American College of Physicians: Internal Medicine — Doctors for Adults ®

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Clinical Issues

Abuse/violence | Addiction/substance abuse | Adolescent medicine | Aging | Alternative & complementary therapies | Allergies | Alzheimer's/aging | Autoimmune diseases/disease management | Bioterrorism | Cancer | Cardiovascular disease | Chronic diseases | Communication | Diabetes | Diagnosis | Disaster response | Disease Management | End of life | Epidemiology | Gastrointestinal illness | Gender-based medicine | Genetics | Gray Matters | Guidelines/evidence-based medicine | Headache | Health care access | Hematology | Hospital medicine | Infectious diseases | Lung diseases | Mental health | Mindful Medicine | MKSAP | Nephrology | Neurology | Nutrition | Obesity | Opioids | Pain management | Patient communication | Patient management | Patient safety | Prescribing | Pulmonary medicine | Referrals | Rehabilitation | Revitalization | Rheumatology | Screening tests | Sleep disorders | Smoking | Stroke rehabilitation | Titration | Women's health | Miscellaneous


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Abuse/violence

Risk of financial abuse in elders should draw internists' attention

An expert counsels internists to consider screening their elderly patients for financial abuses, from investment scams to pressure from family members. Doctors can partner with financial experts to prevent financial exploitation. More

Asking right questions key to detecting abuse

Unexplained bruising or injuries are red flags for intimate partner violence, but less obvious signs might include chronic pain, depression or anxiety. Experts advise how to help victims at risk. More

Recognizing the signs of domestic violence
Abuse may cause many complaints—but few patients will volunteer their story. (June 2006)

Tips to recognize—and respond to—domestic violence
Learning how to gently ask for information is the first step toward helping abused patients (March 2001)

Tips for detecting and preventing violent behavior in teens
Recent school shootings should serve as a wake-up call to screen all teenagers for psychosocial risk factors (May 1998)

Tips for detecting—and treating—domestic abuse
By asking the right questions and using some simple strategies, physicians can do a better job (February 1998)

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Addiction/substance abuse

Taking a drink: what patients should know

Alcohol is associated with so many benefits and harms that it’s hard to know where to start talking to patients about using it. One place might be alcohol misuse and abuse. Teach patients where they fall on the continuum of drinking behavior. More

Tools to screen for alcohol abuse

Medicare now reimburses for problem drinking as part of its Annual Wellness Visit, and a few easy-to-follow tips can help doctors screen for alcohol abuse and get paid for doing so. More

Marijuana requests: Relief or ‘permission’?

Fourteen states have legalized medical marijuana. Internists who have issued the controversial authorizations describe how they sort out legitimate uses from trivial requests. More

Uncertain diagnosis for pain leads doctor to dig further

A 66-year-old woman presents with abdominal pain radiating to her back, and CT scans show multiple lesions worrisome for metastatic disease. But when the pain resolves and the lesions don’t change, one internist reconsiders the diagnosis. More

Smokers take heart when doctors believe they can quit
Survey finds physicians devote little time to counseling and rarely give smokers the cessation tools they need. (November 2006)

Smoking Cessation
For patients, smoking represents a physical and psychological dependency; for physicians, smoking cessation is a frequent source of frustration. (October 2005)

Empathy, engagement are key to treating alcoholism
It is important to screen and identify every patient for substance abuse. (June 2005)

Strategies to help patients change their behavior
While relapses may be seen as a failure, they are a critical time for physicians to intervene. (June 2004)

When it comes to smoking cessation, more is better
From counseling to combination therapies, sustained engagement and education can break a ferocious habit. (June 2004)

With smoking cessation drugs, dosing is key
By using the right drug doses and combining therapies you can take some concrete steps to help patients stop smoking for good. (April 2002)

How to convince patients it's time to quit
To help patients stop smoking, you must find the motivation that best fits each patient's individual circumstances. (Web only)

Tips to spot patients who abuse prescription drugs
An addiction specialist gives pointers on how to spot drug-seeking patients—and how to avoid becoming entangled with them. (April 2002)

Treating alcohol problems in primary care settings
Physicians should be empathetic and optimistic about the efficacy of treatment (June 2000)

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Adolescent medicine

Lifelong Care

History is key after childhood disease

A generation ago, most children with severe disabilities died before reaching adulthood. Now, more than 90% survive. From cancer or congenital heart disease to cystic fibrosis and Down syndrome, pediatric survivors need internists who can coordinate chronic care. More

More teens are on drugs—the legal kind
Survey shows increases in adolescent prescriptions for chronic and mental illness (November/December 2007)

Internists wanted for complex adolescent care
A growing number of childhood disease survivors need to transition from pediatric care. (December 2004)

Struggling to treat teens? Try talking to them
How physicians can help adolescent patients dealing with risky behaviors and psychosocial stress (May 2001)

Tips for detecting and preventing violent behavior in teens
Recent school shootings should serve as a wake-up call to screen all teenagers for psychosocial risk factors (May 1998)

With teens, talk is the most valuable treatment tool
How to ask the right questions to get the real answers about sex, drugs and other issues (July/August 1997)

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Aging

Finesse required to treat anxiety in the elderly

Elderly patients may have many concerns on their mind. Maintaining their independence and managing their finances are two. But when does worry become anxiety? And how can internists not only manage chronic diseases but also ensure that patients are able to care for themselves? More

A few tips can improve older patients’ memory

Most complaints of memory problems aren’t related to cognitive impairments, and as such they can be alleviated with a few simple tips. More

Advance directives are the beginning of care, not the end

Despite the best planning, patients may change their minds at the end of life once they recognize their unique situations and their sometimes surprising decisions. More

Baby boomers' health isn't what they expect

The normal aspects of aging will place extraordinary demands on the health care system as the baby boomers enter their retirement years. Sheer numbers, coupled with high expectations of this population, pose a problem for primary care. More

Managing the elderly with cardiovascular disease

As patients are living longer, they're seeking more care for their cardiovascular diseases, as well as the accompanying comorbidities such as diabetes. Effective therapy is possible in the older population, say the experts. More

Simple assessment helps doctors break patient’s falls
Medicare to add assessments to its quality reporting initiative and pay more to doctors who make it routine (June 2007)

Geriatric guidelines help—until there are too many
The studies used to create guidelines don’t always include elderly patients. (June 2007)

A new look at the elderly and how to care for them
Medical groups band together in an effort to convince internists to improve their knowledge of geriatric issues. (January-February 2007)

Ranks of disabled elderly drop sharply. (January-February 2007)

Patients' fears help keep incontinence in the closet
Bringing up the issue in annual exams and suggesting simple solutions can help patients gain better control. (March 2006)

How to detect and treat gait disorders
Taking time to assess gait is an important part of patient evaluation. (November 2005)

New advisory on antipsychotics may limit care options
If the drugs' risks now outweigh their benefits, where do physicians and patients go for help? (July-August 2005)

Letters
Readers discuss substance abuse in the elderly, coding issues. (December 2003)

Alzheimer's or age? Some tips to make the right diagnosis
Tips to recognize dementia—and strategies to avoid mistaking common conditions for Alzheimer's. (September 2003)

Caring for seniors: making the most of 20-minute visits
Innovative ways to save time while improving patient care for the elderly. (July-August 2003)

Geriatric assessment tools
A collection of forms to help you assess elderly patients for common geriatric conditions. (Web only)

The MKSAP Challenge
How do you prevent fractures in an elderly patient on a multi-drug regimen? (June 2003)

Strategies to prevent falls in high-risk elderly patients
Assessing patients' risk factors, managing patients with a history of falls and educating patients to reduce those risks. (May 2003)

Three developments that could change how you treat osteoporosis
New screening guidelines, fears about HRT and a breakthrough medication bring changes to skeletal care (January 2003)

Do you know what to look for in Alzheimer's patients?
Generalists rarely catch the diagnosis. Here are tips to help identify—and treat—Alzheimer's disease (June 2001)

Working in geriatrics: Look beyond chronic conditions
Internists need to use screening tools to focus on geriatric patients' overall health and function (May 1997)

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Alternative & complementary therapies

Probiotics have potential, though definitive evidence is lacking

Probiotics are gaining some rationale for use—not for everything, but for preventing anti-biotic-associated diarrhea and Clostridium difficile infections in hospitals. But many products on the market don’t live up to their own hype. More

New research creates debates on calcium’s benefits vs. risks

Calcium supplements pit potential outcomes against one another—heart attacks vs. bone fractures vs. increased falls. The debate leaves doctors wondering what the researchers are really doing and saying about supplements. More

Readers Respond

Letters to the editor

Reader comments on the role of ancillary services in an internal medicine practice, and on the need for attention to nutrition and lifestyle in caring for rheumatoid arthritis. More

Proof or promise? Get the facts on CAM
Growing evidence base helps doctors advise patients about alternative therapies (November/December 2007)

If physicians don't ask, patients won't tell about CAM
Reassuring patients that they won't be judged or dismissed can help open up the lines of communication (November/December 2007)

How to help patients who use alternative medicine
With alternative therapies booming, you need to identify patients' nonconventional treatments (June 2001)

Do 'natural' treatments put your patients at risk?
Unlike complementary therapies, alternative medicine offers products and techniques that may be hazardous (May 2001)

What you need to know about herbal supplements
The number substances available continues to grow, creating confusion among physicians (June 2000)

Safety, communication issues slowing internists' use of alternative medicine
Physicians must view alternative medicine as a reality in today's practice environment (June 1999)

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Allergies

Allergist offers answers for internists’ practice encounters

Allergies and all the “As” of asthma, aspirin and anaphylaxis get considered in a session on conditions that affect one-fifth of the population. More

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Alzheimer's/aging

A few tips can improve older patients’ memory

Most complaints of memory problems aren’t related to cognitive impairments, and as such they can be alleviated with a few simple tips. More

Alzheimer's markers make management tougher

Diagnostic advances are identifying Alzheimer's disease and its precursors much earlier. The bad news is that, for now at least, these improvements may only create more dilemmas for general internists, who could find themselves fielding questions on how and whether new guidelines apply to clinical practice. More

Alzheimer’s, genomics and the personal utility of testing

As many as one in 10 doctors get asked for “the blood test” for Alzheimer’s risk. A flurry of research will further drive patient interest, but also cause rethinking of clinical guidelines that discourage such testing. More

Alzheimer's Disease
Prevention, diagnosis and treatment overview. (April 2005)

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Autoimmune diseases/disease management

When you look, but don’t see the diagnosis

Gradual yet significant change in a woman’s appearance, first noticed by a daughter she hadn’t seen for a year, leads to the diagnosis of a common yet frequently missed ailment. Why hadn’t those who’d seen the woman daily noticed anything? Intuitive vs. deliberative thought processes made all the difference. More

Readers Respond

Letters to the editor

Reader comments on the role of ancillary services in an internal medicine practice, and on the need for attention to nutrition and lifestyle in caring for rheumatoid arthritis. More

Rheumatologists consider cancer, cardiovascular disease
Conference coverage addressing highlights: TNF-antagonists don't increase cancer risk, Patients with RA have about the same risk of developing cardiovascular disease as type 2 diabetics, and an association between arthritis and periodontal disease. More

New research evaluates RA patients’ cardiovascular risks (January 2008)

Options and challenges in treating RA
Drugs give better control of a once-crippling disease—but need close monitoring. (October 2004)

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Bioterrorism

Bioterrorism agents physicians should know
An overview of major symptoms and treatments for six biological agents (Annual Session News 2003)

New CDC guide to smallpox vaccination has photos of normal and adverse reactions (March 2003)

As the country gears up for smallpox vaccinations, physicians find themselves on the front lines
Prophylactic immunizations may protect you, but are they necessary—or safe? (January 2003)

The trouble with vaccines to fight bioterrorism
While vaccines seem like an obvious line of defense against bioterrorism, available drugs are not viable options (June 2002)

Lessons learned from last fall's anthrax attacks
Maryland's bioterrorism coordinator talks about her state's response to the anthrax attacks—and their plans to prepare for future attacks (April 2002)

Are you prepared to respond to bioterrorism?
Doctors will have to trigger the alarm—and make tough calls about patient care (December 2001)

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Cancer

Communication skills vital to cancer conversations

Cancer patients want information, but not in a way that makes them lose hope. Effective shared decision making and risk communication strategies can help. More

Internists play primary role in detecting skin cancer

While it isn’t recommended that primary care physicians perform whole-body skin exams for skin cancer, they can and should be alert for skin lesions with malignant features. An easy acronym and other tips and tricks can make the difference. More

Diagnosing a disorder with few symptoms

Hypercalcemia can have absent, few or nondifferential symptoms, but the condition can indicate the presence of major diseases such as breast cancer. Experts review how to quickly apply a high index of suspicion to make a diagnosis. More

It's tough to navigate return from cancer care to primary care

An Institute of Medicine report suggests that patients are becoming lost in transitions between oncology and primary care. Educating physicians is a key to overcoming many of the barriers.More

Cancer's cure may be found by using the right diagnostic tree

Advances in the understanding of the molecular pathogenesis of cancer, rooted in knowledge of the genetic derangements underpinning each tumor type, lead to the question of whether clinicians should classify cancers by their tissue of origin, or their mutation of origin. Which diagnostic tree is the better example? More

Promoting literacy to increase adherence

Roughly 80 million Americans navigate health care's complexities with limited health literacy skills. Learn easy steps that help patients understand what they need to do, without formal literacy screening or potentially embarrassing questions. More

Speaking of cancer: Tips on how to convey risks to patients

How physicians express cancer risks to patients determines how they might use that knowledge to make decisions about genetics, family history and potential future screens and tests. More

Marijuana requests: Relief or ‘permission’?

