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President’s Column 2020 Reflections: It is about Our People Karen DeSalvo, MD, President, SGIM My year as SGIM president has been a rewarding and stimulating time learning to represent not only the members and our interests but also to balance the expectations coming at us from all directions. As I reflect on SGIM, one of the things I love about this organization is that our people are a priority—the members, the staff, and the communities we serve. As I write this, I am closing out ...
WEB EXCLUSIVE 2020: THE NEXT LEAHP (LEADERSHIP IN HEALTH POLICY) YEAR Anders Chen, MD, MHS; Jennifer Cowart, MD; Latonya Riddle-Jones, MD; Sarah Candler, MD In 2017, SGIM launched the Leadership in Health Policy (LEAHP) program, a first-of-its kind career development initiative to train the next generation of internist health policy leaders to advocate for the Society’s core missions in clinical practice, education and research.1 As the LEAHP program opens for applications for the 2020-2021 ...
MORNING REPORT A BEWILDERING BACTEREMIA: AN EXERCISE IN CLINICAL REASONING WITH COGNITIVE AUTOPSY Ankita Tandon, DO; Francisco Alvarado, MD (presenters); Kellee L Oller, MD, FACP A 60-year-old Hispanic man with a history of insulin-dependent diabetes mellitus presented for six days of abdominal pain, nausea, and vomiting. Broadly, his symptoms can be categorized into two initial diagnostic categories: gastrointestinal etiologies or a gastrointestinal manifestation of systemic disease. The ...
PERSPECTIVE: PART I A CALL TO ACTION: SUPPORT OUR FEMALE INTERNAL MEDICINE RESIDENTS Amanda Simone, MD; Lauren Block, MD, MPH; Nancy LaVine, MD The issue of gender bias and women in medicine has become a “hot topic” in the medical field today, and rightfully so. As of 2019, women now make up more than 50% of incoming medical students; yet, female physicians are still dealing with a gender pay gap and a disparity amongst leadership positions held within healthcare institutions.1 Fewer female ...
From the Editor A Change Is Gonna Come Francine Jetton, MA Ms. Jetton ( jettonf@sgim.org ) is the director of communication & publications at the Society of General Internal Medicine. Those words hung in the air over the video call. It’s not like I wasn’t expecting it; I knew it was coming, having been part of SGIM’s COVID-19 response team that had met daily for the past two weeks. The night before, the CDC had banned group meetings of more than 50 people. Birmingham, Alabama, wasn’t ...
BEST PRACTICES ACHIEVING EQUITABLE CARE FOR YOUNG ADULTS Laura C. Hart, MD, MPH; Mariecel Pilapil, MD, MPH; Sara Mixter, MD, MPH; Jonathan Tolentino, MD, FACP, FAAP Although not always apparent, young adults—both those who are healthy and those with chronic medical conditions—constitute a uniquely vulnerable population. Young adulthood refers to the ages of approximately 18 to 26 years old and represents a critical time of social, economic, physical, and mental development. Many health behaviors ...
Best Practices/Medical Education: Part II A Clear Path Forward: Reflections on Social Determinants of Health through a Resident-Led QI Project Jonathan Salud, MD, MPH Dr. Salud (jsalud@uw.edu) is clinical instructor of medicine at the University of Washington School of Medicine, practicing in the Hospital and Consultative Medicine Program at University of Washington Medical Center. The fields of Quality Improvement (QI) and Social Determinants of Health (SDH) sometimes seem to reside in ...
From the Editor A Day in the Life Joseph Conigliaro, MD, MPH, Editor in Chief, SGIM Forum ... the newspapers of Utopia, he had long ago decided, would be terribly dull. —Arthur C. Clarke, 2001: A Space Odyssey I get my news from a smattering of sources but mostly from lead stories curated on Google’s news feed. I try to be selective and cognizant of the source of information and to include stories from legitimate sources that do not necessarily share the same views as me. The latter ...
PRESIDENT’S COLUMN ADDRESSING THE SOCIAL DETERMINANTS WITH PARTNERS AND HUMILITY Karen DeSalvo, MD, President, SGIM . . . partnership is such an important theme of the NAM report. It is also an essential component of the broad-er work we must all do to address the social determinants of health. I firmly believe that medicine, particularly academic health centers and their associated medical schools, plays a key role in addressing SDOH. However, this is not medicine’s work alone, and we should ...
