June 2014

Disclosing medical errors the right way

After a medical error, patients want an explicit statement that an error occurred, what happened, and the implications for their health. They want an outright apology, not a statement of regret. Work from global organizations is refining the right way to disclose errors.

Get rid of GERD without unneeded costs, tests

Gastroesophageal reflux disease can be diagnosed in the office, without the need for expensive tests such as endoscopy. Learn how to make the right diagnosis while avoiding confounding symptoms that might steer a patient toward the wrong specialist.

For effective smoking cessation, turn ambivalence into action

Smokers sometimes want to want to quit. The ambivalence is the effect of nicotine, which rewires the brain. Instead of being wary of the patient's mixed feelings, use them as a sign to try nicotine replacement therapy systems that make the cravings more manageable.

New cholesterol guideline focuses on statin intensity, not LDL

A new cholesterol guideline focuses on the intensity of statin therapy, the 10-year risk or lifetime risk, and the balancing of those benefits with the risks and side effects of the medicine. Also, the therapeutic response should be considered when managing hyperlipidemia.

Pearls help diagnose, manage drug-resistant hypertension

A few diagnostic pearls can help internists suss out when a patient truly has drug-resistant hypertension and what to do about those cases.

Nurture a good ‘marriage’ with your EHR

Choosing the right electronic health record system follows the same pattern as any romantic relationship: choosing from among all the potential partners and making the relationship work. It even involves working out the kinks when something doesn't suit either party.

Oncologic ‘horrors' can beset hospitalized patients

Common crises that can happen during the management of oncology patients include increased intracranial pressure, metabolic problems, infections, and toxic side effects from drugs. Learn how to manage these conditions.Exercise capacity is the single most power predictor of cardiovascular events, whether or not symptoms are present.

Expert gives advice on perioperative medication management

Much confusion remains about perioperative management of anticoagulants, even though the drugs have been available for several years. And they are only going to become more prevalent, an expert said.

Consider country, culture when caring for Latino patients

Cultural competency can conquer concerns about cultural barriers, said a panel of experts who discussed how to approach and manage patients in the Latino community.

It's all about the history in diagnosing fever of unknown origin

There are 4 types of fever of unknown origin, and distinguishing among them starts with the first step: Look for clues from the history and other presenting symptoms.

Maintaining the sanity of maintenance of certification

ACP seeks ways to make maintenance of certification more educational, professionally fulfilling, and relevant to the practice of internal medicine.

Did the Affordable Care Act make the grade?

Four years since health care reform became law, there is finally enough information to grade how well enrollment is going. It will be many more years before the program can be judged an overall success, however.

Internal Medicine 2014 tackles medical errors, EHRs, and more

This issue provides a comprehensive overview of educational sessions offered at Internal Medicine 2014.

Practice Tips: Overcoming language barriers in your practice

Physicians need to be prepared to use tact and skill when communicating with patients with limited English proficiency and those with hearing impairments.

New grass allergy treatment, opioid overdose solution

This update covers approval of an allergen extract to treat allergic rhinitis induced by grass pollen and of a handheld injector of naloxone for emergency treatment of known or suspected opioid overdose.

MKSAP Quiz: Skin eruption after tick removal

A 22-year-old man is evaluated for a skin eruption on his leg. The patient lives in Virginia and is active outdoors. One week ago, he found a black tick on his lower leg, which his roommate removed with a tweezers. Yesterday he developed diffuse myalgia, neck stiffness, and fatigue. These symptoms have persisted, and today he notes erythema at the site of the previously attached tick. Following a physical examination, and skin findings, what is the most appropriate initial management?.

Crossed Words: Breaking news

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

Emphasize exercise for CAD testing, disease prevention

Exercise capacity is the single most power predictor of cardiovascular events, whether or not symptoms are present.

A new kind of leadership: the physician and administrator role

It was 6:55 a.m. when I got off the shuttle to the hospital. I was going to be late for my first day on my health administration elective. I thought only surgeons had to get up this early!.