Fourteen states have legalized medical marijuana. Internists who have issued the controversial authorizations describe how they sort out legitimate uses from trivial requests. More

Lifelong Care

History is key after childhood disease

A generation ago, most children with severe disabilities died before reaching adulthood. Now, more than 90% survive. From cancer or congenital heart disease to cystic fibrosis and Down syndrome, pediatric survivors need internists who can coordinate chronic care. More

Rheumatoid arthritis hurts the whole body

Taking care of a patient with rheumatoid arthritis involves a partnership between internists and subspecialists, agree physicians managing cardiovascular risks, cancer or infections. More

Attribution error confounds a diagnosis after colon cancer

A rapid deterioration in mental status confounds doctors caring for a colon cancer patient admitted to the hospital for nausea and vomiting. An internist reviews the patient's history for the clue to the right diagnosis. More

Calmer talk needed about mammography

Controversy about implementing new mammography guidelines shouldn’t cloud talks between doctors and the women they counsel. Clarify what the guidelines really say, and share the decision-making with patients, experts counsel. More

Uncertain diagnosis for pain leads doctor to dig further

A 66-year-old woman presents with abdominal pain radiating to her back, and CT scans show multiple lesions worrisome for metastatic disease. But when the pain resolves and the lesions don’t change, one internist reconsiders the diagnosis. More

Primary Care Coordination

Internist follow-up key for breast cancer survivors

Breast cancer survivors may recover from their illness only to face the same diseases as their "well" peers, such as hypertension and diabetes. Experts suggest a shared care model to keep breast cancer survivors healthy. More

Tumors' shared pathways may hold key to cancer cures

The tremendous diversity of genetic alterations in cancer samples leads a governmental senior advisor to look for shared pathways among all tumors for a possible cure. More

Mammography poses small benefits, latent risks in elderly
Like all screening exams, mammography has a potential adverse effect on comfort, function and psychological well-being. More

Mammography a viable option for healthy women as they age
Function, not age, determines whether a woman will benefit from mammography. More

'Tumor boards' take team approach to breast cancer (October 2007)

Genomic tests may allow some breast cancer patients to avoid chemotherapy (October 2007)

Breast density stirs debate over screening standards (September 2007)

Despite the evidence, PSA testing sparks controversy. (July-August 2007)

Author speaks out about controversial lung cancer study
New data suggest that routinely screening high-risk patients pays off in early diagnoses, but critics are skeptical. (January-February 2007)

Breast Cancer
Sorting through the options for screening and treatment. (October 2006)

Recurrence, side effect challenges in colon, breast cancer
As more cancer patients survive, internists must be ready to switch gears from treatment to surveillance. (June 2006)

Colorectal cancer
Early detection, usually before any symptoms occur, correlates with curability. (May 2006)

Cancer survivors are getting lost to follow-up
Late effects among survivors have become more common, due to the increasing complexity of cancer treatments. (March 2006)

Medicare's new office-drug payment policy has oncologists concerned about access
Because of reduced fees, physicians say office infusion services may be at risk. (April 2004)

In cancer treatment, targeted therapies are giving physicians and patients hope
New, focused drugs have produced dramatic results, but more challenges remain. (December 2003)

New thinking on 'precancers' shows promise
Armed with data and drugs, researchers' focus is on prevention, not just treatment (February 2003)

Colonoscopy screening gains momentum, but problems remain
Obstacles include mediocre reimbursements and a shortage of gastroenterologists to do the procedure. (September 2002)

The pros and cons of screening for three cancers
New research calls into question the assumption that detecting cancers earlier saves lives. (June 2002)

In prostate debate, doctors and patients often at odds
Treatment is not always necessary and therapies can have serious side effects, but patients demand action (May 1997)

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Cardiovascular disease

White coat hypertension presents an elusive challenge

Although white coat hypertension is chalked up to general anxiety, it may be the medical setting, and specifically the physician, that acts as the trigger. More

New drugs could improve anticoagulation rates

Dabigatran and rivaroxaban spare patients the need for regular blood checks, but warfarin is less expensive and has an antidote to reverse bleeding, if needed. Does the convenience of the new generation of drugs and the potential to increase compliance with therapy outweigh their downsides? More

Managing the elderly with cardiovascular disease

As patients are living longer, they're seeking more care for their cardiovascular diseases, as well as the accompanying comorbidities such as diabetes. Effective therapy is possible in the older population, say the experts. More

An easy screen for an overlooked disease

Despite poor awareness and a lack of training on handling peripheral artery disease, internists can and should be able to recognize the symptoms and manage 95% of cases. Experts advise how to diagnose and treat the condition. More

Treat metabolic syndrome’s many causes

Metabolic syndrome’s prevalence has rapidly advanced in just the past decade. But medical societies don’t recommend treating it as a distinct entity. They’d rather that physicians address the individual components of the illness, and encourage lifestyle modifications as the primary way to achieve such a goal. More

Why and how to monitor hypertension at home

Home measurement of high blood pressure overcomes variability inherent in office measurements, delivers better assessment of systolic pressure (and hence, of possible cardiovascular events) and offers a better chance of discontinuing drug therapy. More

Group visits bring focus and control to hypertension

A VA center reduced uncontrolled hypertension rates by implementing group visits. The program allowed physicians to titrate medicine to efficacy, and then motivated patients to remain involved and compliant with therapy. More

Know the patient to achieve statin benefits

That statins work is without question. And with costs falling due to many drugs in the class going generic, physicians are now refining when to prescribe the ubiquitous drug class based on the degree of risk. More

Rheumatoid arthritis hurts the whole body

Taking care of a patient with rheumatoid arthritis involves a partnership between internists and subspecialists, agree physicians managing cardiovascular risks, cancer or infections. More

Cardiologists highlight prevention, clopidogrel

Subspecialists leading the Internal Medicine 2010 cardiology pre-course offer advice, but also accept some from general internists about preventing cardiovascular events in high-risk patients. More

Expert lays out controversies for cardio care

February is National Heart Disease Awareness Month, and the field is wide open to controversies seemingly without resolution when it comes to invasive versus therapeutic regimens. Bill Kussmaul, FACP, an associate editor of Annals of Internal Medicine, addressed some of the hottest controversies in cardiology. More

Medicine and management: hits from Hospital Medicine 2009

An expert discusses managing aortic dissection as a disease for life. Also, highlights from Hospital Medicine 2009 discuss caring for the pregnant patient, documenting care for the best reimbursement and ways to improve handoffs from shift to shift. More

Cardiac care critical for diabetic patients

Even the experts feel like they’re missing potential cardiological complications in diabetic patients. They consider how to screen this population effectively for the 3% of patients who experience cardiac-related deaths. More

Predicting heart disease with markers is risky undertaking
Genome-wide association studies have identified at least 22 new genetic markers for CHD risk. The current debate around the value of CRP for CHD risk assessment could be considered a warm-up for things to come. More

Heart failure, statins take center stage at AHA conference
Heart failure, headphones, statins and self-care were just some of the research topics presented at the American Heart Association Scientific Sessions conference. More

New research evaluates RA patients’ cardiovascular risks (January 2008)

Think outside the box when faced with difficult hypertension (June 2007)

Failures become lessons learned in cardiology research. (May 2007)

Coronary artery disease in women
Evidence-based recommendations about care. (May 2007)

Teamwork helps close the gaps in cardiovascular care
One internist's advice for getting lipid screenings to 100%—give up the idea that doctors have all the answers. (December 2006)

Chronic Heart Failure
Current recommendations about care. (November 2006)

Smokers take heart when doctors believe they can quit
Survey finds physicians devote little time to counseling and rarely give smokers the cessation tools they need. (November 2006)

Stroke and transient ischemic attack
Ten years after the approval of tissue-plasminogen activator (tPA), only a small percentage of patients experiencing an ischemic stroke receive the clot-busting drug. (September 2006)

ACS
Acute coronary syndromes may account for as many as 2 million hospitalizations in the U.S. every year. (March 2006)

Taking the pulse of women's heart health
Despite heart disease's toll on women, many fail to heed early warning signs. (January-February 2006)

Heart disease risk: men vs. women
Heart disease risks: the differences between men and women are significant. (Web exclusive)

Hypertension
Hypertension continues to wreak cardiovascular havoc among Americans. (December 2005)

Managing patients in the critical month after heart attack
A recent study underscores the need for aggressive management to avoid sudden death. (September 2005)

Lipid disorders
Usually treatable and arguably preventable, lipid disorders are rarely isolated medical conditions. (September 2005)

From bench to bedside: Does race count?
With 'ethnic' drugs on the horizon, there is growing controversy over how race affects treatment. (November 2004)

Is it time to expand your use of statins?
New update gives doctors the option of a lower LDL goal for patients at very high risk. (September 2004)

A look at ACP's guideline on managing chronic angina
New algorithms can help you evaluate suspected cases, choose the right diagnostic test and stratify patient risk. (September 2004)

The MKSAP Challenge
A 55-year-old woman with mild hypertension and blood pressure that ranges from 140-151/90-96 mm Hg asks about alternatives to drugs to lower her blood pressure. (November 2003)

The MKSAP Challenge
A 43-year-old man comes to the emergency room for evaluation of severe chest pain that awoke him from sleep. (September 2003)

A look at how three groups have kept their patients' hypertension in check
Improving blood pressure control through nurse-led clinics, local guidelines and healthy lifestyle campaigns. (July-August 2003)

Diuretics for hypertension get a big boost, but will data change prescribing patterns?
While experts say diuretics are underused, some physicians remain skeptical (April 2003)

Testing for CRP: red flag or red herring?
While some say the test can predict cardiovascular problems, others want more data (March 2003)

Some surprising uses for ACE inhibitors
Besides preventing heart attacks, the drugs can delay kidney problems and diabetes (December 2002)

When can statins be too much of a good thing?
Statins are often touted as a miracle drug, but these cholesterol-busters may not be for everyone (March 2002)

Do your patients need aspirin therapy? Ask them
Physicians trying to decide which patients to put on aspirin face a more difficult task than they might think (March 2002)

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Chronic diseases

Diagnosing a disorder with few symptoms

Hypercalcemia can have absent, few or nondifferential symptoms, but the condition can indicate the presence of major diseases such as breast cancer. Experts review how to quickly apply a high index of suspicion to make a diagnosis. More

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Communication

Keep up with vaccine recommendations

New vaccines and their recommendations have added complexity and made it tough to stay current. For patients, the extra costs can be prohibitive. Learn how to stay abreast of the requirements and engage patients on the issue. More

New research links empathy to outcomes

Everyone wants to have a physician who understands what they’re feeling, but it’s not just about human contact; better clinical outcomes can result from physician empathy.< More

Don’t give up on self-management

Time-pressed physicians are adopting a team approach as they grapple with how to help their patients improve their health. Referred to as “patient self-management,” the sometimes time-consuming process can be handled directly or through trained coaches. More

Patients and prayer amid medical practice

It’s more important than ever to recognize and understand cultures and spiritual beliefs, including and beyond the end of life. More

Baby boomers' health isn't what they expect

The normal aspects of aging will place extraordinary demands on the health care system as the baby boomers enter their retirement years. Sheer numbers, coupled with high expectations of this population, pose a problem for primary care. More

Framing risks, benefits perilous for physicians and patients

A new column debuts, outlining how physicians can properly frame risks and benefits of treatments so patients can make the best medical decisions for themselves. In this column, risk calculators are explained so the “number needed to treat” isn't so murky to a woman considering statins. More

Information plus documentation a must for informed consent

Documentation of informed consent is an important deterrent to malpractice and negligence claims. One physician describes how his informed consent process was the deciding factor in a missed case of prostate cancer, and outlines how any physician can accomplish it. More

Alzheimer's markers make management tougher

Diagnostic advances are identifying Alzheimer's disease and its precursors much earlier. The bad news is that, for now at least, these improvements may only create more dilemmas for general internists, who could find themselves fielding questions on how and whether new guidelines apply to clinical practice. More

Promoting literacy to increase adherence

Roughly 80 million Americans navigate health care's complexities with limited health literacy skills. Learn easy steps that help patients understand what they need to do, without formal literacy screening or potentially embarrassing questions. More

Aiding patients' decisions on PSA screening

There are many tradeoffs made when advising patients about whether to routinely screen for prostate cancer using prostate-specific antigen. Amid side effects of treatments and conflicting guidelines from professional societies, physicians and patients must come to a decision. Addressing six points directly and honestly can help. More

Tread lightly: Discussing obesity difficult for internists

Physicians are ill-equipped to dicuss obesity with their patients, a problem created by a lack of training in medical school, no clear guidelines on what screening should consist of, and a lack of confidence that patients would act on such counseling. But done properly, such discussions help twice as many patients lose weight. More

Discussing prognosis: The topic that patients and doctors dread

Physicians may try to overcome their discomfort in talking about death by delivering an overly optimistic prognosis. But the eventual, inevitable decline may actually make the patient feel much worse. An effective strategy incorporates the patient’s expectations. More

Learning to parry patient requests

Negotiating the doctor-patient relationship requires understanding what a patient expects from treatment, instead of outright saying “no.” There are easier ways to sort out what a request really means, and how to quickly address the real underlying issue. More

Group visits bring focus and control to hypertension

A VA center reduced uncontrolled hypertension rates by implementing group visits. The program allowed physicians to titrate medicine to efficacy, and then motivated patients to remain involved and compliant with therapy. More

Miserable symptoms mark chronic sinusitis

Chronic sinusitis, an illness that can feel as symptomatically miserable as congestive heart failure or rheumatoid arthritis, is often misdiagnosed or underdiagnosed. But distinctive clues can lead internists to deliver the right treatment. More

Speaking of cancer: Tips on how to convey risks to patients

How physicians express cancer risks to patients determines how they might use that knowledge to make decisions about genetics, family history and potential future screens and tests. More

Practice uses ACP survey for peer review, quality improvement

True North Health Center in Maine surveyed every patient who came through their doors from March through May last year to let each if its 28 practitioners know outcomes for each provider. Proprietary surveys are expensive, so they turned to ACP’s tools. The results helped those performing best to teach their peers about best practices. More

A brave new world of consumer gene tests

Direct-to-consumer tests are easy, cheap—and sometimes wrong. Yet, patients are handing them to their doctors on a weekly basis and asking for advice. Learn how to work with patients after they’ve sought out genome-wide analysis and then bring the results to doctors to sort out subtle meanings from often fallible tests. More

Visits can be more productive when patients set the agenda
First in a three-part series: Motivational interviewing is one technique for engaging patients and developing strategies that work
March ’08

Computer screen can be barrier between doctor and patient
February '08

Put patients in the driver’s seat to steer toward better health
Engaging patients in managing their own chronic diseases can be the key to helping them achieve their goals and improve outcomes
February '08

Teamwork helps close the gaps in cardiovascular care
One internist's advice for getting lipid screenings to 100%—give up the idea that doctors have all the answers. (December 2006)

Listening and prioritizing help keep the visit on track
Tips for finding out what’s really wrong with your patients before they have their 'hand on the doorknob.' (October 2006)

Tune into patients' 'emotional channel' to deliver bad news
Patients with serious illnesses need to hear more than the facts as you guide them through difficult decisions. (April 2006)

Letters
Readers comment on care coordination codes, patient communication, and end-of-life care. (March 2006)

Hospitals adopt new protocols for stroke care
Advances in treatment and communication aim to improve stroke outcomes. (November 2005)

Talking to healthy patients about flu shot alternatives
A Mayo internist and vaccine researcher comments on the country's fifth straight year of scarce flu vaccine. (November 2004)

Strategies to help tackle poor health care communication
Three projects are designed to remove major communication barriers between physicians and their patients. (May 2004)

How to tell patients you've made a serious mistake
Pointers on communicating with patients about medical errors (Annual Session News 2003)

How do you know if your patient is truly informed?
Exploring the sometimes-thorny issues that can surround informed consent (Annual Session News 2003)

Tips to talk to patients in terms they'll understand
Low levels of "health literacy" mean that most patients understand less than half of what you tell them (February 2003)

Bearing bad tidings? Try these communication tips
Communicating bad news with frankness and empathy can help improve your bond with patients (January 2003)

Talking about risk with your patients? Try these tips
Statistics can mislead and confuse, but you can cut through the clutter and communicate more clearly (September 2002)

Patients uncooperative? Try these communication tips
By recognizing important issues and helping set expectations, residents can improve patient encounters (May 2002)

Strategies to make the most of patient appointments
Active listening, the right questions and collaborative decision-making can save time in the long run (June 2001)

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Diabetes

Diabetes debates defy easy resolution

An ever-changing knowledge base without clear consensus makes diabetes management especially challenging. More

Patients with diabetes facing vision loss at ever-earlier ages

Just as diabetes is affecting younger populations, so are its consequences. Childhood obesity can translate into diabetic retinopathy in patients in their 20s, which requires a response from the primary care community. More

‘Goldilocks’ goal for diabetics and CKD

Managing kidney disease in diabetes requires meeting individualized parameters and balancing risks in nephrology and cardiology. Learn whether more aggressive treatment is warranted in this population. More

Teaching diabetes self-management ‘basic survival skills’

Diabetes self-management education is cost-efficient and can improve A1c levels “far greater” than the effect required to approve a new drug for the disease. Smartphones, health coaches and educators are part of the new paradigm to help patients. More

Managing the elderly with cardiovascular disease

As patients are living longer, they're seeking more care for their cardiovascular diseases, as well as the accompanying comorbidities such as diabetes. Effective therapy is possible in the older population, say the experts. More

Experts offer advice on oral drugs, insulin for diabetes

Any type 2 diabetic is eventually going to need oral medications, and some on oral medications may eventually progress to needing insulin. The regimens are complex and vary from patient to patient. Learn how to individually tailor such decisions. More

Attribution error results from a positive stereotype

A 58-year-old man diagnosed with type 1 diabetes at age 38, a case of latent autoimmune diabetes of adulthood, reports worsening control of his blood sugars despite increasing doses of insulin. An internist must sort through the facts of the case to find out what’s responsible. More

