Noteworthy Resources

Guidance Document: Actions and Activities that a Healthcare Organization Can Take to Support Its Physician Workforce Well-Being During COVID-19 and Beyond Prepared by the APA Committee on the Psychiatric Dimensions of Disaster, this guidance document provides practical measures that health care leaders and organizations can implement to sustainably support physician well-being.

In the News

Civility Saves Lives—The Impact and Importance of Civility in the Workplace By Joe Farmer and Penny Hurst On the Wards Blog, Australia

From the Trenches

Responding to Harassment and the Impact on Physician Wellness By Anne L. Becker, MD The elderly man approached me in the clinic hallway; pointed at my name badge; and said, “That says ‘Physician.’ You must have stolen that from someone!” As a woman physician, I am assumed to be not-a-doctor on a regular basis, and I felt a familiar swirling of emotions—confusion and disbelief, followed quickly by irritation and disgust—in response to his “joke.”

ACP Webinars

Back to Basics—Preventing Burnout, Building Trust, and Coping With the EMR Mark Linzer, MD, MACP, and Sara Poplau

July 16, 2021

Support mental health and reduce stigma

Visit the I.M.

Patients Before Paperwork

ACP Advocate Newsletter Advocacy in Action: ACP Strengthens Advocacy to Prevent Firearm Violence Amid Recurrence of Mass Shootings The American College of Physicians continues to press legislators to take action to prevent firearm violence.

Institutionalize well-being as a long-term value

Implement recommendations from the Surgeon General Advisory on Health Worker Burnout and Resignation.

From the Trenches

Opportunities to Connect: Topic: Small Feedings of the Soul: Readings and Reflections Series

Create and sustain positive work and learning environments and culture in medicine

Apply positive systems changes skills in 2 mins. or less with ACP’s unique mobile-friendly microlearning resources. Learn about Promoting Psychological Safety, Your Circles of Control and Influence, and Standing Up to Bias and Harassment.

Framing Obesity Beyond Disease: The Unintended Consequences of Not Casting a Wider Net

Paternal and Maternal Metformin Use and the Risk for Major Congenital Malformations

Feeling the Heat: Cardiovascular Consequences of Heat Exposure Under Controlled Experimental Conditions

Medicare Advantage: High Costs and Poor Protection

Strategic Allocation of a Finite Resource: Clinician Brain Power

Long COVID: The Enduring Pandemic

The Cost-Effectiveness of Prostate Cancer Screening That Incorporates Magnetic Resonance Imaging

The Heap, the Hype, the Reality: Generative Pretrained Transformer for Systematic Reviews

The More Things Change, the More They Stay the Same: Understanding the Safety of Outpatient Care

The Relationship of Sex Steroid Hormones and Clinical Outcomes Is Complex

Multitarget stool DNA tests not as cost-effective as FIT for early CRC detection

Put words in our mouth

New ACP position paper addresses ethics in long-term care

New ACP MKSAP CORE helps users demonstrate continuous learning

Stroke risk higher in Black women with history of gestational diabetes

MKSAP Quiz: Follow-up evaluation for thrombocytopenia

Surgical, medical options offered similar outcomes for women with urinary incontinence

Confirmatory testing for primary aldosteronism can misinform care

Stepping wisely for migraine relief

Preventing migraine, managing men's health, and more stories

Starting small | ACP Hospitalist

Hospital finds multiple cases of C. diff with reduced susceptibility to fidaxomicin | ACP Hospitalist

Guidance issued on providing high-value, low-carbon care | ACP Hospitalist

Forgoing fasting before PCI or angiography is safe, acceptable, meta-analysis finds | ACP Hospitalist

First rapid-acting insulin biosimilar approved | ACP Hospitalist

Finerenone is effective for heart failure with mildly reduced or preserved ejection fraction | ACP Hospitalist

Updated guidelines advise managing sedation, mobilization, sleep in ICU | ACP Hospitalist

Take a quiz about the Feb. 26 issue! | ACP Hospitalist

Studies assess effects of cardiac rehab, PT, OT on later health care use | ACP Hospitalist

Risk score accurately predicts major bleeding risk in COVID-19 patients, study finds | ACP Hospitalist

Double Right Coronary Artery Originating From Separate Ostia in an Older Female Cadaver With Cerebrovascular Disease: A Case Report | Annals of Internal Medicine: Clinical Cases

This case report presents an extraordinary finding: a double right coronary artery with each artery originating from separate ostia off the aorta. This case was discovered in the cadaver of a 76-year-old woman whose cause of death was cerebrovascular disease. We discuss the diagnostic intricacies and implications of this unique anomaly, emphasizing its rarity in reported cases, particularly in the circumstances of gender distribution and ostial origins.

Recurrent 2,8-Dihydroxyadenine Crystalline Nephropathy in Renal Allograft | Annals of Internal Medicine: Clinical Cases

Adenine phosphoribosyltransferase deficiency is a rare cause of crystalline kidney disease. We present a case of end-stage kidney disease secondary to crystal deposition from adenine phosphoribosyltransferase deficiency with immediate recurrence of the crystals after transplantation.

