HIV and ID Observations

February 18th, 2019

Yes, Many People Are “Pleasant” or “Delightful,” Even “Lovely” — But Should That Be in the Medical Note?

When writing medical notes, some clinicians include an appreciation of their patient’s personality and disposition in their opening line (the “Chief Complaint”), or when they’re wrapping up (in the “Assessment and Plan”), or in both locations. You know — it goes like this: “CC:  Ms. Smith is a very pleasant 62-year-old woman admitted with …” or: […]

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February 10th, 2019

Six Musings Triggered by the Latest Measles Outbreak

In 2018, there were 372 cases of measles in the United States, the largest number since 2014. This year, we’ve already had 79 cases, many from a large outbreak in the Pacific Northwest — where anti-vaccine proponents recently protested efforts to restrict nonmedical vaccine exemptions. A few ruminations triggered by this outbreak. 1. The vaccine […]

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February 3rd, 2019

An “Interview” with the OVIVA Study of Oral vs. IV Antibiotics for Osteomyelitis

An “interview” inspired by publication of a landmark clinical trial. All responses written by me — but be assured, they are based on reading the paper, the accompanying editorial, the supplemental appendix, hundreds of comments on Twitter (some of them from the study investigators), and even a few generous comments from the the senior author in […]

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January 27th, 2019

For Our Stable HIV Patients, Why Are We Still Sending All These Lab Tests So Often?

Interesting query from a colleague recently: I’m a community ID doc in the trenches (the measles trenches at present) with an HIV question. Why do we still check CBCs & chem panels every 3-6 months in our HIV patients? Particularly our well-controlled, virologically-suppressed patients? This strikes me as a tremendous waste. I haven’t been in practice that […]

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January 22nd, 2019

Unanswerable Questions in Infectious Diseases — Treatment Duration in Endocarditis: 4 Weeks, 6 Weeks, Other?

Time to get back to some tough clinical decisions. It’s been a while. We’ve done The Abdominal Collection and Duration of Antimicrobial Therapy, Persistent MRSA Bacteremia, and The Positive Cultures for Candida in an ICU Patient. However, that series of posts appeared here in early 2014, which means it’s been 5 years with no “Unanswerable Questions.” Lest […]

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January 13th, 2019

Are We ID Doctors Really So Unhappy Outside of Work?

Medscape released their 2019 Physician Lifestyle & Happiness Report, and the results aren’t pretty for a certain cognitive specialty, one commonly abbreviated “ID.” Out of 29 medical and surgical specialties, infectious diseases physicians ranked second to last when responding to a 7-point scale rating on their happiness. Only neurologists were gloomier than we were during their […]

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January 6th, 2019

Rabies After Trip to India, Aortic Dissections with Quinolones, a Vaccine for Candida, Koala Bites, and More: A Welcome-to-2019 ID Link-o-Rama

As 2018 tips over into 2019, here are a bunch of ID- and HIV-related studies that, for one reason or another, haven’t made their way to this site yet — but still yearn for your attention: Cases of infective endocarditis have increased since release of the 2007 dental prophylaxis guidelines. Recall that those guidelines only recommended […]

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January 2nd, 2019

How Did Our Medical Notes Become So Useless?

Among the many complaints about electronic medical records (EMRs), the death of the useful medical note ranks very high. Notes are too long, too complex, and filled with unhelpful words. It’s often impossible to glean what the clinician thinks is going on, or what’s planned. Ever get a note from an urgent care clinic on […]

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December 16th, 2018

ID Doctors Are Lousy Golfers, and Time to Pick Your Favorite Cartoon Caption

Some might wonder how people who take care of patients, who deal with illness and suffering on a regular basis, can find humor in medicine. Alternatively, one could take the opposite perspective — with so much misery around all the time, how could we survive without humor? Clearly the folks at The BMJ are in the […]

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December 12th, 2018

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

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 […]

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