Stephen E. Helms

A practical approach to antibiotic treatment in women taking oral contraceptives

Clinical situations that require the use of systemic antibiotic therapy are common. Because millions of women choose oral contraceptives for birth control, the potential for interaction between these drugs frequently has to be considered. We review the available information and present a practical approach for dealing with this situation based on sharing responsibility with an educated patient.

Relapsing livedo reticularis in the setting of chronic pancreatitis

Livedo reticularis (LR) is a characteristic netlike violaceous discoloration caused by a physiologic or pathologic cutaneous blood flow disturbance. Cutaneous vasculature consists of cones of arterioles whose margins have diminished arterial but prominent venous flow. Therefore, impeded blood flow through the skin can increase deoxyhemoglobin concentration, producing livid coloration in marginal zone venous areas.1 Benign causes include cutis marmorata and asymptomatic idiopathic LR. Diseases associated with LR include vessel wall disease, intravascular obstruction, and endocrine diseases.1-3 Rare clinical reports of LR associated with pancreatitis “Walzel’s Sign” exist.4 We describe a patient with asymmetric relapsing LR of the flank temporally associated with painful flares of her chronic pancreatitis.

Reducing cognitive errors in dermatology: Can anything be done?

An increasing focus on the prevention of medical errors is a direct result of a growing patient safety movement. Although the reduction of technical errors has been the focus of most interventions, cognitive errors, usually more than one error linked together, actually cause the majority of misdiagnoses. This article examines the most common types of cognitive errors in dermatology. Two methods to minimize these errors are recommended: first, cognitive debiasing techniques reduce the common initiating factor of error cascades; and secondly, the application of prospective hindsight attacks the final common pathway that leads to misdiagnosis.

Hospital Consultations: Embracing Professionalism Even When It Hurts

The American Medical Association met in Philadelphia in 1847 and revolutionized medicine in the United States by establishing standards for professional education, training, and conduct. The world’s first national code of medical ethics has remained the authoritative guide for practicing physicians since that time. The AMA’s Code of Medical Ethics is an ever evolving entity changing as the practice of medicine and healthcare delivery change [1]. The American Academy of Dermatology has developed The Code of Medical Ethics for Dermatologists in part from the Principles of Medical Ethics and Current Opinions of the Council on Ethical and Judicial Affairs of the American Medical Association [2].