Journal of General Internal Medicine最新文献

{"title":"Progressive Multifocal Leukoencephalopathy Arising in HIV-Negative Idiopathic CD4+ Lymphocytopenia: A Multidisciplinary Case.","authors":"Madeleine Davis, Christina J Dietz, Christopher Brooks, Cole A Harrington, Carlos Malvestutto, Kaitlyn Greiner","doi":"10.1007/s11606-026-10874-w","DOIUrl":"https://doi.org/10.1007/s11606-026-10874-w","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in H-1B Visa Certifications Among Physicians in the USA, 2016-2024.","authors":"Arjun K Venkatesh, Olga D Reykhart, Benjamin Mba, Steven Huot, Craig Rothenberg","doi":"10.1007/s11606-026-10942-1","DOIUrl":"https://doi.org/10.1007/s11606-026-10942-1","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Illusion of Inaction: Lessons from Medicare Physician Payment Reform.","authors":"Tracey L Henry","doi":"10.1007/s11606-026-10933-2","DOIUrl":"https://doi.org/10.1007/s11606-026-10933-2","url":null,"abstract":"<p><p>In July 2026, the Centers for Medicare & Medicaid Services released its 2027 Medicare Physician Fee Schedule proposed rule, once again placing physician payment at the center of a familiar policy debate. Despite broad recognition that the current Medicare physician payment system is unstable, meaningful reform has repeatedly failed to materialize. Drawing upon my experience as a Robert Wood Johnson Foundation Health Policy Fellow serving on the U.S. Senate Finance Committee, this perspective examines the disconnect between widespread agreement about the need for reform and the political, fiscal, and procedural realities that impede legislative action. Ultimately, lasting reform will require moving beyond temporary fixes and toward a more predictable and sustainable payment system.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discontinuation of a Language-Concordant Phone Line and Its Impact on Access and Care Quality.","authors":"Sahoko H Little, Michael Amano","doi":"10.1007/s11606-026-10941-2","DOIUrl":"https://doi.org/10.1007/s11606-026-10941-2","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Ambulatory Patient Experience with Ambient Artificial Intelligence Scribes: A Qualitative Study.","authors":"Oliver T Nguyen, Majid Afshar, Michael A Jaeb, Mary Ryan Baumann, Felice Resnik, Anne Gravel Sullivan, Graham Wills, Jason Dambach, Leigh A Mrotek, Mariah Quinn, Kirsten Abramson, Peter Kleinschmidt, Thomas B Brazelton, Margaret A Leaf, Heidt Twedt, Brian Patterson, Frank Liao, Stacy Rasmussen, Elizabeth S Burnside, Douglas A Wiegmann, Joel E Gordon","doi":"10.1007/s11606-026-10931-4","DOIUrl":"https://doi.org/10.1007/s11606-026-10931-4","url":null,"abstract":"<p><strong>Objective: </strong>The effect of ambient artificial intelligence (AI) scribes on patient experience remains understudied and has been largely limited to closed-ended surveys. Qualitative studies are needed to more fully explore how ambient AI scribes influence patient experience. The aim of this study was to explore how ambient AI scribes influence the patient experience and to identify factors that improve patients' comfort with these tools.</p><p><strong>Materials and methods: </strong>We conducted a qualitative study using a semi-structured interview guide that captured key patient experience domains from a literature review. We recruited patients from numerous ambulatory specialties (e.g., dermatology, primary care) whose clinicians were participating in a pragmatic randomized clinical trial of an ambient AI scribe implementation at an academic medical center. We deductively and inductively drew patterns in patients' reported experiences and the factors that contributed to patients' comfort with these tools.</p><p><strong>Results: </strong>Twenty patients were included in our sample before thematic saturation occurred. Patients reported improvements in patient experience through increased respect for patients' preferences (e.g., fewer distractions), improved thoroughness of visit notes, and increased time spent answering patients' questions. Factors influencing comfort included demographic factors (e.g., exposure to similar technologies), lack of saliency of the device, lack of privacy-related concerns, positive pre-existing patient-clinician relationships, and anticipated benefits to care.</p><p><strong>Conclusion: </strong>Ambient AI scribes may improve the patient experience through improved patient-clinician verbal, non-verbal, and written communication. These findings contribute to our understanding how these tools shape the patient experience.