Our Privilege

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Another lonely locked-down day. Seems like months. Rent is due, phone and EMR fees next week. Loan is pending. Seems impossible to treat complex diseases without touch and only computer screen rapport. And yet, it is a good day.

Safe Practices for Outpatient Appointments

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Need for Pre-operative Hyperglycemia Testing Prior to Total Joint Replacement

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JAMA reports on a large Medicare cohort study showing that amongst patients undergoing total joint replacement (TJR), preoperative HbA1c testing was performed in 26% to 43% of patients with diabetes and in only 5% of those without diabetes. Importantly research has shown that an elevated HbA1c level is associated with postoperative complications.

Shutdown and the New Normal

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COVID-19 is not going to suddenly end on June 1st. This is a long haul change and you need to be prepared for the aftershocks and fallout. It’s time to be be a Marine and ”Improvise, Adapt, and Overcome”.

Urgent or Not

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Our practice standards have been flipped. The physician’s best clinical tool has become the webcam or telephone. The nagging question is: “who needs to be seen in clinic or in the hospital with a F2F evaluation?” It basically boils down to urgency.

Some Good Things, During the Time of COVID-19

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It is not hyperbole to acknowledge that the COVID-19 pandemic has changed the world, inflicting pain and suffering to many, and inconvenience to all. As everyone struggles to make it through these difficult times, it might be worth pointing out some small silver linings that have emerged despite this pernicious dark cloud.

Telemedicine Bloopers and Successes

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Staying Abreast of COVID-19

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Dealing with unknowns is both difficult and frustrating, as the answer is often not within our reach. The current pandemic has created a tidal wave of unknowns, scaring patients and putting physicians in a difficult spot.

Goodwill Wednesday

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Business as usual, Wednesday morning, as I quickly stop at 7-Eleven for my morning coffee and it all begins. A nice stranger holds the door open for me; I reach for a carton of milk for someone unable to; the cashier skips the 2 cents on a $2.02 bill (with a smile). What transpired in a quick five minutes was a series of random, unrelated, unprovoked acts of kindness. Blatant politeness, sincere smiles, compliments between strangers and lots of open doors. This made me think.

ACR20 Pearls Part 3: Pragmatic Applications for Managing Vasculitis

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Steroid Poker

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It began as many cases do: an ill patient, in the ICU, with signs and symptoms across several body systems, yet no clear unifying diagnosis on admission. With things stabilizing, the internal medicine hospital team on which I was serving as hospitalist that week assumed care of the patient. As the case unfolded – pulmonary infiltrates that could be hemorrhagic, renal dysfunction with proteinuria – rheumatic diseases rose in the differential. When serologic studies and other data suggested GPA rather than glomerular basement membrane (GBM) disease or other possibilities such as infection, it seemed the right time to act. And that is when a game of what I call “steroid poker” began.

Best of 2019 - The House of God After 40 Years: A Rheumatologist's Reflection

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The House of God is probably more known of than read, with over 3 million copies sold since its release when I was a Chief Medical Resident in the era of its writing. The book itself, according to the author Samuel Schem (aka Steven Bergman, MD, DPhil), a psychiatrist and currently Professor of Humanities at NYU, is a true account of his internship, albeit laden with some liberties of fiction - and it's been quoted for generations. The House of God is cruelly funny and portrays many uncomfortable and dehumanizing aspects of medicine, including substance abuse, bawdy sex (and lots of it), sleeplessness, depression, and suicide to name a few. Taken at face value, it would seem countercultural to our current aspirations of putting patients first, #MeToo and burnout concerns. Is this book merely a humorous anachronistic rant, or a serious work of reflection meritorious of being read and pondered upon?