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The collagen vascular diseases can be challenging for the internist and are associated with higher utilization of resources and less favorable outcomes among patients admitted to the inpatient medicine services.1 In this context, the acquisition of proficiency in recognizing a range of disease manifestations, common and uncommon, and familiarity with the appropriate therapeutic interventions are critical skills to be enhanced.2 In this report, we highlight the challenging diagnostic and therapeutic predicament, centered around daily high spiking fevers, of an enigmatic patient whose hospital course achieved a favorable outcome when the etiology of the fever was reformulated and managed in a novel manner.

Cardiac tumors have generally been considered to be rare. They are often found incidentally, as they tend to remain clinically silent, but they can sometimes present with symptoms secondary to obstruction, embolization, or invasion of the myocardium. Most cardiac tumors are secondary tumors from metastases, with primary cardiac tumors constituting approximately 15% of all cardiac tumors.1 Although melanoma and pleural mesothelioma often have cardiac involvement, the most common cancers to be identified in cardiac metastases are lung cancer (36%-39%), breast cancer (10%-12%), and hematologic cancers (10%-21%).

There is no longer any serious doubt that what each of us does in our daily lives profoundly affects our short- and long-term health and quality of life. An overwhelming body of scientific and medical literature supports this idea. But are we really utilizing this evidence to help achieve betterhealth and quality of life for our patients and in our own lives?

The American Board of Internal Medicine (ABIM) is the largest of 24 certifying boards recognized by the American Board of Medical Specialties (ABMS) and currently certifies approximately 25% of all physicians in the United States.1 The ABIM was founded in 1936, and in December of that year offered its first certifying written examination in Internal Medicine. In later years, the ABIM offered certifying examinations in various subspecialties of medicine. Since its foundation, the mission of the ABIM has been “to enhance the quality of health care by certifying internists who demonstrate the knowledge, skills and attitudes essential for excellent patient care.”1 In particular, from its beginning, the ABIM strove to reassure the public that a board-certified internist is a well-trained and competent internist.

GJ is a 79-year-old woman with hypertension, diabetes, osteoporosis, depression, and New York Heart Association class II heart failure with a left ventricular ejection fraction of 30%. She is a potential candidate for an implantable cardioverter-defibrillator (ICD), and you would like to discuss this with her using evidence from a clinical trial. Which of the following statistics would be most helpful in explaining the possible survival benefit of an ICD?

Use of bridging anticoagulation has been shown to be harmful and without benefit in warfarin-treated patients with atrial fibrillation. We performed a quasi-experimental interrupted time series analysis between 2010 and 2017 in the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) collaborative before and after the BRIDGE trial publication (July 2015). Predicted use of bridging at the end of the study period was calculated with and without the effect of the BRIDGE trial after adjustment for patient-level clustering.

In 2004, the Association of American Medical Colleges defined underrepresented in medicine as “racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.1” The population of the United States is composed of 30% underrepresented minorities, but the current physician workforce identified as underrepresented minorities is <10%.2 Underrepresented minority physicians are more likely to practice in underserved areas and care for patients in their own ethnic groups who are on Medicaid, uninsured, and of poorer health status, thus offering the potential to impact health outcomes for underprivileged populations.

A fundamental issue in biomedical research is how we prove a therapy is effective. When considering medications intended to improve objective endpoints such as mortality, the randomized, blinded, placebo control trial is the standard. There is less agreement when it comes to procedural interventions intended to improve subjective endpoints such as pain, dyspnea, or angina. Recent trials evaluating the efficacy of 2 widely accepted practices make the case that the comparison of procedural interventions with sham controls is not only ethically permissible, but should be the expected standard prior to widespread uptake.

Prior to World War I, most US physicians were general practitioners.1 A smaller number considered themselves to be ‘specialists.’ Specialties were not clearly defined. Specialists may or may not have had special training in their specialty. The public had no way to determine what skills a physician might have.

In April 2018, Barbara Bush, champion for universal literacy and former First Lady of the United States, died at the age of 92 after a prolonged illness. Two days prior, a family spokesperson announced that she had “decided not to seek additional medical treatment and [would] instead focus on comfort care.” We analyzed Google Trends data to assess whether this announcement generated public curiosity regarding the phrase ‘comfort care.’ Google searches for the phrase ‘what is comfort care?’ spiked immediately after the April 15 announcement, exceeding the prior year’s search frequency by nearly fourfold (Figure).