Treat metabolic syndrome’s many causes

Metabolic syndrome’s prevalence has rapidly advanced in just the past decade. But medical societies don’t recommend treating it as a distinct entity. They’d rather that physicians address the individual components of the illness, and encourage lifestyle modifications as the primary way to achieve such a goal. More

Monitoring glucose minute by minute

Continuous glucose monitoring presents challenges not only to patients, but to internists learning how best to teach their patients how to use it. But without enough endocrinologists to care for the 1 million patients with type 1 diabetes, internists have to pick up the slack. More

Cardiac care critical for diabetic patients

Even the experts feel like they’re missing potential cardiological complications in diabetic patients. They consider how to screen this population effectively for the 3% of patients who experience cardiac-related deaths. More

Two-pronged approach to attack prediabetes
Until recently, internists had very little guidance on how to treat prediabetes and reduce the risk of the full-blown disease. The most recent advice: Treat it early, with simple lifestyle changes. More (October 2008)

Endo ’08: new research ignites debate about best A1C goals
From diabetes and dyslipidemia to hormones and hirsutism, the Endocrine Society’s 90th annual meeting in San Francisco last June was a wellspring of new information and fresh debate.
September ’08

Diabetes project narrows gap between theory and practice
Following a successful first phase, the College’s diabetes programs reach out to a wider audience of members, residents and patients
March ’08

Rosiglitazone drama has internists scratching their heads
E. Victor Adlin, FACP, an endocrinologist at Temple University School of Medicine, discusses how the rosiglitazone drama has affected internists’ prescribing habits
March ’08

Specialists mull incretin-based therapies for diabetics (September 2007)

Coordination is key in caring for complex diabetes. (January-February 2007)

Better drugs, new devices help keep diabetes in check. (December 2006)

Type 2 diabetes mellitus
The prevalence and complications of diabetes point to major gaps in the care of chronic disease. (November 2005)

How small changes can bring big rewards in diabetes care.
When it comes to incorporating evidence into daily practice, physicians admit there may be a gap between best practices and the care they can provide. (September 2004)

Taking a new approach to type 2 diabetes
Recognizing clues like metabolic syndrome is one key to catching 'prediabetes' (May 2002)

New questions about diabetes management: How far is it from type 1 to type 2?
Certain inferences regarding treatments for type 1 disease can be extrapolated to type 2 diabetes (January 1996)

A rich resource for diabetes education
Dieticians and nurses can help diabetics better understand the disease and how to manage it (January 1996)

The latest on managing cardiovascular disease in type 2 diabetics
Diabetics with heart disease have atypical symptoms and don't respond to some treatments—like aspirin (January 1996)

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Diagnosis

Learn to see signs of an often fatal disease

Pulmonary arterial hypertension can be recognized and treated. But it remains a diagnosis that is often missed, and the delay can lead to a rapidly progressing and fatal outcome. Learn the signs beyond a patient who reports “being out of breath.” More

Undiagnosed diseases program tries to crack the tough cases

When a condition stumps the experts, the experts turn to a center of last resort, the federal Undiagnosed Diseases Program at the National Institutes of Health. Medical teams take a “big picture” view and a fresh eye to pick up on what may have been missed. More

Genetic tests are being used more, and they're worth it

Molecular diagnostics tests could cost Americans $15 billion to $25 billion by the end of the next decade. Physicians believe the tests are warranted, although they're skeptical about costs and their ability to interpret them properly for patients. More

Diagnosing a disorder with few symptoms

Hypercalcemia can have absent, few or nondifferential symptoms, but the condition can indicate the presence of major diseases such as breast cancer. Experts review how to quickly apply a high index of suspicion to make a diagnosis. More

Thinking about our thinking as physicians

Cognitive errors have been the bane of making the right diagnosis. The final installment of the Mindful Medicine column reviews the past three years' discussions of traps and pitfalls that physicians must account for when presented with patients who aren't getting any better, often despite multiple encounters in the health care system. More

Cancer's cure may be found by using the right diagnostic tree

Advances in the understanding of the molecular pathogenesis of cancer, rooted in knowledge of the genetic derangements underpinning each tumor type, lead to the question of whether clinicians should classify cancers by their tissue of origin, or their mutation of origin. Which diagnostic tree is the better example? More

Priming to diagnose an atypical case, avoid representativeness

A patient's deteriorating mental health status points to an underlying cause. But it takes “priming” for an endocrinologist to look for the right diagnosis despite the lack of a prototypical case. More

Vulvovaginal disorders common but commonly misunderstood

Nearly one in eight women have chronic vaginal pain. Although there’s a lack of regular training in internal medicine, the gold standards for diagnosis remain the history and physical, pH and saline wet mount, and a whiff test and biopsy (if indicated). More

The case of a young woman mistakenly diagnosed with asthma llustrates the danger of confusing correlation and causation. More

Mindful Medicine, by Jerome Groopman, FACP, and Pamela Hartzband, FACP
May '08

Mindful Medicine, by Jerome Groopman, FACP, and Pamela Hartzband, FACP
Case study: Patient’s doubts about diagnosis prompt a second opinion
March ’08

Mindful Medicine: Send in your cases of medical diagnosis
Jerome Groopman, FACP, author of the bestselling "How Doctors Think," and his wife, endocrinologist Pamela Hartzband, ACP Member, discuss the art of medical diagnosis and decision making through a series of case studies suggested by readers. (January 2008)

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Disaster response

Internists healing tsunami's aftereffects

Six months after an earthquake and tsunami, Japan's populace and its clinicians are sizing up the long-term health effects of the physical injuries, the mental trauma and the damage to the nation's health care facilities. Internists describe the aftermath in their own words. More

Volunteer internists help to rebuild Haiti

Physicians in Haiti face a new set of challenges as they stem the spread of infectious diseases and restore medical care to a country that had little before a devastating earthquake struck. More

New disaster response plans build on past lessons
Post-Katrina, officials outline key strategies to bolster emergency preparedness. (June 2006)

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Disease Management

‘Goldilocks’ goal for diabetics and CKD

Managing kidney disease in diabetes requires meeting individualized parameters and balancing risks in nephrology and cardiology. Learn whether more aggressive treatment is warranted in this population. More

Better treatment, low awareness for hepatitis C

Amid rising rates of long-term hepatitis C infection, particularly among older populations, better treatments are able to treat the condition. But first, patients have to know they have it, and internists have to be able to recognize the diagnosis. More

Many malaria prophylaxis options, but none perfect

Malaria research is turning from short-term prophylaxis for travelers to elimination and eradication. Drug costs and new ethics rules for research are key drivers of the new direction. More

Trichomoniasis is unpopular, underdiagnosed, expert says

A neglected disease of poverty gets little attention, yet it's more common than better-known diseases and has serious consequences. Fortunately, once diagnosed, the treatment is simple and inexpensive. More

Experts debate the pros and cons of starting dialysis early

Two experts find common ground in deciding that individualized decisions are the best way to consider early dialysis. More

It's tough to navigate return from cancer care to primary care

An Institute of Medicine report suggests that patients are becoming lost in transitions between oncology and primary care. Educating physicians is a key to overcoming many of the barriers.More

HIV comes of age as disease of mid-to-late life

Protease inhibitors revolutionized management of HIV, morphing it from a death sentence to a chronic, manageable condition. Medical issues have since grown more complex as doctors consider how HIV interacts with aging, and how aging interacts with these sometimes toxic drugs used to control the virus. More

Project ECHO expands the reach of primary care

To improve local care of hepatitis, Project ECHO uses videoconferencing and case-based learning to connect front-line primary care physicians with skilled and knowledgeable specialists. More

Primary care integral to new national viral hepatitis action plan

Experts hope a new plan launched in May by the U.S. Department of Health and Human Services will target hepatitis from a number of fronts, including education, treatment and prevention, and increased training of clinicians to diagnose and treat hepatitis and immunize patients. More

Cancer's cure may be found by using the right diagnostic tree

Advances in the understanding of the molecular pathogenesis of cancer, rooted in knowledge of the genetic derangements underpinning each tumor type, lead to the question of whether clinicians should classify cancers by their tissue of origin, or their mutation of origin. Which diagnostic tree is the better example? More

Priming to diagnose an atypical case, avoid representativeness

A patient's deteriorating mental health status points to an underlying cause. But it takes “priming” for an endocrinologist to look for the right diagnosis despite the lack of a prototypical case. More

Food allergies are a tough nut to crack

As public awareness of food allergies increases, identification and management into adulthood can be difficult to sort out, carrying the risk of misdiagnosis, according to specialists who are trying to improve physician education. More

An easy screen for an overlooked disease

Despite poor awareness and a lack of training on handling peripheral artery disease, internists can and should be able to recognize the symptoms and manage 95% of cases. Experts advise how to diagnose and treat the condition. More

Learning to parry patient requests

Negotiating the doctor-patient relationship requires understanding what a patient expects from treatment, instead of outright saying “no.” There are easier ways to sort out what a request really means, and how to quickly address the real underlying issue. More

Treat metabolic syndrome’s many causes

Metabolic syndrome’s prevalence has rapidly advanced in just the past decade. But medical societies don’t recommend treating it as a distinct entity. They’d rather that physicians address the individual components of the illness, and encourage lifestyle modifications as the primary way to achieve such a goal. More

Miserable symptoms mark chronic sinusitis

Chronic sinusitis, an illness that can feel as symptomatically miserable as congestive heart failure or rheumatoid arthritis, is often misdiagnosed or underdiagnosed. But distinctive clues can lead internists to deliver the right treatment. More

When you look, but don’t see the diagnosis

Gradual yet significant change in a woman’s appearance, first noticed by a daughter she hadn’t seen for a year, leads to the diagnosis of a common yet frequently missed ailment. Why hadn’t those who’d seen the woman daily noticed anything? Intuitive vs. deliberative thought processes made all the difference. More

Marijuana requests: Relief or ‘permission’?

Fourteen states have legalized medical marijuana. Internists who have issued the controversial authorizations describe how they sort out legitimate uses from trivial requests. More

Know the patient to achieve statin benefits

That statins work is without question. And with costs falling due to many drugs in the class going generic, physicians are now refining when to prescribe the ubiquitous drug class based on the degree of risk. More

Monitoring glucose minute by minute

Continuous glucose monitoring presents challenges not only to patients, but to internists learning how best to teach their patients how to use it. But without enough endocrinologists to care for the 1 million patients with type 1 diabetes, internists have to pick up the slack. More

Rheumatoid arthritis hurts the whole body

Taking care of a patient with rheumatoid arthritis involves a partnership between internists and subspecialists, agree physicians managing cardiovascular risks, cancer or infections. More

‘Year of the Lung’ draws attention to COPD, asthma

Chronic obstructive pulmonary disease is projected to be the third most common cause of death by 2020, but it is currently underestimated. This year’s American Thoracic Society meeting focuses on lung disease issues to bring them to the attention of the rest of the medical community. More

Not sleeping but not sleepy with asymptomatic apnea

As many as 25% of apnea sufferers don’t complain of daytime sleepiness. Compliance is a problem because these patients may not see the value of treatment, according to researchers at the American Thoracic Society. More

Expert explains thyroid diagnosis, treatment and common red flags

The estimate that 25 million people have thyroid problems would double if the normal range for thyroid-stimulating hormone was adjusted, as some medical societies suggest. In this Web-only feature, Victor Bernet, FACP, the author of MKSAP 15’s chapter on disorders of the thyroid gland, offers his insights into management. More

Influenza featured at infectious disease meeting

A digest of information on seasonal and H1N1 influenza, mandatory vaccines for health care workers, and new rapid diagnostic tests for the flu from the Infectious Diseases Society of America’s meeting. More

Cardiac care critical for diabetic patients

Even the experts feel like they’re missing potential cardiological complications in diabetic patients. They consider how to screen this population effectively for the 3% of patients who experience cardiac-related deaths. More

Do placebos have a place in clinical practice?

Placebo use is common in internal medicine. But is it ethical? Experts examine the disconnect between the standards of medicine, and how it's actually practiced in the office. More

Elusive Sjogren's manageable—if diagnosed

Lack of awareness compounds a condition that is exceedingly difficult to diagnose. Experts offer signs and symptoms for ruling it out or diagnosing it more quickly. More

Osteoporosis no longer just a woman’s disease
New ACP guidelines urge internists to assess their older male patients for osteoporosis risk factors, especially those over the age of 65.
June ’08

Make path to health one of least resistance
Behavioral economics explains why patients sacrifice their long-term health for short term rewards, and suggests ways that internists can easily convince them to change.
May '08

Is your staff prepared to respond to a stroke?
Education about symptoms should target office staff with patient contact, as well as patients and relatives of those at risk.
May '08

Latest in stroke research is both suspected and surprising
Conference coverage focuses on studies about abdominal obesity, symptoms and the importance of dialing 911 first.
May '08

The best self-management is ‘specific, do-able and realistic’
Second in a three-part series: Simple ways to engage patients in their own health care
April ’08

Barrett’s esophagus: screening guides are in flux over reflux
April ’08

Web extra: Hypothyroid treatments may help, but without resolving symptoms (September 2007)

Web extra: Benefits of statins may outweigh the risks for many patients (September 2007)

Dialysis might not be the right call for the very old. (September 2007)

Weight training lightens physical, psychological loads
Study shows that resistance training during dialysis can counteract muscle wasting better than aerobic exercise (September 2007)

Treat rheumatoid arthritis early, aggressively for best outcomes (June 2007)

Alcohol abuse and related disorders
Evidence-based recommendations about care. (April 2007)

To conquer depression, try and try again
The majority of depression sufferers are initially seen by primary care doctors. (April 2007)

HPV vaccine raises questions and debate
Supply, cost issues and ethical controversies are having a major impact on internists. (March 2007)

Merits of group visits can be tough sell for small practices. (March 2007)

Readers express views on dialysis alternatives, electronic medial record systems. (December 2006)

New kidney disease strategy aimed at earlier intervention
The goal is to slow, halt, prevent or partially reverse kidney disease through medical treatments and lifestyle changes. (October 2006)

Study finds generation gap in guidelines
Single-disease focus may leave complex patients out of pay-for-performance pool. (December 2005)

Metabolic syndrome: flawed science or clinical tool?
As experts debate the validity of a label, clinicians weigh in on using it in practice. (December 2005)

Is it time for universal HIV screening?
With HIV becoming a chronic disease, internists need to manage complex care. (June 2005)

Asthma
Asthma is the paradigm illness for self-management, owing to its unpredictable nature. (May 2005)

Overcoming resistance to disease management
Key factors that drive acceptance are collaboration, competition and positive results. (January-February 2005)

Web only:
Managing disease: a healthy—and growing—trend? (January-February 2005)

From bench to bedside: Does race count?
With 'ethnic' drugs on the horizon, there is growing controversy over how race affects treatment. (November 2004)

Group visits can save time, but are they right for you?
The new trend in scheduling group visits makes both physicians and patients happy. (April 2004)

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End of life

Patients and prayer amid medical practice

It’s more important than ever to recognize and understand cultures and spiritual beliefs, including and beyond the end of life. More

Advance directives are the beginning of care, not the end

Despite the best planning, patients may change their minds at the end of life once they recognize their unique situations and their sometimes surprising decisions. More

Integrate palliative care from early illness onward

The medical community has made progress in palliative care, moving it from the end of the line to a part of a terminal illness’ earliest aspect of care. More

Talking points on palliative care address public, patients

Experts decry “death panels” as a step backward for the public perception of palliative care. Clarifying its scope would help the profession move forward, according to speakers at a recent conference. More

Discussing prognosis: The topic that patients and doctors dread

Physicians may try to overcome their discomfort in talking about death by delivering an overly optimistic prognosis. But the eventual, inevitable decline may actually make the patient feel much worse. An effective strategy incorporates the patient’s expectations. More

