Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
How do you approach ADT in patients with high-risk prostate cancer who have risk factors for VTE, such as Factor V Leiden?
My default recommendation for patients with localized, high-risk prostate cancer is to recommend the use of long-term ADT. This intervention seems to offer a relatively large, clinically significant OS benefit for patients in the modern era receiving dose-escalated ADT. This benefit has been observe...
How did the SPRINT MIND study influence your approach to blood pressure management in older patients at risk of dementia?
In general, results from SPRINT MIND as well as other studies of blood pressure management in older adults have changed my thinking from being conservative in blood pressure management to favoring more aggressive management in patients able to tolerate higher doses or additional medications for bloo...
Do you ever use POCUS to evaluate for fecal impaction or stool burden in a patient with abdominal pain?
I have used POCUS in the evaluation of abdominal pain suspected of being constipation. I generally find it easiest to assess this in the right upper quadrant near the gallbladder, where you can often get a decent view of the ascending/transverse colon. If there is significant stool in the colon at t...
Do you ever use POCUS to evaluate for fecal impaction or stool burden in a patient with abdominal pain?
I have used POCUS in the evaluation of abdominal pain suspected of being constipation. I generally find it easiest to assess this in the right upper quadrant near the gallbladder, where you can often get a decent view of the ascending/transverse colon. If there is significant stool in the colon at t...
In what situations would you treat a rectal mass as cancer despite negative biopsies?
It is not uncommon to see a patient with rectal mass highly suspicious for malignancy by endoscopic evaluation but has a negative biopsy. Usually, this is due to superficial biopsy specimens. In our clinic, we usually get repeated endoscopic evaluation with biopsy as our first step. However, a small...
When, if ever, would you consider tapering patients started by another provider on low-dose, as-needed lorazepam for insomnia without a history of cognitive impairment or substance use disorders?
It is important to have a conversation with your patient about potential side effects and benefits of discontinuation of benzodiazepines, especially when it is used for an indication like insomnia. I have had this conversation with any of my patients who are using benzodiazepines. Benzodiazepines ar...
What are your thoughts about lion's mane supplementation to slow the decline or improve cognitive capacity for those at risk of dementia?
Lion's mane is the latest in the ever-evolving list of supplements that have a whiff of animal data, very small human trials, or frankly, anecdotal evidence. A decade ago, it was coconut oil; last week, it was lithium. There will always be suggestions of the benefit of this or that. Currently, there...
What is the role for inpatient limited-montage EEG recording?
Unequivocal YES! For purposes of detecting severe seizures that cause brain injury (i.e., high seizure burden, status epilepticus), a reduced montage EEG is more than adequate, performs equivalently, and in fact BETTER because of the Clarity AI algorithm which continuously monitors, interprets, and ...
How would you approach the consideration of continuing or ceasing colonoscopy for colon cancer screening in a relatively fit man in his 80s without a history of polyps on prior colonoscopies?
For someone in his 80s who has received good screening and never had polyps, continuing colonoscopy brings little benefit. The risks and difficulties from the procedure become greater with age, so, for most older adults, stopping routine screening is usually the better option for geriatric care. Whe...
How do you counsel older adults regarding the use, dosing, and safety of CBD-containing products for insomnia?
When counseling older adults on CBD use for insomnia, I usually explain that evidence for safety and effectiveness is limited. Most products are not FDA-approved, and their labeling, purity, and dosing can be inconsistent. It’s important to review the patient’s comorbidities and medications closely,...