Professional Fulfillment Zone

Cultivating Excellence: The Power of Coaching in Medical Education—New Webinar Is Available Now!Coaching is more than a buzzword! It is a vital skill for medical educators and leaders striving to create meaningful impact in today's fast-paced academic and clinical settings.

Patients Before Paperwork

Advocacy in Action Get Involved: Participate in Essential Advocacy Now Join more than 15,000 colleagues in the Advocates for Internal Medicine Network (AIMn) in advocating for the interests of internal medicine in Washington, DC, and across the country. The AIMn program is for ACP members interested in participating in federal advocacy. It is designed to help members engage with their federal lawmakers on policy issues important to ACP and internal medicine. Follow @AdvocatesIM

Noteworthy Resources for Well-being

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

In the News

Quality Agenda for Internal Medicine From the American College of Physicians Annals of Internal Medicine: May 2025 by Darilyn V. Moyer, Cynthia D. Smith, Shari M. Erickson, Davoren Chick, and Amir Qaseem

From the Trenches

“National Physician Burnout Study: Latest Statistics on Burnout in Healthcare and Doctor Well-Being” Burnout in medicine: When was burnout at its peak for doctors? Why are doctors so burnt out? What causes burnout in health care? Is there a National Burnout Study? From the latest episode of AMA Update, Michael Tutty, PhD, group vice president of Professional Satisfaction and Practice Sustainability at the American Medical Association.

July 18, 2025

ACP Well-being Champions: Cultivating Connections in Uncertain Times

Support mental health and reduce stigma

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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

Low-Value Care: A Multilayer Problem Requiring Multilayer Solutions

Pharmacologic Treatments in Adults With Type 2 Diabetes: Cost-Effectiveness and Comorbidity Considerations

A Salty Odyssey: A Potassium-Enriched Journey Inspired by Don Quijote

Time-Restricted Eating in Adults With Metabolic Syndrome: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 177, No 11

Background: Time-restricted eating (TRE), limiting daily dietary intake to a consistent 8 to 10 hours without mandating calorie reduction, may provide cardiometabolic benefits. Objective: To determine the effects of TRE as a lifestyle intervention combined with current standard-of-care treatments on cardiometabolic health in adults with metabolic syndrome. Design: Randomized controlled trial. (ClinicalTrials.gov: NCT04057339) Setting: Clinical research institute. Participants: Adults with metabolic syndrome including elevated fasting glucose or hemoglobin A1c (HbA1c; pharmacotherapy allowed). Intervention: Participants were randomly assigned to standard-of-care (SOC) nutritional counseling alone (SOC group) or combined with a personalized 8- to 10-hour TRE intervention (≥4-hour reduction in eating window) (TRE group) for 3 months. Timing of dietary intake was tracked in real time using the myCircadianClock smartphone application. Measurements: Primary outcomes were HbA1c, fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance, and glycemic assessments from continuous glucose monitors. Results: 108 participants from the TIMET study completed the intervention (89% of those randomly assigned; 56 women, mean baseline age, 59 years; body mass index of 31.22 kg/m2; eating window of 14.19 hours). Compared with SOC, TRE improved HbA1c by −0.10% (95% CI, −0.19% to −0.003%). Statistical outcomes were adjusted for age. There were no major adverse events. Limitation: Short duration, self-reported diet, potential for multiple elements affecting outcomes. Conclusion: Personalized 8- to 10-hour TRE is an effective practical lifestyle intervention that modestly improves glycemic regulation and may have broader benefits for cardiometabolic health in adults with metabolic syndrome on top of SOC pharmacotherapy and nutritional counseling. Primary Funding Source: National Institutes of Health.

