From the Trenches

Call for Collaboration: ACP Interchapter Rituals and Traditions Series 2025–2026The ACP Well-being Champion community is cordially invited to join the next session of the Rituals and Traditions Series on January 10, 2026. This innovative series, created by WBC alumnus Dr. Mukta Panda and Tennessee Governor Dr. Daniel Ely, invites participants to explore how rituals—through shared meals, storytelling, and cultural practices—serve as pathways to understanding others' lived experiences and worldviews.

November 21, 2025

ACP Well-being Champions: Promoting Well-being Through Awareness, Advocacy, and Action“Paying attention in new ways is a very healthy and potentially healing thing to do, although, as you wi

November 20, 2020

Resources to help you thrive and navigate the way forward.

Patients Before Paperwork

ACP Advocate Newsletter highlights that affect physician well-being and professional fulfillment. ACP Urges Senate to Pass Legislation Aimed at Combating Workplace Violence in Health Care Settings As violence against health care workers continues to threaten lives, the American College of Physicians is calling for a decisive response from the U.S. Senate, which is considering vital legislation.

Noteworthy Resources

Advocacy Toolkit: Modernizing License and Credentialing Applications to Not Stigmatize Mental Health ACP Advocacy Toolkit Included in this toolkit are tools and resources that clinicians can use to advocate for organizations and state medical boards to change or remove inappropriate medical licensing and application questions that perpetuate the stigma about receiving mental health care or having a mental health diagnosis, which may result in physicians not receiving care. View here!

In the News

How Health Systems Can Improve Relationships with Their Doctors By Michael R. Rose, Robert L. Colones, and Kathleen MacDonald Harvard Business Review McLeod Health, a health system that serves patients in South Carolina and North Carolina, has worked for a decade in forging a collaborative partnership with 903 physicians. This article shares the process that McLeod Health used to achieve that alignment. By applying its approach, other health systems can reduce physician burnout and improve clinical, operational, and financial performance.

From the Trenches

Invitation to Submit Quality and Well-being Champion Posters The annual Quality and Well-being Champion Reception is a wonderful opportunity to showcase your QI or well-being initiatives and network with fellow champions. Poster presenters will have the opportunity to present their project outcomes to ACP Governance and Leadership, ACP Advance coaches, faculty, and fellow QI and Well-being Champions. The reception will take place on Friday, April 28, 2023, from 6:00 to 7:30 p.m. Pacific Time.

ACP Multimedia Education

Game Plan Refresh Series for Trained WBCs Marion McCrary, MD, FACP, and NC Well-being Champion (WBC), revisits strategies learned during your WBC training and new skills to grow your toolkit to support you and your colleagues. Logistics for Well-being Champions Watch Video

November 18, 2022

Well-being Champion Resources That Facilitate Networking and Interventions

Patients Before Paperwork

New ACP Toolkit Empowers Members to Lobby for Prior Authorization Reform Members can use the toolkit to learn about the policy landscape and take action to help advocate for reform at the state and federal levels. View Here! Keep Up to Date:

Dual Health Care System Use and Unsafe Medication Prescribing in Veterans With Dementia

Diagnosis and Management of Gout: Clinical Practice Guidelines From the American College of Physicians

Effect of a Structured Exercise Program on the Overall Burden of Major Mobility Disability Among Older Adults

Acupuncture With Electrical Stimulation as a Treatment for Severe Chronic Constipation

Variation in Assessments of Breast Density on Mammograms in Clinical Practice

Assessing the Risk for Diabetes in Patients With Unexpectedly Identified Tumors in the Adrenal Glands

Special Shoes for the Management of Knee Osteoarthritis Symptoms

Pioglitazone for Patients With Nonalcoholic Steatohepatitis and Prediabetes or Type 2 Diabetes

Tai Chi Versus Physical Therapy for Knee Osteoarthritis

Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians

Vestibular suppressants associated with higher fall risk in dizzy patients

NOACs, aspirin carry similar risks of major bleeding, intracranial hemorrhage

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Changes coming to dues cycle

