Finding and treating a tricky disorder

Hypercalcemia can be a challenge to work up in primary care, in part because it's so difficult to find. Patients with this condition can have no symptoms at all, and it's often detected as an incidental finding on a blood test. Once a physician notes it, the journey is just beginning, since potential causes run the gamut from relatively benign to very serious. In our cover story, Kathy Holliman outlines the causes of hypercalcemia, how the condition can present, how it can be managed, and when patients should be referred.

Although patients in the U.S. have the legal right to access their medical records by request, a growing movement has been pushing to make such access much more common. Pilot projects such as OpenNotes have experimented with routinely giving patients free access to their records through online portals, and the Centers for Medicare and Medicaid Services recently proposed that labs be able to give patients test results directly. Physicians involved with the pilot projects have said that for the most part they work well, but others have raised concerns about open access, saying it could affect patient privacy and the doctor-patient relationship. Stacey Butterfield looks at the risks and benefits of open access as well as its implications for patients and physicians.

We feature rural medicine in this issue with a look at the federal government's Indian Health Service in New Mexico. Doctors there have partnered with specialists at Brigham and Women's Hospital in Boston to help improve access to care for the people of the Navajo Nation. In the program's first two years, volunteer clinicians have logged over 1,000 clinical hours and 800 teaching hours in fields such as endocrinology, dermatology, rheumatology, and orthopedic care, making it easier for general internists to care locally for patients with more complicated conditions.

Also in this issue, our conference coverage from the American Society of Tropical Medicine and Hygiene details the state of malaria prophylaxis and looks at why trichomoniasis remains underdiagnosed and undertreated despite being a fairly common sexually transmitted disease. And, find out more about the new surgeon general of the Navy in our profile of Matthew L. Nathan, MD, FACP.

What do you think about giving patients open access to their medical records? Let us know your thoughts on this or on other stories.

Sincerely,

Jennifer Kearney-Strouse