Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 34-year-old man is evaluated for several slow-growing lesions on his penis. He first noticed the wart-like growths 3 years ago, and they have progressively enlarged. He was treated with topical cryotherapy six times and topical imiquimod over the past year […]
Category: Infectious disease
Antibiotics vs. surgery for appendicitis: what one surgeon thinks
Here are a few thoughts about the latest chapter in the never-ending debate about antibiotics vs. surgery for the treatment of uncomplicated appendicitis. You will recall the randomized controlled trial from Finland published in 2015 that found a 27% rate of failure of antibiotics within the first year. Now that the patients have now been followed for […]
A physician’s breakthrough against prior authorization
A few weeks ago, I saw a young patient who was suffering from an ear infection. It was his fourth visit in eight weeks, as the infection had proven resistant to an escalating series of antibiotics prescribed so far. It was time to bring out a heavier hitter. I prescribed ciprofloxacin, an antibiotic rarely used […]
No, the flu shot doesn’t cause the flu
Does the flu shot cause the flu? Let me tell you, without a doubt, that the flu shot does not give you the flu. This is perhaps one of the most common misconceptions I hear as a physician. People absolutely swear by it. I’ve even had people tell me that family members got the flu […]
Inaccurate penicillin allergies worsens antimicrobial resistance
September 28, 2018 marks 90 years since Sir Alexander Fleming discovered penicillin as an effective antimicrobial which would soon save millions of lives. He warned soon afterwards that unless we used penicillin judiciously, we would see antibiotic resistance, and he was right. With decades of inappropriate antibiotic prescribing, we have dug ourselves a deep hole […]
Remembering the age of polio
“Polio. I’ve seen polio.” Last night, I was speaking with one of the most experienced pediatricians I’ve ever met, Dr. Jack Burstiner. I’ve known him for 50 years. I would have known him even longer if I had been born earlier. He lived in my neighborhood, two doors down. He was my pediatrician. Jack is […]
Remembering the age of polio
“Polio. I’ve seen polio.” Last night, I was speaking with one of the most experienced pediatricians I’ve ever met, Dr. Jack Burstiner. I’ve known him for 50 years. I would have known him even longer if I had been born earlier. He lived in my neighborhood, two doors down. He was my pediatrician. Jack is […]
Sepsis awareness: Should there be different awareness goals for the young and the old?
Sepsis, the body’s self-destructive inflammatory response to severe infection, is the leading cause of death in U.S. hospitals, particularly among the elderly. It starts as mild sepsis, advances to severe sepsis, and all too frequently blossoms into septic shock. More than 1.5 million Americans get sepsis each year. More than 250,000 die of the illness. One […]
You can’t always expect a miracle, but you can always hope for one
I began practicing as an internist/nephrologist in the early 1960s. Having rented an office in Los Angeles, I introduced myself to the local medical community and set out to build a practice. With a growing family, a mortgage and an office to support, I was hungry for patients. Hospital emergency rooms were good referral sources, […]
MKSAP: 25-year-old man with dark-colored urine
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 25-year-old man is evaluated for dark-colored urine for 2 days, swelling of the face and hands for 1 day, and severe headaches this morning. He reports having an upper respiratory tract infection 1 week ago with fever, sore throat, and […]
