September 2008 E-Newsletter

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September is Women in Medicine Month!

In honor of Women in Medicine month this September, several resources and programs have been developed for your information and enjoyment. On ACP Online, you will find a special programs page dedicated to women in medicine that includes information on women leaders of ACP. A special podcast of a panel interview of women physicians at various stages of their careers is included in this section as well. You will also find links to past IMpact interviews with women physicians. On Tuesday, September 23, ACP will hold an informational luncheon with Dr. Barbara Turner, ACP Regent and Professor of Medicine at the University of Pennsylvania, who will discuss the changing landscape of women in medicine as well as her own experiences as a female physician in academic medicine. A review of the luncheon will be included in the October issue of IMpact. If you have any questions about ACP's celebration of Women in Medicine month, please contact Amy Allen-Collins at aallen@acponline.org.

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Medical Student Perspectives: How to Choose Your Specialty

Deciding to go to medical school seemed like a big enough ordeal in itself. And now that you are in medical school, you have to take the next step and decide in a very short amount of time what you want to do with your life. The task of picking your medical specialty is daunting, to say the least. Aside from those rare few medical students who matriculate into medical school with the foreknowledge of what they want to do with their lives, most medical students change their minds several times. That being said, here are my tips on how to choose your medical specialty from among the near limitless possibilities.

Do Not Panic
Every medical student is going to feel unsure about which specialty to choose. At least half of the medical students I know did not know what specialty they were going to choose until after the completion of their first rotation during fourth year. There is plenty of time to figure out where you belong, if you take advantage of your first three years.

Get Involved Early
As clinical exposure opportunities tend to be limited to third- and fourth- year medical students, professional societies and interest groups are invaluable resources to first- and second- year medical students who are ready to start figuring out what they want to be when they grow up. Your school’s Internal Medicine Interest Group and your ACP Chapter, for example, are your best opportunities to begin exploring internal medicine as a specialty. From information nights to a-day-in-the-life of your favorite internist (cardiologist, neurologist, rheumatologist, etc.) to mentor-mentee shadowing opportunities and networking, these groups can begin to show you the working life and behind-the-scenes world that such specialists have created. These events and relationships will often enlighten a student to a much greater degree than would the few weeks spent on a third-year rotation in general medicine.

Experience Everything
Nothing will substitute for the value of diversity in experience. Explore everything; observe any procedure to which you are invited. If you follow a patient on your service, go with the patient for any and every auxiliary diagnostic test offered or therapeutic procedure scheduled. These are often your best opportunities to work one-on-one with an attending in that field and to see first-hand what working in that field would entail. Also, as you go between rotations third year, try to keep an open mind. Start each block with a goal of fully exploring it before you cross it off your list. I have personally known many medical students who began a rotation so sure that they would hate it just to realize that they loved the field and would ultimately pursue it. By not limiting yourself, you can be more objective in your evaluations of these one-in-a-lifetime opportunities. This will help you to realize more than just whether you are a procedure-oriented person vs. an intuitive-oriented person, but more importantly whether you have a true passion for the medicine involved.

Ask Questions
When you meet physicians in a specialty you are considering, talk to them about their careers. Remember, you are on this rotation to see patients and learn medical content, but you are also there to explore the specialty as a future practice. Your questions will demonstrate your interest in the physician’s personal experience and may provide you with valuable information. Interestingly, most practicing physicians that I have spoken with suggest that the medical school clerkship is quite a different experience from the everyday life in their specialties. Here is a favorite question to ask your attending: “If you were in my shoes in today’s medical environment, would you choose the same specialty again?” The answer to this question could very well provide you with real insight into the future prospects of the specialty.

Only You Know the Answers
Since choosing your specialty is such a subjective decision, I suggest that you ask yourself the following questions as you experience and learn about each specialty. 1. Does the specialty interest you? 2. Are you a competitive applicant for this specialty? 3. Could you do this for 30 or more years, instead of the few short weeks of the clerkship/rotation? 4. Are you satisfied with the attending’s lifestyle? How about the resident’s lifestyle? 5. Are you satisfied with the compensation? 6. Are you satisfied with the length of training required? 7. Can you accept the intensity of residency training? 8. Are you interested in private, hospital, or academic practice? Are you interested in teaching or research? Will this specialty allow whatever flexibility you would like? 9. How will this specialty change in the future?

