- ACP Internal Medicine 2011 Highlights
- New International Masters
- Update Your Knowledge with MKSAP 15 Q & A
- ACP Leaders on the Road
- International Meetings Update
- Future World Wide Internal Medicine Meetings
- New International Members
- Highlights from ACP Internist and ACP Hospitalist
- College Corner
- Akua Agyeman, MD, PhD - Gympie
Sergio Diez Alvarez, MBBCh - Boambee
Airton Galarca-Da-Silva, MD - Porto Alegre
- Alhussain M. Asiri, MD - Toronto
- Noemie Chessex, MD - Thunder Bay
Marie-France J. Levac, MD - Cornwall
- Luis Jose Castillo, MD - Santiago
Maria de Los Angeles De Leon, MD - Santiago
Pablo Jimenez Murillo, MD - Quito
Nawfal M. Sheaheed, MBChB - Baghdad
- Davlyn Dewar, MBBS - Kingston
Gabriel C. Ukala, MBBS - Manchester
- Yasuaki Hayashino, MD - Kyoto
- Hiroshi Itagane, MD - Osaka
- Rei Suzuki, MD - Fukushima
Takashi Watanabe, MD - Miyagi
Ibrahim A. Abdulrahman, MD - Amman
Tee Teong Jin, MD - Kuala Lumpur
Zaheer Ahmad, MBBS - Punjab
Minerva H. Ramos Sanchez, MD - Aguadulca
- Learning to parry patient requests
Negotiating the doctor-patient relationship requires understanding what a patient expects from treatment, instead of outright saying “no.” There are easier ways to sort out what a request really means, and how to quickly address the real underlying issue.
- Treat metabolic syndrome's many causes
Metabolic syndrome’s prevalence has rapidly advanced in just the past decade. But medical societies don’t recommend treating it as a distinct entity. They’d rather that physicians address the individual components of the illness, and encourage lifestyle modifications as the primary way to achieve such a goal.
- An easy screen for an overlooked disease
Despite poor awareness and a lack of training on handling peripheral artery disease, internists can and should be able to recognize the symptoms and manage 95% of cases. Experts advise how to diagnose and treat the condition.
- Adult immunization rates fall far short of goal
The CDC’s Healthy People 2010 campaign aimed to have 60% of high-risk patients under 65 vaccinated against pneumonia and influenza. Actual immunization rates may be half of that. The president of the National Foundation for Infectious Diseases describes the barriers and the solutions.
- The July effect: Real or urban myth?
At teaching hospitals, the learning process restarts each summer. Does hospital quality dip at this crucial point?
- Want to know why a patient's readmitted? Ask him.
Physicians, hospital administrators and even politicians are eagerly searching for ways to reduce hospital readmissions. But one closely involved party isn't typically consulted: the patient.
- ACP issues guideline on glucose management for hospitalized patients
ACP's director of clinical policy discusses a new guideline for intensive insulin therapy.
ACP Internal Medicine 2011 Highlights
San Diego, California
Internal Medicine 2011, ACP's premier annual meeting, was held in San Diego, California from April 7-9, 2011 and had an attendance of close to 6,800 physicians. The event featured more than 260 workshops, lectures, panel discussions, and interactive courses for doctors of internal medicine and its subspecialties.
At the Convocation ceremony on April 7, 650 physicians were inducted as ACP Fellows and recognized for their medical scholarship and achievement. Twenty-eight countries outside of the US had new Fellows inducted, eight of which were ACP International Chapters. Individuals and organizations were presented with awards in recognition of their contributions to the science and practice of medicine. Masterships were presented, and the College bestowed Honorary Fellowships to seven Presidents of International Internal Medicine Societies.
