Journal of General Internal Medicine最新文献

{"title":"Can ChatGPT Identify Diagnostic Uncertainty Upon Admission?","authors":"Jorge A Rodriguez, Marie Leeson, Savanna Plombon, Abhishek Goyal, Anuj K Dalal","doi":"10.1007/s11606-025-09752-8","DOIUrl":"https://doi.org/10.1007/s11606-025-09752-8","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000699","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":"COVID-19 Pandemic-induced Healthcare Disruption and Chronic Kidney Disease Progression.","authors":"Richard Liu, Rahul Abraham, Sarah E Conderino, Rania Kanchi, Saul B Blecker, John A Dodson, Lorna E Thorpe, David M Charytan, Mara A McAdams-DeMarco, Wenbo Wu","doi":"10.1007/s11606-025-09832-9","DOIUrl":"https://doi.org/10.1007/s11606-025-09832-9","url":null,"abstract":"<p><strong>Introduction: </strong>The coronavirus disease 2019 (COVID-19) pandemic caused unprecedented disruptions to healthcare systems worldwide, significantly affecting patients with chronic kidney disease (CKD). In this study, we evaluated the impact of the pandemic on healthcare-seeking behavior and CKD progression among patients in New York City.</p><p><strong>Methods: </strong>Using electronic health records from PCORnet's INSIGHT Clinical Research Network, we conducted a retrospective cohort study focused on 84,062 patients with CKD aged 50 years or older with multiple chronic conditions seen between 2017 and 2022. Patients were identified using pre-pandemic CKD diagnostic codes, and confirmed by estimated glomerular filtration rate (eGFR) measurements. Care disruption was defined as receiving fewer visits than recommended by Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. We used linear mixed-effects models to estimate annual eGFR changes and analyze trends in care visits stratified by CKD stage and care disruption.</p><p><strong>Results: </strong>The study cohort had a mean age of 75.8 years, 43.2% were male, and mean pre-pandemic eGFR was 51.1 mL/min/1.73 m². Care visits declined sharply in 2020 across patients at all but the end stage, with incomplete recovery by 2022. Patients with adequate pre-pandemic care maintained their visits above KDIGO levels, while those with inadequate care increased visits during the pandemic. Pronounced eGFR decline occurred in 2020 (10.6%), with slower declines observed thereafter.</p><p><strong>Conclusion: </strong>The COVID-19 pandemic disrupted CKD care, potentially leading to reduced healthcare-seeking behavior and accelerated kidney function decline in 2020. Slower decline post-2020 may reflect improved healthcare utilization, better medication adherence, and new therapies, and other factors.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992504","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":"Medical Students' Attitudes and Experiences Regarding Persuasion of Patients by Physicians: Clarifying the Ethics of Shared Decision Making.","authors":"John Muckler, James C Thomas, Laura Shinkunas, Lauris C Kaldjian","doi":"10.1007/s11606-025-09807-w","DOIUrl":"https://doi.org/10.1007/s11606-025-09807-w","url":null,"abstract":"<p><strong>Background: </strong>Ethical principles of autonomy and beneficence guide clinical decision making. Little is known about how clinicians prioritize these principles and integrate them with virtue ethics when assessing the ethics of persuasion.</p><p><strong>Objective: </strong>Survey medical students about their attitudes and experiences regarding the use of persuasion by physicians in shared decision making.</p><p><strong>Design: </strong>Cross-sectional, on-line survey.</p><p><strong>Participants: </strong>Pre-clinical and clinical medical students at one US medical school.</p><p><strong>Main measures: </strong>Survey instrument contained 31 items including a three-part clinical vignette, attitudes toward persuasion and ethical principles, experiences observing or participating in persuasion, and demographic information. Bivariate and multivariable analyses were performed, including LASSO regression using a 30-point persuasion score derived from six items.