Ethics in medicine

Doctors debate the ethics of assisted suicide

The medical community and the world at large are looking at how physician-assisted suicide is playing out in Washington, Oregon and Montana. Are these states a bellwether or a death knell for legalizing the issue elsewhere? And how should physicians respond when presented with such requests from their patients? More

Physicians can help patients decide about end-of-life issues

The recent decrying of “government death panels” undercuts patient welfare, patient autonomy and social justice, and physicians have a duty to take a leadership role in the debate over health care reform. More

New end-of-life guidelines recommend earlier palliative care
The College’s new guidelines recommend that clinicians regularly assess end-of-life patients for symptoms of pain, dyspnea and depression, and use proven therapies to treat these conditions
March ’08

Better communication at the end of life
New form ensures that dying patient's wishes are carried out as medical orders. (July-August 2007)

Guidelines aimed at changing end-of-life conversation
Physicians can ease relatives' anxieties by listening more, asking questions and acknowledging guilt and sorrow. (July-August 2007)

Treatment vs. harm: How to care for seriously ill patients
Ditching the 'either/or' model can help reduce patient suffering—and ease hospitalists' palliative care role. (June 2006)

Letters
Readers comment on care coordination codes, patient communication, and end-of-life care. (March 2006)

Dying patients deserve to live final days with dignity
Physicians should be consensus builders, laying out the available options and working with family members. (June 2005)

Surrogate decision-makers and end-of-life care: no 'right' answers, but plenty of tough choices
Helping families make decisions about palliative care when dying patients' wishes aren't known. (June 2003)

Avoiding trouble when using opiates to treat patient pain
Overcome fears about sanctions for overprescribing painkillers and patient addiction to better ease your patients' pain. (June 2003)

How to address spirituality issues at the end of life
To provide patients truly compassionate care, physicians need to look beyond the medical aspects of dying. (June 2003)

Tips to talk to patients about end-of-life care
Tips to help steer families—and colleagues—clear of futile care. (Web Only)

Issues to consider when ending life support
Hospital-or hospice-based caregivers must make tough decisions in order to ease the dying process for terminally ill patients (May 2001)

How teams can help during end-of-life care
A team-oriented approach helps patients and physicians better deal with the dying process (May 2001)

How to avoid conflicts with patients and families during end-of-life care
End-of-life discussions ideally begin when patients are still healthy (June 2000)

Tips on talking to patients about advance directives
Getting beyond simplistic statements like 'no machines' can dramatically improve end-of-life planning (March 1999)

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Epidemiology

Better treatment, low awareness for hepatitis C

Amid rising rates of long-term hepatitis C infection, particularly among older populations, better treatments are able to treat the condition. But first, patients have to know they have it, and internists have to be able to recognize the diagnosis. More

Army physicians on the front line of infectious disease research

Walter Reed’s infectious disease unit travels the globe to identify and combat the world’s deadliest infectious diseases. Driven to find vaccines that protect troops stationed overseas, the work quickly benefits civilian populations, too. More

Influenza featured at infectious disease meeting

A digest of information on seasonal and H1N1 influenza, mandatory vaccines for health care workers, and new rapid diagnostic tests for the flu from the Infectious Diseases Society of America’s meeting. More

A warmer, wetter world will mean more work for internists
June ’08

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Gastrointestinal illness

Probiotics have potential, though definitive evidence is lacking

Probiotics are gaining some rationale for use—not for everything, but for preventing anti-biotic-associated diarrhea and Clostridium difficile infections in hospitals. But many products on the market don’t live up to their own hype. More

PPI’s benefits can outweigh their possible risks

The key to proper use of proton-pump inhibitors is monitoring patients closely to determine if they are benefitting from long-term therapy, or could potentially discontinue or reduce their dose. More

Expressive writing could help erase irritable bowel syndrome

Expressive writing, used for other illnesses with a known psychological component, is now being studied to control the symptoms of irritable bowel syndrome. More

Attribution error confounds a diagnosis after colon cancer

A rapid deterioration in mental status confounds doctors caring for a colon cancer patient admitted to the hospital for nausea and vomiting. An internist reviews the patient's history for the clue to the right diagnosis. More

Array of symptoms can point to celiac

Celiac incidence has risen since the 1950s to today, so alert internists listen to the symptoms, get to the basis, and make accurate attributions to make the right diagnosis. A constellation of symptoms can point to a common underlying condition. More

Seeing the whole diagnostic picture

For a year, one patient saw specialist after specialist and received a different diagnosis each time. Like the story of the blind men and the elephant, specialists often see the patient through only one component of training, as anchoring and availability sneak into their thinking. More

Work up the whole patient when treating IBS

With so many confounding factors to consider with irritable bowel syndrome, physicians can benefit their patients most with an important diagnostic tool—listening. Learn how to work up these patients from first steps to cognitive therapy options. More

Conference coverage

Guiding clinicians through GI diagnoses

ACP Internist wraps up highlights of Digestive Disease Week, including dyspepsia, weight loss and incontinence, as well as the latest about the risks of proton-pump inhibitors and antithrombotics. More

Urgent update on acute diarrhea

While most episodes of diarrhea are brief, and most people don’t seek medical attention for them, some do end up becoming more severe and requiring medical care. As such, internists need to know how to recognize the subtle differences in presentation. More

The Colonoscopy Conundrum: Studies suggest the importance of screening, but convincing patients is another matter (January 2008)

Tips for weaning your patients off PPIs
Cutting back on medications can save patients money—and reduce side effect risks. (July-August 2004)

New drugs—and some respect—for IBS
Revised guidelines and targeted therapies are leading to a new view of the condition. (September 2003)

Does diet affect IBS?
While many patients suspect that what they eat is a factor, physicians aren't so sure. (Web Only)

The MKSAP Challenge
Test your knowledge of treatment for persistent GERD (February 2003)

Should you test for H. pylori to treat dyspepsia?
The strategy appears to be popular, but the evidence is unclear on how many patients you can expect to help (January 2002)

Colonoscopy screening gains momentum, but problems remain
Obstacles include mediocre reimbursements and a shortage of gastroenterologists to do the procedure (September 2002)

When it comes to screening, what is cost effective?
A look at the cost effectiveness of colorectal cancer screening options (Web Only)

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Gender-based medicine

A silent syndrome with serious side effects
Polycystic ovary syndrome can cause infertility, diabetes and/or metabolic syndrome, and distressing physical symptoms like hirsutism and alopecia. Fortunately, once internists recognize the symptoms the condition can be managed effectively. More

Gender gap increases women's heart risks
Nearly half the time, the first clue a physician gets that a woman has heart disease is that she drops dead. Updated guidelines now dictate physicians should first screen for a woman's risk factors for heart disease by age 20. More

Sexual Dysfunction
When to screen, how to treat, what to ask. (March 2005)

Referring a patient with breast problems? You can manage many common complaints
Breast specialists say that they see many cases that can be successfully dealt with in the primary care setting. (October 2004)

New Pap guidelines reduce screening but raise concerns about compliance
Some worry that the call for less frequent Pap tests will reduce patient compliance with regular screening (April 2003)

The MKSAP Challenge
A pregnant patient is short of breath and coughing pink sputum. What's the likely diagnosis? (April 2003)

Weighing the risks of hormone therapy
New data on estrogen/progestin therapy have researchers urging caution (September 2002)

Menstrual cycles and patient care: a new view
When research is still preliminary, some are treating patients with menstruation in mind (May 2002)

A new solution to confusing Pap smear reports
Revised terminology on lab reports aims to clarify which patients need follow-up care (November 2001)

The key to understanding gender-based biology
Sexual differences affect every organ and system in the body (May 2001)

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Genetics

Determining actionability of genetic findings in clinical practice

Just as radiology screenings can return results of incidentalomas, genetic scans can also return inadvertent findings. But some guidance can be taken from criteria developed in 1968 for adopting any screening test. More

Internists becoming the ‘gatekeepers’ for genetic testing

Genetic tests have made tremendous advances, and primary care physicians are going to be the ones who determine whether they're used, and how frequently. Here are a few pointers from Internal Medicine 2012 on what criteria to use. More

Genetic tests are being used more, and they're worth it

Molecular diagnostics tests could cost Americans $15 billion to $25 billion by the end of the next decade. Physicians believe the tests are warranted, although they're skeptical about costs and their ability to interpret them properly for patients. More

Microscopic genes affected by macroeconomic events

Genes may express themselves differently, depending upon their environment. So, economic disparities and differences in access to health care could impact a person's health. In an era of personalized care, technology, biology and business intersect in novel ways. More

Don’t look now, but you are surrounded

Skin, teeth and guts. Microbes live on or in each, and a new interest exists in how to manipulate the human microbiome to benefit human health. More

Blueprint reveals clinical slant to upcoming genomics research

The 10th anniversary of the publication of the entire sequenced human genome is celebrated with another publication, this time of clinical applications for the research. Not only can diseases be treated, but better drugs and streamlined clinical trials may result. More

Practical Genomics

Expectations exceed understanding in unraveling the genome

Genomic advances have come at a tremendous pace, yet frustration exists that the benefits are not available today. Members of the medical community debate where to focus resources to balance long-term goals against pressing needs. More

Practical Genomics

Court case questions patentability of human genomic structure

Our columnist discusses a building controversy over the legality of DNA patenting. More

Filling in the GAPPs will strengthen evidence-based medicine

Little data supports the use of genomic testing for subjects such as warfarin dosing. Paradoxically, that lack of evidence leaves open the potential for the misuse of direct-to-consumer genomics tests for fun, or for their premature adoption by clinicians. More

Alzheimer’s, genomics and the personal utility of testing

As many as one in 10 doctors get asked for “the blood test” for Alzheimer’s risk. A flurry of research will further drive patient interest, but also cause rethinking of clinical guidelines that discourage such testing. More

Practical genomics

Asthma genetics paving the way for new approaches to care

Asthma is the most common chronic disease in children in the United States today, with prevalence and severity of the disease escalating over the past 20 years. It’s a disease in which genetic and environmental factors combine in ways that are still poorly understood. Genomics, molecular biology and immunology are changing the way physicians think about the condition. More

Creating a blueprint for genomic medical training

Genomics education should be integrated into existing paradigms for teaching about health and disease, because the intersection of the patient-centered medical home and genomics requires primary care physicians and specialists with advanced genetics training as necessary links to effective care delivery. More

Genomics impacts everyday practices in unexpected ways

The hospitalization of a relative sets a leader in genomic research musing about how far medical practice has advanced in treating a common condition, and how far cutting-edge advances could go. More

A brave new world of consumer gene tests

Direct-to-consumer tests are easy, cheap—and sometimes wrong. Yet, patients are handing them to their doctors on a weekly basis and asking for advice. Learn how to work with patients after they’ve sought out genome-wide analysis and then bring the results to doctors to sort out subtle meanings from often fallible tests. More

New tool makes it easy to add crucial family history to EHRs

Electronic medical records are slowly pushing out the family history, eliminating valuable diagnostic information. But a free tool offers an easy way to restore important details to a clinician's files. More

Unraveling autism's many causes, spread across the genome

Despite the 90% heritability of autism, suggesting a very strong genetic component to its etiology, zeroing in on the genetic underpinnings of this disorder has been very challenging. More

Tumors' shared pathways may hold key to cancer cures

The tremendous diversity of genetic alterations in cancer samples leads a governmental senior advisor to look for shared pathways among all tumors for a possible cure. More

Predicting heart disease with markers is risky undertaking
Genome-wide association studies have identified at least 22 new genetic markers for CHD risk. The current debate around the value of CRP for CHD risk assessment could be considered a warm-up for things to come. More

Simple family history acts as a genetic test for skin cancer
Melanoma rate shave been rising, and while genetic tests are available for high-risk patients, a family history is a better way to identify patients who need potentially life-saving surveillance. More

Practical Genomics
Genes dictate which patients smoke, quit and die from the habit. Genomics can provide small victories that will make a difference in many lives. More

Practical Genomics
Target unique genetic diseases through common pathways
Marfan syndrome may benefit from angiotension receptor blockers, just one example of how genetic diseases can be cured by available drugs instead of genetic cures, by W. Gregory Feero, MD, PhD
September ’08

The Genetic Information Nondiscrimination Act—the first civil rights bill of the new century of the life sciences—affords nationwide protection from discrimination based on genetic heritage. More

Practical Genomics, by W. Gregory Feero, MD, PhD
Carrier screening makes risk-benefit analysis more complex
June ’08

Practical Genomics, by W. Gregory Feero, MD, PhD
Even the rarest cancer syndromes exist among your patient panel
May '08

Practical Genomics, by W. Gregory Feero, MD, PhD
Mustard plants have more genes than humans, so how can we possibly ‘ketchup’
April ’08

Practical Genomics, by W. Gregory Feero, MD, PhD
Fleshing out the debate over meat from cloned animals
March ’08

Practical Genomics
Companies may bring genetic scans direct to consumers
February '08

Practical Genomics
Personalized medicine with a genomic twist (January 2008)

Family history may be primary care's best genetic test (November/December 2007)

Perceived risks have chilling effect on genetic testing (October 2007)

Genetic discoveries are in the news and on their way (September 2007)

Genomic frontiers: dashboards, Detroit and DNA
New series offers primary care physicians a roadmap to steer patients toward promising genetic therapies. (July-August 2007)

Q&A: Heart-disease physician leads new research on genetics
Eric J. Topol, FACP, heads up cutting edge-search for connections that could alter cardiac screening and treatment. (July-August 2006)

Promise, problems for molecular medicine
Researchers say they're getting close to bringing genomic testing into clinical practice. (January-February 2004)

When should you test your patients for breast cancer genes?
Many women want the test, but the results often raise difficult questions (December 2001)

Why you need to start thinking about the 'new genetics'
The legal system is beginning to recognize genetics as part of the standard of care (July/August 1999)

The dilemma of genetic testing
The 'breast cancer gene' and the physician's role: an ethics case study (March 1998)

Genetic counseling: Your new job
Are you ready to handle public misconceptions, confidentiality dilemmas? (February 1995)

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Gray Matters

Decisional conflict: Balancing risks, benefits for each patient

A 73-year-old man struggles with the decision whether to consider anticoagulation for atrial fibrillation, a “decisional conflict” that affects many trying to balance risks and rewards of medical treatments. Doctors should help the patients choose, but then abide by that decision. More

Framing risks, benefits perilous for physicians and patients

A new column debuts, outlining how physicians can properly frame risks and benefits of treatments so patients can make the best medical decisions for themselves. In this column, risk calculators are explained so the “number needed to treat” isn't so murky to a woman considering statins. More

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Guidelines/evidence-based medicine

Keep up with vaccine recommendations

New vaccines and their recommendations have added complexity and made it tough to stay current. For patients, the extra costs can be prohibitive. Learn how to stay abreast of the requirements and engage patients on the issue. More

Food allergies are a tough nut to crack

As public awareness of food allergies increases, identification and management into adulthood can be difficult to sort out, carrying the risk of misdiagnosis, according to specialists who are trying to improve physician education. More

Treat metabolic syndrome’s many causes

Metabolic syndrome’s prevalence has rapidly advanced in just the past decade. But medical societies don’t recommend treating it as a distinct entity. They’d rather that physicians address the individual components of the illness, and encourage lifestyle modifications as the primary way to achieve such a goal. More

Simple tools, teamwork manage depression in primary care

Embedding mental health professionals directly into a primary care setting threatens to add complexity to primary care’s already hefty ‘to do” list. Clinics that have accomplished that task explain how not only was it easier than expected, but it adds tremendous benefits to the practice. More

Letters to the editor

Readers respond to the ACP Internist cover story that questioned the value of the annual physical exam. Whether they are for or against the practice, their opinions are strongly held. More

