Professional Fulfillment Zone

Announcing ACP Internal Medicine Meeting 2025 Well-being Poster WinnersCongratulations to this year's poster winners in the Physician Well-being and Professional Fulfillment category!

Patients Before Paperwork

Advocacy in ActionVaccines effective, and controversial, since their inventionBy Jason M. Goldman, MD, MACP, for I.M. Matters from ACPThe amount of vaccine misinformation and disinformation in recent years has truly been astounding, ACP's President says.Read here

Noteworthy Resources for Well-being

ACP: Design Your Own Well-being ProgramExplore these tools to create a well-being program tailored to any organization's needs and budget.View here!

In the News

September Is Suicide Prevention Awareness MonthThere are many ways to take action, start a conversation, and raise awareness for Suicide Prevention. You can:

From the Trenches

Physician Coaching by Professionally Trained Peers for Burnout and Well-BeingJAMA Network Open: S.B. Kiser, MD, MPH; J.D. Sterns, MD, MPH; P.Y. Lai, MS; Nora K. Horick, MS; K. Palamara, MD

September 19, 2025

ACP Well-being Champions: Promoting Well-being Through Awareness, Advocacy, and Action“Loneliness does not come from having no people about one, but from being unable to communicate t

Patients Before Paperwork

ACP Advocate Newsletter highlights that affect physician well-being and professional fulfillment. ACP Advocacy for Reproductive Health Care Rights to Focus on the States With the U.S. Supreme Court ruling to overturn Roe v. Wade, ACP will work with state chapters to advocate for patient autonomy and access to reproductive health care services.

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

In the News

Protective Equipment for Physicians' Mental Health By Mollie Frost ACP Internist

From the Trenches

After a Physician Dies by Suicide By Ryan DuBosar ACP Internist This article shares resources and discusses the multiple factors that contribute to physician death by suicide. Highlighted tools include advocating for systems changes, destigmatizing mental health help-seeking in the culture of medicine, and creating supportive communities for those associated with or affected by the tragic event. View here!

Breast Cancer Risk After Childbirth

Benefits and Harms of Using Statins to Prevent Cardiovascular Disease

The Effect of High-Deductible Insurance Plans on Diabetes Care

Comparing Diabetes Outcomes for Primary Care Provided by Physicians, Nurse Practitioners, and Physician Assistants

Effectiveness and Safety of Bariatric Procedures for Weight Loss

Fecal Immunochemical Test Screening for Colon and Rectal Cancer

Stroke Rates, Atrial Fibrillation, and Drugs to Prevent Blood Clots

Tumor Necrosis Factor Inhibitors and Cancer Relapse

Outcomes of Bariatric Surgery in Patients With Diabetes

Screening for Urinary Incontinence in Women: A Recommendation From the Women's Preventive Services Initiative

And the winner is …

Volunteers needed to answer ACP MKSAP pretest questions

Annals publishes CDC immunization schedules, stresses the importance of vaccination

Drug reactions a risk with NOAC treatment for afib

MKSAP Quiz: Abdominal distention in cirrhosis

Digital intervention helped improve depression outcomes in primary care

Study charts rising rates of U.S. psilocybin use across age groups

Vote for your favorite entry

Register now for Internal Medicine Meeting 2026 in San Francisco

ACP calls for urgent policy action on rural health

Review assesses interventions to increase clinical encounter time in the hospital | ACP Hospitalist

Morbilliform | ACP Hospitalist

Guidance highlights risk of psychological distress post-MI | ACP Hospitalist

Finding experts in plain sight | ACP Hospitalist

The evolving story of sodium in heart failure | ACP Hospitalist

Take a quiz about the Sept. 17 issue! | ACP Hospitalist

RRT activation outside the ICU did not improve sepsis survival | ACP Hospitalist

Reversal of subtherapeutic warfarin does not affect ICH outcomes, study finds | ACP Hospitalist

Incidence of carbapenemase-producing carbapenem-resistant Enterobacterales rose 69% from 2019 to 2023, CDC analysis finds | ACP Hospitalist

Empirical antifungal treatment linked with reduced IAPA rates in critically ill patients | ACP Hospitalist

Coin in the Bronchus Intermedius for 25 Years: Complication of Chronic Foreign Body Aspiration | Annals of Internal Medicine: Clinical Cases

Chronic bronchial obstructions from inhaled objects are uncommon in the adult population. Long-term complications of foreign body aspiration have included hemoptysis, recurrent pneumonia, empyema, and abscess formation. We report the patient case of a 66-year-old man, with an accidental inhalation of a coin 25 years ago that was never retrieved, who presented with progressive shortness of breath and was found to have an infected lung bulla in the setting of giant bullous emphysema secondary to the chronic right bronchial foreign body.

A Rare Case of Bivalvular Infective Endocarditis and Mural Vegetation Caused by Bartonella quintana | Annals of Internal Medicine: Clinical Cases

Bartonella quintana is a rare but increasingly recognized cause of culture-negative infective endocarditis. We report a patient who presented with features of congestive heart failure without associated fever or detectable bacteremia. Diagnostic work-up revealed infective endocarditis due to B. quintana causing a large right atrial mural vegetation along with severe mitral regurgitation and severe aortic regurgitation, for which the patient had surgical valve replacements. The case highlights the indolent nature of the disease, leading to late presentation and challenging management, especially in a vulnerable patient population.

