Helping to Keep Bugs at Bay

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In terms of infectious disease, what should patients be paying attention to? We should all be paying attention to how emergence of antibiotic resistance has become a major threat to global health and what role we could play in turning this around. Antibiotic use in itself creates an environment that selects for resistance, and we need to stop indiscriminate antibiotic use in both human health and animal agriculture. Many times, prescribers feel pressured by patients to prescribe antibiotics for colds. Antibiotics treat bacteria, not viruses, and most colds, sore throats and coughs are caused by viruses. Furthermore, antibiotics alter our normal gut microbiome, the “healthy” bacteria that we carry, contributing to infections with superbugs, such as Clostridium difficile, which is associated with severe colitis and diarrhea and has reached an epidemic level across the nation.

Why did you choose this specialty? Growing up in India, I witnessed firsthand the devastation caused by infections. Many infections are indeed easy to prevent and treat with the right resources. I saw how the socioeconomic fabric of the individual’s life played a large role in the development of many infections. This is a specialty where it is key to know both the patient and their disease, turning the therapeutic relationship into a partnership, which I truly cherish. I also felt an intellectual draw to the specialty, since diagnosing infectious diseases frequently requires detective work, asking the right questions, listening carefully to get the story right and then choosing the correct set of diagnostic tests. There is a good measure of thrill and excitement in the field, with new pathogens and diseases always around the corner.

What are your areas of special interest? One special niche is caring for persons with immunocompromising conditions, be it HIV or a result of being on immunosuppressive drugs, such as cancer chemotherapy, anti-rejection drugs after an organ transplant or treatment for autoimmune diseases. A newer interest for me is wound care, a field where there have been exciting developments with emergence of new specialty and bioengineered products. Many patients with chronic wounds are frequently severely ill, and it is gratifying to bring some comfort and healing to their lives.

Is there a recent development in your field that you’re especially excited about? A huge change has been the development of new, highly effective and well-tolerated regimens for the treatment of HIV and hepatitis C infections. These new drugs have virtually changed the outlook for these diseases. The majority of my patients with HIV infection are now thriving on daily regimens consisting of one to two pills, while those with hepatitis C are experiencing cures after two months of easy, single-pill regimens.

What’s the most fun—outside of medicine—that you’ve had recently? Road-tripping with my daughter through Oregon and California prior to sending her off to college this fall. We had a lot of fun traveling together through Crater Lake National Park, the Redwoods, Mendocino Headlands, and many towns on the California and Oregon coasts.

What qualities should a patient look for when choosing a doctor?
Besides the expertise of the doctor, a successful disease outcome rests on a strong therapeutic relationship, particularly when managing a chronic and recurrent medical condition. So the key is to choose a doctor with whom you are comfortable, whom you can access and trust.