Expert lays out controversies for cardio care

February is National Heart Disease Awareness Month, and the field is wide open to controversies seemingly without resolution when it comes to invasive versus therapeutic regimens. Bill Kussmaul, FACP, an associate editor of Annals of Internal Medicine, addressed some of the hottest controversies in cardiology. More

Filling in the GAPPs will strengthen evidence-based medicine

Little data supports the use of genomic testing for subjects such as warfarin dosing. Paradoxically, that lack of evidence leaves open the potential for the misuse of direct-to-consumer genomics tests for fun, or for their premature adoption by clinicians. More

Calmer talk needed about mammography

Controversy about implementing new mammography guidelines shouldn’t cloud talks between doctors and the women they counsel. Clarify what the guidelines really say, and share the decision-making with patients, experts counsel. More

Rethinking the value of the annual exam

Patients expect it and internists won’t let it go. But does the evidence support the need for the periodic health exam? Data say routine lab tests are of little or no use, but experts weigh in on the value of regularly seeing patients for preventive screening. More

Irritable Bowel Syndrome
Evidence-based recommendations about care (November/December 2007)

Chronic kidney disease
Evidence-based recommendations about care (October 2007)

Osteoarthritis
Evidence-based recommendations about care (September 2007)

Pressure Ulcers
Evidence-based recommendations about care (July-August 2007)

Butterflies, happy couples and prescription decisions (June 2007)

Experts spar over treatment for 'chronic' Lyme disease. (January-February 2007)

Universal HIV screening opens up new set of problems for primary care doctors
Access to specialists and counseling after diagnosis are high on list of concerns. (January-February 2007)

CMS tests ways to help sickest patients
Home visits and innovative technology are helping improve care—at less cost. (November 2006)

Prehypertension: Is new evidence a call to action?
Internists debate whether early drug treatment can ward off more serious problems down the road. (September 2006)

Research spurs new thinking on hormone use
WHI data have changed physicians' risk-benefit conversations with menopausal women. (July-August 2006)

Internists play key role in DVT prevention
Experts urge wider prophylaxis but leave doctors to work out clinical details. (March 2006)

Physicians make new push for better glycemic control
With guidelines now available for inpatient glycemic control, the next step is to coordinate hospital staff to implement those standards. (January-February 2006)

Study finds generation gap in guidelines
Single-disease focus may leave complex patients out of pay-for-performance pool. (December 2005)

Common symptoms: When to test, treat
Common complaints can be frustrating, but knowing when to refrain from testing is key. (June 2004)

New Pap guidelines reduce screening but raise concerns about compliance
Some worry that the call for less frequent Pap tests will reduce patient compliance with regular screening (April 2003)

COX-2s get a boost for treating osteoarthritis pain
New guidelines urging the use of more aggressive drug therapies are raising serious questions (November 2002)

Under new chief, AHCPR finds life after guidelines
The agency shifts from creating clinical protocols to sponsoring evidence-based outcomes research (November 1997)

Doctors' new focus on evidence
Clinical decisions should be based on the best available scientific evidence, but not all evidence is equal (March 1997)

Putting guidelines to work—lessons from the real world
Moving towards the "second phase" of the clinical practice guidelines movement: actually using them (March 1995)

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Headache

Complexity of ‘migraineurs’ challenges diagnosis, treatment

Migraines are a seemingly simple complaint for patients, but a diagnostic challenge for internists, who have to sort through the symptoms and potential causes. Sometimes, the treatment regimens are just as complex as the condition itself. More

Diagnosing headaches a pain for doctors
Gaining confidence in headache management is first step to successful treatment. (June 2007)

Headache specialist tackles 'undertreated' condition
Co-editor of new College book outlines strategies for treating a disorder that may affect one in four patients. (December 2004)

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Health care access

Integrate mental health into medical practice

Partnerships between internists and mental health professionals are rare but proving their worth. Advantages include recognizing symptoms in a primary care setting and easing co-management for physicians and patients alike. More

Internists taking primary care to the streets

Practicing medicine changes when homeless patients don’t have a phone, food or access to first aid
Free health care programs have been converting buses and vans into clinics on wheels as they discover that mobile care is an effective way to reach homeless patients.
March ’08


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Hematology

‘Sic’ing primary care physicians on sickle cell disease

Sickle cell patients who survive into adulthood are falling into a gap in care as they leave a pediatric practice and don’t enter an adult one. A pilot program is offering medical education to patients and to clinicians. More


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Hospital medicine

PCPs, hospitalists work at communication

Closer relationships between primary care physicians and hospitalists and resulting improvements in patient care are achievable with relatively little effort. More

Hospital medicine meeting offers advice for all internists

In addition to complete coverage of the American College of Physicians’ Internal Medicine meeting, readers can find coverage from the Society of Hospital Medicine’s annual meeting, including a digest of palliative care, consulting as a career and infectious disease control. More

With EHRs or paper, outpatient practices can improve safety

The idea is evolving that improving transitions of care from hospital to outpatient settings reduces readmissions. From medication lists to tracking labs to missed referrals that delay diagnosis, an expert in the field considers it all. More

Medicine and management: hits from Hospital Medicine 2009

An expert discusses managing aortic dissection as a disease for life. Also, highlights from Hospital Medicine 2009 discuss caring for the pregnant patient, documenting care for the best reimbursement and ways to improve handoffs from shift to shift. More

Weighing the risks of anticoagulant bridging post-op
Experts debate how to interpret the data on whether to offer pre- and post-operative bridging therapy. (July-August 2006)

A quick checklist for rounding on hospitalized seniors
Here are eight areas you should cover to reduce complications and speed up discharge. (June 2006)

To prevent ICU infections, try doing less to patients
Heading off common complications calls for fewer interventions and strategic use of ventilators, sedatives. (June 2006)

The new thinking on perioperative medicine
Recent results question some benefits of beta-blockers and revascularization. (May 2006)

Imaging hand-offs: tips to help prevent medication errors
Many errors listed in a recent USP report were linked to patient hand-offs and communication lapses. (April 2006)

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Infectious diseases

Spare the emergency visit for skin and soft-tissue infections

Internists can save patients the anxiety, time and expense of an emergency department visit by screening for severity of most infections, experts say. The focus should be on acuteness and the factors surrounding onset of symptoms. More

‘Unlearning’ how to prescribe antibiotics

Health care leaders have spent endless hours trying to break a habit that’s been surprisingly intractable: prescribing antibiotics when they’re not warranted. More

Better treatment, low awareness for hepatitis C

Amid rising rates of long-term hepatitis C infection, particularly among older populations, better treatments are able to treat the condition. But first, patients have to know they have it, and internists have to be able to recognize the diagnosis. More

Many malaria prophylaxis options, but none perfect

Malaria research is turning from short-term prophylaxis for travelers to elimination and eradication. Drug costs and new ethics rules for research are key drivers of the new direction. More

Trichomoniasis is unpopular, underdiagnosed, expert says

A neglected disease of poverty gets little attention, yet it's more common than better-known diseases and has serious consequences. Fortunately, once diagnosed, the treatment is simple and inexpensive. More

HIV comes of age as disease of mid-to-late life

Protease inhibitors revolutionized management of HIV, morphing it from a death sentence to a chronic, manageable condition. Medical issues have since grown more complex as doctors consider how HIV interacts with aging, and how aging interacts with these sometimes toxic drugs used to control the virus. More

Treating HIV, teaching trainees motivate this internist

Harvard Medical School's first African-American full professor, and Mass General's first African-American female professor, finds that mentoring and teaching are her greatest accomplishments. More

Project ECHO expands the reach of primary care

To improve local care of hepatitis, Project ECHO uses videoconferencing and case-based learning to connect front-line primary care physicians with skilled and knowledgeable specialists. More

Primary care integral to new national viral hepatitis action plan

Experts hope a new plan launched in May by the U.S. Department of Health and Human Services will target hepatitis from a number of fronts, including education, treatment and prevention, and increased training of clinicians to diagnose and treat hepatitis and immunize patients. More

Internists healing tsunami's aftereffects

Six months after an earthquake and tsunami, Japan's populace and its clinicians are sizing up the long-term health effects of the physical injuries, the mental trauma and the damage to the nation's health care facilities. Internists describe the aftermath in their own words. More

Set up your flu clinic now

Setting up an influenza vaccine clinic is a simple way to immunize all patients in a practice. It's easy to achieve that goal if the practice is well organized. Here is a step-by-step guide to running a successful flu vaccine clinic. More

Adult immunization rates fall far short of goals

The CDC’s Healthy People 2010 campaign aimed to have 60% of high-risk patients under 65 vaccinated against pneumonia and influenza. Actual immunization rates may be half of that. The president of the National Foundation for Infectious Diseases describes the barriers and the solutions. More

When patients don’t tell all: The diagnostic challenge

Patients don’t always disclose aspects of their history that may be shameful or stigmatizing, posing a challenge of attribution errors for physicians. More

Hospital medicine meeting offers advice for all internists

In addition to complete coverage of the American College of Physicians’ Internal Medicine meeting, readers can find coverage from the Society of Hospital Medicine’s annual meeting, including a digest of palliative care, consulting as a career and infectious disease control. More

Army physicians on the front line of infectious disease research

Walter Reed’s infectious disease unit travels the globe to identify and combat the world’s deadliest infectious diseases. Driven to find vaccines that protect troops stationed overseas, the work quickly benefits civilian populations, too. More

Infectious disease doctors tackle bad bugs with fewer drugs
Annual meeting unveils research, techniques that could help stem the tide of resistance and disease, particularly with the increase of 'C-diff' (January 2008)

Spring is crawling with critter-borne infections
With warm weather—and tick season—upon us, the good news is that physicians now are spotting infections like Lyme disease earlier in their progression. (June 2007)

Protect vulnerable seniors by vaccinating their juniors. (April 2007)

U.S. looks at 'social distancing' response to pandemic. (March 2007)

HIV screening
Evidence-based recommendations about care. (March 2007)

Experts spar over treatment for 'chronic' Lyme disease. (January-February 2007)

Universal HIV screening opens up new set of problems for primary care doctors
Access to specialists and counseling after diagnosis are high on list of concerns. (January-February 2007)

Acute sinusitis
Current recommendations about care. (January-February 2007)

Community Acquired Pneumonia
Current recommendations about care. (December 2006)

More people feel the bite of MRSA bug. (December 2006)

Next weapon in war on AIDS: universal HIV screening
Aggressive testing may slow transmission but some say resources would be better spent elsewhere. (December 2006)

Q&A: Education plays key role in making flu shots routine
Gregory A. Poland, FACP, talks about the barriers to achieving widespread immunization. (September 2006)

Hepatitis C
Hepatitis C, considered a stealth virus, can infect a patient for up to 30 years without causing symptoms. (April 2006)

Hospital medicine fast facts: HIV hospital admissions
The number of U.S. hospital admissions for HIV infections has fallen by half since 1995. (January-February 2006)

Is it time for universal HIV screening?
With HIV becoming a chronic disease, internists need to manage complex care. (June 2005)

Rising pertussis rates spark new public health concern
Misdiagnoses and undertreatment among adults and adolescents may warrant revised vaccination strategies. (March 2005)

Letters
Readers discuss pay for performance, tort reform and access to care, community-acquired MRSA, the flu vaccine shortage and the death of Craig W. Borden, MACP. (March 2005)

In a difficult flu season, another bug is a big worry
Potent MRSA clones may take advantage of higher flu rates and cause more cases of necrotizing pneumonia. (December 2004)

Strategies for coping with the flu vaccine shortage
Health officials say some vaccine may still arrive in time to help with the worst of the flu season. (November 2004)

Talking to healthy patients about flu shot alternatives
A Mayo internist and vaccine researcher comments on the country's fifth straight year of scarce flu vaccine. (November 2004)

Physicians prepare for a busy flu season
Officials say last year's vaccine shortages could boost this season's demand. (July-August 2004)

A look at the new needle-free flu vaccine
No shots may be good news, but concerns about cost and contraindications remain. (October 2003)

The MKSAP Challenge
A 37-year-old male respiratory therapist complains of fever, rigors, generalized muscle aches and mild respiratory symptoms. (October 2003)

Tips to combat three common drug-resistant infections
Dealing with antibiotic-resistant UTIs, pneumonia and gonorrhea is proving a challenge for physicians (March 2003)

Quiz
The MKSAP Challenge: influenza (January 2003)

CDC hopes new immunization charts will give vaccines for adults a boost
For the first time, the CDC has compiled all of its recommendations on adult vaccines into easy-to-use charts (December 2002)

New evidence to relieve fears about Lyme disease
Despite the public's anxiety, Lyme disease is difficult to catch and easy to treat (July-August 2002)

Your patients are sick, but do they need antibiotics?
Despite some improvement, physicians need to cut back on inappropriate antibiotics. Here are some tips (November 2001)

The changing face of therapy for HIV
How soon should asymptomatic HIV patients start antiretroviral therapy? (October 2001)

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Lung diseases

‘Year of the Lung’ draws attention to COPD, asthma

Chronic obstructive pulmonary disease is projected to be the third most common cause of death by 2020, but it is currently underestimated. This year’s American Thoracic Society meeting focuses on lung disease issues to bring them to the attention of the rest of the medical community. More

Smokers take heart when doctors believe they can quit
Survey finds physicians devote little time to counseling and rarely give smokers the cessation tools they need. (November 2006)

COPD is high on mortality, low on public recognition
Campaign urges those at risk to get checked and asks physicians to be more vigilant about screening. (October 2006)

COPD
Easily preventable, chronic obstructive pulmonary disease remains the country's fourth largest killer. (January-February 2006)

Smoking cessation: the golden rule of COPD
There is no disease-modifying intervention in COPD except smoking cessation, says one noted pulmonologist. (Web exclusive)

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Mental health

Don’t be anxious about psychiatric diagnoses

Tips can help physicians with the screening and treatment of mental disorders seen in primary care, including somatoform, bipolar and anxiety disorders. More

Searching for signs of eating disorders

Internists are often the first clinicians to see signs of an eating disorder, with the rapid or extreme changes in weight apparent both in person and from the history recorded in a patient’s chart. But primary care clinicians may sometimes be afraid to ask about it because they are unsure how to handle what they might learn. More

Finesse required to treat anxiety in the elderly

Elderly patients may have many concerns on their mind. Maintaining their independence and managing their finances are two. But when does worry become anxiety? And how can internists not only manage chronic diseases but also ensure that patients are able to care for themselves? More

A few tips can improve older patients’ memory

Most complaints of memory problems aren’t related to cognitive impairments, and as such they can be alleviated with a few simple tips. More

Sleep disorders may be overlooked on exams

Experts want sleep habits considered as a vital sign. Sleep problems are important in themselves and can also have consequences on other major comorbidities such as mood disorders, diabetes and hypertension. More

Antidepressants no easy fix in primary care

Is depression on the rise, or just the prescriptions for it? Primary care is poised to play a bigger role in mental health care, and that puts an educational burden on internists to learn the proper role of medications. More

Manage diagnosis, follow-up of depression systematically

Improvements to treating depressive symptoms led to improvements in A1c levels and blood pressure in one internist’s practice. A systematic, manageable approach exists to diagnosis and treatment. More

Integrate mental health into medical practice

Partnerships between internists and mental health professionals are rare but proving their worth. Advantages include recognizing symptoms in a primary care setting and easing co-management for physicians and patients alike. More

Simple tools, teamwork manage depression in primary care

Embedding mental health professionals directly into a primary care setting threatens to add complexity to primary care’s already hefty ‘to do” list. Clinics that have accomplished that task explain how not only was it easier than expected, but it adds tremendous benefits to the practice. More

Guidelines call for depression screening

Guidelines call for internists to screen for depression, but only if they can offer support once they make a diagnosis. Internists who’ve already achieved this describe how they did so, and how it’s benefited their patients. More

