Nonspecific symptoms may have a very specific cause

This issue covers topics including management of lupus, the effect of telemedicine on primary care practice, and new approaches to treating Clostridium difficile.

Nonspecific symptoms, including fatigue and muscle pain, are commonplace in most internists' practice, but sometimes, especially in women, they can be the result of a larger problem: lupus. Since many patients with this disorder may present first to primary care, internists can do a lot to help arrive at a correct diagnosis early, according to experts. In our story, Terri D’Arrigo looks at tips on diagnosing lupus, handling flares, and overseeing patients' long-term management, which can be especially necessary in more remote areas where subspecialists may be scarce.

Technology has long been making inroads into health care, from electronic health records to online portals. It's even become more common for patients to be able to consult with their primary care physicians via e-mail or other online methods. However, a new technology trend, virtual visits, allows patients to pay for an instant Internet consult with a physician they have never met in person, or often at all. The ease of access offered by these visits can be a bonus, but critics worry that they may interfere with continuity of care as well as with the doctor-patient relationship. In our story, Charlotte Huff outlines how these visits work and offers perspectives on their pros as well as cons.

Fecal transplants for recurrent Clostridium difficile infection have met with much success, but they also have to overcome a substantial “ick” factor. At IDWeek 2014, held in October in Philadelphia, experts presented the results of cutting-edge research on some methods, including frozen fecal capsules and enemas, that might make this type of treatment a bit easier to administer. New antibiotics may help, too, the experts said. Check out our coverage to learn more.

In College news, ACP's President, David A. Fleming, MD, MA, MACP, discusses the importance of our international members, and Bob Doherty, ACP's Senior Vice President for Governmental Affairs and Public Policy, outlines a new initiative, “Patients Before Paperwork,” that aims to identify physicians' highest-priority administrative challenges and help eliminate, mitigate, or manage them. Finally, turn to our Practice Rx column to learn more about accurate coding for Medicare's Annual Wellness Visit and our Practice Tips column for information on meeting the 3 main goals of physician compensation: performance, productivity, and profitability.

Do you handle long-term management of patients with lupus in your practice? Have any of your patients reported seeking out virtual visits? Let us know.


Jennifer Kearney-Strouse