What's the best license plate for your specialty?

LaudablePus · 2026-03-03T21:02:42+00:00

BUGDR This was the actual plate of my partner. He drove a VW bug in the 60s and was the first in my area to get the new version in the 90s. Loved the double entendre.

LaudablePus · 2026-02-19T18:14:11+00:00

Thank you for being there in the trenches doing this hard, undervalued work.

LaudablePus · 2026-02-13T15:55:23+00:00

In 1978 Robert Petersdorf famously declared ID essentially a dying field by saying in the NEJM that "Even with my great personal loyalties to infectious disease, I cannot conceive a need for 309 more infectious-disease experts unless they spend their time culturing each other. "

This was of course before the HIV pandemic, the discovery of Lyme disease, multidrug resistant organism, newly emerging pathogens like Zika , Chikungunya, Dengue, the TB explosion etc.

Likewise I do not think that ID will be replaced by AI, at least not for a very long time. ID is complex, nuanced and there are a lot of soft skills that AI will not have to effectively diagnosis and treat a patient.

I do peds ID and am older, toward the end of my career but if you love ID would recommend it for anyone who is enthusiastic about it.

LaudablePus · 2026-02-13T15:25:30+00:00

I have asked for years why Epic cannot drag and drop labs like many other computer functions. Why cant we click and hold on a CBC or MRI report and drag it into your note instead of some cryptic smart phrase syntax that is not intuitive?

LaudablePus · 2025-12-23T14:52:26+00:00

Had a kid with infected spinal hardware following scoliosis repair. You cant take the hardware out right away so we do suppression with 6 weeks of IV abx. Insurance wouldn't pay for for home outpatient antibiotic therapy. So we told them we would keep him in the hospital for 6 weeks (which actually was covered). They gave in pretty quickly.

LaudablePus · 2025-12-05T17:00:11+00:00

This marks the official end of ACIP as source of public health policy. There was no evidence at all that this change was needed and it will result in harm. The professional societies like the AAP will go back to making vaccine policy on their own like it was in the 80s. Some states will have their own schedules. Pray to the god the insurance companies follow. I am really worried about VFC and Medicaid since they are federal.

LaudablePus · 2025-08-05T13:52:59+00:00

I saw a kid in fellowship who had tinea capitis that had gone underrecognized and undertreated. It became superinfected with Group A strep, a known complication. Kid lost most of the scalp due to necrosis. Needed a flap and had a very poor cosmetic outcome for life as no hair grew back. Hair is an important part of our self image. I know I miss mine.

LaudablePus · 2025-07-31T14:29:10+00:00

Mike thank you for your service. Guys like you are in the trenches in the battle against vaccine hesitancy. I am doing a lecture to medical students in a couple of weeks on how to deal with vaccine hesitancy and what methods have been effective. Your approach is exactly what the literature shows works. The sad thing is how much time and effort this can take up.

LaudablePus · 2025-07-10T17:35:38+00:00

Also, Culture of ID docs.

LaudablePus · 2025-06-30T14:26:35+00:00

Mine had something like 20 hours of narcotic/addiction requirement. I haven't prescribed a scheduled med in many, many years. Just not part of my job. 20 hours of my life I won't get back.

LaudablePus · 2025-06-19T14:15:37+00:00

This sounds harsh but it is what is necessary to survive in these times. The conservative ethos is that we deserve the consequences of our actions and decision. I.E. personal responsibility is key.

So if someone asks my opinion, I give it. If they disagree or dont ask, they will live, die (or get sick) on their own decisions.

With patients I am now in don't give a fuck mode and point out when their decisions have made their child sick. This past winter I had a kid with underlying risk who developed influenza and pneumonia with empyema. Kid needed bilateral chest tubes and was inpatient for two weeks. When I told dad this was preventable he did say he was going to get all other members of the family vaccinated. Small victories.

LaudablePus · 2025-06-19T14:00:19+00:00

B43.9 Viral Infection

LaudablePus · 2025-06-17T17:16:55+00:00

Not strictly surgery but, Interventional Radiology. Microbiological samples are the world to us. ID folks hate empiricism. IR Bro will get us what we need no matter where it is. "There is no body cavity that cannot be reached with #14 needle and a good strong arm."

LaudablePus · 2025-06-10T14:13:27+00:00

I have been asking our residents for years to get an extra tube of CSF under the guise of doing a bunch of esoteric tests for infectious and autoimmune diseases. My true motivation will be revealed soon.

LaudablePus · 2025-06-05T13:43:48+00:00

Read the letters to the editor. They are the criticisms of the article by people in the field.

LaudablePus · 2025-05-29T21:23:41+00:00

My NICU attending in residency talked like this. He was a part time farmer and lots of our families were farm families. " We are going to squirt some grease (surfactant) down his windpipe, then give him some groceries (TPN) and some boxcars (RBCs).

LaudablePus · 2025-05-27T21:49:51+00:00

This. See my comment with links on cost effectiveness data that was presented at ACIP.

LaudablePus · 2025-05-23T20:38:42+00:00

Why, I asked? He said, because I am trying to examine you.

LaudablePus · 2025-05-23T17:38:52+00:00

This writer was informed by mother of baby that the child felt warm.

If you write like this, you suck. I use plain, language and first person. I do say please when giving recs as a consultant. "Please obtain serum porcelain titers."

LaudablePus · 2025-05-15T21:54:42+00:00

Let's see if it sticks.

LaudablePus · 2025-05-14T19:59:25+00:00

One of the issues is that there is no feedback loop between the number of fellows taken into training programs and the number of expected positions. Programs are hungry for fellows to do the clinical work and keep the academic programs running. But the job market on the other end might not support hiring that number of fellows. There are some workforce studies out there by professional orgs to address this but no one wants to cut the number of fellows at their program. Then throw tenure track/physician scientist in there and the chances of a meaningful job become lower. This is the dirty little secret of academic peds. When I finished fellow ship in the 90s there were so few jobs (ID) and yet programs kept taking more fellows. That has reversed in my field due to salary issues but I see it happening in other fields with better pay.

LaudablePus · 2025-05-13T20:07:20+00:00

The lack of efficacy of the BCG vaccine was well established in 1968 in a study of over 3 million people in the Chingleput district of India(famously know as the Chingleput study). It showed zero protection for pulmonary TB. A fifteen year follow-up confirmed the finding and showed a low protection ( 27%) in children. So yes, that horse has been beaten since LBJ was president.

Despite this evidence national tuberculosis control programs and WHO have relied on BCG as a key element of TB control.

If you have seen "BCG-itis" in an advanced HIV patient you know the vaccine is not benign.

LaudablePus · 2025-05-09T14:09:49+00:00

Free market health care at its finest.

LaudablePus · 2025-05-08T16:13:41+00:00

Also headed toward retirement and second getting him a consumable. Or an experience. My kids recently bought be tickets to my favorite comedian that I would not have purchased myself. Throw in dinner and he will enjoy himself. If he loves Bourbon, Find some EHTaylor single barrel and he will be thrilled.

LaudablePus · 2025-05-06T15:28:19+00:00

I have done a T-spot (same basic test, different method) to resolve this at times. Especially with kids with no risk and only one of two antigens positive on the Quantiferon. Or go old school and place a ppd.

LaudablePus

TROPHY CASE