Infectious disease physicians and clinicians writing on KevinMD about outbreaks, antimicrobial resistance, vaccines, and the ongoing challenge of preventing and treating infection. Contributors include the physicians who treat infectious disease and the public health physicians who track it. For a maintained record of what physicians have said about vaccines and vaccine refusal since 2004, see Vaccines: what physicians say, in their own words. For what clinicians wrote during the COVID-19 pandemic as it happened, see COVID-19: what physicians wrote as it happened.
In a recent report released by the UNAIDS, the number of new HIV (human immunodeficiency virus) infections has fallen by 19% since 1999. And of the 33.3 million people living with HIV, only a little over 5 million people are receiving HIV treatment. That is, roughly 15 percent of the world’s population. Ghastly, some might say, but improving, optimists would say.
According to the 2010 UNAIDS Report on the Global Aids …
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The HIV vaccine does not promise the end of AIDS
Most of us will not have the opportunity to just die of “old age” or to simply fall to sleep one night never to wake again. Most often, we develop an illness which causes our death. These have changed markedly over the years. For the pioneers, accidents, infections, childbirth were times and causes of great likelihood of death. A century ago, infections were the leading causes of death. Today, we …
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The dramatic change in the causes of death
A silent pattern of discrimination persists today in healthcare institutions in the United States, according to a number of hepatitis B experts and advocates. A number of doctors have been recently dismissed or threatened with dismissal when they were discovered to carry the hepatitis B virus (HBV). Infected medical and dental students have had their acceptances deferred or rescinded altogether. These are nefarious instances of defensive medicine, based on an …
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Discrimination against providers and students with hepatitis B
On the day the U.S. Supreme Court delivered its historic decision on the Affordable Care Act (ACA), aka Obamacare, I was rounding on my hospital patients: a man on the ventilator with pneumonia who had private insurance, one elderly woman with abdominal pain going for gall bladder surgery on Medicare, and one middle aged obese woman with a skin infection without any health insurance.
On my patients’ TV screens I watched …
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With the ACA, put politics aside and focus on the facts
I had just put him on a ventilator. Mr. Barnes (not his real name) had come in by ambulance sweating, barely responsive, gasping for air. The paramedics said he was from the local rehabilitation hospital and had just been sent there 2 weeks ago after a protracted hospitalization for a stroke which had left him partially paralyzed. Then they showed me medical orders indicating that he was “full code,” medical …
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5 questions to change your end-of-life path
“Educate the young, regulate the old.”
That quote has literally followed me around the world. I can vividly remember when first making the statement. I was one of five “safety experts” on the closing panel at an international safety and quality meeting in Sydney, Australia a number of years ago. The thought was that the five of us would somehow be able to share “pearls” of wisdom regarding what was …
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How to improve physician compliance
“Doc, I’m going to the Olympics do I need anything?” It happens every 4 years. Millions of people converge upon a city to watch athletes compete. It seems easy enough, but did you know that this year there is a concurrent UEFA soccer championship in Poland and the Ukraine too? So how do you help your patients prepare to be in close contact with thousands of people from all over the …
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How do you prepare your patients for travel to the London Olympics?
I am not a huge baseball fan to begin with, and when I am, I root for the Nationals. Thus, I pay little attention to the New York Yankees, and was not aware that Yankee player Mark Teixeira had been suffering from a cough for the past month until it the story from the New York Times came through one of my Twitter feeds. According to the story: “Mark Teixeira had …
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Using Advair to treat postinfectious cough
When you are handed a prescription by your physician or your pharmacist there are many questions you should know the answer to before walking out the door.
1. What is this medication for?
This may seem obvious, but countless times when I ask a patient if they know what their prescription is for they tell me they have no idea. When someone doesn’t know what a medication is for, there is little motivation to take it correctly or …
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5 questions to ask about your prescription
There’s nothing better than sitting down with a patient, going though an entire visit, and collaborating on a well thought out plan that meets everyone’s expectations.
