Pearls from I.M. Peers
Why obstetrics history should be part of primary care
Pregnancy brings a lot of women into medical care, creating an opportunity for education, patient counseling, and even disease diagnosis.
Surviving cancer starts at its diagnosis
For the growing number of patients who are cancer survivors, the rest of their lives starts at diagnosis, not cure.
Pearls on low sexual desire, OTC menopause tests
A women's health expert explains how to treat low sexual desire if it causes distress, and how to counsel patients on diagnostic testing for menopause.
Parsing periop predicaments
Due to a lack of evidence for best perioperative procedures, clinicians have debated for decades how to address circumstances such as stroke or atrial fibrillation.
Two tips for the physical exam
James O’Keefe, MD, FACP, explains why blood pressure should be checked in both arms and why clinicians should routinely measure patients' waist circumference.
Pearls for lower-extremity cellulitis
A simple hands-on physical test can help rule out cellulitis in favor of other diagnoses.
Digoxin still used, but toxicity not appreciated
Add digoxin toxicity to your checklist of diagnostic suspicions, and consider standing orders to check serum levels in certain populations.
Motion is the notion for diagnosing shoulder pain
A 60-second examination of the shoulder coupled with a conceptual model of how the shoulder works can help interpret examination findings and make an orthopedic diagnosis.
Points on providing gender-affirming care
There are simple things that physicians can do, regardless of their practice setting, to communicate to patients that they are safe in the clinical space.
Urinalysis as a ‘liquid biopsy of the kidney’
Components of the urinalysis can really be helpful for a few specific diagnoses that sometimes might be ignored.
Dyspnea should lead to testing for every patient
An expert discusses why every individual with dyspnea should have pulmonary function tests and every individual with fixed airflow obstruction on pulmonary function tests should be tested for alpha-1 antitrypsin deficiency.
Three keys for teaching: Think aloud, simplify, be kind
Three simple techniques can help teachers and mentors when they are working with students.
Consider menopause's impact ‘beyond the bikini area’
While 80% of women have menopausal vasomotor symptoms, 70% of them go untreated.
Useful physical exam skills for inpatient assessment
This month's expert discusses measuring vital signs, orthostatic hypotension, and the cardiac exam in the context of inpatient care.
Which decongestant when?
This month's expert discusses decongestant use and some of the myths and misperceptions around what is commonly available.
Just breathe: Assessing pulmonary function
This month's column offers observational pearls for obvious respiratory distress in the ICU and on the wards.
Uncover trauma to treat patients efficiently
Uncovering past trauma in a patient's life can help steer the physician toward treatment of current health problems.
Getting to know GLP-1 receptor agonists
Choosing among glucagon-like peptide-1 (GLP-1) receptor agonists depends on many factors, such as the desired outcome and individual risks among patients.
Being deliberate about spontaneous bacterial peritonitis
Physicians all use diagnostic criteria when trying to determine a patient's condition, but it's important to remember the patients in whom those diagnostic criteria have been validated.
3 physical exam pearls for patients with pain
Pearl No. 1: The Carnett sign can help clinicians determine if imaging is needed to diagnose pain.
Bedside tests for a ‘slam-dunk’ delirium diagnosis
Tests for delirium involve a stepped approach of progressively more difficult questions in an attempt to provoke disorganized thinking.
Applying the ‘ketchup rule’ to diagnosing cirrhosis
Finding cirrhosis requires specifically looking for symptoms that can be easily missed unless a physician is primed to see them.
Improving medication adherence
Asking “How do you take your medicine?” instead of “Do you take your medicine?” is one way to learn more about a patient's ideas, philosophy, and understanding.
Incorporating families into the care team
Involving one member of a patient's family can benefit the patient and boost work efficiency.
POCUS puts focus on the patient encounter
Point-of-care ultrasound has made its way from a niche practice to everyday use in the clinic. One expert explains an acronym she uses to teach clinicians to do a full POCUS exam.
Basal insulin for beginners
It can be tough to start and titrate basal insulin in a patient with type 2 diabetes because of the many options available, but a key number can measure the difference between a patient's bedtime and morning blood glucose values to ease the way.
Get comfortable talking about obesity
Kimberly N. Sims, MD, FACP, explains ways to make obesity counseling easier for patients and for their doctors.
Observe, listen, feel: Going back to Osler
These three skills hold enormous opportunity to strengthen physicians' diagnostic acumen.
Intentionally seek deviations to avoid early anchoring
In a new series, Pearls from I.M. Peers, Maria (Gaby) Frank, MD, FACP, explains how noting variations in expected patterns can help internists avoid early anchoring errors when making a diagnosis.
Diagnosis at 10 paces for bitemporal wasting
In a new series, Pearls from I.M. Peers, Paul Dallas, MD, MACP, explains how making a simple observation in a patient could indicate a serious diagnosis.