May 2014

Medical student Wendy Hansen left acquires the parasternal long axis view of the heart during a medical student workshop at Pullman Regional Hospital Janice Boughton MD FACP middle used medica

Portable ultrasound scopes out a new role

Enthusiasts argue that point-of-care ultrasonography extends the scope of the physical exam far beyond what can be auscultated through a stethoscope. Detractors worry about overdiagnosis and a loss of medical skills that have intrinsic value. Both sides seek balance when considering how to use this new technology.

Treat the epidemic of medical nonadherence

Multiple diseases and multiple medications can lead to some patients not following their medical regimens. Experts are examining why in an effort to help improve nonadherence rates that can reach 50% by some estimates.

Cognitive strategies take good physicians to greatness

On-the-job learning, feedback, simulation, and deliberate practice can take a good clinician to the next level.

More things you shouldn't do based on the lack of evidence

Unwarranted testing and use of resources make up the biggest chunk of unnecessary health care costs, estimated at between $250 and $325 billion per year, and include such items as folic acid tests for patients with altered mental status, creatine kinase muscle-brain testing, and 24-hour patient observation after switching from IV to oral antibiotics.

FDA asks clinicians to limit prescriptions of acetaminophen

The FDA recommends that clinicians stop prescribing and dispensing combination drugs that contain more than 325 mg of acetaminophen per dose.

Alzheimer's patients prepare, enlighten future physicians

A mentoring program pairs Alzheimer's patients with medical students to heighten students' awareness of the skills and strengths of Alzheimer's patients and familiarize them with related care and communication issues.

And so it begins: The long but not-so-lonely road

ACP's incoming president reflects on the coming year, concerns about the future of internal medicine, and goals of the College.

Four things that would improve the Affordable Care Act

After reflection on the first year of health care reform, and the conclusion of the first enrollment period, 4 aspects could make the program work even better.

Letter to the Editor

A reader disagrees with an article that stated it is unacceptable to ever dismiss a patient who does not comply with medical advice.

Portable ultrasounds offer advantages, but some experts say no

This issue includes stories about incorporating portable ultrasound into clinical care and about encouraging patients to fully comply with their prescription regimens.

Practice Tips: Hardship exceptions for meaningful use

There are exceptions that may apply for some physicians who cannot meet the meaningful use electronic health record incentive requirements due to circumstances out of their control.

Doripenem not for pneumonia; migraine device approved

This update covers a labeling change for doripenem (Doribax) and a warning about risk of death for ventilator patients with pneumonia, among other regulatory actions.

Governance Committee seeks Regent candidates for 2015

The Governance Committee is beginning the process of seeking Regents to join the Board in May 2015.

Chapter awardees

In recognition of their outstanding service, exceptional individuals received chapter awards in the winter and spring of 2014.


Richard Dale Ruppert, MD, MACP, former president of the American Society of Internal Medicine (ASIM), died on Oct. 22, 2012, at the age of 81.

MKSAP Quiz: Increasing fatigue for 8 months

A 62-year-old man undergoes a routine examination. He notes increasing fatigue of 8 months' duration but states he can perform his usual daily activities. He has no fever, night sweats, anorexia, or weight loss. The medical history is noncontributory, and he takes no medications. On physical examination, vital signs are normal. The spleen is palpable three finger breadths below the left midcostal margin. There is no lymphadenopathy or hepatomegaly. Following lab studies and a peripheral blood smear, what is the most appropriate management of the patient now?.

Crossed Words: Seeking some relief

ACP Internist's puzzle feature challenges readers to find clues placed horizontally in rows to reveal an answer written vertically.