The Take Home Message
Take advantage of your first three years of medical school to get information and to research lots of medical specialties. Join every interest group that you medical school offers, and especially use the opportunities available during your third year to figure out what you want to do with your medical career. See as much as you can, because you really need to love the specialty that you choose.

Helpful Website
This is a popular link to the Medical Specialty Aptitude Test (based on the book "How to Choose a Medical Specialty" by Anita Taylor), designed to help medical students find the specialty for which they are best suited.

John Paul Henao
Council of Student Members Representative, North Central Region
Drexel University College of Medicine, 2009
Email: jph32@drexel.edu

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My Kind of Medicine: Real Lives of Practicing Internists: Georges Benjamin, MD, FACP

Georges Benjamin, MD, FACPFrom the vantage point of his eighth grade science classroom in Chicago, it was difficult for Georges Benjamin to see the future ahead of him, but the frog—primed for dissection on the table in front of him—was a clue. Although he did not realize it at the time, mastering the art of frog dissection would instill in him a focus and discipline that he would need for the many roles he would later play: as a Major in the Army, as the chief of an emergency medicine service, as a medical administrator, as a Deputy State Secretary for public health services, as a State Health Secretary, and as the Executive Director of the American Public Health Association (APHA). But for all his calculation and skill, none of these achievements could have been possible if it were not for his great passion. “I literally fell in love with internal medicine as a fundamental discipline,” he says.

Falling in Love
Dr. Benjamin’s career can be traced back to two major decisions. The first decision he made while in college at the Illinois Institute of Technology, when a friend suggested he pursue medical school. As an undergrad, Dr. Benjamin was engrossed in research and studied sickle cell disease, and while he found the research fascinating, he was frustrated by his lack of fundamental knowledge from a medical standpoint. “Unlike many doctors, ‘being a doctor’ was never on my radar screen when I was younger,” he explains, “but I wanted to know more—more about the basics like anatomy and physiology.” So he heeded the advice of his friend and attended the University of Illinois College of Medicine. And once he got a taste of clinical medicine and saw his first patients, things began to change. “As I learned more about clinical medicine, the research idea began to drift away,” he says. “I also fell in love with the emergency department.”

His first student rotation in internal medicine was in Chicago, where he worked in community hospitals. There, he worked under an attending physician who helped him understand what the field was all about. “He was extraordinary,” Dr. Benjamin recalls. “From him I began to understand the detail needed to provide comprehensive care and the focus needed to address patients’ most serious problems. Internal medicine is really the core of understanding the process of health. I believe that internal medicine is an honored discipline and the core of being a primary care physician.” He says that today’s medical students need to understand how studying internal medicine has the capacity to lay a foundation that can open up many doors. “If you study internal medicine, you can go on to do a number of things because you have so many skills. Students need to understand what a wonderful opportunity that presents.”

Timing is Everything
In 2002, Dr. Benjamin’s tenure as State Health Secretary for Maryland was coming to a close. After such a successful run, which included playing a key role in developing the state’s bioterrorism plan and Medicaid managed care plan, he knew he wanted to stay in health policy, and he knew he was ready for the national level. The chances of that happening however, were rare. “Jobs like this don’t open up very often,” he says, “but in this case the timing was right. I just knew it had to be other forces coming together.”

Three months later he got the gig, where he has stayed happily for five and a half years. As Executive Director of APHA, Dr. Benjamin oversees a staff of about 75 people, a budget of $15,000,000 and a membership base of about 50,000. His role on the most basic level is to make sure the organization fulfills its overall purpose of protecting American communities from preventable, serious health threats. He does this in a number of ways: by speaking publicly, developing media advocacy, crafting APHA’s advocacy message, and attending a lot of business meetings. He takes his job to heart and is mindful of the organization’s 136-year history. “This is an honored association,” he says. “It has a historic need and at this time in history I feel our purpose is more critical than ever. What I love most about my job is that it gives me a chance to influence the health of millions of Americans in a helpful way. It really makes me want to get out of bed in the morning.”