HEALTH POLICY: PART I ADVOCACY FOR PATIENTS WITH VULNERABLE LEGAL STATUS: PILOTING IMMIGRATION LEGAL NAVIGATION IN PRIMARY CARE Sarah Kimball, MD; Mehar Maju; Lily Sonis, LCSW, MPH; Mara Eyllon, PhD The climate of fear created by anti-immigrant rhetoric and immigration policies that target vulnerable immigrant populations critically undermines the health and wellbeing of immigrant patients. Healthcare professionals have an ethical and professional obligation to provide care to anyone who ...
FROM THE EDITOR ADVOCACY: SGIM AND ITS MEMBERS LOUD AND CLEAR!! Joseph Conigliaro, MD, MPH, Editor in Chief, SGIM Forum SGIM members never cease to amaze me. Last fall, when I announced on GIMConnect that April would be Forum’s Advocacy Issue to coincide with the national meeting’s theme of “Courage to Lead: Equity, Engagement, and Advocacy in Turbulent Times,” I never imagined the response we would receive … Download the full article below. #Year2019 #April
Perspective: Part I After COVID Peaks: Views from Four Global Regions Tiffany I. Leung, MD, MPH, FACP, FAMIA; Yousaf Ali, MD, MS; Evelyne Bischof, MD; Agustina Sosa Belaustegui, MD; Maria G. Frank, MD, FACP Dr. Leung ( t.leung@maastrichtuniversity.nl ) is an assistant professor at the Faculty of Health, Medicine and Life Sciences and a PhD candidate at the Care and Public Health Research Institute at Maastricht University in The Netherlands. Dr. Ali ( yousaf_ali@urmc.rochester.edu ) is a professor ...
FROM THE EDITOR A GUN VIOLENCE MOONSHOT Joseph Conigliaro, MD, MPH, Editor in Chief, SGIM Forum Columbine, CO, Sandy Hook, CT, Aurora, CO, Sutherland Springs, TX, Killeen, TX, Pittsburgh, PA, Las Vegas, NV, Orlando, FL, El Paso, TX. Some of these places I’ve visited and some I’ve never heard of before. At least not before they hit the news as places where mass shootings have occurred. The Gun Violence Archive, a nonprofit research group that tracks shootings in the United States, defines ...
MEDICAL EDUCATION A MEDICAL STUDENT APPROACH TO A HEALTH POLICY AND ADVOCACY ELECTIVE Michael Luke, BE; Sara Abrahams, BA; Danielle Llanos, BA; Danielle Howell, BA; Lauren Block MD, MPH Literature suggests the majority of medical students feel they are not appropriately educated in health policy, yet there are currently no mandatory health policy curricula in medical schools. Healthcare reform training has been shown to help prepare medical students for the growing role of advocacy in the ...
FROM THE EDITOR AN APPRECIATION OF THOSE WHO MADE A DIFFERENCE Joseph Conigliaro, MD, MPH, Editor in Chief, SGIM Forum We have all lost people in our lives, and we each find our own personal ways to manage their loss and remember them. Over the last year, four of my friends and colleagues passed away: three, from my medical school class, and one with whom I was currently working. I am still of an age where my contemporaries dying is not at all usual and, therefore, not at all easy to take. ...
LEADERSHIP PROFILE/IN CONVERSATION AN INTERVIEW WITH DR. PETER BOLING—THE 2019 DISTINGUISHED PROFESSOR OF GERIATRICS Patricia Harris, MD, MS At the 2019 meeting, Dr. Peter Boling gave the annual Distinguished Professor in Geriatrics (DPG) address. We were treated to the story of his career as a home visit physician and of the development of homebased medical care over his career. The following is a postDPG interview by Dr. Harris via email, with Dr. Boling… Download the full article below. ...
Medical Education: Part I Application of One Minute Preceptor to Teaching Social Determinants of Health Frank Cacace, MD, FACP Dr. Cacace ( fcacace@northwell.edu ) is an associate professor of medicine at the Zucker School of Medicine at Hofstra Northwell and associate chief for education, Division of General Internal Medicine, Northwell Health. In this article, an adaptation of the One Minute Preceptor to teach about social determinants will be proposed. The application of the technique ...
