Internal medicine

  The Resurgence of the Physical Exam in the Digital Era: Rediscovering the Art of Clinical Medicine Dr Neeraj Manikath , claude.ai Abstract The physical examination, once the cornerstone of clinical diagnosis, has experienced a renaissance in contemporary medical practice. Despite—or perhaps because of—the proliferation of sophisticated diagnostic technologies, the physical exam has re-emerged as an essential clinical skill that enhances diagnostic accuracy, reduces healthcare costs, and strengthens the patient-physician relationship. This review explores the evidence supporting physical examination techniques, examines the factors contributing to its decline and resurgence, and provides practical pearls for clinicians seeking to refine their examination skills in the modern era. Introduction The stethoscope, introduced by Laënnec in 1816, symbolized medicine's transformation into a scientific discipline grounded in physical signs.¹ Yet paradoxically, as medical technology has...

  Antibiotic Resistance and New Treatment Approaches: A Clinical Perspective for the Modern Internist Dr Neeraj Manikath , claude.ai Abstract Antibiotic resistance represents one of the most pressing challenges in contemporary medicine, with the World Health Organization declaring it a global health emergency. This review synthesizes current understanding of resistance mechanisms, emerging therapeutic strategies, and practical approaches for clinicians managing increasingly complex infections. We emphasize actionable insights for internists navigating the post-antibiotic era while highlighting novel treatment paradigms that may reshape clinical practice. Introduction The discovery of penicillin in 1928 ushered in medicine's "golden age," yet Alexander Fleming himself warned of resistance in his 1945 Nobel lecture. Today, antimicrobial resistance (AMR) causes an estimated 1.27 million deaths annually, with projections suggesting 10 million deaths yearly by 2050 if curr...

  Physician Burnout and Mental Wellness: A Contemporary Crisis in Internal Medicine Dr Neeraj Manikath , claude.ai Abstract Physician burnout has evolved from an occupational hazard to a public health crisis, with internal medicine practitioners experiencing among the highest rates across all specialties. This review examines the epidemiology, pathophysiology, and evidence-based interventions for physician burnout, with particular emphasis on systemic and individual strategies for promoting mental wellness. Contemporary research reveals that burnout extends beyond individual resilience, representing a complex interplay of organizational culture, workload demands, and existential professional challenges that require multilevel interventions. Introduction The modern physician faces an unprecedented constellation of stressors: electronic health record (EHR) burden, administrative complexity, loss of professional autonomy, moral injury from healthcare system constraints, and the li...

  The Art and Science of Daily Vital Signs Monitoring: A Clinical Review Dr Neeraj Manikath , claude.ai Abstract Vital signs remain the cornerstone of clinical assessment, yet their interpretation and application continue to evolve with emerging evidence. This review synthesizes contemporary understanding of vital signs monitoring in hospitalized patients, highlighting clinical pearls, common pitfalls, and evidence-based approaches for postgraduate physicians and consultants. We explore the physiological underpinnings, technological advances, and practical strategies that optimize patient outcomes through meticulous vital signs assessment. Introduction Despite technological advances in medicine, vital signs—temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation—remain fundamental to clinical practice. Florence Nightingale's pioneering work emphasized systematic observation, a principle that resonates today as we recognize that deterioration in hospita...

  Early Recognition of Clinical Deterioration: A Practical Guide for  Physician Dr Neeraj Manikath , claude.ai Abstract The ability to recognize subtle harbingers of clinical deterioration represents a cornerstone of expert clinical practice. Despite advances in monitoring technology and early warning scores, the astute clinician's gestalt remains irreplaceable in identifying patients at risk of decompensation. This review synthesizes evidence-based approaches with time-honored clinical wisdom to enhance the recognition of early deterioration across common acute medical scenarios. Introduction Clinical deterioration rarely occurs without warning. The concept of the "golden hour" in trauma has its parallel in acute medicine—a window of opportunity where early intervention can prevent cascade failure of physiological systems. Studies demonstrate that up to 84% of patients who experience cardiac arrest or unexpected ICU admission show documented physiological abnormaliti...