He says the bigger rewards of the job can be slow-coming but worth it. “In these jobs, you don’t get the rush of treating critically ill patients and seeing them walk out the door healthy,” he explains, “it’s more slow and methodical. But when something comes to fruition on your watch it’s wonderful.” He cites the recently passed prevention benefit in the Medicare bill as an example. “For us here, we’re pleased as punch at how far it’s come,” he says. “From Medicare being created as a treatment-only program to now including important preventive health benefits is a major change that will support future efforts on health reform.”

Another rewarding experience for Dr. Benjamin came while he was working as State Health Secretary for Maryland when the state had successfully obtained its portion (several million dollars) of the national settlement agreement from the tobacco companies. “We were able to work with the legislature in a very productive way to strike a compromise to ensure the dollars went to health and not roads,” he recalls, “which sounds easy enough but coming to an agreed decision on how the state was going to use those resources was a very political process. There were certain points where I was sure the deal was going to die, but at the end of the day it came together.”

Army of One
The second big decision was joining the Army, where he would earn the eventual rank of Major and help construct a teaching program for nonemergency medicine residents at the Walter Reed Army Hospital in Washington, D.C., where he was chief of emergency medicine. It was intimidating, as all of the officers he worked with outranked him. “I had to develop this program as a young captain in a place full of nothing but colonels!” he remembers. “I learned a lot from them. They were smart, experienced administrators and extraordinary clinicians. For me, it was a very maturing experience. I learned about systems, about quality improvement.” The experience helped Dr. Benjamin greatly when he returned to civilian life, as well. “In essence I had to build an academic service and I was struggling for resources. My experience in the Army made me better able to handle that. The people I worked with at Walter Reed are still very much my close friends,” he says. “I consider many of them my mentors.”

“The most important lessons I have learned are in the realm of institutional and medical politics. Managing in a highly political environment is also challenging but I have learned a lot about how to create partnerships, which is an essential skill particularly in large or complex organizations.”

In all of his roles, Dr. Benjamin has learned something different. From his time working in medical administration and in the Army, he learned management. From emergency medicine, he learned how to perform in the thick of chaos. From working in state health, he learned the game of politics, and from being an internist, “I learned to be thoughtful and strategic in my thinking,” he says. And to think it all started with a frog.

Check out previous articles as physicians share what motivated them to become physicians as well as why they chose their particular type of practice.

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Internal Medicine Interest Group of the Month: Meharry Medical College

Meharry Medical College (MMC), founded in October 1876, was part of the mission of the Freedman’s Aid Society of the Methodist Episcopal Church to educate freed slaves and provide health care services for their communities. Presently, the College includes schools of Medicine, Dentistry, Graduate Studies and Research, and Allied Health Professions. Meharry’s Internal Medicine Residency Training Program in the Department of Internal Medicine has been accredited for over 60 years.

Internal medicine is considered to be one of the most exciting, rewarding specialties of medicine. It is the cornerstone of tertiary medical care and the major provider of primary care training. To introduce students to the appeal of internal medicine, Dr. John Thomas, Jr., FACP, FACC, conceptualized the idea of an internal medicine student club. The major goals of the club are to: • Highlight internal medicine as a major provider of primary care training;
• Enlighten students to the stimulating physical and mental challenges of internal medicine; and
• Enhance the recruitment efforts of our residency program among our students.

The MMC2 (Meharry Medicine Club of Meharry Medical College), composed of sophomore, junior and senior medical students, was launched September 3, 1997. The faculty advisors were Dr. John Thomas, cardiologist and the founding father, and Dr. Clinton Cummings, pulmonologist. A special feature of MMC2 is the free-flowing informal communications between senior faculty and student members.