MEDICAL EDUCATION A QUALITATIVE REPORT OF RESIDENTS’ IMPRESSIONS OF A HIGH-VALUE CARE CURRICULUM Tanya Nikiforova, MD, MS; Maggie K. Benson, MD, MS; Megan E. Hamm, PhD; Anna K. Donovan, MD, MS Nearly 30% of U.S. healthcare spending is considered wasteful and potentially avoidable, and physicians are responsible for helping curtail these costs. Internal medicine (IM) programs are mandated to train residents in high-value care (HVC), but optimal methods for teaching these concepts are not established. ...
Breadth: Part I / Perspective: Part II A Scarce Resource Lauren Block, MD, MPH Dr. Block (( lblock2@northwell.edu ) is an associate professor of medicine and science education at Zucker School of Medicine at Hofstra/Northwell in Hempstead, NY. One of the privileges of primary care is getting to know patients over time. Mr. B was a patient who brought a smile to my face whenever he called or came to see me. At 93, he lived independently, had a girlfriend, and always arrived wearing a dapper ...
ANNUAL MEETING UPDATE: PART III ATTENDING SGIM19 AS A FORMER YOUNG SCHOLAR IN GIM Joan Bosco, MD Among physicians, it is increasingly common to feel detached from patients and work, with decreasing feelings of motivation, inspiration, or purpose. From day to day, it is sometimes difficult to see the big picture, the why rather than the how or when. In particular, general internists are at high risk, with 49% of internists who responded to a 2019 Medscape survey1 reporting having experienced ...
MORNING REPORT AVOID THE PITFALLS OF AGE-BASED PRECONCEPTIONS: SUICIDE ATTEMPT IN A NONAGENARIAN Seki A. Balogun, MBBS, FACP, AGSF A 92-year-old Caucasian woman is a resident in a continuing care retirement community and was transferred to the nursing home section after acute hospitalization for recurrent right-sided malignant pleural effusion for which she had a tunnel pleural catheter inserted. Prior to this, she was in the independent living section and was independent of all basic and ...
PRESIDENT’S COLUMN A YEAR IN REVIEW Giselle Corbie-Smith, MD, MSC, President, SGIM I have been incredibly honored to serve SGIM as your president. SGIM has given me so much since I became a member in 1996, so I am grateful to have had the opportunity to give back in this way to my professional home. Over this last year, I’ve been fortunate to be surrounded by SGIM staff and leaders who have supported me and the challenging work we have undertaken. I want to express my sincere gratitude to ...
FROM THE EDITOR BEAM ME UP, SCOTTY!! Joseph Conigliaro, MD, MPH, Editor in Chief, SGIM Forum This month’s SGIM Forum is dedicated to the subject of point-of-care ultrasound (POCUS) and how internists teach and use it. I don’t know how to use an ultrasound. But I do know how to use a stethoscope! I have often thought that the stethoscope was the ultrasound of my age or at least the age of providers who were around when it was introduced. The stethoscope was invented in Paris, France, in 1816 ...
Medical Education: Part I Bedside Rounding: Rolling with Resistance Mel L. Anderson, MD; Sarita S. Warrier, MD; Attila S. Nemeth, MD; Jeremy P. Smith, MD Dr. Anderson ( Melver.Anderson@va.gov ) is associate professor of medicine, Division of Hospital Medicine, University of Colorado Department of Medicine and Hospital Medicine Section, Minneapolis VA Healthcare System. Dr. Warrier ( Sarita_Warrier@brown.edu ) is assistant professor of medicine and medical science, assistant dean of medical ...
Perspective: Part III Behavioral Health and Needs Assessment at a Homeless Shelter  Sanah Ali, MD Dr. Ali (sanah.ali@stonybrookmedicine.edu) is a second-year internal medicine resident at Stony Brook University Hospital. What does a homeless person need? A home. Chronically sheltered homeless individuals, a vulnerable and marginalized population, disproportionately suffer from preventable diseases such as metabolic syndrome. They experience high rates of psychiatric illnesses, such ...