Some Honorary Fellows and Special Representatives pose for a photo with the ACP Japan Chapter Governor before the Convocation Ceremony. From left: Dr. Montoya, Philippines; Prof. Tan, Singapore; Dr. Kobayashi, Japan; Prof. Seng, Singapore
Following the ceremony, members, friends, and families gathered at the annual ACP International Reception that included over 300 international internal medicine leaders and attendees along with ACP leaders. During the reception, Eve C. Swiacki, recently retired Director of International Activities at ACP, was honored for her years of service to the college.
ACP was honored to host presidents and representatives of internal medicine societies from around the world. The international delegates were part of the stage party in the Convocation ceremony. They also participated in ACP’s 5th Annual International Forum, entitled “Generalists vs. Subspecialists: What Distribution is Best for Our Patients?”. The Forum provided an opportunity for ACP leaders and the presidents and special representatives from international internal medicine societies to discuss this important topic that crosses national boundaries and affects the health care of people around the world.
On Saturday, April 9, new ACP officers started their terms. Virginia L. Hood, MBBS, MPH, FACP, of Burlington, VT, became the 2011-2012 ACP President; Yul D. Ejnes, MD, FACP, of Cranston, RI, became the 2011-2012 Chair of the Board of Regents; David L. Bronson, MD, FACP, of Cleveland, OH, became the ACP President-elect; and, Phyllis A. Guze, MD, FACP, of Los Angeles, CA, became the Chair-elect of the Board of Regents.
Internal Medicine 2012 will be held April 19-21, 2012 in New Orleans, LA. For more information, please visit: http://www.acponline.org/meetings/internal_medicine/2012/.
Left to right, back row: Dr. Louis Hugo Francescutti, President, Royal College of Physicians and Surgeons of Canada; Dr. Miguel Angel Falasco, President,
Buenos Aires Society of Internal Medicine; Dr. Victor Huggo Cordova Pluma, President, Mexican College of Internal Medicine; Prof. Kok Chai Tan, Master, Academy of
Medicine of Singapore; Dr. Jaime C. Montoya, President, Philippine College of Physicians.
Left to right, front row: Dr. Ian W. R. Anderson, President, Royal College of Physicians and Surgeons of Glasgow; Dr. J. Fred Ralston, 2010-11 ACP President; Dr. Robert G. Luke, 2010-11 Chair, ACP Board of Regents; Prof. Kammant Phanthumchinda, President, Royal College of Physicians of Thailand.
Left to right, back row: Dr. Rosa Cotrina Pereira, Past President, Peruvian Society of Internal Medicine; Dr. Israel Montes de Oca, Past President,
Venezuelan Society of Internal Medicine; Dr. Hector Ugalde, President, Medical Society of Santiago - Chilean Society of Internal Medicine; Dr. Amal Kumar Banerjee,
President, Association of Physicians of India; Dr. William J. Hall, President, International Society of Internal Medicine; Dr. Werner O. Bauer, Immediate Past President,
European Federation of Internal Medicine; Dr. Arvo Mesikepp, Past President, Estonian Society of Internal Medicine; Prof. M. A. Jalil Chowdhury, President, Bangladesh
Society of Medicine; Prof. Wong Kok Seng, President, College of Physicians, Singapore.
Left to right, front row:Dr. Juan M. Senior, President, Colombian Association of Internal Medicine; Dr. Adri Kok, President, Faculty of Consulting Physicians of South Africa; Dr. Neil Gordon Dewhurst, President, Royal College of Physicians of Edinburgh; Prof. Hans-Peter Kohler, Secretary General, International Society of Internal Medicine; Dr. J. Fred Ralston, 2010-11 ACP President; Dr. Robert G. Luke, 2010-11 Chair, ACP Board of Regents; Dr. Jose Luis Franceschi Diaz, President, Panamanian Society of Internal Medicine; Dr. Jurg Pfisterer, Co-President, Swiss Society of Internal Medicine; Dr. John. F. Donohoe, President, Royal College of Physicians of Ireland; Dr. Sally Nasution, Vice Secretary General, Indonesian Society of Internal Medicine.