Psychotropic drug prescriptions by medical specialty

Prescribing of psychotropic medications by nonpsychiatrists improves access to treatment but raises questions about adherence to evidence-based guidelines, provision of psychotherapy, adequacy of medication monitoring, and appropriateness of treatment intensity. More

Post-war, vets face new battle with PTSD
While the military screens soldiers returning from combat, post-traumatic stress disorder can show up months or years after, when the person may have left the military health system and returned to private care.
September ’08

Tearing down walls between mind, body health
Pending bills seek to end inequity of insurance coverage for mental, physical illnesses (September 2007)

Dementia
Evidence-based recommendations about care (June 2007)

Separating anxiety disorders from mimics and masks
Antidepressants may help, but these patients often need additional medications and therapy to help them cope. (May 2007)

Tips for recognizing and managing adult ADHD
Experts say awareness in primary care is key to proper diagnosis and treatment. (September 2006)

Doctors face new challenges of PTSD
As combat veterans seek care, internists need to know how to screen and treat. (July-August 2006)

Special focus: depression
New feature takes a look at this insidious disease. (January-February 2005)

SSRIs: Too much—or too little—of a good thing?
Experts say a "one-dose-fits-all" approach does not work with antidepressants. (March 2004)

ACP: Mental health benefits need parity with other health insurance. (March 2004)

Tips to treat the psychological fallout of trauma
When treating patients who have endured a traumatic event, physicians must heal them both physically and psychologically (June 2002)

Clinical depression: more than just residency blues
Getting past old stigmas is the key to recognizing symptoms—and helping vulnerable residents (December 2000)

Exploring the link between depression and suicide
Learn to recognize the risk factors that causes some depressed patients to become suicidal (June 1999)

A new take on treating depression
Depression presents differently in a primary care setting than in psychiatric one (July/August 1996)

How to better diagnose and treat anxiety disorders
Learn to distinguish the cause of a patient's cluster of symptoms (May 1995)

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Mindful Medicine

Thinking about our thinking as physicians

Cognitive errors have been the bane of making the right diagnosis. The final installment of the Mindful Medicine column reviews the past three years' discussions of traps and pitfalls that physicians must account for when presented with patients who aren't getting any better, often despite multiple encounters in the health care system. More

Priming to diagnose an atypical case, avoid representativeness

A patient's deteriorating mental health status points to an underlying cause. But it takes “priming” for an endocrinologist to look for the right diagnosis despite the lack of a prototypical case. More

Attribution error results from a positive stereotype

A 58-year-old man diagnosed with type 1 diabetes at age 38, a case of latent autoimmune diabetes of adulthood, reports worsening control of his blood sugars despite increasing doses of insulin. An internist must sort through the facts of the case to find out what’s responsible. More

When you look, but don’t see the diagnosis

Gradual yet significant change in a woman’s appearance, first noticed by a daughter she hadn’t seen for a year, leads to the diagnosis of a common yet frequently missed ailment. Why hadn’t those who’d seen the woman daily noticed anything? Intuitive vs. deliberative thought processes made all the difference. More

When patients don’t tell all: The diagnostic challenge

Patients don’t always disclose aspects of their history that may be shameful or stigmatizing, posing a challenge of attribution errors for physicians. More

Attribution error confounds a diagnosis after colon cancer

A rapid deterioration in mental status confounds doctors caring for a colon cancer patient admitted to the hospital for nausea and vomiting. An internist reviews the patient's history for the clue to the right diagnosis. More

Letters to the editor

Readers consider Mindful Medicine’s cautionary tale about The Blindmen and the Elephant, in which subspecialists each consider a diagnosis within their own field instead of seeing the entire diagnostic picture. More

Seeing the whole diagnostic picture

For a year, one patient saw specialist after specialist and received a different diagnosis each time. Like the story of the blind men and the elephant, specialists often see the patient through only one component of training, as anchoring and availability sneak into their thinking. More

What to do when one expects everything to fit, but it doesn’t

James Hennessey, FACP, reports on a young woman’s elevated testosterone level, and how he made a diagnosis even though the lab results and imaging conflicted. Our diagnostic experts consider confirmation bias and how this internist sidestepped being misled. More

Uncertain diagnosis for pain leads doctor to dig further

A 66-year-old woman presents with abdominal pain radiating to her back, and CT scans show multiple lesions worrisome for metastatic disease. But when the pain resolves and the lesions don’t change, one internist reconsiders the diagnosis. More

Unmasking the patient’s hidden agenda

Something about a response of ‘so-so’ triggers Ian Gilson, FACP, to delve further into how a patient is feeling—and a potentially suicidal hidden agenda. More

Start at the top to get to the bottom of a diagnosis

ACP Member C. Christopher Smith reconsiders a patient’s self-reported diagnosis of irritable bowel syndrome to uncover the true cause of his symptoms. More

It's just old age—or is it? Don't be guided by stereotypes

Would you make the same diagnosis in a 50-year-old patient that you would in an 80-year-old? This and a vague history led one internist to press for a better answer to a patient's anemia and SED rate. More

Meld intuition with deliberation to sidestep diagnostic trap

Would you pass "the eyeball test" if the patient in this case study presented in your hospital's emergency room? Find out how one physician pressed for a better answer on a patient who presented with cardiac pain but no evidence of a heart attack. More

Perils of diagnosing the physician-patient
A physician diagnoses himself, leaving a colleague to undo some of the mistaken thinking and come up with a simple diagnosis. More

Anchoring errors ensure when diagnoses get lost in translation
In two cases, a patient's use of key words led to anchoring errors in diagnosing an abdominal aortic aneurism and a classic case of intermittent claudication. More

Mindful Medicine
Don’t let emotion impede right diagnosis
A case study shows how affective errors can lead to a missed diagnosis, by Jerome Groopman, FACP and Pamela Hartzband, FACP
September ’08

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MKSAP

From the MKSAP case studies

A 67-year-old woman is evaluated for the abrupt onset of right-sided pleuritic chest pain and moderate dyspnea seemingly triggered by an episode of vigorous coughing during symptoms typical of an upper respiratory infection. She smokes and has COPD. On physical examination, she appears uncomfortable but is not in respiratory distress. Pulmonary examination is significant for a prolonged expiratory phase but no wheeze; breath sounds are symmetrical bilaterally. In addition to hospital admission, what is the most appropriate next step in management? More

From the MKSAP Case Studies
A 50-year-old black man with ischemic cardiomyopathy presents for a routine follow-up. His medical history is significant for biventricular pacemaker/cardioverter-defibrilator placement and diabetes mellitus. Which medication should be added? More

Test yourself
A MKSAP case study of menorrhagia marks the return of this popular feature to ACP Internist.
September ’08

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Nephrology

A new risk for patients with chronic kidney disease
Mark A. Perazella, FACP, explains why a common MRI agent is suspected in nephrogenic systemic fibrosis. (May 2007)

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Neurology

Coordinating Care

Collaboration key to post-stroke follow-up

Post-stroke care often fragments after patients leave the hospital. Patients being treated by specialists should keep the primary care physician at the center of their follow-up regimen. More

MS confounds, calls for better coordination

Internists are closely involved in care for multiple sclerosis, from recognizing symptoms to preventing complications. As the first line of defense, primary care physicians can find reassurance in guidance from a recent consensus paper on differential diagnosis. More

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Nutrition

Searching for signs of eating disorders

Internists are often the first clinicians to see signs of an eating disorder, with the rapid or extreme changes in weight apparent both in person and from the history recorded in a patient’s chart. But primary care clinicians may sometimes be afraid to ask about it because they are unsure how to handle what they might learn. More

Fighting obesity means fighting evolution's urges to gorge

Physicians seeking to counsel patients on weight management need to start early, be proactive and discuss activity and nutrition at every visit, said one presenter at Internal Medicine 2012. More

Attribution error confounds a diagnosis after colon cancer

A rapid deterioration in mental status confounds doctors caring for a colon cancer patient admitted to the hospital for nausea and vomiting. An internist reviews the patient's history for the clue to the right diagnosis. More

Experts debate pros, cons of vitamin D

An obscure nutrient is now being hailed as a link to prevention of diseases as disparate as diabetes, schizophrenia, cancer, strokes and heart attacks. Experts square off on how much vitamin D can be associated with illnesses, the proper amount that people should get, and how they can get it. More

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Obesity

Early interventions overlooked in OA

Osteoarthritis has been somewhat neglected, according to a recently formed consortium that is advocating for more proactive diagnosis and intervention. Earlier screening and a less reactive approach might head off some of the worst of the difficulties and related treatment costs. More

Doctors don’t have to dread discussing dieting

Many internists are not discussing obesity and weight loss with their patients, even though they have the best opportunity to offer counseling about diet and new drugs that are now available to help. More

Fighting obesity means fighting evolution's urges to gorge

Physicians seeking to counsel patients on weight management need to start early, be proactive and discuss activity and nutrition at every visit, said one presenter at Internal Medicine 2012. More

Tread lightly: Discussing obesity difficult for internists

Physicians are ill-equipped to dicuss obesity with their patients, a problem created by a lack of training in medical school, no clear guidelines on what screening should consist of, and a lack of confidence that patients would act on such counseling. But done properly, such discussions help twice as many patients lose weight. More

Treat metabolic syndrome’s many causes

Metabolic syndrome’s prevalence has rapidly advanced in just the past decade. But medical societies don’t recommend treating it as a distinct entity. They’d rather that physicians address the individual components of the illness, and encourage lifestyle modifications as the primary way to achieve such a goal. More

New research creates debates on calcium’s benefits vs. risks

Calcium supplements pit potential outcomes against one another—heart attacks vs. bone fractures vs. increased falls. The debate leaves doctors wondering what the researchers are really doing and saying about supplements. More

Arthritis and other musculoskeletal conditions are the leading cause of limited activity among all adults. Second-most-common causes include mental illness (ages 18-44), cardiovascular (ages 45-64 and 65 and older). More

Steady increases in number of obese[PDF] adults drove sharp rise in overweight populations since 1980
The National Health and Nutrition Examination Surveys showed substantial increases in overweight among adults since 1980, primarily reflecting an increase in the percentage of adults 20–74 years of age who are obese.
September ’08

Gastroenterologists face consequences of obesity epidemic (January 2008)

Assessing BMI, waist size vital to preventing worsening obesity (January 2008)

National Trends: Obesity (January 2008)

Diets, drugs or surgery? The skinny on weight loss
As an obesity expert and researcher whose average patient weighs about 325 pounds, Dr. Fujioka has counseled many people on the best ways to lose weight. (June 2007)

Obesity
Easy to diagnose, but a challenge to cure. (July-August 2005)

Weight loss drugs: Give your patients facts, not lectures
Addressing the pros and cons of medications may be the best way to get patients on track for lifestyle changes. (June 2005)

New ACP guidelines target obesity management
Physicians should make referrals, study the drugs, and for some, consider surgery. (April 2005)

Nature and nurture: twin culprits in obesity epidemic
Counsel patients early, before they become severely obese. (June 2004)

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Opioids

Documenting opioid management is as important as doing it

It’s important to protect your practice by documenting opioid management in the medical record and adhering to extra regulatory requirements. More

‘Party drugs’ require hard work to spot and treat

Taking a history is important for identifying abuse of some drugs that aren’t caught by screening tests but may still have serious consequences for users. More

Reducing the risks of opioid management

Patients with known drug-seeking behavior can be managed by establishing and closely following office procedures. More

Making opiates safe, efficient in the office

Managing opiates leads to a host of issues with patients, for pre-empting pain while ensuring communication of clear limits and preventing abuse. These goals confound many internists, but clear-cut and easy guidelines presented at Internal Medicine 2012 can help internists achieve the best outcomes. More

Internists don’t need to defer treating pain

Pain is one of the most common symptoms seen by primary care physicians, but it can be the most difficult to handle. Chronic pain often requires time-intensive, complex regimens that call for careful management and monitoring, which is not easy to achieve in a busy primary care practice. More

Opioid abuse potential prompts monitoring role for internists

Opioids can be used safely for pain management in most patients, but for a small but significant percentage, there is a real chance of addiction and other harms. Experts increasingly look to the prescribed drugs in a medicine cabinet as a source of concern. More

New algorithm helps weed out unneeded drugs in the elderly

Geriatrician Doron Garfinkel, MD, developed the Good Palliative-Geriatric Practice algorithm for discontinuing elderly patients’ unneeded medications. In a study, he showed how it led to discontinuing 58% of the drugs taken by a group of community-dwelling elderly. More

Marijuana requests: Relief or ‘permission’?

Fourteen states have legalized medical marijuana. Internists who have issued the controversial authorizations describe how they sort out legitimate uses from trivial requests. More

Pearls aid treatment of opioid dependence

Agonist treatments over “cold turkey,” foiling abuse of oral medications and “the eyes have it” for inpatient diagnoses. Pearls lay out the best ways to manage opioid-dependent patients in many settings. More

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Pain management

Take time to ease the pain of elderly patients

Assessing and managing pain can be complicated in elderly patients. Learn which tools work, which tools don’t, and how to optimize treatment. More

Making opiates safe, efficient in the office

Managing opiates leads to a host of issues with patients, for pre-empting pain while ensuring communication of clear limits and preventing abuse. These goals confound many internists, but clear-cut and easy guidelines presented at Internal Medicine 2012 can help internists achieve the best outcomes. More

Internists don’t need to defer treating pain

Pain is one of the most common symptoms seen by primary care physicians, but it can be the most difficult to handle. Chronic pain often requires time-intensive, complex regimens that call for careful management and monitoring, which is not easy to achieve in a busy primary care practice. More

Opioid abuse potential prompts monitoring role for internists

Opioids can be used safely for pain management in most patients, but for a small but significant percentage, there is a real chance of addiction and other harms. Experts increasingly look to the prescribed drugs in a medicine cabinet as a source of concern. More

New algorithm helps weed out unneeded drugs in the elderly

Geriatrician Doron Garfinkel, MD, developed the Good Palliative-Geriatric Practice algorithm for discontinuing elderly patients’ unneeded medications. In a study, he showed how it led to discontinuing 58% of the drugs taken by a group of community-dwelling elderly. More

Ethics in medicine

Doctors debate the ethics of assisted suicide

The medical community and the world at large are looking at how physician-assisted suicide is playing out in Washington, Oregon and Montana. Are these states a bellwether or a death knell for legalizing the issue elsewhere? And how should physicians respond when presented with such requests from their patients? More

Pearls aid treatment of opioid dependence

Agonist treatments over “cold turkey,” foiling abuse of oral medications and “the eyes have it” for inpatient diagnoses. Pearls lay out the best ways to manage opioid-dependent patients in many settings. More

Hospital medicine meeting offers advice for all internists

In addition to complete coverage of the American College of Physicians’ Internal Medicine meeting, readers can find coverage from the Society of Hospital Medicine’s annual meeting, including a digest of palliative care, consulting as a career and infectious disease control. More

Bringing comfort to patients through palliative care

A primary care internist with a background in hospital medicine, hospice care and psychiatry explains how he grew an inpatient consult service to include outpatient services, home services and research programs. More

How to care for patients suffering from chronic pain
For chronic nonmalignant pain, you need to meet the challenges of prescribing opioids and building trust. (June 2006)

Migraine
More prevalent than asthma or diabetes, migraine is the most common headache disorder found in a medical setting. (June 2005)

Pain Management for the Internist
Assessment, Treatment, Follow-Up (December 2004)

Avoiding trouble when using opiates to treat patient pain
Overcome fears about sanctions for overprescribing painkillers and patient addiction to better ease your patients' pain. (June 2003)

COX-2s get a boost for treating osteoarthritis pain
New guidelines urging the use of more aggressive drug therapies are raising serious questions (November 2002)

Drug therapies to treat—and prevent—migraines
Physicians can now offer migraine patients a multi-tiered regimen of drugs to bring needed relief (July-August 2002)

Managing the fifth vital sign: your patients' pain
By learning to use drugs and other therapies wisely, residents can bring hurting patients needed relief (April 2001)

How to discern drug-seekers from patients really in pain
Physicians don't want to fall victim to substance abusers faking pain symptoms (May 1998)

Dealing with pain management
Patients know more about their pain than their physicians do (May 1997)

Separating fact from fiction in treating low back pain
Physicians need to follow a systematic and rational early approach to treating back pain (May 1995)

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Patient communication

Being a patient partner means collaborating for better care

The third column in our series describes a patient partner’s experience in working toward patient-centered care. More

Toward a patient- and family-centered practice

A physician in the process of transforming his practice into a medical home discovered a resource that was already at his fingertips: patients and families who could help apply patient- and family-centered care concepts to primary care. More

Taking a drink: what patients should know

Alcohol is associated with so many benefits and harms that it’s hard to know where to start talking to patients about using it. One place might be alcohol misuse and abuse. Teach patients where they fall on the continuum of drinking behavior. More

Finesse required to treat anxiety in the elderly

Elderly patients may have many concerns on their mind. Maintaining their independence and managing their finances are two. But when does worry become anxiety? And how can internists not only manage chronic diseases but also ensure that patients are able to care for themselves? More

A few tips can improve older patients’ memory

Most complaints of memory problems aren’t related to cognitive impairments, and as such they can be alleviated with a few simple tips. More

Creating a practice that’s open to GLBT patients

A gay physician offers advice on how to adapt a medical practice to make it more accessible to gay, lesbian, bisexual and transgendered patients. The effort begins in the waiting room and continues through a sometimes complex set of needs for this population.

