Censorship coming for medical professionals
This is absolutely crazy. Non-medical independent fact checkers from big tech companies determining what is appropriate for medical professionals to discuss on social media?!?
Censorship minimizes scientific conversation and minimizes important discussion. This not only decreases the addition of new data/knowledge, but blunts science moving forward to answer questions that don’t have answers. Critical thinking and asking questions that get us closer to the truth have unfortunately become a lost art in this polarizing time of cancel culture that doesn’t follow a narrative that big tech companies want to hear. This is not only dangerous, but also fundamentally destructive to medicine as a whole.
—Salim R. Rezaie, MD
No, just no. How or why is this even a thing?
—Andrew Kalnow, DO
Future generations will look back on this era of medicine in contempt. Let social media implode. When medical professionals allow debate over medical topics to be not just stifled but to be “erased” because someone is “offended” by factual data or because an opinion isn’t popular, we no longer have the right to call ourselves scientists. Yes, I’m looking at YOU, Johns Hopkins.
https://www.jhunewsletter.com/article/2020/11/a-closer-look-at-u-s-deaths-due-to-covid-19. Wouldn’t it have been great if Dr. Barry Marshall’s views on causation of gastric ulcers were shouted down and erased from medical journals? We’d all still be babbling on in our echo chambers about how Type A personalities need to relax and we need to eat less spicy foods. Shame on our profession for letting any censorship of medical opinions occur.
– William Sullivan, DO, JD
#billisright and while we’re at it, Dr. Seuss anyone (still a local hero in my neck of the woods)? Oh, the places you’ll go…until you get canceled.
—E. Paul DeKoning, MD, MS, FACEP, FAAEM
Differences in antibiotic prescribing for uncomplicated urinary tract infection
The biggest flaw in this article is the assumption that either nitrofurantoin or sulfa should be prescribed as a first line agent in all cases. The MICs for sulfa in our community hospital are abysmal. The study says that Keflex is inappropriate even though that is the recommended first line agent for UTIs on our hospital antibiogram.
The study didn’t address which patients had alternate prescriptions based upon allergies, intolerances or drug interactions. I get the point about duration of treatment, but this study says use of nitrofurantoin for more than five days is “inappropriate” when the manufacturer’s monograph recommends treatment for seven days. https://www.drugs.com/nitrofurantoin.html. To call a physician’s prescriptions “inappropriate” (and the authors state that their definition may have been “too lenient”) without following drug monographs and without knowing the reasoning for using a specific medication is, well, inappropriate.
– William Sullivan, DO, JD
The guru of ABX guides in my opinion (the EMRA guide) also lists Keflex as appropriate first- line, but local antibiograms are key. Nitrofurantoin (five days) is actually first-line and Keflex (five- to seven-days) is second with Bactrim for beta-lactam allergy for empiric uncomplicated UTI coverage at my rural academic tertiary-care referral hospital.
Unless I missed something, the study used the 2011 ISDA clinical practice guidelines for the treatment of uncomplicated cystitis in women, in their words “per current guidelines.” Uh, ok. As an aside I remember a urology resident telling me once that the reason to prescribe someone antibiotics for seven days is so that they take it for three. There’s probably a lot of truth in that.
—E. Paul DeKoning, MD, MS, FACEP, FAAEM
Inappropriate antibiotic prescribing is not a new phenomenon in medicine. I find data mining studies looking at prescriptions frustrating, as we don’t get granular data like antibiotic resistance, patient allergies, clinical decision and clinical decision making. Additionally, just because a prescription is filled, does not mean that the antibiotic was taken, taken correctly, or for the full duration it was prescribed.
Secondly, I take issue with what the authors call an acceptable first line agent (i.e. trimethoprim-sulfamethoxazole and nitrofurantoin) due to my own local resistance patterns. These would not be acceptable first line agents where I work, and I suspect this definition will vary depending on where one works. Finally, the more concerning issue with this study is the duration of prescription being longer than it should be in ≈75% of patients, which can lead to bacterial resistance. All-in-all, this study doesn’t give us anything useful other than it is important to prescribe the “right” antibiotic for the “right” duration of time.