Shared decision making is a wonderful and necessary concept in modern patient care. Paternalistic attitudes are fading away in the medical community as the next generations of doctors continue to get educated on how to manage patients who are very knowledgeable and yearn to be …
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Shared decision making is a necessary concept in modern patient care
It was during my residency that the first indication of heart toxicity of antibiotics affected me personally. The threat was related to the use of the first of the non-drowsy antihistamines – Seldane – in combination with macrolide antibiotics, such as Erythromycin causing a potentially fatal heart arrhythmia. I remember the expressions fear from other residents, as we had used this combination of medications often. Were we killing people when we treated their …
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What is the truth about Zithromax?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 65-year-old woman is evaluated because a screening urine culture for an insurance policy grows greater than 105 colony-forming units/mL of Escherichia coli. She does not have fever, dysuria, urinary frequency, or other symptoms. Medical history is unremarkable. She has no allergies and takes no medications. …
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MKSAP: 65-year-old woman with E. coli in a urine culture
As the Supreme Court deliberates the Affordable Care Act, Americans should take a closer look at the commonsense reforms embedded in the law, including those that strengthen public health. Fixation on the law’s individual mandate has overlooked the law’s very important benefits for public health.
Lost amid the rhetoric about individual liberty is the public interest and common good of protecting all Americans from the costly and deadly menace of preventable …
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How the Affordable Care Act combats preventable hospital infections
Should we all have the TB Blues? I think you’d agree that we should after listening to this 1931 classic by Jimmie Rodgers who died from TB.
Tuberculosis is known to have existed in ancient Egypt and TB may have even been referenced in the Bible – “The Lord will smite you with consumption, and with fever, inflammation, and fiery heat …” Deuteronomy 28:22.
Many well known authors, artists, musicians, and …
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Singing the blues about tuberculosis
Consider this scenario.
Joan, age 75, living in Ft. Lauderdale, was diagnosed with Stage IV Ovarian Cancer. Joan’s daughter, Beth, who lives in Kansas, contacts Maxine, a private patient advocate and RN who works in Ft. Lauderdale, to help her mother. Joan, Beth and Maxine have extensive conversations about the care Joan will need. The decision is made that Joan will need surgery and chemo. Maxine is hired to oversee the …
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Patient advocates need to manage expectations
How can you determine whether you are in a “developed” or a “developing” country? We used to call these latter “un- or underdeveloped” or “3rd world” countries, but those terms are no longer politically acceptable, considering the tinderbox of feelings about this topic.
If one objectively examines all 20 dozen or so of the world’s countries, a geographer would divide them into either north or south of the Equator. And if, …
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What separates a developed and a developing country?
My patient ran away from the hospital.
This ordinarily is almost common place for a hospital bordering the south side of Chicago. In the last two years at the hospital, I had first grown surprised, and then helpless and finally weary to such mysterious absconding. This time however, it struck a chord.
Long before Mr B ran away, I had an inkling the new diagnosis of HIV would be difficult for him …
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Why my patient ran away from the hospital
Studies, medical societies and position papers are unanimous in their condemnation of inappropriate antibiotic prescriptions for an uncomplicated URI … but not a single voice tells us how to do that.
Let me give you a three part structure you can use in your patient conversations in the future – and some exact words to try out. This structure is adapted from the Parenting literature, another role where boundaries and inappropriate …
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How to say no to inappropriate antibiotic requests
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 27-year-old man is evaluated for concerns noted by his wife of a marked change in overall behavior over the past 6 months, including deterioration in his general hygiene and episodes of talking to imaginary people. His employer has also raised concerns about his work performance. The patient has also noted intermittent tingling in the …
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MKSAP: 27-year-old man with a marked change in overall behavior
Doctors, nurses, ministers, first-responders and many individuals have interrupted their daily lives for weeks and months at time to lend a helping hand. To show solidarity communities have thrown parties, organized fundraisers and joined with relief organizations. “Text for Haiti” became a popular way to make individual contributions through mobile phone text messages as many leaders urged financial contributions over direct donations of foodstuffs, clothes and other supplies. Early indications …
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Early lessons from Haiti in global health