Physician Humility: A Review and Call to Revive Virtue in Medicine

Physician virtues, including humility, are crucial for shaping a physician's identity and practice. The health care literature offers varied views on humility, and the rising call for discussing virtues as a framing for professional identity formation underscores the need for a clearer understanding of physician humility. This review aimed to develop a cohesive conceptualization of physician humility and to define how it functions in medical practice. To achieve this, a comprehensive search was done across PubMed, Ovid MEDLINE, Web of Science, Embase, ERIC, and PsycInfo, covering all records up to 30 October 2023. Articles were included if they discussed physician humility and excluded if they were unrelated to physician humility, focused on nonphysician health professionals, lacked conceptual depth, or focused solely on cultural humility. An applied thematic analysis was conducted. The results provide a synthesized conceptualization of physician humility across stances toward self, others, and the profession. The included articles identified the pivotal role of physician humility within the following 5 domains of medical practice: learning and professional growth, navigating error, uncertainty tolerance, trust and entrustment, and teamwork and communication. The authors highlight some of the intrapersonal, interpersonal, and sociocontextual challenges to cultivating and practicing physician humility. These findings highlight the importance of promoting humility in shaping physicians’ actions, thoughts, and relationships with patients, colleagues, and their profession. Integrating such virtues as humility into medical education is essential for upholding the ideals of the medical profession and cultivating moral agents who engage in self-reflection and embody the principles of exemplary physicians.

What You May Have Missed in 2023: Keeping Up With the Constant Flow of New Medical Evidence

Visual Guideline - Newer Pharmacologic Treatments in Adults With Type 2 Diabetes: A Visual Clinical Guideline From the American College of Physicians

The purpose of this visual clinical guideline is to provide a visual summary of ACP's clinical guideline, “Newer Pharmacologic Treatments in Adults With Type 2 Diabetes.” In addition, this visual clinical guideline features an interactive data visualization of findings associated with ACP's clinical recommendations for this topic.

Cardiovascular Disease Mortality Among Native Hawaiian and Pacific Islander Adults Aged 35 Years or Older, 2018 to 2022

Background: Native Hawaiian and Pacific Islander (NHPI) adults have historically been grouped with Asian adults in U.S. mortality surveillance. Starting in 2018, the 1997 race and ethnicity standards from the U.S. Office of Management and Budget were adopted by all states on death certificates, enabling national-level estimates of cardiovascular disease (CVD) mortality for NHPI adults independent of Asian adults. Objective: To describe CVD mortality among NHPI adults. Design: Race-stratified age-standardized mortality rates (ASMRs) and rate ratios were calculated using final mortality data from the National Vital Statistics System for 2018 to 2022. Setting: Fifty states and the District of Columbia. Participants: Adults aged 35 years or older at the time of death. Measurements: CVD deaths were identified from International Classification of Diseases, 10th Revision codes indicating CVD (I00 to I99) as the underlying cause of death. Results: From 2018 to 2022, 10 870 CVD deaths (72.6% from heart disease; 19.0% from cerebrovascular disease) occurred among NHPI adults. The CVD ASMR for NHPI adults (369.6 deaths per 100 000 persons [95% CI, 362.4 to 376.7]) was 1.5 times higher than for Asian adults (243.9 deaths per 100 000 persons [CI, 242.6 to 245.2]). The CVD ASMR for NHPI adults was the third highest in the country, after Black adults (558.8 deaths per 100 000 persons [CI, 557.4 to 560.3]) and White adults (423.6 deaths per 100 000 persons [CI, 423.2 to 424.1]). Limitation: Potential misclassification of underlying cause of death or race group. Conclusion: NHPI adults have a high rate of CVD mortality, which was previously masked by aggregation of the NHPI population with the Asian population. The results of this study support the need for continued disaggregation of the NHPI population in public health research and surveillance to identify opportunities for intervention. Primary Funding Source: National Institute of General Medical Sciences, National Institutes of Health.

Development and Evaluation of a Framework for Identifying and Addressing Spin for Harms in Systematic Reviews of Interventions

“Spin” refers to misleading reporting, interpretation, and extrapolation of findings in primary and secondary research (such as in systematic reviews). The study of spin primarily focuses on beneficial outcomes. The objectives of this research were threefold: first, to develop a framework for identifying spin associated with harms in systematic reviews of interventions; second, to apply the framework to a set of reviews, thereby pinpointing instances where spin may be present; and finally, to revise the spin examples, offering guidance on how spin can be rectified. The authors developed their framework through an iterative process that engaged an international group of researchers specializing in spin and reporting bias. The framework comprises 12 specific types of spin for harms, grouped by 7 categories across the 3 domains (reporting, interpretation, and extrapolation). The authors subsequently gathered instances of spin from a random sample of 100 systematic reviews of interventions. Of the 58 reviews that assessed harm and the 42 that did not, they found that 28 (48%) and 6 (14%), respectively, had at least 1 of the 12 types of spin for harms. Inappropriate extrapolation of the results and conclusions for harms to populations, interventions, outcomes, or settings not assessed in a review was the most common category of spin in 17 of 100 reviews. The authors revised the examples to remove spin, taking into consideration the context (for example, medical discipline, source population), findings for harms, and methodological limitations of the original reviews. They provide guidance for authors, peer reviewers, and editors in recognizing and rectifying or (preferably) avoiding spin, ultimately enhancing the clarity and accuracy of harms reporting in systematic review publications.