More

‘Goldilocks’ goal for diabetics and CKD

Managing kidney disease in diabetes requires meeting individualized parameters and balancing risks in nephrology and cardiology. Learn whether more aggressive treatment is warranted in this population. More

Doctors don’t have to dread discussing dieting

Many internists are not discussing obesity and weight loss with their patients, even though they have the best opportunity to offer counseling about diet and new drugs that are now available to help. More

Making opiates safe, efficient in the office

Managing opiates leads to a host of issues with patients, for pre-empting pain while ensuring communication of clear limits and preventing abuse. These goals confound many internists, but clear-cut and easy guidelines presented at Internal Medicine 2012 can help internists achieve the best outcomes. More

Diving into delicate patient conversations

Delivering unpleasant news is one of the hardest tasks a physician faces. Assessing sensitive topics heightens the difficulty, and two physicians at Internal Medicine 2012 address ways to handle especially sensitive areas: sexual history, and the inability to safely drive a car. More

Decisional conflict: Balancing risks, benefits for each patient

A 73-year-old man struggles with the decision whether to consider anticoagulation for atrial fibrillation, a “decisional conflict” that affects many trying to balance risks and rewards of medical treatments. Doctors should help the patients choose, but then abide by that decision. More

Diagnosing a disorder with few symptoms

Hypercalcemia can have absent, few or nondifferential symptoms, but the condition can indicate the presence of major diseases such as breast cancer. Experts review how to quickly apply a high index of suspicion to make a diagnosis. More

Open access requires an open mind by doctors

Patients have always been able to review their records, but making this a routine practice has most patients enthused and some physicians worried. Learn how some large health systems are applying open access to improve patient communication and compliance. More

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Patient management

Dismissing patients always a last resort

Stopping the physician-patient relationship can be seen as abandonment if not done properly. More

Communication skills vital to cancer conversations

Cancer patients want information, but not in a way that makes them lose hope. Effective shared decision making and risk communication strategies can help. More

How to start and stop bisphosphonates

A new online tool and a few simple rules can inform internists how to start bisphosphonates and when to consider taking a drug holiday at the request of another physician, a dentist or even the patient. More

Early interventions overlooked in OA

Osteoarthritis has been somewhat neglected, according to a recently formed consortium that is advocating for more proactive diagnosis and intervention. Earlier screening and a less reactive approach might head off some of the worst of the difficulties and related treatment costs. More

Start with bloodwork to diagnose anemia

Anemia is fairly common, but its many etiologies complicate diagnosis. It affects more than one in five black and Hispanic people, one in 10 seniors and one in five of those over the age of 85. Learn how to fine-tune the diagnosis to best help patients. More

Doctors don’t have to dread discussing dieting

Many internists are not discussing obesity and weight loss with their patients, even though they have the best opportunity to offer counseling about diet and new drugs that are now available to help. More

Patients and prayer amid medical practice

It’s more important than ever to recognize and understand cultures and spiritual beliefs, including and beyond the end of life. More

Chronic disease model helps improve smoking cessation efforts

Smoking cessation programs are traditionally treated as discrete, standalone attempts. One program applied dedicated counselors who could form a relationship with the patient over long stretches of time, resulting in better success. More

Assess statin-associated myalgia on a patient-by-patient basis

Statin-associated muscle pain is controversial and poorly understood. But the consequence of stopping cholesterol drugs has a much clearer downside. Counsel patients on potential side effects, and let them know that switching is preferable to stopping. More

Better treatment, low awareness for hepatitis C

Amid rising rates of long-term hepatitis C infection, particularly among older populations, better treatments are able to treat the condition. But first, patients have to know they have it, and internists have to be able to recognize the diagnosis. More

Making opiates safe, efficient in the office

Managing opiates leads to a host of issues with patients, for pre-empting pain while ensuring communication of clear limits and preventing abuse. These goals confound many internists, but clear-cut and easy guidelines presented at Internal Medicine 2012 can help internists achieve the best outcomes. More

Diving into delicate patient conversations

Delivering unpleasant news is one of the hardest tasks a physician faces. Assessing sensitive topics heightens the difficulty, and two physicians at Internal Medicine 2012 address ways to handle especially sensitive areas: sexual history, and the inability to safely drive a car. More

Scribes: A write way and a wrong way

Taking a patient's history is considered an intimate part of the exam process, one long-cherished by traditionally minded physicians. Like much of the traditional practice of medicine, it's facing a new model for efficiency. Should doctors delegate the dictation? More

HIV comes of age as disease of mid-to-late life

Protease inhibitors revolutionized management of HIV, morphing it from a death sentence to a chronic, manageable condition. Medical issues have since grown more complex as doctors consider how HIV interacts with aging, and how aging interacts with these sometimes toxic drugs used to control the virus. More

Alzheimer's markers make management tougher

Diagnostic advances are identifying Alzheimer's disease and its precursors much earlier. The bad news is that, for now at least, these improvements may only create more dilemmas for general internists, who could find themselves fielding questions on how and whether new guidelines apply to clinical practice. More

Promoting literacy to increase adherence

Roughly 80 million Americans navigate health care's complexities with limited health literacy skills. Learn easy steps that help patients understand what they need to do, without formal literacy screening or potentially embarrassing questions. More

Aiding patients' decisions on PSA screening

There are many tradeoffs made when advising patients about whether to routinely screen for prostate cancer using prostate-specific antigen. Amid side effects of treatments and conflicting guidelines from professional societies, physicians and patients must come to a decision. Addressing six points directly and honestly can help. More

Tread lightly: Discussing obesity difficult for internists

Physicians are ill-equipped to dicuss obesity with their patients, a problem created by a lack of training in medical school, no clear guidelines on what screening should consist of, and a lack of confidence that patients would act on such counseling. But done properly, such discussions help twice as many patients lose weight. More

Use caution when seeking medical information online

Researching medical knowledge online involves knowing three different types of resources, summary sites, society sites and primary literature. Knowing when to use each ensures the physician makes the correct diagnosis, and preserves the patient's confidence. More

Priming to diagnose an atypical case, avoid representativeness

A patient's deteriorating mental health status points to an underlying cause. But it takes “priming” for an endocrinologist to look for the right diagnosis despite the lack of a prototypical case. More

Learning to parry patient requests

Negotiating the doctor-patient relationship requires understanding what a patient expects from treatment, instead of outright saying “no.” There are easier ways to sort out what a request really means, and how to quickly address the real underlying issue. More

Treat metabolic syndrome’s many causes

Metabolic syndrome’s prevalence has rapidly advanced in just the past decade. But medical societies don’t recommend treating it as a distinct entity. They’d rather that physicians address the individual components of the illness, and encourage lifestyle modifications as the primary way to achieve such a goal. More

Why and how to monitor hypertension at home

Home measurement of high blood pressure overcomes variability inherent in office measurements, delivers better assessment of systolic pressure (and hence, of possible cardiovascular events) and offers a better chance of discontinuing drug therapy. More

Group visits bring focus and control to hypertension

A VA center reduced uncontrolled hypertension rates by implementing group visits. The program allowed physicians to titrate medicine to efficacy, and then motivated patients to remain involved and compliant with therapy. More

Miserable symptoms mark chronic sinusitis

Chronic sinusitis, an illness that can feel as symptomatically miserable as congestive heart failure or rheumatoid arthritis, is often misdiagnosed or underdiagnosed. But distinctive clues can lead internists to deliver the right treatment. More

PCPs, hospitalists work at communication

Closer relationships between primary care physicians and hospitalists and resulting improvements in patient care are achievable with relatively little effort. More

Speaking of cancer: Tips on how to convey risks to patients

How physicians express cancer risks to patients determines how they might use that knowledge to make decisions about genetics, family history and potential future screens and tests. More

When you look, but don’t see the diagnosis

Gradual yet significant change in a woman’s appearance, first noticed by a daughter she hadn’t seen for a year, leads to the diagnosis of a common yet frequently missed ailment. Why hadn’t those who’d seen the woman daily noticed anything? Intuitive vs. deliberative thought processes made all the difference. More

House calls becoming a viable practice model

Think of it as the patient-centered medical home’s ultimate evolution—care inside the patient’s own home. More doctors are making house calls, either to patients who don’t travel easily, or to improve the quality of care they could deliver in an office. More

Expressive writing could help erase irritable bowel syndrome

Expressive writing, used for other illnesses with a known psychological component, is now being studied to control the symptoms of irritable bowel syndrome. More

When patients don’t tell all: The diagnostic challenge

Patients don’t always disclose aspects of their history that may be shameful or stigmatizing, posing a challenge of attribution errors for physicians. More

Physicians and social media: Debating where to draw the line

Blogging doctors have a powerful megaphone and a new way to interact with their patients. But mishandling this tool, or misusing Twitter or Facebook, can blur the patient-physician divide or place the relationship at risk. Some of the internet’s most famous physicians log in to discuss the pros and cons of social media. More

‘Preventive’ measures don’t translate properly to the public

Prevention is an important tool, but it must be placed in the context of evidence and value. The cost of ignoring that is false reassurance and the politicization of medical care. More

Letters to the editor

Readers respond to the ACP Internist cover story that questioned the value of the annual physical exam. Whether they are for or against the practice, their opinions are strongly held. More

Practice uses ACP survey for peer review, quality improvement

True North Health Center in Maine surveyed every patient who came through their doors from March through May last year to let each if its 28 practitioners know outcomes for each provider. Proprietary surveys are expensive, so they turned to ACP’s tools. The results helped those performing best to teach their peers about best practices. More

Calmer talk needed about mammography

Controversy about implementing new mammography guidelines shouldn’t cloud talks between doctors and the women they counsel. Clarify what the guidelines really say, and share the decision-making with patients, experts counsel. More

Rethinking the value of the annual exam

Patients expect it and internists won’t let it go. But does the evidence support the need for the periodic health exam? Data say routine lab tests are of little or no use, but experts weigh in on the value of regularly seeing patients for preventive screening. More

Patient Communication

Sorting out the worst offenders among herbal supplements

Most internists have a tough enough time keeping up with developments in pharmaceuticals that they don’t have the energy to get up to speed on the ever-expanding range of herbs and supplements their patients might be taking. But they ought to be well informed, for their patients’ and their own benefit. More

Patient Coordination

Shared visits improve access, productivity and satisfaction

Shared office visits provide groups of patients with more time with their doctors, not less, and come under the rubric of smart care. Learn how leading institutions have adopted them. More

Shared visits improve access, productivity and satisfaction

Shared office visits offer 90-minute blocks of time to groups facing common and chronic conditions. A few distinct models have gained broad acceptance by doctors and their patients. More

Mistrust, costs, side effects keep patients from taking pills
Medication non-adherence is a big problem—much bigger than most physicians realize. The first step in getting patients to adhere is understanding the reasons why they don't. More

'Gently does it,' caring for adults with autism
With autism rates at 1 in 150, you can be absolutely sure you have patients with autism in your practice. Practical tips ease transitions from pediatric care into adulthood, and easier ways to examine, care for and understand autistic patients. More

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Patient safety practices

Assess statin-associated myalgia on a patient-by-patient basis

Statin-associated muscle pain is controversial and poorly understood. But the consequence of stopping cholesterol drugs has a much clearer downside. Counsel patients on potential side effects, and let them know that switching is preferable to stopping. More

Drugs come up short for doctors, patients

Drug shortages, especially among injectables and cancer medications, have left physicians and patients alike wondering where their next doses will come from. Even simple antibiotics have become scarce commodities. More

Combating conflicting information on prescription drug labels

A Consumer Reports check found that five chain drugstores in the New York area provided different warnings for the same warfarin prescription. A College Fellow who is the magazine's chief medical advisor explains how primary care physicians can help their patients stay abreast of their prescriptions. More

How many are too many for CT scans?