A Case of Intraocular Tuberculosis Presenting With Neuroretinitis and Serpiginous Choroiditis | Annals of Internal Medicine: Clinical Cases

A 38-year-old unvaccinated man from India presented with reduced unilateral visual acuity and posterior fundus examination results that were consistent with neuroretinitis with macular serpiginous choroidopathy. The clinical diagnosis of tubercular choroidopathy was made, and he was successfully treated with 6 months of antituberculosis therapy. Ocular tuberculosis diagnosis can be challenging, with conventional testing such as interferon-γ release assay or acid-fast bacilli stain having low diagnostic effect, and is often guided by clinical assessment, fundus examination findings, and response to therapy.

Cholecystalgia: An Atypical Presentation of Congestive Heart Failure in a New Diagnosis of Alcohol-Induced Cardiomyopathy | Annals of Internal Medicine: Clinical Cases

Right upper quadrant (RUQ) pain is a frequent presenting symptom in the emergency department, and gallstone-induced acute cholecystitis is one of the main causes; in addition, RUQ pain can be a consequence of several other conditions. Although rare, it may also indicate cholecystalgia from gallbladder edema, which is usually related to other conditions, such as congestive heart failure (CHF), alcoholic and nonalcoholic liver cirrhosis, acute viral or drug-induced hepatitis, renal failure, and hypoproteinemia. We present a case of cholecystalgia resulting from gallbladder edema in a patient with a newly diagnosed alcohol-induced cardiomyopathy without the common CHF signs and symptoms.

Kaposi Sarcoma: A Forgotten Complication in Well-Controlled HIV | Annals of Internal Medicine: Clinical Cases

Kaposi sarcoma (KS), often described as one of the AIDS-defining illnesses, has decreased in prevalence with the widespread use of antiretroviral therapy (ART). This case series includes an atypical presentation of KS in 2 patients with well-controlled HIV and a brief review of the literature on KS. Both patients had multiple cutaneous discolored plaques and ulceration with pathology confirmation of KS. They had normal CD4 counts and undetectable HIV and human herpesvirus-8 viral loads at the time of diagnosis. Therefore, patients with HIV with new skin lesions should be screened for KS regardless of the CD4 count or adherence to ART.

Therapeutic Management of Symptomatic Calcification in a Patient With Normophosphatemic Tumoral Calcinosis | Annals of Internal Medicine: Clinical Cases

Tumoral calcinosis is a rare autosomal recessive disorder marked by lobulated soft tissue calcifications not associated with physiologic osteogenesis but rather phosphate metabolism dysregulation. Management of this rare condition involves symptomatic medical management to slow progression of disability from growth of calcifications. Controversially, surgical management in acute presentations has been implemented with varying results. We report a case of a 31-year-old African American man with known history of tumoral calcinosis who presented complaining of acute pain/inflammation of his right ankle. Medical management alone was found to be inadequate, requiring calcification partial resection, of which this patient benefitted from without recurrence.

Pyoderma Gangrenosum Secondary to Herpes Zoster | Annals of Internal Medicine: Clinical Cases

This is a clinical image demonstrating pyoderma gangrenosum (PG) as a rare but important complication of herpes zoster. The proposed mechanism for why herpes zoster may cause PG is discussed.

α-Gal Syndrome: A Case Report of Diagnosis and Meat Reintroduction | Annals of Internal Medicine: Clinical Cases

We report a patient case of a 52-year-old man, with known tick bites, presenting with multiple episodes of generalized urticaria and angioedema that woke him from sleep 8 hours after eating beef. This history, combined with positive galactose-α-1,3-galactose (α-gal serology), led to the diagnosis of α-gal syndrome. Over a 5-year period, he abstained from mammalian meat, avoided further tick bites, and α-gal levels decreased. He was successfully challenged in an allergist's office with meat with no adverse reactions. This case details the process by which our team reviewed available evidence to risk-stratify meat reintroduction in the absence of official guidelines.

Lungs of a Chronic Smoker: The Case of Heroin-Induced Emphysema in a 35-Year-Old Man | Annals of Internal Medicine: Clinical Cases

Recently, heroin has become more easily accessible, which has led to an increase in its tolerance, addiction, and misuse potential. According to several reports, among many modes of use, smoking and inhaling heroin are the most common methods of its misuse among young adults. As a result, many users younger than age 40 years are now presenting with severe airway disease. In this case report, a 35-year-old man with a history of heroin use subsequently had severe emphysema with numerous bullae. The patient reported a long-standing history of inhaling heroin vapor. A genetic work-up for alpha-1 antitrypsin deficiency was negative. Here, we raise the concern of heroin-induced bullous emphysema.

A Case of Daptomycin-Induced Eosinophilic Pneumonia | Annals of Internal Medicine: Clinical Cases

Daptomycin is commonly used for methicillin-resistant Staphylococcus aureus infections, but 1 rarely reported adverse reaction for its use is daptomycin-induced eosinophilic pneumonia. It is unclear how or why the drug produces this reaction. Workup includes ruling out other infectious causes and discontinuing daptomycin, and bronchoscopy showing more than 25% eosinophils is diagnostic. Here, we report a rarely described patient case of daptomycin-induced eosinophilic pneumonia and discuss its management.