

Read more...