PRESIDENT’S COLUMN BEING IN IT FOR THE LONG HAUL Giselle Corbie-Smith, MD, MSC, President, SGIM My father loves words. As my siblings and I were growing up, he gave each of us a phrase or adage that he thought we would need or would find to be a source of comfort. After I missed being valedictorian in high school by a fraction of a point in my GPA, he told me to remember, “The race is not for the swift but for the sure” … Download the full article below. #Year2019 #March
Perspective: Part II Being There Amy D. Lu, MD Dr. Lu (Amy.Lu@ucsf.edu) is a VA Quality Scholar at the San Francisco VA Medical Center and clinical instructor at the University of California, San Francisco. (Patient names and specific identifiers were changed or concealed to protect patient privacy. The views and opinions expressed in this article are those of the author and do not reflect the official position of the Department of Veterans Affairs or any agency of the U.S. government. ...
BOOK REVIEW BOOK REVIEW: ATTENDING: MEDICINE, MINDFULNESS, AND HUMANITY Elisa M. Sottile, MD, FACP I recently read Attending: Medicine, Mindfulness, and Humanity by Dr. Ronald Epstein last fall while preparing for a lecture. I had been tasked to speak to a large group of internists, specialists and trainees about restoring the joy in practice. I had just reread Epstein’s 1999 Mindful Practice. In this landmark article, he had proposed that mentoring and guidance is essential for teaching ...
BOOK REVIEW BOOK REVIEW: FRAMEWORKS FOR INTERNAL MEDICINE Avital Y. O’Glasser, MD, FACP, FHM I t gives me great excitement to introduce and review the new internal medicine textbook Frameworks for Internal Medicine by Dr. André Mansoor for the SGIM Forum audience. This incredible new book has been published by Wolters Kluwer and is available directly from the publisher as well as other sellers, including Amazon … Download the full article below. #Year2019 #March
BOOK REVIEW BOOK REVIEW: GRAPHIC REPRODUCTION Tiffany I. Leung, MD, MPH, FACP, FAMIA When I started reading Graphic Reproduction: A Comics Anthology , edited by artist Jenelle Johnson, the then news cycle in November included coverage of another book, former first lady Michelle Obama’s new memoir, Becoming . “I felt lost and alone and I felt like I failed because I didn’t know how common miscarriages were, because we don’t talk about them,” she had said in an interview … Download the ...
BOOK REVIEW BOOK REVIEW: PRESENTING YOUR CASE: A CONCISE GUIDE FOR MEDICAL STUDENTS Avital O’Glasser, MD, FACP, FHM I n the day and age of scrolling rather than flipping, I was excited to recently receive a new medical education book that I anticipate will become a staple on the shelves of internal medicine clinician educators. Dr. Clifford Packer, who has published multiple pieces in SGIM Forum about clinical vignette writing and authored a textbook on the subject … Download the full article ...
BOOK REVIEW BOOK REVIEW: TRAUMA-INFORMED HEALTHCARE APPROACHES: A GUIDE FOR PRIMARY CARE Jason Persoff, MD Traumatic experiences, ranging in scope from individual to interpersonal to community, are highly prevalent and can have long-lasting negative impacts on health. Early adversity has been shown to have a striking dose-response effect on the prevalence of diseases, ranging from depression to cardiovascular disease to lung cancer. Because aspects of health care can retraumatize survivors, ...
PRESIDENT’S COLUMN BUILDING A PHYSICIAN WORKFORCE TO ADDRESS THE SOCIAL DETERMINANTS OF HEALTH Karen DeSalvo, MD, President, SGIM Throughout this year, I plan to devote my column to cover some of the exciting work happening in the United States to address health beyond clinical excellence. I believe that understanding and addressing the social determinants of health (SDOH) to be a part of the core work we do as general internists, whether we consider ourselves predominantly clinicians, researchers, ...
