Background: Internal medicine and hospital medicine providers are under pressure to move patients quickly through the hospital and decrease length of stay. Providers spend most of their clinical time seeing patients, documenting or coordinating care and have minimal time to disrupt workflow to perform common bedside procedures such as paracentesis, lumbar punctures, central lines, arthrocentesis [...]

Background: De-implementation of low-value services remains a challenge in healthcare. Research has shown that Choosing Wisely recommendations are ineffective in reducing low value care alone, and more robust interventions are needed. Additionally, most of the published efforts of reducing unnecessary inpatient services are done in smaller settings within a single hospital. Furthermore, initiatives in resource [...]

Background: The COVID-19 crisis has put an unprecedented strain on the US healthcare system (1). Hospital Medicine (HM) has been on the front lines of the crisis response (2). Multiple surges and troughs are expected before the pandemic subsides with a very large surge predicted for the winter of 2020-2021 (3). As the HM service [...]

Case Presentation: A 40-year-old woman with a history of anxiety presented with one week of diffuse abdominal pain, associated with constipation, decreased oral intake, nausea, and bilious emesis three times a day. She was admitted to an outside hospital one month prior with similar symptoms and treated for pneumonia. The patient lives alone and denied [...]

Case Presentation: A 60-year-old woman with no past medical history presented for evaluation of progressive dizziness with associated right-sided hearing loss. On exam, a fluctuant right occipital scalp abscess was noted. CT of the head was suspicious for mastoiditis. She underwent incision and drainage and was subsequently discharged with oral Amoxicillin-clavulanate. Her symptoms persisted for [...]

Case Presentation: This is a 21 year old man with prior polysubstance use who presented with worsening pleuritic chest pain, subjective fever, diffuse abdominal pain, and diarrhea for three days. He reported testing positive for COVID-19 17 days prior to admission, but for 14 days thereafter had only mild symptoms of non-productive cough and malaise. [...]

Case Presentation: The patient is an immunosuppressed 57 year old male with small bowel and liver transplant due to trauma from a motor vehicle accident 20 years prior and end ileostomy due to anal carcinoma. His chief complaint was “dizziness,” consisting of lightheadedness and diplopia. His wife described three months of progressive forgetfulness and fabricating [...]

Case Presentation: 46 year old male with history of hypertension on losartan, gastroesophageal reflux disease on omeprazole and history of gout (not on medications) presents to his primary care provider for a new onset skin rash. Examination revealed a non-pruritic, petechial rash on his anterior chest and upper extremities that started 5 days ago. He [...]

Case Presentation: Case presentationA 47 yo female with a history of hypertension, obesity, and prediabetes presented to the emergency department of a community hospital with a 2 week history of a nonproductive cough and generalized weakness. Her chest x-ray showed bilateral patchy airspace opacities. Chest CT PE protocol was negative for pulmonary embolus, but showed [...]

Case Presentation: A 50 year-old non-smoking Hispanic man with history of interstitial lung disease and recurrent pulmonary infections including recent Pneumocystis jiroveci pneumonia (PJP) presented with 2 weeks history of fever, productive cough, and worsening of dyspnea. The patient reported dyspepsia with oral thrush. During his childhood in Mexico, the patient experienced multiple upper and [...]