MMC2 activities include holding monthly dinner meetings, which feature scientific presentations by faculty members; establishing a Journal Club designed to teach members to properly read, decipher, evaluate and present peer-reviewed journal articles; conducting community-based health fairs; providing triage emergency medical care to the community-based African Street Festival located on the Tennessee State University campus; and publishing articles written by the Club president in the Cardioscapes journal which is published semi-annually by the Brothers - Thomas Cardiovascular Learning Resources Center at Meharry (BTCLRC). MMC2 members are provided additional opportunities to train on the HARVEY cardiac patient simulator and utilize the BTCLRC for computer-aided instruction or study time. Members also receive additional training in indirect blood pressure measurement and special tutoring from attending physicians.

Dr. John Thomas expired in Nashville General Hospital during the MMC2 meeting held on December 1, 1999. At their January 2000 meeting, MMC2 members unanimously voted to adopt the name Thomas – Hardy Internal Medicine Society (THIMS) in commemoration of Drs. John Thomas and Robert E. Hardy, two devoted Meharrians committed to student advocacy and clinical research. Presently, Dr. James Potts, FACC, an ACP Member, serves as a faculty advisor and Johniene Thomas, MSPH, Educational Coordinator, serves as the group’s coordinator. Current THIMS officers are: President, Daniel Addison (MSIV); Vice President, Joshua Gilchrist (MSIV); President-elect, Nkiruka Emeagwali (MD/PhD candidate); Corresponding Secretary, Lakeshia Entzminger (MSII); and Recording Secretary, Dejeunou Tchamba (MSIV).

Two noteworthy accomplishments sponsored by THIMS this past academic year were:
• The Inaugural Internal Medicine Residency Training Program Symposium. Representatives from the internal medicine residency training programs at Meharry Medical College, Baptist Hospital-University of Tennessee, Cleveland Clinic, Creighton University, and Vanderbilt University participated as panelists at the Symposium. One-on-one interactions with the program directors and residents highlighted the Symposium. This will become an annual event.
• The outstanding response to the plea for dental hygiene items received from Windsor Child Care Facility, an orphanage in Saint Ann’s Bay, Jamaica. Within 10 days of receiving the plea from the African American Cultural Alliance, more than 100 tubes of toothpaste and toothbrushes, numerous personal-sized hand sanitizers and bottles of mouthwash were collected for donation.

These are some of the highlights of the scope of activities of THIMS. We are looking forward to an exciting new academic year filled with events and activities to help students learn about the opportunities available in internal medicine.

D. Johniene Thomas, MSPH, Coordinator
Daniel Addison, MSIV, President
Thomas – Hardy Internal Medicine Society
Meharry Medical College
Email: jthomas@mmc.edu

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Interest Form for Student Member Mentoring Breakfast

Each year the College provides a networking/mentoring session during our annual meeting specifically geared towards the needs of Medical Student Members. To make this session more effective, the College is interested in learning from you what issues you are confronting as a medical student that you would like to receive advice about. It is not necessary to be an attendee to our annual meeting. This is a general request for information to the broader medical student membership. The information you provide will help shape mentoring programs and provide ideas for new medical student programs. Please take a minute to complete the interest form. Thank you.

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Winning Abstracts from the 2008 Medical Student Abstract Competition: Breast Cancer Tumor Size in MRI versus Surgical Pathological Specimen: A Correlative Study.

Author: Andrew D Schwartzman, West Virginia University

Introduction
Although Magnetic Resonance Imaging (MRI) is superior to conventional imaging techniques in breast cancer, its correlation with actual tumor size has not been shown to be impressive. The purpose of our study is to determine the correlation of MRI with pathological findings of breast cancer in patients treated in West Virginia University Hospitals.

Methods
This is a retrospective study analyzing a database of 43 patients with breast cancer who had preoperative MRI. We estimated the correlation between the preoperative largest tumor diameter on MRI and diameter on pathological evaluation after surgery. The size of the surgical specimen is considered the gold standard for tumor measurement. A subset of 15 patients received neoadjuvant chemotherapy, while 28 patients did not. In all patients, MRI diameters were measured preoperatively. All MRI diameters were estimated by ONLY two radiologists in our institution.