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Do No Harm: Moral Distress and the Attack on DEI Initiatives.","authors":"Alia Chisty, Megan McNamara, Amy H Farkas, Anne Cioletti, Rakhee Bhayani, Jennifer Koch","doi":"10.1007/s11606-026-10938-x","DOIUrl":"https://doi.org/10.1007/s11606-026-10938-x","url":null,"abstract":"<p><p>Since January 2025, several executive orders have been issued that aim to dismantle diversity, equity, and inclusion (DEI) initiatives in public and private institutions and national medical education accreditation agencies. Many of the DEI initiatives were developed to address existing healthcare inequities, and as a result, the executive orders have had a profound impact on physicians, patients, and medical educators. Physicians may be experiencing moral distress due to the conflict between their ethical responsibility to patients and learners and institutional compliance with anti-DEI directives. In this paper, the authors will explore the concept of moral distress and propose evidence-based strategies for addressing moral distress in healthcare settings. They will share their personal viewpoints and suggest individual and organizational strategies to approach moral distress related to anti-DEI efforts.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-Related Differences in Clinician Communication About Colorectal Cancer Screening in the USA.","authors":"Jordan Baeker Bispo, Priti Bandi, Ahmedin Jemal, Farhad Islami","doi":"10.1007/s11606-026-10854-0","DOIUrl":"https://doi.org/10.1007/s11606-026-10854-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Low Breast Cancer Screening Rates by Resident Physicians.","authors":"Saul N Weingart, Katrina S Kufer, Meghan I Short, Joseph Gillis, Kinjalika Sathi, Prianka Chawla, Kimberly Schelling, Kristin T L Huang, Julie Tishler","doi":"10.1007/s11606-026-10899-1","DOIUrl":"https://doi.org/10.1007/s11606-026-10899-1","url":null,"abstract":"<p><strong>Background: </strong>While research has shown that medical residents often achieve poorer cancer screening rates than faculty in the same practice, residents' disadvantages in experience and continuity may be overcome in high-functioning primary care practices. To explore this observation, we compared breast cancer screening rates of resident and faculty physicians at an academic primary care practice with robust practice support.</p><p><strong>Methods: </strong>We measured breast cancer screening compliance in CY2025 using tools embedded in EPIC. Patients were considered compliant if they were women age 40-74 with a mammogram within 2 years and no disqualifying characteristics. We abstracted patient data from the electronic medical record and collected physician data on gender, language facility, and years in practice. We compared breast cancer screening rates by physician type in bivariate and multivariable logistic regression models.</p><p><strong>Results: </strong>Resident patients comprised 1024 (12%) of the 8825 patients eligible for breast cancer screening. Faculty panels included a higher percentage of patients who were white, English speakers, on commercial insurance, and with more medical comorbidities. The resident panel had more patients with serious mental illness and fewer primary care encounters. Faculty physician exceeded resident performance overall (83% vs. 66%, p < 0.001). The odds ratio of a resident patient having up-to-date breast cancer screening was 0.41 (95% confidence interval 0.35-0.47) in the unadjusted model. The adjusted odds ratios improved from 0.5 (0.40-0.62) in model 1 (patient sociodemographic only) to 0.59 (0.48-0.74) in model 2 (clinical and utilization variables) to 0.73 (0.54-0.98) in model 3 (physician attributes).</p><p><strong>Conclusion: </strong>In a teaching practice with a robust primary care infrastructure, disparities in breast cancer screening between faculty and resident panels improved with rigorous adjustment. However, residency training programs may need to be redesigned to eliminate remaining disparities in care.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare Providers are Less Likely to Ask About and Advise Cessation for Non-Cigarette Tobacco Products: NSDUH 2021-2023.","authors":"Lauren R Pacek, Min-Jeong Yang, Melissa Mercincavage, Monica J Gilles, Kimberly Jordan-Casarona, Nicolette E Garthe, Cristine D Delnevo, Michael B Steinberg","doi":"10.1007/s11606-026-10925-2","DOIUrl":"https://doi.org/10.1007/s11606-026-10925-2","url":null,"abstract":"<p><strong>Background: </strong>Tobacco use assessment during clinical encounters is often suboptimal and has focused predominantly on cigarette smoking, to the exclusion of non-cigarette tobacco use. Current estimates of assessing non-cigarette tobacco use are needed.