Cause of chronic pancreatitis can be hard to pinpoint

This issue includes stories on diagnosing chronic pancreatitis and on transitioning medical practices into care teams.

Chronic pancreatitis often first presents in outpatient offices but is harder to diagnose than the acute form of the disorder. Early symptoms can be confused with those of other gastrointestinal diseases, experts say, and although chronic alcohol abuse and some drugs can cause pancreatitis, up to one-third of cases are idiopathic. Our story looks at diagnosis and treatment of chronic pancreatitis and which populations are at higher risk, as well as the role of nutrition and the types of complications that internists should monitor for in affected patients.

Team care is a popular concept in health care now, but although most people agree that it's necessary, many disagree on what it should look like, and especially on which clinicians should be leading newly created teams. ACP offered some guidance late last year in the form of a position paper, “Principles Supporting Dynamic Clinical Care Teams,” that engendered spirited discussion among physicians, nurse practitioners and others. In our story, Stacey Butterfield examines the state of the team care debate and offers suggestions from experts on how to apply team-based principles in practice.

Our conference coverage section in this issue is from the American Academy of Family Physicians' (AAFP) annual meeting, held in San Diego last fall. Most physicians know that it's easy to recommend exercise to patients but much harder to do so in way that's taken seriously. Our story discusses one physician's preferred model for “prescribing” exercise, which covers specific factors like frequency, intensity and time. Also addressed are ways to address potential barriers and excuses right out of the gate, making it easier for patients to overcome them. And a report from another AAFP session offers physicians advice on how to transform their practices to fit new models of care, including predicting risk, creating appropriate care plans, engaging patients' families and other caregivers and improving communication.

Finally, our Letters section features a response from Richard J. Baron, MD, MACP, president and CEO of the American Board of Internal Medicine, to an October 2013 ACP Internist column by ACP president Molly Cooke, MD, FACP, on Maintenance of Certification (MOC) and ways in which the existing process might need to change.

What are your thoughts on MOC? What suggestions do you have for potential improvement? Please let us know. We always enjoy hearing from you.


Jennifer Kearney-Strouse