PERSPECTIVE: PART II BURNOUT AS AN OCCUPATIONAL PHENOMENON: OUR CONVERSATION Tiffany I. Leung, MD, MPH, FACP, FAMIA; Gaetan Sgro, MD Inspired by The New York Times’ opinion columnists who write The Conversation, an informal and brief dialogue on important issues of the time, we had our own conversation about physician burnout. The following exchange has been lightly edited for readability and flow … Download the full article below. #Year2019
Perspective Can We Live-Stream Primary Care?: Challenges in the Adoption of eConsults and Video Visits Danielle L. Tepper, MHA; Matthew A. Weissman, MD, MBA, FAAP Ms. Tepper ( danielle.tepper@mssm.edu ) is the project coordinator for the Department of Medicine at Mount Sinai Beth Israel. Dr. Weissman ( matthew.weissman@mssm.edu ) is the site chair of medicine at Mount Sinai Beth Israel and an associate professor of internal medicine and pediatrics at the Icahn School of Medicine at Mount Sinai. ...
BEST PRACTICES: PART I CHAOS IN MEDICAL PRACTICE: AN IMPORTANT AND REMEDIABLE CONTRIBUTOR TO PHYSICIAN BURNOUT Jane B. Lemaire, MD; Diane W. Shannon, MD, MPH; Elizabeth Goelz, MD; Mark Linzer, MD, MACP The practice of medicine traditionally comprised an encounter between a physician and a patient. That practice now occurs within healthcare systems which offer a wide range of diagnosis and care options, delivered in different settings by multidisciplinary teams. Healthcare systems are now ...
Medical Education: Part II Chest Tube Management in Hospitalized Patients: An Interdisciplinary Collaborative Approach Rebecca Allyn, MD; Jeff Zoucha, MD; Marshall Miller, MD; Gerard Salame, MD; Martina King, MD; Brendan Notestein, NP; Janice Van Bockern, PA; Maria G. Frank, MD Dr. Allyn ( Rebecca.Allyn@dhha.org ); Dr. Zoucha ( jeff.zoucha@dhha.org ); Dr. Miller ( marshall.miller@dhha.org ); Dr. Salame ( Gerard.salame@dhha.org ); Dr. King ( martina.king@dhha.org ); Mr. Notestein ( Brendan. ...
PERSPECTIVE: PART I CHOOSING STORIES OVER SCREEN TIME Zachary G. Jacobs, MD According to a recent study in JAMA, 1 first-year residents in internal medicine training programs spend surprisingly little time face-to-face with their patients. Over a three-year study period at six different U.S. teaching programs, researchers found that, on average, interns spent just three hours per 24-hour period on direct patient care in the hospital … Download the full article below. #Year2019
IMPROVING CARE CLINICAL HARM REDUCTION FOR ADDICTION: A STRATEGY INTERNISTS CAN (AND DO) EMBRACE Dale Terasaki, MD MPH With the opioid epidemic raging, there are many calls from advocates and policymakers to expand access to addiction treatment as well as harm reduction services in cities around the United States. Clinicians of all stripes understand the concept of treating a disease. But fewer appreciate how medical practice aligns with the latter endeavor: reducing harm. I posit that practitioners ...
Morning Report Clinical Reasoning for a Worsening Rash: When You’re Left with the Diagnosis of Exclusion Jessica J. Dreicer, MD (Presenter); Jesse Keller, MD, and Stephanie Halvorson, MD, FACP (Discussants) Dr. Dreicer ( jd3nd@virginia.edu ) is a hospitalist and co-director of the Internal Medicine Residency Patient Safety and Quality Improvement Track at the University of Virginia Health. Dr. Keller ( kellerje@ohsu.edu ) is a dermatologist at Oregon Health & Science University (OHSU). ...
MEDICAL EDUCATION: PART I CLINICAL REASONING THROUGH PRE-OPERATIVE DYSPNEA: LISTENING TO THE PATIENT’S CLUES Katherine E. Ferguson, MD (Presenter); Avital Y. O’Glasser, MD, FACP, FHM (Discussant) A 55-year-old gentleman was referred to our hospitalist-led, pre-operative medicine clinic before paraesophageal hernia (PEH) repair. He had dysphagia, chronic reflux, and chronic progressive dyspnea with mild-moderate restriction on PFTs, attributed in part to his paraesophageal hernia… Download ...
Medical Education: Part III Clinical Teaching Champions—An Innovative Approach to Enhancing Clinical Education and the Careers of Clinician Educators Alexandra Moretti Morrison, MD; Somnath Mookherjee, MD Dr. Morrison ( randim@uw.edu ) is an assistant professor of medicine and Clinical Teaching Champion at the University of Washington School of Medicine, practicing in the hospital medicine group at Harborview Medical Center. Dr. Mookherjee ( smookh@u.washington.edu ) is associate professor ...