New International Masters
The following international physicians were awarded Mastership at Internal Medicine 2011.
Masters (MACP) comprise a small group of highly distinguished physicians who have achieved recognition in medicine by exhibiting a preeminence in practice or medical
research, holding positions of high honor, or making significant contributions to medical science or the art of medicine. Mastership is considered a special class of
membership. However, Masters are selected confidentially by the Awards Committee from among Fellows and are not self-nominated. More information regarding awards is
available at http://www.acponline.org/awards. Nomination materials are due by July 1, 2011.
Jorge A. Motta, MD, MACP
Panama City, Panama
Walter F. Schlech III, MD, MACP
Halifax, NS, Canada
Rolf A. Streuli, MD, MACP
Marta Velasco Reyo, MD, MACP
Tsuyoshi Watanabe, MD, MACP
Fukushima City, Japan
Update Your Knowledge with MKSAP 15 Q & A
A 78-year-old woman is evaluated because of concerns about her ability to drive. She has trouble seeing on bright, sunny days and also at night because of the glare from headlights of oncoming cars. The patient has type 2 diabetes mellitus and a 55-pack-year smoking history. Her current medications include metformin and glipizide.
This patient’s history is most suggestive of which of the following ophthalmologic disorders?
A. Age-related macular degeneration
D. Primary open-angle glaucoma
E. Proliferative diabetic retinopathy
Click here for the answer and critique.
ACP Leaders on the Road
Yul D. Ejnes, MD, FACP
The annual meeting of the Bangladesh Society of Medicine was held on March 15 and 16 at the Sheraton Hotel in Dhaka. Six hundred physicians and students attended. The meeting featured several clinical and health policy topics in a variety of formats. I presented the “State of the Art” lecture on the topic of cancer screening guidelines. Although the resource availability and incidence of specific cancers is different in Bangladesh, the planning committee wanted me to focus on the US screening guidelines given the title of the lecture. I discussed briefly the applicability of the US guidelines to patient care in Bangladesh.
In addition to presenting the “State of the Art” lecture, as the ACP Ambassador, I was asked to participate in other parts of the meeting. The format for the plenary sessions, both single lectures and symposia, is for the presentations to be followed by commentary from two “Chair Persons” for each session – no Q and A from the audience. I was assigned as a Chair Person for a three-speaker symposium on malaria. Fortunately, by then the meeting was 30 minutes behind schedule and I was asked to keep my comments brief, which I had no trouble doing. The other session in which I participated was a “Meet the Experts” session on the second morning of the meeting. This was a set of case presentations to five “experts” (four real experts plus me) organized similar to the ACP IM meeting’s “The Professor in Action” or NEJM’s “Clinical Problem Solving” cases. We were presented two cases of patients with seizures and one case of a patient with muscle wasting and very low potassium. The seizure cases had final diagnoses but the third case was in progress and the treating physicians were interested in our input. The patients were presented by resident physicians, who did wonderful jobs. I was relieved that the cases were “core” internal medicine cases and not on exotic infectious diseases. It was a great honor to share the podium with Bangladesh’s most respected professors of medicine.
Other session formats that were very familiar to me included “Multiple Small Feedings of the Mind” and abstract presentations by the residents. There was also a debate on whether proton pump inhibitors can be used in patients taking clopidogrel, with three presenters on either side of the discussion with the session chairs serving as jurors for the debate (which was declared a draw).
There was a discussion titled “The Role of Internist in Patient Management in a Demographically Changing Society in Bangladesh” that reviewed how changes in population growth and progression up the economic ladder are changing physician practice. A key concept of the discussion was the role of the internist. While Bangladesh is in a different place from the US economically and demographically, the discussion of the role of the internist would have been apropos in the US. The speaker covered the challenge of defining internal medicine, the need for the government to support general internal medicine, the advantages of patients’ having an internist instead of seeing multiple subspecialists (better quality and lower cost), and the emergence of a team model of practice.
