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November 13, 2015


If I have an aesthetic, it tends towards the minimalist. I like Japanese and Mission Style and Degas and Rock with guitar, bass, drums, and vocal. Clean lines, right angles. That defines elegance. I was a physics major in college and I was always attracted to the idea that understanding how the universe works result in equations that are 'simple'. 

I apply that same aesthetic to the practice of medicine. At heart I am an Occams kind of guy: Entities must not be multiplied beyond necessity.

Progress notes should be short, almost haiku in brevity, but if you choose your words correctly, 5–7–5 is often verbose.

You should be able to get the diagnosis with a minimum of steps since the core s...

Posted By: Mark Crislip  

November 11, 2015

The Odd Allure of Augmentin

The most common infections have the acronym PUS: pneumonia, UTI, and soft tissue infection.

And the most common bugs for these infections? S. pneumoniae, E. coli and Group A streptococcus aka S. pyogenes.

One would think, and that one would be me, that common things being common people would know how to treat these infections. It ain’t brain surg...

Posted By: Mark Crislip  

November 9, 2015


The patient has abrupt vision loss and a seizure. She is otherwise healthy with zero medical problems or risks.

An MRI suggests cerebritis and a repeat 2 days later shows a ripening abscess in the occipital lobe. So they call me and I say call a neurosurgeon.

It is a brain abscess and we need cultures. She goes to surgery and pus is drained and, as I predicted, grows a S. in...

Posted By: Mark Crislip  

November 4, 2015

Something Evil Must Be Going On

I like not working. I do have the best job in medicine but somehow 5 days in Pacific Beach is just so much nicer than, say, the ICU and rush hour traffic. Fewer tats and less obesity as well. Ah well, bills must be paid, although I am not so certain the life of a beach bum is such a bad idea.

As I have mentioned in the...

Posted By: Mark Crislip  

October 26, 2015

110 Years Ago

Today I saw in a chart the diagnosis qi deficiency and blood stagnation as a reason for acupuncture. Don’t get me started. It was so very dispiriting to see ancient nonsense in an EMR as if it were actually meaningful. I knew that it was really a problem with too much phlegm and the patie...

Posted By: Mark Crislip  

October 23, 2015

Double Coverage Rant

I graduated medical school in 1983, long before the current crop of housestaff was a failure of contraception. There was a lot we did not know back in the day and what we did know was hard to find in the literature. Going through the Index Medicus and the stacks was a slow way to find new information.

I remember the day I recycled a stack of papers as tall as me, realizing that with Pub...

Posted By: Mark Crislip  

October 21, 2015


I am always amazed at what IVDA’s will not do. I recently had a patient with classic right sided endocarditis leave AMA after only three days of iv antibiotics. And another who was semi-paralyized from a cervical spine epidural who, while barely being able to walk post-op, also left the in the middle of the night AMA. Both needed a fix. The siren call of heroin addiction is more powerful ...

Posted By: Mark Crislip  

October 19, 2015

A Tale of Two PETS

“It is a far, far better thing that I do, than I have ever done; it is a far, far better test that I order than I have ever known.

Two patients with identical issues:

Dialysis patients with pacemakers, both with sustained MRSA bacteremia for no reason. Both with negative exams. Both with negative TEE's. Both with fistulas. Both dependent on the pacemaker.</...

Posted By: Mark Crislip  

October 16, 2015

Two in a Career

I once counted up the number of bugs I need to know to be an ID doctor. About 1200. Not that many, but there are a few diseases I have yet to see. I have never seen a case of measles, although I may yet. I have yet to see Bubonic Plague or Rocky Mountain Spotted Fever. Maybe someday.

Some diseases I never expect to see more than once in a career.

Middle aged patient is admitted ...

Posted By: Mark Crislip  

October 14, 2015

Unlikely Occurance

The patient comes in with urosepsis and bacteremia with K. pneumoniae. Not that uncommon, she responds to ceftiaxone.

Klebsiella, with the expectation of the serotypes K 1 & K2, has little propensity for causing metastatic focus. There are hundreds of thousands of Enterobacteriaceae bacteremias a year in the US and only a hand...

Posted By: Mark Crislip  

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About This Blog

For the Benefit of Mr Kite, there will be ID tonight. Infectious Diseases! Antibiotics! Viruses and Bacteria and Fungi! Oh my! Exclamation marks!!!!!! No trampolines, nor will any band be playing at 10 to 6. And Henry the Horse died of the Strangles. Sorry. That's the problem with infections.

The endless excitement that is the daily practice of Infectious Diseases in a Portland teaching hospital! The need for meta data!

Every day I make infectious disease rounds in the hospital and see at least one cool case or learn something new. 25 years and I still do not know everything. Why be selfish and keep all of that wonder and knowledge to myself? This blog will be a mostly qod account of days events, a cool ID case, a referenced pearl, and a minimum of 1 horrible, yet ultimately feeble, attempt at humor.

While usually written in the present tense, the cases are not necessarily current and all identifying information is altered or obscured as long as it is not absolutely pertinent to the case. Can't have a female with prostate infection for example.

I write these at night or in spare moments. There is always someone who will quibble about spelling, punctuation or grammar. My response is live with it. It's a blog, not Mandel.

Read and listen to more of me at my multimedia empire linked below.

The first 2 years blog posts have been collected and edited and are available on Amazon as The Puswhisperer, Volumes 1 and 2. Really. Perfect for the pus lover in your life.
Because The World Needs More Mark Crislip (tm).

Disclosure: Mark A. Crislip, MD, has disclosed the following relevant financial relationships:
Received income in an amount equal to or greater than $250 from: Pusware LLC
Have a 5% or greater equity interest in: Pusware LLC (owner)

  • Mark Crislip

    Mark Crislip, MD, has been practicing in infectious diseases in Portland, Oregon, since 1990. He is nobody from nowhere, but he has an enormous ego that leads him to think someone might care about what he has to say about infectious diseases. And so he blogs and podcasts and writes on the most endlessly fascinating specialty in all of medicine.

    Mark A. Crislip, MD, has disclosed the following relevant financial relationships: Owner, Pusware LLC. He as not talked to a drug rep in over 25 years and does not even eat the pizza provided at conferences. But he is for sale for the right price. Please. Someone. Buy me.

The content of this blog does not necessarily reflect the viewpoints of Medscape.
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