Hello! Welcome back to The Friday Sign Out - a newsletter for primary care physicians and advanced practice providers.

I hope everyone is having a great start to December! The holiday festivities are full swing around here. My kids were out of bed at 5:30 am last week asking if there were presents under the tree 🤪 The countdown has begun!

I hope you all have a chance to relax and unwind this month with hopefully a few days off work in there somewhere. I know the end of the year gets a little wild, both in the clinic and at home. With that being said, this will be the last newsletter of the year. More to come in January!

Here’s what I’m reading and thinking about this week.

In the News

This article in the Journal of the American Geriatrics Society discusses the risk of gastric ulcers in adults > 65 years old who are taking a combination of NSAIDs and cholinesterase inhibitors. The risk of developing a peptic ulcer was higher in patients prescribed both medications vs patients only taking an NSAID. Cholinesterase inhibitors alone were not associated with ulcer development. You can read the study here.

Cholinesterase inhibitors such as donepezil and rivastigmine are most often prescribed to patients with dementia. These are the same patients who possibly have arthritis and joint pain and are medicating with NSAIDs. This study sheds light on the drug-drug interaction we need to consider when prescribing these medications.

In Your Practice

Let’s talk about CME! I’m planning to travel to a conference this spring and would love to hear about some of the conferences you’ve attended and loved. I’m always looking for recommendations. Here are some of my past favorites:

• Mayo Clinic Annual Selected Topics in Internal Medicine: This is a fantastic week long conference in Hawaii, usually every January. Well-run and enjoyable. Plus the sessions are in the morning only, leaving plenty of time for sunshine and fun. It’s Hawaii after all! My husband and I went (pre-kids) to Maui. It was the most magical trip!

• Brave Enough Conference hosted by Dr. Sasha Shillcutt: If you’re aren’t familiar with Sasha, you need to check her out! She is an anesthesiologist and also a women’s physician life and career coach. Her Brave Enough Conference is amazing. She covers everything from leadership development, work-life control, wellbeing, restoration, the list goes on. Also, it’s hosted at a spa in Arizona 😍 Read more here! I would love to go back one day.

• Harvard - The Office Practice of Primary Care: I’ve attended this virtually 2 years in a row, starting during the pandemic. It’s a great review of primary care medicine, specific to the outpatient practice. Highly recommend! Link is here.

I’m headed to Boston for the ACP annual meeting in April. I’m looking forward to connecting with other internists and brushing up on clinical skills. If you’ve been and have any recommendations for can’t-miss events or specific lectures, let me know. If you are also going, feel free to message me - I would love to meet up!

In Your Heart

Another quote from James Clear’s weekly newsletter! I love this little reminder to work on making our first thoughts and actions positive vs negative or critical. It can be easy to jump to the critiques and judgements. He’s right, being positive and optimistic IS fun and worth the effort, even in tough moments.

Have a wonderful weekend!

Ashley