By Stacey Butterfield
Leonard Feldman, MD, FACP, has been warning hospitalists for years about the things they do for no reason. Yet he’s still finding new examples, a few of which are highlighted in his Internal Medicine Meeting 2021: Virtual Experience session, available to conference attendees on Thursday at 4 p.m.
"This is stuff that happens all the time every day," Dr. Feldman, an associate professor of medicine at Johns Hopkins University School of Medicine in Baltimore, said in a recent interview.
During his talk, he tackles three categories in hospital medicine: radiologic studies that are overused in inpatient care, unnecessary laboratory tests, and consistent violations of evidence‐based medicine. For each, he offers an example and then summarizes the relevant evidence (that is, the reasons not to do the things).
There are a host of radiologic orders that would fit the bill, including ultrasound for acute kidney injury, Doppler ultrasound for cellulitis, and echocardiogram for pulmonary embolism, Dr. Feldman said. But he focused on stress tests for chest pain, reporting studies showing that many patients would be better served by CT angiography.
Of the many misused laboratory tests, Dr. Feldman chose potassium levels in patients with acute myocardial infarction, which, as he explains in the above video, are overtreated, according to a number of studies. “Don’t reflexively buff the potassium,” he advises, but instead target “the sweet spot” between 3.5 and 4.5 mmol/L.
The advice to avoid reflexive action applies to many other common inpatient labs, including prealbumin and vitamin D levels, folate testing, and thrombophilia workups, as well as the third focus of the talk, docusate prescriptions. Meeting attendees who join at the scheduled time can talk about these or their own examples with Dr. Feldman during a live Q&A session. ■
During Internal Medicine Meeting 2021: Virtual Experience, experts will be available in the ACP Job Placement Center to discuss CV review and immigration issues with registered meeting attendees. Tanja Getter, a physician recruiting expert, will review physicians' CVs, while Robert Aronson, an experienced immigration attorney, will answer questions about all stages of the U.S. immigration process.
Ms. Getter is available for one-on-one virtual meetings on April 29 and April 30 from 12 to 4 p.m. ET and on May 1 from 1 to 4 p.m. ET. Mr. Aronson is available for one-on-one virtual meetings on April 29 from 9 a.m. to 3 p.m. ET and on April 30 and May 1 from 9 a.m. to 4 p.m. ET. At 3 p.m. on April 29, Mr. Aronson will give a talk in the Job Placement Center on U.S. immigration.
Registered meeting attendees can visit the ACP Job Placement Center in the Exhibit Hall to learn more. ■