PERSPECTIVE CONSIDERATIONS WHEN ACQUIRING POINT-OF-CARE ULTRASOUND (POCUS) EQUIPMENT: ADVICE FOR GENERAL INTERNISTS Mike Wagner, MD, FACP First, while it is true that we are entering the brave new world of affordable, personal ultrasound machines, there is a wide range of equipment cost and functionality. The general internist should be familiar with their options before settling on one device or company. Second, one’s ultrasound equipment needs may change considerably over time, particularly ...
HEALTH POLICY: PART I CONSIDERING INNOVATIVE FUNDING FOR GRADUATE MEDICAL EDUCATION: WHAT WE HAVE TO GAIN Sarah G. Candler, MD, MPH Washington is interested in accountability for federal funds. Physicians and academic institutions need funding sources that allow trainees to meet patients where they are—both geographically and by specialty distribution. Hospitals could benefit from diversification of payers and transparency of Graduate Medical Education (GME) funding to ensure sufficient resources ...
FROM THE EDITOR CONSIDER THIS… Joseph Conigliaro, MD, MPH, Editor in Chief, SGIM Forum On September 10, 2019, the Society sent out an e-mail to the general membership soliciting applications for the new Forum editor in chief for its next three-year term, May 2020-May 2023. I know what you’re thinking. Has it been three years already? Yes, it has. For me, serving as the Forum’s editor in chief has been a rewarding and energizing experience, one that has allowed me to serve the Society and ...
BEST PRACTICES COPING WITH PEER-TO-PEER HARASSMENT AND DISCRIMINATION IN THE WORKPLACE: A PRIMER FOR HEALTHCARE PROVIDERS Quratulain Syed, MD; Nicole Redmond, MD, PhD, MPH, FACP*; Jada Bussey-Jones, MD, FACP; Eboni Price-Haywood MD, MPH, FACP; Inginia Genao, MD While physician burnout and related mental health concerns are getting increasing attention, it is crucial to examine the impact of discrimination and harassment at the workplace which are widely prevalent across disciplines, though ...
LETTER TO THE EDITOR CORRECTING THE RECORD ON MEDICARE FOR ALL David U. Himmelstein, MD Dr. Himmelstein (dhimmels@hunter.cuny.edu) is a distinguished professor at the City University of New York at Hunter College and Lecturer in Medicine at Harvard Medical School. Block and Bedell’s description of Medicare for All in the September 2019 SGIM Forum includes some important oversights, errors, and misconceptions.1 They ignore the well-documented savings on administrative costs in hospitals ...
MORNING REPORT COUGH IN A PATIENT WITH HEART FAILURE: TO B OR NOT TO B (LINES) Michelle Fleshner, MD; Steve Fox, MD; Thomas Robertson, MD; Sanjay A. Patel, MD, FACP, FHM A 50-year-old man with heart failure (HF) presents with cough and generalized malaise for two days. In a patient with a history of HF, initial diagnoses to entertain for cough and malaise include infectious and cardiopulmonary etiologies (i.e., pulmonary edema). Further history and physical exam in conjunction with point ...
TECHNOLOGY UPDATE COURAGE TO TWEET: TWITTER POWER TIPS FOR #SGIM19 Julia Holber, BA; Kaidia Pickels, MA; Bruce Rollman, MD, MPH The rise of social media use, specifically Twitter, among the medical community has extended the potential reach and influence of scientific conferences, such as SGIM’s Regional and Annual Meetings. Attendees tweeting these events can form lasting connections, gain real-time feedback, and amplify thought-provoking ideas and new research findings to an international ...
Perspective: Part III COVID-19 Reflections Laura C. Hart, MD, MPH Dr. Hart ( Laura.Hart@nationwidechildrens.org ; Twitter: @mrslcrobinson ) is assistant professor of pediatrics and adjunct assistant professor of medicine, Nationwide Children’s Hospital/The Ohio State University College of Medicine. I hit a wall today. I felt like I was doing really well with the changes that COVID-19 had brought on. Sure, we were making all sorts of clinic adjustments, but it was going to be fine because ...