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Building Confidence in your WBC Role

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Patients Before Paperwork

Patients Before Paperwork Update: On August 3, 2020 the Centers for Medicare & Medicaid Services (CMS) issued its Physician Fee Schedule and Quality Payment Program proposed rule. A number of the proposals are aimed at reducing administrative burden, especially in the telehealth services space.

Noteworthy Resources

Stigma Compounds the Consequences of Clinician Burnout During COVID-19: A Call to Action to Break the Culture of Silence By Jennifer B. Feist, J. Corey Feist, and Pamela Cipriano

New ACP Webinars

Well-being Champion Webinar: Feelings and Needs Kerri Palamara, MD, FACP Tuesday, September 22, 2020, 2:00–3:00 p.m. ET

In the News

“It's Time to Stop Stigmatizing Mental Health Among Healthcare Workers” By Jessica Gold, Forbes This summer, physicians took to Twitter to discuss their own mental health struggles and treatment in hopes that transparency will help break the stigma of mental illness and seeking help, and ultimately change the culture of medicine.

Group Coaching for ACP Well-being Champions

There is still time to sign up for group coaching sessions facilitated by ACP Physician Services Coaching Lead, Dr. Kerri Palamara. Well-being Champions will be grouped into cohorts to participate in monthly group coaching sessions over Zoom. Champions will be able to discuss well-being goals and interventions and plan collaborative efforts.

From the Trenches

September 18, 2020

Answering the Call for Our Members and Our Communities

Patients Before Paperwork

Fact Sheet: Calendar Year (CY) 2022 Medicare Physician Fee Schedule Proposed Rule | CMS

Noteworthy Resources

Physician Suicide Prevention and the Ethics and Role of a Healing Community: An American College of Physicians Policy Paper Matthew DeCamp, MD, PhD, and Mark Levine, MD, for the ACP Ethics, Professionalism and Human Rights Committee

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Displaying 151 - 160 of 241 in ACP Store

I.M. PROUD Car Magnet

I.M. PROUD Car Magnet

"I Think, Therefore I.M." Car Magnet

"I Think, Therefore I.M." Car Magnet

I.M PROUD Luggage Tag

I.M PROUD Luggage Tag

ACP POCUS 5: Urinary System

ACP POCUS 5: Urinary System

ACP POCUS 6: Deep Venous Thrombosis

ACP POCUS 6: Deep Venous Thrombosis

ACP POCUS 4: Intra-Abdominal Free Fluid

ACP POCUS 4: Intra-Abdominal Free Fluid

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ACP Checkered Silk Neck Tie

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ACP Diamond Silk Neck Tie

ACP Diamond Silk Neck Tie

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Displaying 151 - 160 of 500 in Annals of Internal Medicine: Clinical Cases

Bouveret Syndrome: Excavating a Unique Geode-Like Gallstone With White Crystal Inner Core From Duodenum | Annals of Internal Medicine: Clinical Cases

Bouveret syndrome is a rare complication of cholelithiasis where a gallstone creates a cholecystoduodenal fistula resulting in gastric outlet obstruction. We present a case of a 66-year-old man with Bouveret syndrome with unique stone characteristics, which was successfully extracted using electrohydraulic lithotripsy during endoscopic retrograde cholangiopancreatography. The stone had an unusual appearance of a white crystal inner core surrounded by a dark brown covering resembling a geode.

Bronchobiliary Fistula Mimicking Pneumonia: A Case Report and Diagnostic Dilemma | Annals of Internal Medicine: Clinical Cases

Bronchobiliary fistula is a rare condition where the bronchial tree and biliary tract are abnormally connected, leading to bilioptysis (bile in the sputum). It can be misdiagnosed as pneumonia due to overlapping symptoms. This case report describes a 45-year-old man with severe necrotizing gallstone pancreatitis, presenting with pneumonia-like symptoms, who was diagnosed with a bronchobiliary fistula. The case highlights the challenge of distinguishing bronchobiliary fistulas from pneumonia in patients with hepatobiliary issues. Diagnosis requires recognizing bilioptysis and using tools, such as bronchoscopy, bile testing, and imaging. Management focuses on addressing biliary obstruction.

Pneumocystis Pneumonia and Hypercalcemia: An Underrecognized and Atypical Feature of a Common Opportunistic Infection | Annals of Internal Medicine: Clinical Cases

Pneumocystis pneumonia (PCP) is a common opportunistic infection that presents as acute hypoxemic respiratory failure with fever and respiratory distress in immunocompromised patients. However, the diagnosis of PCP can be difficult to confirm, emphasizing the importance of recognizing atypical features of infection. This article describes three cases of PCP presenting with parathyroid hormone–independent hypercalcemia in patients receiving immunosuppressive medications for autoimmune conditions. These patients did not meet established criteria for prophylaxis before presentation. In each case, patients’ hypercalcemia resolved with empirical treatment of PCP. These cases affirm the relationship between PCP and hypercalcemia in patients without obvious risk factors.