In addition to the sessions, there were social events. On the night before the meeting, a “pre-conference” event included a business meeting of the BSM, which even in Bangla sounded very much like one of our ACP Board of Governors meetings, and a cultural program of music. On the first night of the meeting, there was another cultural program of music and dance from various regions and genres, as well as a magician. These events were very well received – I was told later by one of the BSM leaders that since everyone is so busy, these gatherings and events are an opportunity for the physicians to have fun and reconnect with their colleagues.
Another feature of this meeting was several raffles. Like raffles at ACP chapter meetings, they were positioned to keep the audience through the end of the meeting. The prizes varied from home goods to laptop computers and wide-screen TV’s and were donated by the exhibitors. Again, these raffles were another opportunity for the physicians to have fun and the number callers had wonderful senses of humor.
Pharmaceutical support was quite evident at this meeting, with logos in the meeting room, on the raffle tickets, and in acknowledgements from the moderators. I could not detect any bias in the presentations.
Before and after the meeting, my hosts saw to it that I experience as much of their beautiful country as could be fit into my visit. For example, I arrived in Dhaka at 4 am on Sunday and reached my hotel by 5:30 am. Minutes after I arrived, I received a phone call from my host, Dr. Rahman, checking to make sure I arrived safely and inviting me to meet him in the hotel lobby at 11 am to discuss my itinerary. While meeting with him, a representative of the travel agency that BSM uses arrived to begin my tour. From Sunday noon until early evening and all day Monday, I was taken all over Dhaka with my guide in a private car. Then at mid-day Wednesday, I left the meeting and was escorted by Dr. Zahir to the airport, from which we flew to Cox’s Bazar, a resort town on the Bay of Bengal, where I was taken to many sites and enjoyed the beach until Friday afternoon, when I returned to Dhaka for a flight home early Saturday morning.
International Meetings Update
ACP Saudi Arabia Chapter Inauguration Meeting
February 20, 2011
From left: Dr. Khalid Qushmaq, Interim Governor, ACP Saudi Arabia Chapter; Dr. Virginia Hood, ACP President; Dr. Robert Luke, Immediate Past Chair, ACP Board of Regents; Prof. Mohammad Al Hadrami; Prof. Mahmoud Al Ahoul, President, Saudi Society of Internal Medicine; Dr. Salih Bin Salih; and Dr. Farouqe Khan.
The recently established ACP Saudi Arabia Chapter held its inaugural meeting on February 20, 2011 in Riyadh, Saudi Arabia. Virginia L. Hood, MBBS, MPH, FACP, ACP President, and Robert G. Luke, MD, MACP, Immediate Past Chair, ACP Board of Regents, were in attendance to celebrate this historical moment in internal medicine practice in Saudi Arabia. The event was also attended by the Secretary General of the Saudi Commission for Health Specialists, Prof. Abdu Aziz Al Sayegh; President of the Saudi Society of Internal Medicine, Prof. Mahmoud Al Ahoul; and Executive Director for Medical Affairs at King Fahad Medical City, Dr. Nahar Al Azmi.
Annual Educational Conference and Ethics Symposium of the Polish Society of Internal Medicine
March 30-31, 2011
The Annual Educational Conference and Ethics Symposium of the Polish Society of Internal Medicine was held March 30-31, 2011 in Warsaw, Poland.
A conference for healthcare managers, entitled "Safe Patient - Safe Doctor - Safe Hospital", was held on March 30 and was attended by approximately 200 physicians, surgeons, managers, policy makers, and lawyers from across Poland.
The Ethics Symposium was held on March 31 and was entitled "Ethical Dilemmas in Medical Practice - What should a physician do when he/she commits an error." This was a satellite conference to the annual meeting of the Polish Society of Internal Medicine. The symposium was attended by approximately 600 participants, mostly practicing physicians from across Poland.