</p><p><strong>Key results: </strong>237 students completed the survey (45% response rate). In general, 55.7% supported persuasion by physicians for the good of the patient's health. Nearly half supported persuasion for an at-risk cardiovascular patient who declines recommendations for walking or statin treatment; 64.1% supported persuasion for a patient with myocardial infarction who wants to leave the hospital against medical advice. While 70.0% believed persuasion is appropriate because it promotes beneficence and nonmaleficence, 16.9% believed persuasion is inappropriate because it disrespects patient autonomy. Most students (81.0%) had seen a good physician role model for persuasion, and 38.0% had willingly participated in persuasion. LASSO regression identified four items contributing positively to the persuasion score (belief that persuasion promotes beneficence/nonmaleficence, observation of a good role model, experience participating in persuasion, male gender) and two negatively (belief that persuasion disrespects patient autonomy, observation of inappropriate use of persuasion).</p><p><strong>Conclusions: </strong>Medical students vary in attitudes toward persuasion of patients by physicians, and variations are associated with differences in ethical beliefs, clinical experiences, and gender. Education regarding the use of persuasion should address ethical justification, experience, and role-modeling-which can be encompassed by virtue ethics.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992545","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":"Hospitalists Caring for Behavioral Health Inpatients: A Hybrid Consultation Model.","authors":"Kimberly Bloom-Feshbach, Rebecca E Berger, Arthur T Evans, Margaret L McNairy, Leonardo V Lopez, Sharon J Parish","doi":"10.1007/s11606-025-09725-x","DOIUrl":"https://doi.org/10.1007/s11606-025-09725-x","url":null,"abstract":"<p><strong>Background: </strong>There is no established best practice for optimal medical consultant care to address the medical needs of psychiatric inpatients at a behavioral health center (BHC).</p><p><strong>Aim: </strong>To evaluate the feasibility and acceptability of a hybrid on-site and virtual model of internal medicine consultative care in a BHC.</p><p><strong>Setting and participants: </strong>To provide continuous medical consultation availability for 233 patients in a BHC, 9 internal medicine hospitalists from the affiliated academic medical center joined 1 full-time internist and 21 medical nurse practitioners, supporting 34 psychiatry providers.</p><p><strong>Program description: </strong>Hospitalists performed medical evaluation prior to electroconvulsive and ketamine therapies, hybrid on-site and remote consultation for acute concerns, test results, medication effects, and chronic diseases, electrocardiogram review, and pre-admission assessments.</p><p><strong>Program evaluation: </strong>BHC faculty were anonymously surveyed. 8/8 hospitalists and 11/34 psychiatrists responded. Qualitative data were coded and thematically analyzed. Psychiatrists appreciated hospitalists' expertise, communication, and collaborative problem-solving. Hospitalists found meaning in developing new clinical expertise and caring for vulnerable patients. Hospitalists credited the hybrid role with enhancing work-life integration. Challenges included handoffs, delineation of responsibilities, and virtual work impacting team cohesion.</p><p><strong>Discussion: </strong>A hybrid consultation model allows hospitalists and psychiatrists to collaboratively care for BHC inpatients with professionally and personally rewarding work.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992577","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":"Is Physical Exam a Lost Art? A Resident's Perspective.","authors":"Mohammed Ayyad","doi":"10.1007/s11606-025-09756-4","DOIUrl":"https://doi.org/10.1007/s11606-025-09756-4","url":null,"abstract":"<p><p>The word clinical derives from the Greek klinikos, meaning \"at the bedside, reflecting medicine's roots in human observation and presence. While a detailed history is foundational, a thoughtful physical examination remains critical for guiding diagnosis and comprehensive care. Yet modern clinical practice, driven by time constraints and reliance on technological advancements, has reduced the physical exam to a perfunctory ritual. Bedside maneuvers such as orthostatic vitals, the Dix-Hallpike maneuver, and jugular venous pressure assessment are becoming obsolete, despite their value in bedside competence and diagnostic reasoning. This perspective presents four clinical vignettes in which physical exam findings led to early recognition of pathology, ranging from acute mitral regurgitation and intra-abdominal hemorrhage to pancreatitis and undiagnosed aortic stenosis. In each case, the bedside exam altered diagnostic strategy and directly impacted patient outcomes. Beyond diagnostics, the physical