Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
Do you ever recommend the use of a Creatine Monohydrate supplementation to your patients looking to improve physical fitness?
Yes. I do recommend Creatine Monohydrate for patients/athletes hoping to gain strength and muscle mass. The current data is favorable for short bursts of strength or speed, but there is some growing evidence that there may be some benefit for higher rep/longer exertion and possibly for cognitive hea...
How do you counsel patients struggling to decide if they wish to pursue an invasive diagnostic procedure to confirm a severe illness with poor prognosis and/or limited treatment options?
First, I would reassure them that there is no right answer to this question. What we're trying to do is to come up with an answer that the patient can be psychologically at peace with. Second, I would begin to inquire about what we will do with the information, or, to put it differently, how the inf...
How do you counsel patients struggling to decide if they wish to pursue an invasive diagnostic procedure to confirm a severe illness with poor prognosis and/or limited treatment options?
First, I would reassure them that there is no right answer to this question. What we're trying to do is to come up with an answer that the patient can be psychologically at peace with. Second, I would begin to inquire about what we will do with the information, or, to put it differently, how the inf...
What is your approach to treating hypercalcemia secondary to immobilization?
My first approach is to have the patient become mobile if at all possible, even just increasing mobility in bed by doing leg and arm exercises, which can help, and getting up and walking is preferable if at all possible. Physical therapy is also helpful. I would make sure that the patient is well hy...
What is your approach to treating hypercalcemia secondary to immobilization?
My first approach is to have the patient become mobile if at all possible, even just increasing mobility in bed by doing leg and arm exercises, which can help, and getting up and walking is preferable if at all possible. Physical therapy is also helpful. I would make sure that the patient is well hy...
What ways can POCUS assist in volume status assessments in the clinic for patients who are unable to lie at an incline or get onto the exam table?
Good question. POCUS would assist with my assessment in a few ways (interpretation and application depend on comorbidities and pretest probabilities of certain pathologies). In someone with mobility issues, you can use POCUS to find the jugular vein meniscus and assist with JVP assessment. Additiona...
How do you decide when to recommend conservative kidney management over dialysis initiation in a frail older adult with stage 5 CKD?
This is definitely not a one-size-fits-all answer. Functional status and cognitive status, rather than age, are the most important considerations. The frailty syndrome itself is associated with poor outcomes for patients on dialysis. There is a clear association between kidney disease and frailty, w...
How would you approach the treatment of a patient with solid food esophageal dysphagia and GERD without a detectable esophageal stricture on upper endoscopy?
I would obtain a barium esophagram followed by high-resolution esophageal manometry and 48-hour esophageal pH testing.
When do you consider giving IV albumin for severe hypoalbuminemia with third-spacing of fluid outside of standard indications (i.e., large-volume paracentesis, HRS, SBP, shock, etc.)?
On the wards, I do not treat the albumin number. Severe hypoalbuminemia with third spacing, by itself, is not an indication for IV albumin. The consistent signal from the literature is that albumin should not be used simply to raise serum levels or to “pull fluid back in” as an adjunct to diuretics....
How, if at all, have you changed your approach to the use of escitalopram for agitation in Alzheimer's dementia based on results from the S-CitAD RCT?
I have changed my approach to the use of escitalopram for agitation in AD only slightly based on this article. For treatment of agitation in AD, the first line is always going to be non-pharmacologic, based on the acknowledge, reassure, and redirect strategy. Caregivers need to be taught to respond,...