—Salim R. Rezaie, MD
After reading this, I completely question my own prescribing patterns. But then again, I am following my local antibiogram and using cephalexin (Keflex) as my first line agent based on sensitivities from local culture results. The research is based on 2011 IDSA guidelines, five years out of date when it was applied to the study population.
The actual prescribing patterns are clearly useless for today’s practice. I am intrigued however about the idea that urban physicians were more compliant with rural physicians in general as a concept and wonder how much of this is due to local continuing education offerings and years of practice. Before I put my foot in my mouth and offend anyone, I will leave it there…
—Andrew Kalnow, DO
California doctor performs surgery during video traffic court appearance
https://www.sacbee.com/news/local/article249549993.html
Appearing in court during surgery: Heard about this one and thought “that’s about right.” This takes a certain kind of…um…something. Perhaps the more important question is if he can bill for it and how to attest: “I was present for the key portions…”
—E. Paul DeKoning, MD, MS, FACEP, FAAEM
I mean in the ED we are full of distractions throughout the shift. On the phone with a consultant, ECG in your face, putting in orders, nurse asking questions about another patient. I couldn’t imagine placing a central line or intubating a patient while on a Zoom call. This is an entirely different level of distraction that I would never like to be part of. Suspect he will be in court now for an entirely different reason, like keeping his medical license.
—Salim R. Rezaie, MD
That is absurd and horrible for patient care, not to mention the disregard it shows the court and whatever the surgeon was in court for. How do you have that conversation with your scrub tech, “hey, can you hold my phone, I have a court appearance I need to hop on real quick”? Also, what documentation is required in the Op Note?
—Andrew Kalnow, DO
This doc apparently didn’t see anything wrong with attending a Zoom court hearing while scrubbed in during an operation. Now he may be investigated by the state medical board. You can’t make this stuff up. Hope he has enough sense to attend THAT hearing in person.
– William Sullivan, DO, JD
CDC Study shows 85% of Coronavirus Patients Reported Regular Mask Use
What does “always” wearing a mask even mean? The details matter. Was the mask worn correctly? What setting was it in? What was the ventilation like in the places the person was at? I mean, how do you wear a mask “always” when you are at a public restaurant eating? People wearing masks “always” were two times more likely to have been dining at a restaurant.
Additionally, the majority of transmission was from family members, which means transmission was most likely occurring in the home rather than out in public. There is no one public health measure that is 100% effective. Even vaccination is not 100% effective. A better way to think about this is that, each additional layer of protection is most likely additive in preventing COVID-19 infection.
—Salim R. Rezaie, MD
I will start by saying MASKS WORK! How many cases of croup, bronchiolitis, bronchitis, generic URIs, strep, etc have we seen this winter? It’s a far cry from past years and while social distancing plays a part, so do masks. This article highlights the problem with lay-media interpreting scientific data and trying to give a headline that will draw attention. First, the conclusion stated in the Breitbart is not the conclusion of the CDC study and one has to wonder if this is just an attempt to pander to its politically leaning readership.
Sure, I will concede that cloth and surgical masks do not provide great protection to the person wearing them, but that is not the purpose. They are designed to prevent spread, not prevent inhalation. The question is not frequency of use for the individual, but rather population compliance with mask wearing in general, the better compliance the less spread. For this study specifically, the devil is in the details and the article does cover it 2/3 of the way in, which is the population that was more likely to get infected where in environments that naturally lead to less mask wearing, coffee shops, restaurants, etc. So, I return to my opening statement, MASKS WORK, but they need to be used as intended and purpose understood.
—Andrew Kalnow, DO
A bit dated, but this is just another study showing that masks may be more effective as a talisman than as a COVID prevention measure.
– William Sullivan, DO, JD
#billisrightagain Yes, Bill. A thousand times yes! I have found masks good for a few things, however: reminding me to brush my teeth; hiding smirks (doesn’t hide eye-rolling); masking interesting ED smells. Not good for wiping up spilled coffee.
—E. Paul DeKoning, MD, MS, FACEP, FAAEM