How Would You Manage This Patient With Type 2 Diabetes and Chronic Kidney Disease? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Nearly 15% of U.S. adults have diabetes; type 2 diabetes (T2D) accounts for more than 90% of cases. Approximately one third of all patients with diabetes will develop chronic kidney disease (CKD). All patients with T2D should be screened annually for CKD with both a urine albumin–creatinine ratio and an estimated glomerular filtration rate. Research into strategies to slow the worsening of CKD and reduce renal and cardiovascular morbidity in patients with T2D and CKD has evolved substantially. In 2022, a consensus statement from the American Diabetes Association and the Kidney Disease: Improving Global Outcomes recommended prioritizing the use of sodium–glucose cotransporter-2 inhibitors and metformin and included guidance for add-on therapy with glucagon-like peptide 1 receptors agonists for most patients whose first-line therapy failed. It also recommended nonsteroidal mineralocorticoid receptor antagonists for patients with hypertension that is not adequately controlled with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. Here, an endocrinologist and a nephrologist discuss the care of patients with T2D and CKD and how they would apply the consensus statement to the care of an individual patient with T2D who is unaware that he has CKD.

Hyperglycemia risk increased in COPD patients taking glucocorticoids

MKSAP Quiz: Evaluation for mild dementia

Studies consider cardiovascular risk prediction in women, all U.S. adults

Care models reduce opioid dosage in patients with chronic pain

And the winner is …

Governor-elect election results announced

AI-powered tool addresses conversations on obesity management

Social, genetic factors improve prediction of CHD risk

MKSAP Quiz: Evaluation for painless hematuria

Many stroke survivors don't follow recommendations for physical activity, study finds

Low score on LKA associated with higher patient mortality, ABIM study finds | ACP Hospitalist

Early anti-enterococcal empirical therapy may not improve survival in BSI | ACP Hospitalist

Between discharge and the next stop | ACP Hospitalist

Take a quiz about the June 11 issue! | ACP Hospitalist

Most inpatients not using hospital patient portal, study finds | ACP Hospitalist

Fend off pain, delirium, and future fractures | ACP Hospitalist

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

Acute Lower-Extremity Posterior Compartment Syndrome: A Rare Complication of Apixaban Use | Annals of Internal Medicine: Clinical Cases

Apixaban is an oral anticoagulant that directly inhibits factor Xa and is indicated for the prophylaxis and treatment of deep venous thrombosis and stroke prevention in nonvalvular atrial fibrillation. Acute lower-extremity posterior compartment syndrome is a rare complication of apixaban use. We present a 78-year-old man with significant medical morbidities taking apixaban for atrial fibrillation presenting with posttraumatic extensive hemorrhagic bullae on the left proximal pretibial region secondary to anticoagulation. We recommend that clinicians develop awareness of the potential for serious bleeding complications of anticoagulants and devise strategies to identify the need for early recognition and prompt management.

Giant Coronary Artery Aneurysm After Breast Radiation in a Patient With Congenital Coronary Arteriovenous Fistula | Annals of Internal Medicine: Clinical Cases

An 84-year-old Hispanic woman with medical history of coronary artery disease, hypertension, breast cancer, and left circumflex coronary artery ectasia with arteriovenous fistula to the coronary sinus was found with a new giant obtuse marginal 1 (OM1) saccular aneurysm measuring 8.4 × 6.5 cm on gated computed tomography angiogram 15 years after the first coronary angiogram. Coronary artery aneurysms are unusual anomalies that are encountered in 0.3% to 4.9% of patients who undergo coronary angiography. The incidence of giant coronary artery aneurysm is reported at 0.02% and we are not aware of any reports of OM1. Here, we report an extremely rare case of a OM1 giant coronary artery aneurysm.