As many as one-third of the 70 million imaging tests ordered during the year may not be needed. Experts attempt to determine whether repeated radiation scanning doses could prove potentially yet unintentionally harmful. More

With EHRs or paper, outpatient practices can improve safety

The idea is evolving that improving transitions of care from hospital to outpatient settings reduces readmissions. From medication lists to tracking labs to missed referrals that delay diagnosis, an expert in the field considers it all. More

Making drug labels say what they mean
With drug in hand, patients wonder: Does red mean danger? How much is plenty? (April 2007)

FDA speeds device response. (December 2006)

Trial registration can cure dangerous publication bias. (December 2006)

National series highlights efforts to ‘remake medicine’
Reducing catheter-associated infections with business principles. (October 2006)

Getting patients right drugs at right time no easy task
With reconciliation a top source of medical errors, hospitals are under pressure to improve their programs. (October 2006)

Tips to avoid key drug interactions and side effects
Warfarin, SSRIs, statins top the list of drugs that can cause problems, especially for the chronically ill or elderly. (June 2006)

Low health literacy leads to mistakes, poorer outcomes
Literacy problems are associated with chronic illness and poorer health. (June 2006)

Imaging hand-offs: tips to help prevent medication errors
Many errors listed in a recent USP report were linked to patient hand-offs and communication lapses. (April 2006)

Tips for heading off harmful drug interactions
The list of drugs that can trigger interactions includes antibiotics and statins. (September 2005)

New advisory on antipsychotics may limit care options
If the drugs' risks now outweigh their benefits, where do physicians and patients go for help? (July-August 2005)

Letters
Readers discuss clinical research, drug safety reporting, and access to health care. (July-August 2005)

When data go AWOL: filling the clinical gaps
Clinical information often goes AWOL
A first-of-its-kind study found that patient information often goes missing. (May 2005)

Letters
Readers discuss drug safety, physician titles, sleep disorders. (May 2005)

To improve patient safety, try treating problem physicians
A patient safety expert paints a pervasive picture of problem physicians. (July-August 2004)

Seven simple steps to prevent outpatient drug errors
Statistics show that nearly half of all drug errors are the result of problems in the prescribing process. (June 2003)

Don't forget to tap a major safety resource: your patients
Tips to educate patients to do more to ensure their own safety. (June 2003)

Navigating the handoff from hospital to community care
Improving the transition period when patients go from hospital to community care (Annual Session News 2003)

Pre-op evaluations: emerging evidence for four areas
A look at patient safety practices that can make an enormous difference in patient morbidity and mortality (November 2002)

Strategies to tackle outpatient errors
Tracking test results, referrals and even no-shows can help keep you out of trouble (June 2002)

What we can do to prevent errors and improve patient safety
Improving system—and our own practice habits—can reduce medical errors (June 2001)

Letters: patient safety
In their study of medical errors, IOM researchers deliberately designed their study to target high-risk admissions (February 2000)

Why we need a systems approach to prevent deadly medical errors
While most errors can be prevented, we won't find a real solution until the culture of medicine changes (November 1999)

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Prescribing

‘PharManure’ and some drugs to hate the most

Drugs that made this doctor's least-most-wanted list, presented at Internal Medicine 2012, included those that increase costs without improving care, or that raise the risk of antibiotic resistance. More

Drugs come up short for doctors, patients

Drug shortages, especially among injectables and cancer medications, have left physicians and patients alike wondering where their next doses will come from. Even simple antibiotics have become scarce commodities. More

Promoting literacy to increase adherence

Roughly 80 million Americans navigate health care's complexities with limited health literacy skills. Learn easy steps that help patients understand what they need to do, without formal literacy screening or potentially embarrassing questions. More

Dumping drugs puts traces of meds in taps
How can you keep the contents of one patient's medicine cabinet from getting into everyone's drinking water? Eventually, physicians could even be asked to pay attention to environmental impact when deciding which drugs to prescribe. More

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Pulmonary medicine

Learn to see signs of an often fatal disease

Pulmonary arterial hypertension can be recognized and treated. But it remains a diagnosis that is often missed, and the delay can lead to a rapidly progressing and fatal outcome. Learn the signs beyond a patient who reports “being out of breath.” More

Decision-making rules for diagnosing PE may save lives

Early detection of pulmonary embolism is critical, which puts the primary care internist on the front lines of preventing a patient’s continual deterioration that culminates in death. Patients are as likely to present in the office with symptoms as they are at the emergency department. More

‘Year of the Lung’ draws attention to COPD, asthma

Chronic obstructive pulmonary disease is projected to be the third most common cause of death by 2020, but it is currently underestimated. This year’s American Thoracic Society meeting focuses on lung disease issues to bring them to the attention of the rest of the medical community. More

Not sleeping but not sleepy with asymptomatic apnea

As many as 25% of apnea sufferers don’t complain of daytime sleepiness. Compliance is a problem because these patients may not see the value of treatment, according to researchers at the American Thoracic Society. More

Diagnosing Pulmonary Embolism
Evidence-based recommendations about care (January 2008)

Strategies to overcome "steroid phobia"
Tailored dosages and combination therapies can help minimize troubling side effects of inhaled corticosteroids. (May 2004)

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Referrals

Evaluating ‘weekend warrior’ knee injuries

Knee injuries are a common complaint attended to in the primary care setting. Many diagnostic tests can be performed in under a minute, sparing unneeded referrals to orthopedists. More

When should you refer asthma patients for an allergy consult?
While there are no clear cut answers, there are some clues that difficult-to-manage asthma patients could benefit from a subspecialist referral. (June 2004)

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Rehabilitation

Evaluating ‘weekend warrior’ knee injuries

Knee injuries are a common complaint attended to in the primary care setting. Many diagnostic tests can be performed in under a minute, sparing unneeded referrals to orthopedists. More

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Revitalization

Doctor-patient relationship is the key to revitalization. (June 2004)

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Rheumatology

Rheumatoid arthritis hurts the whole body

Taking care of a patient with rheumatoid arthritis involves a partnership between internists and subspecialists, agree physicians managing cardiovascular risks, cancer or infections. More

Elusive Sjogren's manageable—if diagnosed

Lack of awareness compounds a condition that is exceedingly difficult to diagnose. Experts offer signs and symptoms for ruling it out or diagnosing it more quickly. More

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Screening tests

Determining actionability of genetic findings in clinical practice

Just as radiology screenings can return results of incidentalomas, genetic scans can also return inadvertent findings. But some guidance can be taken from criteria developed in 1968 for adopting any screening test. More

An easy screen for an overlooked disease

Despite poor awareness and a lack of training on handling peripheral artery disease, internists can and should be able to recognize the symptoms and manage 95% of cases. Experts advise how to diagnose and treat the condition. More

How many are too many for CT scans?

As many as one-third of the 70 million imaging tests ordered during the year may not be needed. Experts attempt to determine whether repeated radiation scanning doses could prove potentially yet unintentionally harmful. More

Array of symptoms can point to celiac

Celiac incidence has risen since the 1950s to today, so alert internists listen to the symptoms, get to the basis, and make accurate attributions to make the right diagnosis. A constellation of symptoms can point to a common underlying condition. More

Letters to the editor

Readers respond to the ACP InternistWeekly item about lower pay driving physicians to cut their hours, and to the cover story that questioned the value of the annual physical exam. More

Seeing the whole diagnostic picture

For a year, one patient saw specialist after specialist and received a different diagnosis each time. Like the story of the blind men and the elephant, specialists often see the patient through only one component of training, as anchoring and availability sneak into their thinking. More

What to do when one expects everything to fit, but it doesn’t

James Hennessey, FACP, reports on a young woman’s elevated testosterone level, and how he made a diagnosis even though the lab results and imaging conflicted. Our diagnostic experts consider confirmation bias and how this internist sidestepped being misled. More

A brave new world of consumer gene tests

Direct-to-consumer tests are easy, cheap—and sometimes wrong. Yet, patients are handing them to their doctors on a weekly basis and asking for advice. Learn how to work with patients after they’ve sought out genome-wide analysis and then bring the results to doctors to sort out subtle meanings from often fallible tests. More

General internists are performing 50% fewer procedures than they did 18 years ago. (May 2007)

Next weapon in war on AIDS: universal HIV screening
Aggressive testing may slow transmission but some say resources would be better spent elsewhere. (December 2006)

Sorting through the latest breast imaging alternatives
A breast imaging expert weighs in on MRIs, ultrasound, PET scanning and digital mammography. (October 2006)

Is an access crisis on the horizon in mammography?
A convergence of problems has some talking about looming access problems. (October 2003)

Getting breast cancer diagnoses right: help from an insurer
One medical liability insurer in Massachusetts has worked to cut failure-to-diagnose claims against its physicians by more than 50%.(Web Only)

New Pap guidelines reduce screening but raise concerns about compliance
Some worry that the call for less frequent Pap tests will reduce patient compliance with regular screening (April 2003)

Colonoscopy screening gains momentum, but problems remain
Obstacles include mediocre reimbursements and a shortage of gastroenterologists to do the procedure (September 2002)

CT scans: new screening tool or risky fad?
Physicians are trying to decide whether the procedures are merely the latest consumer health craze or the dawn of a new age of diagnostic imaging (February 2002)

When should you test your patients for breast cancer genes?
Many women want the test, but the results often raise difficult questions (December 2001)

A new solution to confusing Pap smear reports
Revised terminology on lab reports aims to clarify which patients need follow-up care (November 2001)

Archive

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Sleep Disorders

Bed bug infestations can bring itchy, stressed patients

A surge in bed bug infestations leads internists to look for warning signs: not just rashes, but recent travel, confirmation by an exterminator, and bullous reactions. More

Sleep disorders may be overlooked on exams

Experts want sleep habits considered as a vital sign. Sleep problems are important in themselves and can also have consequences on other major comorbidities such as mood disorders, diabetes and hypertension. More

Not sleeping but not sleepy with asymptomatic apnea

As many as 25% of apnea sufferers don’t complain of daytime sleepiness. Compliance is a problem because these patients may not see the value of treatment, according to researchers at the American Thoracic Society. More

Sleep disorder rise is wake-up call for internists (November/December 2007)

Putting chronic fatigue syndrome's myths to bed
A new campaign aims to raise awareness of a condition that many say doesn't exist. (May 2007)

Insomnia
When patients complain of insomnia, the challenge for physicians stems from the complexity of diagnosis and the need to tailor treatments to individuals. (July-August 2006)

Letters
Readers discuss drug safety, physician titles, sleep disorders. (May 2005)

How to detect common sleep disorders
A growing body of evidence links troubled sleep to diabetes and hypertension. (March 2005)

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Smoking

For tobacco dependent, pharmacotherapy is the best medicine

Evidence is mounting that most smokers will require some sort of pharmacotherapeutic intervention to help them quit. Experts parse out prescriptions, but don’t discount behavioral strategies for quitting. More

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Stroke rehabilitation

The timing is right, and possibly expandable, for giving tPA

Tissue plasminogen activator (tPA) was the star of the show at this year's International Stroke Conference 2009, with much discussion of expanding its treatment window, and several studies presented on gender differences in tPA treatment. More

Help from afar: telemedicine vs. telephone advice for stroke

Experts sparred over whether telephone advice or telemedicine is best during a session at February's International Stroke Conference 2009 in San Diego. More

Waking up the brain after stroke. (July-August 2007)

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Titration

Try more meds for depression. (December 2006)

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Women's health

Hormone therapy stirs debate 10 years after WHI

The Women’s Health Initiative dramatically decreased hormone therapy for menopause, but 10 years later, the “knee-jerk” reaction has become more nuanced in how the regimen can be used. More

Vulvovaginal disorders common but commonly misunderstood

Nearly one in eight women have chronic vaginal pain. Although there’s a lack of regular training in internal medicine, the gold standards for diagnosis remain the history and physical, pH and saline wet mount, and a whiff test and biopsy (if indicated). More

Incontinence in women a neglected but treatable problem

Incontinence affects one in four pre-menopausal women and nearly half of post-menopausal women. But it’s treatable at any age, and treatment is associated with far less morbidity. More

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Miscellaneous

Improving your patient’s health without hurting the planet
As evidence mounts about the effects of environmental degradation on all patients’ health, many physicians are making simple and environmentally friendly changes to their practices.
September ’08

The MKSAP challenge
A 53-year-old man with a recent inferior myocardial infarction, hpertension and type 2 diabetes needs to lower his LDL cholesterol. (July-August 2006)

Low back pain
Acute episodes of low back pain should prompt a discussion of weight control and exercise. (June 2006)

The MKSAP Challenge
A 58-year-old man with a history of congestive heart failure develops psoriatic arthritis. (May 2006)

The MKSAP Challenge
A 64-year-old man with severe chronic obstructive pulmonary disease with mild hypercapnia and persistent dyspnea on minimal exertion is evaluated. (April 2006)

The FDA takes action on inhalable insulin, ranolazine and more. (March 2006)

The MKSAP Challenge
A 55-year-old-man is hospitalized because of a four-week history of problems, including progress left-sided weakness. (March 2006)

Internists play key role in DVT prevention
Experts urge wider prophylaxis but leave doctors to work out clinical details. (March 2006)

The MKSAP Challenge
A 44-year-old woman with type 2 diabetes mellitus and hyperlipidemia is evaluated because of, among other issues, intermittent right upper quadrant discomfort. (January-February 2006)

The MKSAP Challenge
A 45-year-old man is evaluated in the emergency department for nausea and severe dizziness. (December 2005)

Medically managing your pregnant patient
Internists need to play a bigger role to safeguard the health of moms and babies. (November 2005)

Hospitals adopt new protocols for stroke care
Advances in treatment and communication aim to improve stroke outcomes. (November 2005)

The MKSAP Challenge
A 36-year-old woman is admitted to the intensive care unit with Guillain-Barre syndrome. (November 2005)

Letters
Readers discuss orthopedists and internists, MKSAP, and the rising costs of physician services. (October 2005)

Tips for heading off harmful drug interactions
The list of drugs that can trigger interactions includes antibiotics and statins. (September 2005)

The MKSAP Challenge
A 37-year-old man is evaluated in the office for a first episode of syncope. (September 2005)

Not all sports injuries need specialist care
More internists are learning how to tackle musculoskeletal complaints in-house. (July-August 2005)

Deciphering the telltale signs of osteoarthritis
Physicians need to distinguish this common condition from other joint disorders. (July-August 2005)

Letters
Readers discuss clinical research, drug safety reporting, and access to health care. (July-August 2005)

The MKSAP Challenge
A 40-year-old woman, treated five years ago for breast cancer, is evaluated for pain in her back, a nagging cough and fatigue. (July-August 2005)

'I feel dizzy' doesn't have to mean a long workup
For most patients with dizziness, a thorough history should provide the diagnosis. (June 2005)

Fear factor: DVT and the hospitalized medical patient
Lowering the "threshold for suspicion" is a good way to improve patients' odds of avoiding a fatal embolism. (June 2005)

The MKSAP Challenge
A 39-year-old executive had a generalized tonic-clonic seizure one week ago, and returns for an office visit. (June 2005)

The MKSAP Challenge
Two years after undergoing mitral valve replacement, a 48-year-old man has a cerebrovascular accident. (May 2005)

Is there a crisis looming in clinical research?
New pressures are thinning the numbers of clinical researchers at academic centers. (May 2005)

Prescribing DME? Tips to help keep your patients safe
Experts urge physicians to take a team approach to find out what equipment patients may need at home. (April 2005)

The MKSAP Challenge
A 63-year-old woman with a 30-year history of rheumatoid arthritis is evaluated prior to an elective hip arthroplasty. (April 2005)

March is DVT Awareness Month. (March 2005)

The MKSAP Challenge
A new, 52-year-old male patient requests an annual exam and a serum prostate-specific antigen measurement. (March 2005)

Internists wanted for complex adolescent care
A growing number of childhood disease survivors need to transition from pediatric care. (December 2004)

The MKSAP Challenge
A 43-year-old man is evaluated because he falls asleep while working at his computer during the day. (December 2004)

The MSKAP Challenge
An elderly woman has had a headache for eight days and blurring and double vision have begun. (November 2004)

The MKSAP Challenge
A 30-year-old, HIV-infected man has a one-week history of increasing headaches, fever and other symptoms. (October 2004)

The MKSAP Challenge
A 67-year-old man is evaluated because of a two-day history of fever and diminished consciousness. (September 2004)

The MKSAP Challenge
A 20-year-old college student is experiencing a rapid pounding in her chest and neck and recently the episodes have been longer and more frequent. (July-August 2004)

The MKSAP Challenge
A 55-year-old woman with mild hypertension would like to avoid taking medication and asks what else she can do to lower her blood pressure. (June 2004)

The MKSAP Challenge
A 56-year old postmenopausal woman is brought to the emergency department because of severe substernal burning pain and progressive dyspnea. (April 2004)

The MKSAP Challenge
A 36-year old man with a long history of heavy alcohol use presents within 24 hours of his last drink. (March 2004)

The MKSAP Challenge
A 62-year old woman is evaluated because of abnormal results on a chest X-ray. (January-February 2004)

The MKSAP Challenge
A 77-year old man is found to have asymptomatic atrial fibrillation on a routine examination. (December 2003)

Strategies to treat unexplained symptoms
Somatizing patients can be a source of professional satisfaction-not frustration. (November 2003)

Drug therapies to nip allergies in the bud
Sneezing can lead to wheezing. Here's how to keep rhinitis from becoming asthma. (June 2003)

Chemical agents that every physician should recognize
While the media have focused on bioterrorism, chemicals pose a more immediate threat. (May 2003)

Help for treating mild traumatic brain injuries (February 2003)

When it comes to chronic kidney disease, new guidelines call for a bolder approach
Experts are urging primary care physicians to do more to detect and treat kidney disease (October 2002)

The role of drugs in treating obesity
While many physicians have been scared away from prescribing anti-obesity medications, weight loss experts say it is time to take another look (February 2002)

The placebo effect: more than sugar pills
Despite a debate over research, placebo proponents point to real results in patient care (January 2002)

New thyroid therapies raise management questions
A look at existing therapies and when to time treatments (May 1995)

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