Educators can help with trainees' depression

This issue covers topics such as depression in medical residency, guidelines for rheumatoid arthritis, and rehabilitation for knee pain.

Residency is a high-pressure time for most physicians in training, and it can take a heavy toll. A recent study found that almost a third of medical residents suffer from depression or depressive symptoms, with what 1 researcher called clear evidence of an “exposure-outcome relationship.” Medical educators can help address the problem by being alert to signs and symptoms of depression in trainees and creating an environment that incorporates support into the curriculum. In our story , Mollie Durkin talks to experts who share their ideas on possible solutions, such as structuring time off to allow “golden weekends,” promoting open-door policies, and ensuring the availability of confidential help to those who need it.

Rheumatoid arthritis is a complicated disease to manage, and while recent guidelines look to clarify the issue by emphasizing the treat-to-target approach and offering a guide to progressive medical therapy, the extent to which primary care physicians should be involved is a subject of debate. Some subspecialists feel that initial management in primary care is appropriate, especially in areas where rheumatologists are scarce, while others feel that immediate referral to a rheumatologist and comanagement are the most appropriate course. Our story reviews the guidelines and looks at the arguments for and against each approach.

For knee pain, a common reason patients present to their primary care physician, less is almost always more, explains our story . Surgery can be helpful in some cases but should almost always be done after a trial of other noninvasive therapies, experts say. Surgical fixes come with their own risks, including, in cases of early knee replacement, the danger of needing a repeated procedure sometime in the future. Measures such as physical therapy and weight loss can be good alternatives to recommend first.

HIPAA, or the Health Information Portability and Accountability Act, has been around for almost 20 years, but that doesn't mean that everyone is now familiar with its provisions. In particular, HIPAA's rules regarding patients' access to their medical records continue to be the subject of some particularly pervasive myths. Our story breaks those myths down for clinicians and offers some clarity, while our Practice Tips column provides advice on complying with the law.

Finally, ACP will hold Internal Medicine Meeting 2016 in Washington, D.C., from May 5-7, and our staff will be on site as always to bring you the latest news. Check our blog and our Twitter feed , as well as our daily e-mail dispatches, to stay up-to-date. More information on the meeting is online .


Jennifer Kearney-Strouse