New ACP Webinars

Well-being Champion Webinar: Interprofessional Happy Hours as a Wellness Experience During the COVID-19 Pandemic Diana McNeill, MD, MACP; Kristin Dickerson

In the News

“National Physician Burnout Expert Shares Insights: ‘We Can Certainly Do Better’” By Christopher Cheney, HealthLeaders Dr. Tait Shanafelt discusses changes that need to be made at the organizational level and within the culture of medicine itself to help combat clinician burnout. While organizations must improve their health care delivery models, it is also important that individual physicians not see themselves as victims of a system they cannot control.

From the Trenches

By Brian Lich, Oklahoma Well-being Champion Though we are all glad to say goodbye to 2020, there is a lot that we should be proud of as we turn to the New Year. Twelve months ago, could you imagine that we as health care workers would be called superheroes? That there would be parades for us all around the country as we took a pandemic head-on? That you would bond with physicians across the world to take on a common enemy? Have you ever felt so close to your colleagues? To your patients? Have you ever had so many patients thank you for the work that you do?

January 15, 2021

Taking Care of Ourselves and Each Other

Well-being Activities at ACP Internal Medicine Meeting 2020

There are many well-being and professional fulfillment activities to choose from this year at the ACP Internal Medicine Meeting 2020. Browse the pre-courses, scientific programs, and nonticketed sessions at the Clinical Skills Center, and design an experience best suited to your interests and needs.

Patients Before Paperwork

ACP provided comments on a the recent Stark Law and Anti-Kickback Proposed Regulations that had several burden reduction elements, including provisions that would allow clinicians to claim full financial risk exceptions/safe harbors without submitting any additional documentation requirements.

Noteworthy Resources

Core IM Podcast Interprofessional Education Series Listen as Dr. Shreya Trivedi and the Core IM team welcome home health aides, social workers, case managers, and other care team members to discuss their training, scope of practice, and what physicians should know to work on effective interprofessional teams.

New ACP Webinars

Mini Z Data Analysis Mark Linzer, MD, MACP, and Sara Poplau March 2, 1:00-2:00 p.m. ET

In the News

What medicine can learn from the fire department about team-based care By Pooja Desai; Kevin MD Blog Teamwork is sewn into the fabric of the fire department. Each firefighter and paramedic has clearly delineated responsibilities; they work efficiently, communicate well, and interface with other organizations (ambulance, police, trauma doctors, etc.) with little tension. Best of all, they have a great time doing it.

From the Trenches

Sowing Seeds and Cultivating Connections for Well-being By Tiffany Leung, MD, MPH, FACP, Honorary ACP Well-being Champion

Compounded Topical Pain Creams to Treat Localized Chronic Pain

Kidney Transplants in Patients With Lupus Nephritis

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

Vote for your favorite entry

Register now for Internal Medicine Meeting 2026 in San Francisco

ACP calls for urgent policy action on rural health

Targeted screening for patients at highest genetic risk of prostate cancer increased clinical management, radical treatment

MKSAP Quiz: 3-month history of symmetric polyarthritis

Default 90-day statin prescriptions reduced racial, income disparities in practice, trial finds

New guidance issued on cholesterol management in older patients with no history of cardiovascular disease

Put words in our mouth

Dr. Jokela talks Match Day on KevinMD

ACP offers new AI Resource Hub

Say, do you remember? | ACP Hospitalist

Platelet parsimony | ACP Hospitalist

New hospitalist hires mostly come from residency, onboarding poses challenges | ACP Hospitalist

Naloxone, opioid coprescribing increased with clinical decision support tool | ACP Hospitalist

Family-support nurse in ICU increased communication, emotional support | ACP Hospitalist

Take a quiz about the July 23 issue! | ACP Hospitalist

Sync with psych | ACP Hospitalist

Rules for consults | ACP Hospitalist

Paramedian approach to lumbar puncture increased procedure service's success rates | ACP Hospitalist

Outcomes improved with synergistic colistin plus meropenem for resistant gram-negative infections | ACP Hospitalist

Case of Ibuprofen-Induced Liver Injury | Annals of Internal Medicine: Clinical Cases

Drug-induced liver injury (DILI) resulting from nonsteroidal anti-inflammatory drugs (NSAIDs) is a rare phenomenon; however, several cases have been reported in the literature and the LiverTox database. For ibuprofen in particular, only 22 cases have been reported, and the mechanism for liver injury is unclear. In this report, we discuss a case of ibuprofen-induced liver injury to highlight the evaluation of NSAID-induced DILI, as well as the likely mechanism of injury.

Periorbital Purpura as a Presenting Sign of Hereditary Transthyretin Amyloidosis | Annals of Internal Medicine: Clinical Cases

Cardiac amyloidosis is part of a systemic process caused by extracellular deposition of misfolded protein in various tissues. Once thought to be pathognomonic for AL amyloidosis, here we describe a case of periorbital purpura as a presenting sign in a patient with hereditary transthyretin cardiac amyloidosis.

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.