An Interesting Case of Hypercalcemia: Intrathyroidal Parathyroid Adenoma | Annals of Internal Medicine: Clinical Cases

Hyperparathyroidism is the most common cause of hypercalcemia in the general population, with most patients presenting with mild to moderate hypercalcemia on routine bloodwork. Serum parathyroid hormone levels, followed by neck imaging studies, are helpful in diagnosing and localizing parathyroid adenomas. Ectopic parathyroid adenoma causes diagnostic challenges. Here, we present the patient case of a 65-year-old man with severe and symptomatic hypercalcemia who was found to have an intrathyroidal parathyroid adenoma, confirmed only after thyroid resection. Although imaging and laboratory results were helpful in our evaluation, pathology was the key to establishing the final diagnosis.

Culture Negative Endocarditis With Tropheryma whipplei | Annals of Internal Medicine: Clinical Cases

Tropheryma whipplei endocarditis is an increasingly recognized cause of culture negative endocarditis but is challenging to diagnose and often not accompanied by typical symptoms of Whipple disease. In this report, we describe a case of T. whipplei endocarditis and share echocardiographic images from the patient case.

Massive Idiopathic Myocardial Calcification Associated With ANK2 Mutation of Uncertain Significance | Annals of Internal Medicine: Clinical Cases

Massive myocardial calcification is a rare condition for which both diagnosis and therapy are not clearly established in the literature. Although imaging features are often nonspecific, the combination of imaging pattern and clinical history may help determine the clinical implications of myocardial calcification. Here, we report a case of massive idiopathic calcification associated with a rare heterozygous ANK2 mutation of uncertain significance. Mutations in ANK2 are linked to abnormal regulation of intracellular sodium and calcium, predisposing patients to arrhythmias, but there is no description of myocardial calcification.

A Case of Lamotrigine-Induced Inflammatory Myositis | Annals of Internal Medicine: Clinical Cases

We describe a 21-year-old woman with bipolar disorder who started taking lamotrigine 2 months ago who presented with fever and weakness. Physical examination revealed an erythematous rash over the right thenar eminence, as well as proximal muscle weakness in bilateral upper and lower extremities. Magnetic resonance imaging of the lower extremities showed patchy bilateral enhancing myositis. Right quadriceps muscle biopsy revealed inflammatory myopathy. Subsequent bone marrow biopsy demonstrated hemophagocytic lymphohistiocytosis. The patient started a prednisone taper for suspected inflammatory myositis and achieved full remission. This is one of the first descriptions of lamotrigine inducing an autoimmune response presenting as an inflammatory myositis.

Letter From the AIMCC Editors | Annals of Internal Medicine: Clinical Cases

Cavernous Sinus Syndrome: A Unique Presentation of CD5+ Diffuse Large B-Cell Lymphoma | Annals of Internal Medicine: Clinical Cases

Abstract/Background Cavernous sinus syndrome (CSS) is characterized by signs and symptoms that result from the compression and/or disruption of function of the dural venous sinus. Causes of CSS include tumors, inflammation, infection, trauma, and cavernous sinus thrombosis. Although neoplasm is one of the most common causes of CSS in a series of case analyses, CSS is an exceedingly rare initial presentation of lymphoma. Additionally, CSS is a potential cause of secondary headaches, particularly in elderly patients with concomitant neurologic deficits. Here, we discuss a patient case of de novo CD5+ diffuse large B-cell lymphoma that initially presented as CSS.

Homozygous Familial Hypobetalipoproteinemia Diagnosed in Adulthood With a New Splicing Variant of the APOB Gene | Annals of Internal Medicine: Clinical Cases

We report a case of familial hypobetalipoproteinemia presenting with severe fat malabsorption, diagnosed in adulthood, with a new splicing variant of the APOB gene.

Ciprofloxacin-Induced Crystal Nephropathy and Allergic Interstitial Nephritis: Case Report and Review of Literature | Annals of Internal Medicine: Clinical Cases

Ciprofloxacin is a commonly used antibiotic that has the potential to cause acute kidney injury (AKI) secondary to interstitial injury or vasculitis. Of all causes, allergic interstitial nephritis is the most common of ciprofloxacin-induced AKI. There have been very few case reports of crystal nephropathy resulting from ciprofloxacin. Most patients with crystal nephropathy respond well to conservative management, but some require hemodialysis and glucocorticoids treatment. We describe a patient case of a 67-year-old woman who developed AKI secondary to ciprofloxacin-induced crystal nephropathy and allergic interstitial nephritis who was successfully managed with hemodialysis and a short course of glucocorticoids.