Albert W. Wu, MD, FACP, was invited to be the ACP International Ambassador to this meeting by Andrzej Szczeklik, MD, PhD, FACP, Chairman of the Organizing Committee. Dr. Wu gave two presentations at the meeting: "Patient Safety: American Solutions" and "The Doctor as a Second Victim of Medical Error".
Future World Wide Internal Medicine Meetings
The current list of Future World Wide Internal Medicine Meetings is available here. Upcoming meetings will be taking place in Chile, Uruguay, Venezuela, and Australia.
New International Members
Welcome New Members!
Welcome and congratulations to the following new ACP Members who were elected from February 1 - March 31, 2011.
Highlights from ACP Internist and
ACP Internist (formerly ACP Observer) March/April 2011
ACP Hospitalist April 2011
ACP Recruit-a-Colleague Winner Announced
Everard N. Barton, FACP, of Mona Kingston, Jamaica, has been selected as the winner in the 2010-2011 Recruit-a-Colleague Program grand prize drawing for a trip to Internal Medicine 2012 in New Orleans, La.
ACP's Recruit-a-Colleague Program enables you to earn membership dues credits while helping to strengthen the worldwide internal medicine community. The 2011-2012 program runs from April 1, 2011 through March 15, 2012. For more information, please visit http://www.acponline.org/recruitacolleague.
ACP International welcomes submissions from its readers. If you would like to submit an article for consideration for the newsletter, please send it to the ACP International Office mailbox. Articles submitted for consideration should be formatted in a Microsoft Word document and no longer than one page of 12-point Times New Roman font. Articles about unique health issues routinely treated in your country and humanitarian stories are encouraged.
MKSAP 15 Answer & Critique
Answer: B, Cataracts.
Educational Objective: Diagnose vision loss in an elderly patient.
Critique: This patient’s symptoms are typical for cataracts, which commonly cause reduced illumination, reduced contrast sensitivity, increased glare, and impaired blue-yellow color vision. She also has diabetes mellitus and smokes, which are both risk factors for cataract formation. Other risk factors are excessive sunlight exposure and heavy alcohol consumption.
Age-related macular degeneration, presbyopia, primary open-angle glaucoma, and proliferative diabetic retinopathy are the other common ophthalmologic problems in elderly persons. Macular degeneration affects the macula and typically causes decreased visual acuity and, in particular, loss of central vision. There is also loss of contrast sensitivity and the perception of straight lines as wavy (metamorphopsia).
Presbyopia is part of the natural aging process and is manifested by decreased visual acuity and focusing ability. Primary open-angle glaucoma is usually asymptomatic until late in its course because loss of peripheral vision occurs first and loss of central vision occurs much later. Risk factors include age, family history, myopia, black race, and diabetes mellitus.
Proliferative diabetic retinopathy may result in reduced visual acuity, scotomata, a sensation of a “curtain falling” as a result of vitreous bleeding, and floaters due to a resolving episode of vitreous bleeding. Risk factors include hypertension, poor control of diabetes, the duration of diabetes, excessive alcohol consumption, and smoking.
Since visual impairment and disability are common in the elderly, the U.S. Preventive Services Task Force recommends periodic Snellen visual acuity testing. Many professional organizations, including the American College of Physicians, recommend annual screening of patients with diabetes by means of a dilated ophthalmoscopic examination or stereoscopic fundus photography. Consensus also exists that most internists have uncertain ability to detect the intraocular changes of age-related macular degeneration and glaucoma. Therefore, periodic examination by an eye professional is recommended for persons over 65 years of age, especially persons with risk factors for age-related ophthalmologic disorders.
Key Point: Periodic examination by an eye professional is recommended for all persons over 65 years of age, especially persons with risk factors for age-related ophthalmologic disorders.
Rosenthal BP. Ophthalmology. Screening and treatment of age-related and pathologic vision changes. Geriatrics. 2001;56(12):27-31; quiz 32. [PMID:11766560] - See 0PubMed
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Making the Most of Your ICD-10 Transition
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