 Oct. 19, 2002 |
| ASSEMBLY EDITION • SAN DIEGO |
The worst mistakes are made on familiar ground. That point hovered in the background of Thursday's case study session entitled "Strategies for Optimizing Management of Hospitalized Patients," taught by Joseph Zuckerman, M.D. Zuckerman is coordinator of internal medicine at the Halifax Medical Center Family Practice Residency Program in Daytona Beach, Fla., and clinical associate professor of medicine at the University of South Florida School of Medicine in Tampa.
He presented a series of cases, all evidence-based, illustrating familiar issues a primary care physician might be expected to encounter in the management of hospitalized adults. Sounds routine, but it wasn't. In case after case, the crowd was reminded how easy, yet dangerous, it is for a physician to settle into a routine.
What about bed rest?
Zuckerman distributed handouts detailing cases and scenarios that ranged far and wide. One case involved an 82-year-old woman for whom bed rest had been prescribed.
"Why?" he asked rhetorically.
He presented the results of a randomized, controlled trial that showed bed rest to cause no significant improvement in any parameter but a number of negative outcomes, including deep venous thrombosis, weakness, nausea and longer time to recovery.
"Who would have questioned bed rest?" he asked.
Beta blockers?
Zuckerman presented several cases about diabetic patients, each admitted for a different reason. This led to a refresher course on glycemic control during hospitalization, including the factors that influence it, methods to control it, and, not coincidentally, the place of blood sugar in immune function and wound healing.
Zuckerman then complicated the issue with a patient who had a history of type 2 diabetes and presented with myocardial infarction.
"Would you start a beta blocker?" he asked the class.
There was a resounding "Yes."
Zuckerman smiled and nodded at the correct answer, then reflected that when he was a resident (not long ago), he was told to avoid beta blockers in patients with diabetes.
Medicine is never static.
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