Results
The mean age of our patient population was 47.4 years (range: 36-70). The median of the largest preoperative diameter as seen in the MRI was 20 mm, while the median of the diameter at surgery was 15 mm. The difference was significant (Wilcoxon Signed Rank Test, p= 0.0054). The correlation coefficient was 0.47(P-value= 0.0016). Further analysis of the same population based on whether they received neoadjuvant chemotherapy or not showed no difference in the level of correlation.

Conclusion
MRI of the breast tends to overestimate the tumor diameter seen in the pathological specimen of resected masses. However, an evident correlation exists between the MRI estimated diameter and the actual tumor size.

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Subspecialty Careers: Highlights about Careers in Internal Medicine: Endocrinology, Diabetes, and Metabolism

The Discipline
From the Greek endon, "in, inner, or within" and krinein, "to separate or put apart." A term contrived to describe those glands that "put apart" and secrete substances that are used within the body

Endocrinology is the diagnosis and care of disorders of the endocrine system. The principle endocrine problems include goiter, thyroid nodules, thyroid dysfunction, diabetes mellitus, hyper- and hypocalcemia, adrenal cortex dysfunction, endocrine hypertension, gonadal disorders, disorders of sodium and water balance, manifestations of pituitary disorders, disorders of bone metabolism, and hyperlipidemia. While not strictly an endocrine disorder, obesity is considered part of the spectrum of endocrinology because it often enters into the differential diagnosis of endocrine disease and is a major element in the management of type 2 diabetes. Prevention focuses on the complications of obesity, diabetes, hyperlipidemias, thyroid disease, and the iatrogenic effects of glucocorticoids.

Procedures
Endocrinologists are expected to perform dexamethasone suppression tests, adrenocorticotropin (ACTH) stimulation tests, home blood glucose monitoring and fine needle thyroid biopsies. Additionally, endocrinologists commonly order and interpret bone densitometry tests, fasting and postprandial glucose determinations, glycohemoglobin concentrations, imaging studies of the sella turcica, serum gonadotropin concentrations, lipid profiles, and thyroid function studies.

Training
Endocrinology fellowship training requires two years of accredited training beyond general internal medicine residency. Of the two years, a minimum of 12 months must include clinical training in the diagnosis and management of a broad spectrum of endocrine diseases.

Training Positions
As of 2005, there were 122 ACGME-accredited training programs and 486 active trainees in Endocrinology, Diabetes, and Metabolism. 67% percent of the trainees were female and 64% were US medical graduates.

Certification
The American Board of Internal Medicine, ABIM, offers certification in Endocrinology, Diabetes, and Metabolism.

Practice
Approximately 52% of the graduates enter clinical practice in Endocrinology, Diabetes, and Metabolism in the United States and 42% enter academic medicine.

Major Professional Societies

Major Publications

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Advocacy Brief: Where the Candidates Stand on Health Care

The presidential election season is in full swing, and the candidates continue to release more details about their proposals to reform health care in the U.S. However, these proposals can often be difficult to sort through. ACP has developed several tools to help you take a critical-eye to these plans and ways for you to get involved. Building upon our Candidate’s Pledge to Make the U.S. Health Care System Second to None issued in January 2008, ACP offers a comparison of the presidential candidates’ health reform proposals.

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Did You Know You Can Enter the ACP’s National Medical Student Abstract Competition?

Did you know the ACP offers Medical Student Members the opportunity to present their research and interesting cases at the national annual meeting? If you are involved in a research or community service project through your medical school, or have come across an interesting case during your internal medicine rotation or preceptorship program, you should take advantage of the ACP’s National Medical Student Abstract Competition. For the past fourteen years, hundreds of Medical Student Members have presented their work to thousands of College members at ACP’s annual scientific meetings.

To find out more about the competition and win a chance to present at Internal Medicine 2009 in Philadelphia, PA, please check out abstract information. All of the details and instructions for submitting an abstract are located on this site.

