Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
Under what circumstances would you refer a patient with mild autonomous cortisol secretion without features of Cushing syndrome for adrenalectomy?
This depends on a number of factors, including the number and severity of comorbidities, the degree of abnormality in the 1 mg DST, and other biochemical testing, such as ACTH and DHEAS levels. The age of the patient may also have some impact on decision making being more aggressive in younger patie...
Would you recommend switching a diabetic CKD patient on oral semaglutide to the subcutaneous form since the benefits in CKD have primarily been reported in studies using subcutaneous GLP-1 receptor agonists?
Personally, I would not do so today. Obviously, the patient was prescribed oral semaglutide (SEMA) as opposed to injected SEMA for some reason. Assuming that the reason persists (e.g., preference for oral, greater availability) and the response with respect to A1c and weight has been reasonable, I w...
Does norethindrone suppress FSH, LH completely?
I don't think progesterone alone would suppress LH and FSH completely so other pituitary hormones should be checked and if low, check MRI of sella. Also check for other exogenous hormone use/OTC supplements.
Do you consider skin involvement associated with tattoos to be a marker of disease activity and an indication to start treatment in a patient with sarcoidosis?
Some patients give a clear history of swelling/pain/itch of tattoos coincident with extra-cutaneous symptoms. Others report no relationship. The variability may be related to the age, number, and size of the tattoos and the pigments they contain. Tattoos that cause symptoms should certainly be treat...
How do you counsel patients on migraine "triggers"?
What often triggers headaches or migraines is not just one factor acting alone, but rather a combination of triggers compounding together. Consequently, it's generally more effective and less demanding to prevent triggers from compounding, rather than avoiding them altogether. However, the first ste...