Insidious Spinal Brucellosis and Psoas Abscess in a 67-Year-Old Patient: A Case Report | Annals of Internal Medicine: Clinical Cases

A 67-year-old man presented with chronic low-back pain, unintentional weight loss, and intermittent fevers in the setting of a recent trip to Mexico. Imaging showed discitis and osteomyelitis, and epidural cultures confirmed brucellosis. Brucellosis is a zoonotic infection endemic to Eurasia and South America but has a low incidence in the United States. Although the vast majority of cases of vertebral osteomyelitis are due to common bacterial organisms, a thorough history can prompt earlier consideration of atypical infections. This case highlights brucellosis as an etiologic consideration in cases of unexplained osteomyelitis and how expanded history-taking can help clinicians more readily identify risk factors for less common infections.

A Case of Infected Pulmonary Sequestration in Adulthood | Annals of Internal Medicine: Clinical Cases

A 36-year-old woman was hospitalized with worsening left chest pain after a computed tomography–guided biopsy of a lung lesion a few days before admission. Four months before admission, she had been undergoing work-up for a lung mass; however, with careful review of previous imaging, she was found instead to have an infected intralobar pulmonary sequestration requiring prolonged antibiotic therapy and eventual resection. This case demonstrates an important alternative differential diagnosis to consider when evaluating masslike consolidations found in the lung bases on imaging, as well as the importance of reviewing previous imaging.

A Case of Powassan Virus Encephalitis in Massachusetts | Annals of Internal Medicine: Clinical Cases

Powassan virus (PV) is the only known North American tick-borne flavivirus, and it can cause severe neuroinvasive disease. There is no approved treatment of PV and care remains supportive. We present a case of a 76-year-old man who presented 1 month after a known tick bite with diplopia, headache, fever, confusion, and hyperreflexia. He quickly became encephalopathic, his magnetic resonance imaging examination showed cytotoxic lesions of the corpus callosum, and his serum tested positive for PV. This case highlights the importance of obtaining a tick exposure history and testing for PV serology in patients with sudden encephalitis of unknown origin.

Atypical Disseminated Zoster in a Patient With Unrecognized Severe Hypogammaglobulinemia | Annals of Internal Medicine: Clinical Cases

A 74-year-old woman with history of chronic myeloid leukemia status post matched unrelated donor allogenic hematopoietic stem cell transplant in remission for 23 years was transferred to the intensive care unit with diffuse purpuric rash, progressive lethargy, shock, and multiorgan failure. She had presented to a local hospital a few days before admission with severe epigastric pain, radiating to her chest and back. Laboratory work-up revealed multiorgan failure, cytokine storm consistent with hemophagocytic lymphohistiocytosis, and severe hypogammaglobulinemia. Despite supportive management the patient's condition deteriorated, and she died. The skin biopsy and autopsy demonstrated disseminated varicella zoster with widespread leukocytoclastic vasculitis.

Argyria in an Older Man With Rheumatoid Arthritis | Annals of Internal Medicine: Clinical Cases

An 80-year-old man was hospitalized for right lower-extremity cellulitis found to have argyria of nail beds.

Extranodal Natural Killer/T-Cell Lymphoma Masquerading as Chronic Rhinosinusitis in a Native American Man | Annals of Internal Medicine: Clinical Cases

Extranodal natural killer/T-cell lymphoma (ENKTCL) is a rare Epstein-Barr virus–associated malignancy arising from natural killer cells in nonlymphoid tissues, primarily the upper aerodigestive mucosa. It is rare in the United States but is most frequently seen among the Hispanic population. Clinically, ENKTCL often manifests with nonspecific nasopharyngeal symptoms resembling chronic rhinosinusitis (CRS), making it difficult to diagnose. The absence of standard therapy results in challenging therapeutic decisions and poor outcomes. We report a case of ENKTCL in a 67-year-old Native American, non-Hispanic man with a history of relapsing-remitting CRS.

A Perfect Storm: Vibrio Necrotizing Fasciitis During Hurricane Season in Florida | Annals of Internal Medicine: Clinical Cases

Vibrio vulnificus resides in brackish waters following tropical storms, and infections carry a 50% mortality rate. We present a 75-year-old patient with hypotension, altered mental status, pain, swelling, and erythema of the left hand following boat-related trauma after Hurricane Ian. Given concern for necrotizing fasciitis, intravenous antibiotics and fluids were initiated. Due to rapid progression, emergent surgery was required. Diagnostic testing confirmed V vulnificus. Laboratory Risk Indicator for Necrotizing Infection score was initially low-risk but increased to high-risk during hospitalization. During hurricane season, physicians must consider necrotizing fasciitis in hypotensive patients in the setting of wound exposure to seawater.

Subacute Combined Degeneration and Acute Pulmonary Embolism Caused by Nitrous Oxide–Induced Vitamin B12 Deficiency | Annals of Internal Medicine: Clinical Cases

Nitrous oxide (NO) misuse is an underrecognized cause of vitamin B12 deficiency. Patients may present with paresthesia, ataxia, cognitive and behavioral changes, macrocytic anemia, and thromboembolism. We describe a 50-year-old man with heavy NO use who presented with a 1-month history of paresthesia, unsteady gait, and neurocognitive decline and a 2-day history of dyspnea. Laboratory studies revealed macrocytic anemia and low vitamin B12. After further investigation, the patient was diagnosed with subacute combined degeneration and acute pulmonary embolism secondary to NO-induced vitamin B12 deficiency. This case highlights the importance of early recognition and treatment with vitamin B12.