</p><p><strong>Objective: </strong>Evaluate differences in being asked about tobacco use and advice to quit by healthcare providers among exclusive cigarette and non-cigarette tobacco product users.</p><p><strong>Design and participants: </strong>Epidemiological study utilizing adult data from the 2021-2023 National Survey on Drug Use and Health (n = 139,524). Among exclusive cigarette, cigar, smokeless tobacco, e-cigarette, and multiple tobacco product (MTP) users, we evaluated the prevalence of being asked about tobacco use being advised to quit by healthcare providers. We examined correlates of both outcomes.</p><p><strong>Main measures: </strong>Being asked about tobacco use and receiving advice to quit by a healthcare provider during the past year.</p><p><strong>Key results: </strong>Fewer people who used cigars (74.3%; p = 0.040), smokeless tobacco (72.5%; p = 0.007), and e-cigarettes (73.2%; p < 0.001) were asked about tobacco use, versus cigarette smokers (78.9%). Among those asked about tobacco use, 77.1% of cigarette smokers were advised to quit, versus people who used cigars (25.4%; p < 0.001), smokeless tobacco (46.0%; p < 0.001), e-cigarettes (0.5%; p < 0.001), and MTPs (65.4%; p < 0.001). Correlates of being Asked and Advised varied based by tobacco product. Overall, more (e.g., ≥ 6) healthcare appointments (Ask: aOR = 1.51, 95% CI = 1.22-1.87; Advise: aOR = 1.50, 95% CI = 1.14-1.97), having a lifetime chronic health condition (Ask: aOR = 1.71, 95% CI = 1.47-2.00), and older age (e.g., ≥ 50; Advise: aOR = 3.80, 95% CI = 2.96-4.89) were associated with being asked about and advised to quit tobacco use.</p><p><strong>Conclusions: </strong>Non-cigarette product users were less likely than people who smoked cigarettes to be asked about or advised to quit tobacco use. Findings can inform clinical policies to help patients quit non-cigarette tobacco products and highlight the need for educational efforts and intervention development.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of Informal Medical Consultations via Digital Platforms Among Medical Students and Physicians: A Cross-Sectional Survey.","authors":"Kudret Selki, Mustafa Enes Demirel, Mustafa Boğan, Melek Karaduman, Havva Beyza Ertunç, Yasin Bozkurt, Ceren Akkaya, Ömer Akif Öztürk","doi":"10.1007/s11606-026-10944-z","DOIUrl":"https://doi.org/10.1007/s11606-026-10944-z","url":null,"abstract":"<p><strong>Introduction: </strong>Informal medical consultations via phone and messaging apps are increasingly common. Though perceived as practical, they may create stress and blur professional boundaries. This study evaluated the frequency and characteristics of these requests and their impact on occupational well-being.</p><p><strong>Methods: </strong>This cross-sectional, questionnaire-based study included 191 medical students and physicians. The questionnaire assessed the frequency and characteristics of informal medical consultation requests received within the previous week, their perceived impact on work-life balance, stress/anxiety, perceived boundary violation, and response behaviors. A modified version of the Mini-Z 2.0 instrument was used to assess domains such as stress, workload, and job satisfaction. A study-specific composite total occupational well-being score was calculated, with higher scores indicating better occupational well-being. Univariable and multivariable linear regression analyses were performed to identify factors associated with the Mini-Z total score.</p><p><strong>Results: </strong>Of the 191 participants, 29 (15.2%) reported receiving no requests, 140 (73.3%) reported 1-5 requests, and 22 (11.5%) reported ≥ 6 requests in the previous week. Requests were most commonly delivered via WhatsApp or similar applications (60.7%) and were most often initiated by family members or relatives (70.7%). Most participants reported that the requests were unrelated to their own specialty (80.1%) and mostly non-urgent (98.4%). Perceived stress/anxiety and boundary violation increased significantly according to request frequency (p = 0.027 and p = 0.021, respectively), whereas modified Mini-Z total scores did not (p = 0.528). In multivariable analysis, responding \"depending on the situation\" or \"did not respond\" was independently associated with lower modified Mini-Z total scores (B = -2.55; 95% CI -4.72 to -0.38; p = 0.022).</p><p><strong>Conclusions: </strong>Informal medical consultation requests through phone calls and messaging applications are common and, although mostly non-urgent, may generate stress and perceived boundary violation. Their impact on occupational well-being may depend less on request frequency itself than on how these requests are experienced and managed.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}