exam sharpens clinical intuition and deepens patient-physician trust. For trainees, it is a critical educational experience that fosters pattern recognition, diagnostic autonomy, and clinical confidence. Over-reliance on technology risks creating clinicians who struggle to synthesize findings without bedside context. The physical exam remains a daily exercise in presence, discernment, and diagnostic clarity. It reinforces patient connection, promotes cost-effective care, and serves as a formative training ground for the next generation of physicians. Preserving this practice is not nostalgic; it is necessary for safeguarding the art and accuracy of medicine in a technologically advanced but human-centered profession.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000762","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":"Screening Mammography Utilization among Transgender and Gender Diverse Individuals: Insights from a Large Single Institution Center.","authors":"Nithya Krishnamurthy, Ethan Ravetch, Subha Karim, Joshua D Safer","doi":"10.1007/s11606-025-09824-9","DOIUrl":"https://doi.org/10.1007/s11606-025-09824-9","url":null,"abstract":"<p><strong>Background: </strong>Few consensus guidelines exist regarding screening mammography recommendations for transgender and gender diverse (TGD) individuals.</p><p><strong>Objective: </strong>Our study aimed to assess the utilization of screening mammograms in a large cohort of TGD individuals at a single institution and the factors influencing mammogram uptake.</p><p><strong>Design: </strong>Retrospective cross-sectional study.</p><p><strong>Participants: </strong>800 TGD individuals actively engaged in care at a transgender medicine and surgery urban center.</p><p><strong>Main measures: </strong>We conducted a retrospective analysis of a database of TGD patients (N = 4052) actively engaged in gender-affirming care in a specialized center for transgender health in a large urban healthcare system. We included all individuals who were age 40 or older at the time of data collection (N = 800) and conducted chart reviews on use of screening mammography and results.</p><p><strong>Key results: </strong>Of the 800 TGD individuals over age 40, 532 were recorded male at birth, and 268 were recorded female at birth. Among those aged 50 and above, 136 out of 382 (36%) had a screening mammogram, whereas among those aged 40-49 years old, 72 out of 418 (17%) had a screening mammogram. Twenty-five percent (28/88) of those who underwent chest masculinization surgery had a screening mammogram, while 34.2% (94/275) of those who underwent chest feminizing surgery had a screening mammogram. Twenty-one out of the 208 (10%) of mammograms performed had a BI-RADS category greater than or equal to 3 or greater on diagnostic mammograms.</p><p><strong>Conclusions: </strong>In our single-center large cohort of TGD individuals, we found a low percentage of screening mammography use. In those 50 and above, an age cohort with clear guidelines for screening, only 36% had any screening mammogram, and Hispanic ethnicity, chest masculinizing, and chest feminizing surgery were significant predictors for getting any screening mammograms. Our findings suggest the need for increased compliance with screening guidelines in TGD individuals, consistent with those for cisgender women.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992619","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":"Comparing Work Experiences of Internal Medicine Physicians in Veterans Affairs and Non-Federal Hospitals: A National Survey.","authors":"Sarah K Gualano, M Todd Greene, Nathan Houchens, Richard J Schildhouse, David Ratz, Karen E Fowler, Sanjay Saint","doi":"10.1007/s11606-025-09797-9","DOIUrl":"https://doi.org/10.1007/s11606-025-09797-9","url":null,"abstract":"<p><strong>Background: </strong>Fewer physicians are pursuing careers in internal medicine due to workload, work-life integration, and documentation pressures. Integrated health systems like the Department of Veterans Affairs (VA) offer an alternative work model that may affect physicians' experiences differently compared to the private sector.</p><p><strong>Objective: </strong>To examine and compare the self-reported workplace experiences among VA and non-VA internists.</p><p><strong>Design: </strong>A cross-sectional survey.</p><p><strong>Participants: </strong>A random sample of 1421 internal medicine physicians across the USA, with oversampling of hospitalists and VA physicians. Surveys were completed between June 2023 and May 2024. Of the total of 629 (44.3%) physicians responding, 618 indicated working in a VA or non-VA hospital.