ACP announces the release of the all-new ACP MKSAP℠

Brochures mailed to patients may aid deprescribing efforts, study finds

MKSAP Quiz: 3-week history of repeated coughing

SGLT-2, GLP-1 effects on cardiovascular risk differ by age

New ACP guideline on migraine prevention advises starting with monotherapy

Put words in our mouth

Fecal transplant noninferior to vancomycin for first C. diff infection, trial finds | ACP Hospitalist

Conservative oxygen therapy in the ICU does not reduce 90-day mortality, trial finds | ACP Hospitalist

Cases from Main Line Health Lankenau Medical Center | ACP Hospitalist

Augmenting protein in enteral nutrition didn't improve outcomes | ACP Hospitalist

Take a quiz about the June 4 issue! | ACP Hospitalist

Sodium plus diuretics may improve outcomes in acute decompensated heart failure | ACP Hospitalist

Setting standards for hospital at home | ACP Hospitalist

RSV, flu increase risk of secondary S. pneumoniae infection, COVID-19 doesn't, study finds | ACP Hospitalist

New COVID-19 vaccines approved for certain groups | ACP Hospitalist

Liberal RBC transfusion threshold doesn't improve quality of life in MI with anemia | ACP Hospitalist

Tics in the Small Intestine: An Unusual Case of Jejunal Diverticulitis | Annals of Internal Medicine: Clinical Cases

Small bowel (SB) diverticulosis is rare and usually has an asymptomatic presentation. Diverticular microperforations provoke inflammation and diverticulitis. Given the disease rarity, no current treatment guidelines exist. Little is known regarding malignancy-associated SB diverticulitis and screening with endoscopic procedures, capsule endoscopy, or radiographic imaging may be difficult or inadequate. In this case, we report on a 64-year-old woman who presented with abdominal pain secondary to jejunal diverticulitis, received antibiotics with radiographic disease resolution, and will undergo malignancy screening with balloon enteroscopy.

Multiple Hepatosplenic Abscesses From an Uncommon Pathogen in a Patient With Acute Promyelocytic Leukemia | Annals of Internal Medicine: Clinical Cases

We report a patient case of Magnusiomyces capitatus fungemia with multiple hepatosplenic abscesses. Magnusiomyces spp. are rare but emerging, opportunistic fungal pathogens causing potentially lethal invasive disease, especially in patients with neutropenia secondary to chemotherapy for a hematologic malignancy. Given the frequent use of echinocandins as empirical therapy for febrile neutropenia, extra caution should be exercised if culture results indicate the presence of a yeast other than Candida species.

Methotrexate-Associated Lymphoproliferative Disorder With Gingival Swelling | Annals of Internal Medicine: Clinical Cases

A 63-year-old Japanese man being treated for pemphigus vulgaris with methotrexate (MTX) presented with a fever of unknown origin. His only symptom at onset was mild gingival swelling. Suspected to have gingivitis, he was followed for 1 month. After that, he presented with cervical lymphadenopathy, dysphagia, and bicytopenia, and a diagnosis of MTX-associated lymphoproliferative disorder (MTX-LPD) was finally made by gingival biopsy. He had spontaneous remission after the withdrawal of MTX. When MTX-treated patients complain of fever and oral lesions, even if the oral lesions present as mild gingival swellings, physicians should consider MTX-LPD and perform a diagnostic biopsy.

High Radial Nerve Palsy Resulting From Massage | Annals of Internal Medicine: Clinical Cases

Nerve palsies can lead to devastating outcomes that frighten patients. The limited availability in the published literature of information regarding nerve palsies can be disconcerting to patients and primary care physicians alike. This case report identifies this mechanism of injury and follows the path of recovery. A high radial nerve palsy resulting from a deep tissue massage about the shoulder recovered in 6 to 8 weeks. With the apparent increase of massage parlors in our society, the frequency of such events may increase. By providing references regarding such injuries, clinicians can better reassure patients as to expected outcomes.