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MKSAP for Students 3 Question 1

A 60-year-old woman with type 2 diabetes mellitus and hypertension is evaluated for a dry cough of 2 months' duration that began after a viral upper respiratory tract infection. Her usual medications are lisinopril and glyburide, both of which she has taken for more than 5 years. Her cough is worst when she arises in the morning.

Her physical examination is remarkable only for pink, moist nasal mucosa with white exudate and cobblestoning on the posterior pharynx.

Which of the following is the most appropriate management of the patient’s cough?

A. Amoxicillin
B. Antihistamine/decongestant combination
C. Azithromycin
D. Codeine-containing cough syrup
E. Ranitidine

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MKSAP for Students 3 Question 2

A 24-year-old woman is evaluated in the office because of a heart murmur that has been present since birth. She has chronic stable exertional dyspnea. She has no other pertinent history.

On physical examination, her heart rate is 82/min and oxygen saturation is 97%. Jugular venous pressure is normal. Carotid pulses are brisk, with rapid upstroke. Lungs are clear to auscultation. Cardiac examination shows a sustained apical impulse in the sixth left intercostal space, 2 cm lateral to the midclavicular line. S1 is normal. S2 is physiologically split, with a normal P2. A soft S3 is audible. A continuous crescendo-decrescendo murmur is heard throughout the precordium and is loudest over the third left intercostal space. An echocardiogram is performed.

Which of the following is the most likely diagnosis?

A. Mitral regurgitation
B. Mitral stenosis and regurgitation
C. Pulmonary stenosis and regurgitation
D. Patent ductus arteriosus
E. N/A

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MKSAP for Students 3 Answer 1

Answer: B, Antihistamine/decongestant combination

This patient's recent upper respiratory infection, nasal exudate, and cobblestoning in the posterior pharynx all suggest postnasal drip as the cause of her cough. A decongestant is likely to improve her symptoms. Decongestants can be safely used in patients with well-controlled hypertension. Although angiotensin-converting enzyme (ACE) inhibitor therapy can cause cough, she has tolerated this medication well for a number of years and an ACE inhibitor–induced cough is unlikely to develop at this point. Codeine-containing cough syrup will suppress the cough and is useful for patients who are losing sleep due to coughing, although this is not the case for this patient.

In addition, codeine may cause such side effects as constipation and mental slowing, without treating the underlying cause. Antibiotic therapy is not warranted for postnasal drip. In a significant number of cases, chronic cough is due to multiple concurrent precipitants. If her symptoms persist after several weeks of decongestant treatment, reactive airways or gastroesophageal reflux should be considered, but these are not prime diagnostic considerations at this point. Reactive airways can also occur in the setting of a recent upper respiratory infection, even in the absence of wheezing.

Bibliography
1. Irwin RS, Madison JM. The diagnosis and treatment of cough. N Engl J Med. 2000;343:171521. PMID: 11106722 [PubMed]

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MKSAP for Students 3 Answer 2

Answer: D, Patent ductus arteriosus

Patent ductus arteriosus causes a continuous murmur in the left parasternal location. Left ventricular volume overload is common, and an S3 gallop may occur as a result. In the absence of pulmonary hypertension, P2 is normal. Carotid pulses are brisk as a result of increased stroke volume, and pulse pressure is increased as a result of diastolic runoff into the pulmonary artery.

Although left ventricular enlargement and a soft S3 are compatible with a diagnosis of mitral regurgitation, the location of the murmur and its persistence in diastole do not support this diagnosis. Moreover, with significant mitral regurgitation, the carotid upstrokes are rarely brisk because forward flow is reduced. In combined mitral valve disease, systolic and diastolic murmurs are heard, but are not continuous, because they are separated by the isovolumic relaxation period. An opening snap should be audible. The finding of an S3 excludes the diagnosis of pure mitral stenosis because the obstruction limits blood flow into the left ventricle. However, an S3 can be heard if mitral stenosis is associated with aortic or mitral regurgitation. This patient's murmur is best heard at the apex, and the diastolic component of mitral stenosis is rarely audible throughout the precordium.