</p><p><strong>Main measures: </strong>Our primary outcomes were several professional environment factors. Multivariable logistic regression was used to assess relationships between professional environment factors and practicing at the VA (vs. non-VA). All models were adjusted for sex, race, and years practicing as an internist.</p><p><strong>Key points: </strong>The odds of time engaging with health insurance companies (OR = 0.26; P < 0.001), medical record issues (OR = 0.44; P < 0.001), and malpractice concerns (OR = 0.56; P < 0.001) were significantly lower among VA internists compared with non-VA internists. VA internists were significantly less likely to report issues concerning work-life balance (OR = 0.63; P = 0.01).</p><p><strong>Conclusions: </strong>VA internists had reduced odds of some non-clinical administrative tasks and greater odds of better work-life balance. The VA's minimal engagement with insurance tasks and litigation concerns appears to present a compelling work environment.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992552","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":"Inhaled Cannabis, Asthma, and Chronic Obstructive Pulmonary Disease: A Population-Based Cross-Sectional Study of n = 379,049.","authors":"Alison S Rustagi, Abra M Jeffers, F Julian Graham, Beth E Cohen, Christopher G Slatore, Amy L Byers, Stanton A Glantz, Salomeh Keyhani","doi":"10.1007/s11606-025-09833-8","DOIUrl":"https://doi.org/10.1007/s11606-025-09833-8","url":null,"abstract":"<p><strong>Background: </strong>Cannabis may cause chronic pulmonary disease. Prior studies have been limited by low cannabis exposure, lack of data on tobacco cigarettes, and/or limited numbers of those without tobacco cigarette use.</p><p><strong>Objective: </strong>To examine whether inhaled cannabis associated with asthma and chronic obstructive pulmonary disease, independent of tobacco cigarettes.</p><p><strong>Design: </strong>Cross-sectional analysis of population-based, nationally representative survey data.</p><p><strong>Participants: </strong>Adults 18-74 years who participated in the 2016-2020 Behavioral Risk Factor Surveillance System surveys.</p><p><strong>Main measures: </strong>The exposure was past-30-day cannabis use, from 0 (0/30 days) to 1 (30/30 days). Outcomes were self-reported diagnoses by a medical professional of asthma or chronic obstructive pulmonary disease. We used multivariable logistic regression to test whether inhaled cannabis was associated with odds of disease, adjusted for sociodemographics and tobacco cigarette use (current/former/never). Pre-specified analyses restricted to those with no lifetime tobacco cigarette use.</p><p><strong>Key results: </strong>Among n = 379,049, n = 23,035 reported inhaled cannabis use. Inhaled cannabis was associated with asthma overall (adjusted odds ratio (aOR) 1.44, 95% CI 1.26-1.63 for daily use) and among n = 221,767 with no lifetime tobacco cigarette use (aOR 1.51 for daily use, 95% CI 1.18-1.93). Inhaled cannabis was associated with chronic obstructive pulmonary disease overall (aOR 1.27 for daily use, 95% CI 1.10-1.46), with a non-significant elevated odds of disease among those with no lifetime tobacco cigarette use (aOR 1.54 for daily use, 95% CI 0.92-2.57).</p><p><strong>Conclusions: </strong>Inhaled cannabis was associated with asthma and chronic obstructive pulmonary disease after adjusting for tobacco cigarette use. Among those with no lifetime tobacco cigarette use, the association with asthma persisted. Cannabis may be a potential modifiable risk factor for asthma and chronic obstructive pulmonary disease.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992515","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":"Respiratory-Onset Amyotrophic Lateral Sclerosis (ALS): A Rare Initial Presentation.","authors":"Escher L Howard-Williams, Paul Ossman, Jessica Fuller","doi":"10.1007/s11606-025-09831-w","DOIUrl":"https://doi.org/10.1007/s11606-025-09831-w","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992532","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":"EBM BLS: Tirzepatide Helps Obese Patients Lose Weight.","authors":"Hugo Ortega, Harry B Burke","doi":"10.1007/s11606-025-09815-w","DOIUrl":"10.1007/s11606-025-09815-w","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956875","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}