Pathology-Proven Cerebral Amyloid Angiopathy in a Patient With Spontaneous Intracerebral Hemorrhage | Annals of Internal Medicine: Clinical Cases

Cerebral amyloid angiopathy (CAA)–related intracerebral hemorrhage (ICH) accounts for 20% of spontaneous ICH. Results of brain magnetic resonance imaging (MRI) support the clinical diagnosis of suspected CAA and help predict future ICH. Here, we report an interesting case in which the MRI brain imaging demonstrated a left temporal ICH with no underlying mass and no evidence suggestive of amyloid angiopathy. Surgical evacuation of the hemorrhage was performed and histology was consistent with CAA. This case is noteworthy because the diagnosis of CAA was unsuspected owing to the absence of MRI brain findings as per Boston criteria 2.0.

Broncho-Atmospheric Fistula Associated With Xylazine Wound | Annals of Internal Medicine: Clinical Cases

Xylazine, also known as “tranq” wounds, are typically found on extremities of drug users with injection behaviors. Here, we present a patient with a large chest wound with a broncho-atmospheric fistula and destruction of surrounding skeletal structures, exposing internal structures to external pathogens. Our case emphasizes that although healing potential is great with extremity xylazine wounds, chest wounds may be irreversibly destructive.

Polyarticular Septic Arthritis From Streptococcus pneumoniae Infection in an Immunocompetent Adult: A Case Report | Annals of Internal Medicine: Clinical Cases

Polyarticular septic arthritis is a condition with significant morbidity and mortality that is rarely seen in immunocompetent adults. We report a case of a 73-year-old man presenting with a 2-day history of polyarthralgia involving bilateral shoulders, elbows, wrists, knees, and ankles with rigours and chills, initially treated as reactive arthritis and subsequently found to have Streptococcus pneumoniae bacteremia. Bilateral knee aspirations were performed for worsening arthritis despite antibiotics, revealing polyarticular septic arthritis that required bilateral arthroscopic washouts. This case illustrates the diagnostic challenges surrounding polyarticular septic arthritis and emphasizes the importance of timely recognition and treatment.

Hepatic Myelopathy: A Rare Complication of Chronic Liver Failure Treated Conservatively Without Liver Transplantation | Annals of Internal Medicine: Clinical Cases

Hepatic myelopathy (HM) diagnosis requires the exclusion of other causes of spastic paraparesis and typically presents in the setting of recurrent hepatic encephalopathy. Pathophysiology involves toxin accumulation, particularly ammonia, leading to astrocyte swelling and demyelination of the corticospinal tract. While nonpyramidal symptoms can be reversible with treatment, spastic paraparesis may not always respond. Liver transplant is considered a definitive treatment, but outcomes vary. Early intervention and monitoring of ammonia levels in patients with known portosystemic shunts may reduce irreversible HM cases. Recognizing HM in patients with spastic paraparesis and liver disease is crucial for timely intervention and potentially reversing symptoms.

Pneumocystis jirovecii Pneumonia Following Initiation of 15 mg Prednisone Daily | Annals of Internal Medicine: Clinical Cases

A 74-year-old man with chronic obstructive pulmonary disease presented with acute dyspnea and rapidly progressed to hypoxic respiratory failure requiring high levels of noninvasive mechanical ventilation. Three months prior, he was administered prednisone, 15 mg daily for polymyalgia rheumatica. He was subsequently found to have Pneumocystis jirovecii pneumonia, an uncommon infection in the absence of severe immunosuppressive conditions or steroid doses greater than or equal to 20 mg, prednisone daily. The initiation of Pneumocystis jirovecii pneumonia prophylaxis at lower steroid doses is controversial but should be considered in patients with multiple risk factors.

Infective Endocarditis Caused by Fusobacterium nucleatum and Slackia exigua Secondary to Poor Oral Health | Annals of Internal Medicine: Clinical Cases

Infective endocarditis caused by anaerobes may be underrecognized. Here, we report a case of polymicrobial anaerobic infective endocarditis secondary to poor oral health. A 79-year-old man presented with fever, trismus, and a painful swollen jaw. Evaluation revealed pulmonary septic embolism, osteomyelitis, and vegetation on the mitral valve. Fusobacterium nucleatum and Slackia exigua were identified in blood cultures. He was diagnosed with infective endocarditis and was successfully treated with antimicrobials. This highlights the importance of promptly identifying systemic infections even in apparent odontogenic infections. Clinicians should be aware of severe infections caused by oral anaerobes and the importance of maintaining oral health.

Linezolid-Induced Pancreatitis, Hypoglycemia, and Lactic Acidosis: Case Report and Literature Review | Annals of Internal Medicine: Clinical Cases

The triad of pancreatitis, hypoglycemia, and lactic acidosis is a rare adverse effect after linezolid administration. We report the case of a 41-year-old woman treated with oral linezolid for a filler-related Mycobacterium abscessus soft tissue infection. Three weeks after linezolid initiation, the patient presented in the emergency department, where a diagnosis of acute pancreatitis was made. Hyperlactatemia and hypoglycemia were relevant laboratory findings and potential causes were excluded. The patient rapidly deteriorated to shock and multiorgan failure, which led to patient death in 24 hours. Four similar cases have been reported, implicating linezolid-induced mitochondrial toxicity as the likely cause.

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