The location of the patient's murmur is compatible with a pulmonary valve murmur. However, this type of murmur typically causes right ventricular hypertrophy and dilation, with a prominent impulse at the right parasternal border. A systolic ejection click is common as well. P2 is rarely audible, and S3 is unusual.

This patient has no evidence of pulmonary hypertension. After the diagnosis is confirmed by echocardiography, she should be referred for closure of the patent ductus arteriosus.

Bibliography
1. Brickner ME, Hillis LD, Lange RA. Congenital heart disease in adults. First of two parts. N Engl J Med. 2000;342:256-63. PMID: 10648769[PubMed]

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ACP Internal Medicine Residency Database

Interested in obtaining more information about residency programs? ACP offers the Internal Medicine Residency Database which contains information about all internal medicine residency programs in the United States. The Internal Medicine Residency Database provides a description of each program as provided by its internal medicine department or links directly into the program’s Web site.

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ACP Launches an Online, Mobile Game based on the Popular ACP Doctor's Dilemma™ Competition

Test your knowledge in a variety of disciplines with this new online game based on the popular ACP Doctor's Dilemma™ Competition from the ACP's annual Internal Medicine meetings. The game is simple to play and all you need is a web browser.

Because this product was designed using standards for mobile web content, all devices equipped with a Web browser are supported, including mobile smartphones and PDAs like Windows Mobile devices and Palm OS devices. An active Internet connection is required to play, but there is nothing to download or install.

Learn more: Doctors Dilemma™.

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Articles for Medical Students from ACP Internist and ACP Hospitalist

ACP Internist (formerly ACP Observer) September 2008

  • Post-war, vets face new battle with PTSD.
    While the military screens soldiers returning from combat, post-traumatic stress disorder can show up months or years after, when the person may have left the military health system and returned to private care.
  • Mindful Medicine.
    Don’t let emotion impede right diagnosis. A case study shows how affective errors can lead to a missed diagnosis, by Jerome Groopman, FACP and Pamela Hartzband, FACP.
  • Ethical Dilemmas.
    Son’s plea to prolong life at any cost sparks ethical quandary. Physicians aren’t obligated to provide end-of-life care that is ineffective or harmful, by Lachlan Forrow, FACP.
  • Test yourself.
    A MKSAP case study of menorrhagia marks the return of this popular feature to ACP Internist.

ACP Hospitalist August 2008

  • Delivery of a shock in two minutes or less.
    Assessing and improving cardiac arrest response times. Recent research has found that hospitalized patients with ventricular fibrillation or ventricular tachycardia don't always receive defibrillation within the recommended window, and that the delay has a detrimental effect on outcomes and survival. Cardiologists and other experts trying to improve these times say that hospitalists are in the perfect spot to take charge of the problem and lead improvement efforts.
  • The hospitalist teacher.
    Bedside rounding combines medical education and patient care.
  • Expert analysis: Lewy body dementia.
    A 72-year-old right-handed piano teacher is admitted to the hospital for a fractured left hip, agitation and confusion.
  • Test yourself: Sepsis.
    These cases and commentary, are excerpted from ACP’s Medical Knowledge Self-Assessment Program.

Students: Join ACP for Free

Benefits of Membership for Students: ACP's free Medical Student Membership includes benefits designed especially to meet students' needs.

Join Now: Sign-up today and begin enjoying the benefits of ACP Medical Student Membership.

MKSAP 15 Discount 10% Off

MKSAP 15 Discount 10% Off

Get ready for the New Year with the newest edition of MKSAP. Enjoy a 10% discount off MKSAP 15 for a limited time. You must order by December 11, 2009 and use priority code E9048 to get the discount.

Holiday Gift offer - 10% off

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A great gift for a colleague or yourself - Landmark Papers in Internal Medicine: The First 80 Years of Annals of Internal Medicine. Enjoy a 10% discount when you order by December 11, 2009 and use priority code E9049.

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