Listeria monocytogenes–Associated Acute Cholecystitis: A Case Report and Review of the Literature | Annals of Internal Medicine: Clinical Cases

People who are pregnant, immunocompromised, or elderly are at risk for listeriosis, a life-threatening condition. Although Listeria monocytogenes may be asymptomatic or limited to uncomplicated gastroenteritis in healthy adults, it can cause invasive disease such as meningitis and bacteremia in susceptible individuals. Less commonly, L monocytogenes can cause a focal site of infection such as acute cholecystitis. In the literature, previous cases of L monocytogenes–associated acute cholecystitis were treated with antibiotics either provided or held and a cholecystectomy. We present an 80-year-old man who recovered from acute cholecystitis due to L monocytogenes with appropriate antibiotic coverage and a percutaneous cholecystostomy.

Three Cases of Atypical Cutaneous Ovarian Metastases: A Single-Center Case Series | Annals of Internal Medicine: Clinical Cases

Ovarian cancer rarely metastasizes to the skin, but when cutaneous metastases occur, the typical location is within the umbilicus, commonly known as a Sister Mary Joseph nodule. Extraabdominal cutaneous metastases from ovarian cancer are extremely rare. Here, we report a series of 3 patient cases at a single institution who presented with extraabdominal cutaneous ovarian metastases. We discuss the potential mechanisms for cutaneous involvement as well as histopathology, treatments, and outcomes in patients with extraabdominal cutaneous ovarian cancer metastases.

Rosai-Dorfman Disease Presenting as Massive Mediastinal Lymphadenopathy in an Elderly Man | Annals of Internal Medicine: Clinical Cases

We present a patient case of a 73-year-old man with new-onset substernal chest pain and B symptoms, found on computed tomography imaging to have massive mediastinal lymphadenopathy of more than 6 cm. Positron emission tomography imaging revealed fluorodeoxyglucose-avid nodes further extending to the axillary, abdominal, and inguinal regions. After a broad patient work-up for infectious, malignant, and rheumatic causes, he was ultimately diagnosed with Rosai-Dorfman disease, a rare histiocytic neoplasm, by excisional lymph node biopsy.

Physical Examination Manifestations of Aortic Insufficiency | Annals of Internal Medicine: Clinical Cases

The eponyms of aortic regurgitation are well recognized, yet their diagnostic accuracy remains poor. Nevertheless, they remain part of the medical nomenclature, highlight the importance of the physical examination, and provide a historical lens to a disease in the age before more modern technology.

Skeletal Fluorosis: “Huffing” of Inhalant Computer Cleaning Fluid | Annals of Internal Medicine: Clinical Cases

Skeletal fluorosis is a disorder characterized by the deposition of fluoride within the bones. It is a rare presentation in the United States since the administration of sodium fluoride for the treatment of osteoporosis was discontinued several years ago. We report an adult woman manifesting skeletal fluorosis involving both axial and appendicular bones secondary to “huffing” (inhalation) of various commercial electronic cleaning products containing 1,1 difluoroethane. It is important to be alert to the presence of this disorder in patients abusing inhalants to prevent bone deformities, fragility fractures, and consequential morbidities.

Hepatic Encephalopathy in Osler-Weber-Rendu Syndrome | Annals of Internal Medicine: Clinical Cases

Hereditary hemorrhagic telangiectasia or Osler-Weber-Rendu syndrome is a rare condition that leads to multiple vascular malformations. We describe the interesting patient case of a woman with recurrent epistaxis secondary to Osler-Weber-Rendu syndrome, who presented with confusion, and was ultimately found to have a hepatic arteriovenous malformation leading to hepatic encephalopathy. Computed tomography angiography images are provided, which highlight the extensive hepatic arterioportal shunting that caused elevated serum ammonia levels in the setting of gastrointestinal breakdown of blood products.