Journal of General Internal Medicine最新文献

{"title":"Atypical Presentation of Scurvy in a Post-Bariatric Surgery Patient: A Diagnostic Challenge.","authors":"Shruti Mavuri, Eric Kutscher","doi":"10.1007/s11606-026-10870-0","DOIUrl":"https://doi.org/10.1007/s11606-026-10870-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127670","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":"Reboot the Clinical Learning Environment.","authors":"Kathryn E Miller, Lia S Logio","doi":"10.1007/s11606-026-10884-8","DOIUrl":"https://doi.org/10.1007/s11606-026-10884-8","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127808","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":"Moral Infrastructure in Medicine: Conditions for Honest Work.","authors":"Sherry M Adkins, Ronald M Epstein","doi":"10.1007/s11606-026-10918-1","DOIUrl":"https://doi.org/10.1007/s11606-026-10918-1","url":null,"abstract":"<p><p>What happens when clinicians know what good care requires, but the conditions of work make it difficult to realize? Through scenes from primary care, we describe moral infrastructure: the conditions that allow clinicians to notice what matters and respond to it in ordinary work. Compressed time, fragmented attention, and weakened continuity do not erase professional responsibility, but they can make it harder for clinicians to respond with integrity. Moral infrastructure does not label an organization moral or immoral, nor does it guarantee good outcomes. Rather, it complements organizational ethics by asking whether the conditions of work support or erode clinicians' capacity for moral attention, judgment, and response. Protecting those conditions matters for patients, clinicians, professional formation, and medicine's ability to remember what humane care requires.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127822","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":"Does Evidence Travel Well? Rethinking Guidelines and Real-World Effectiveness in Middle-Income Health Systems.","authors":"Vinícius Brenner Felice, Cassiano Teixeira","doi":"10.1007/s11606-026-10867-9","DOIUrl":"https://doi.org/10.1007/s11606-026-10867-9","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127655","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":"Letter to Editor External Clinical Validation of the RECOVER Research Index: A Response to Goldman and Martin.","authors":"Alba Azola, Rebecca T Veenhuis, Leah H Rubin","doi":"10.1007/s11606-026-10851-3","DOIUrl":"https://doi.org/10.1007/s11606-026-10851-3","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127691","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":"Rock Bottom Is Not a Motivator: From Opioid Addiction to Human Flourishing.","authors":"Shiv Ayappa, Divya Manikandan, Katharine Press Callahan, Travis N Rieder, Michael Fingerhood, Margaret S Chisolm","doi":"10.1007/s11606-026-10848-y","DOIUrl":"https://doi.org/10.1007/s11606-026-10848-y","url":null,"abstract":"<p><strong>Background: </strong>\"Hitting rock bottom\" is widely used in narratives of addiction and recovery. Recovery programs often assume, implicitly and explicitly, that \"hitting bottom\" is necessary to motivate recovery. However, a gap in the literature exists regarding the nature of experiences that characterize rock bottom, and the extent to which rock bottom experiences promote recovery.</p><p><strong>Objectives: </strong>Characterize rock bottom experiences in individuals with opioid use disorder, explore any role of these experiences in motivating recovery, and identify factors critical to sustaining recovery.</p><p><strong>Design: </strong>Semi-structured interviews with 20 participants, focusing on \"rock bottom,\" and its role in motivating recovery.</p><p><strong>Participants: </strong>Considered eligible if in recovery from opioid addiction.</p><p><strong>Approach: </strong>Two study team members independently coded each interview transcript using an inductive thematic analysis approach. Discrepancies were resolved through discussion and consensus, and findings were consolidated into a final codebook.</p><p><strong>Key results: </strong>In total, 14/20 (70%) participants reported having a rock bottom. Four themes characterized these experiences: loss of social connection, character erosion, loss of resources, and no will to live. Importantly, only 2/20 (10%) participants reported that a rock bottom experience motivated them toward recovery. For 17/20 (85%) participants, motivation to recovery came from \"turning points\"-events characterized by themes of parenthood, near-death experience, or incarceration. Rebuilding social connection and character growth emerged as themes critical to sustained recovery.</p><p><strong>Conclusions: </strong>Although individuals often report experiencing intensely depressing and isolating periods of \"rock bottom\" during active addiction, these are not necessarily motivators toward recovery. This is significant, as the idea of rock bottom may be stigmatizing, and may hinder timely support for addiction. Themes identified in this study overlap significantly with the concept of human flourishing, suggesting that the losses of its various domains are central to participants' experiences of rock bottom, and that the promotion of human flourishing may lead to sustained recovery.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110746","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":"Manufacturer Coupon Use and Patient and Payer Spending During GLP-1 Treatment Episodes.","authors":"Minji Kim, So-Yeon Kang, Manuel Hermosilla","doi":"10.1007/s11606-026-10862-0","DOIUrl":"https://doi.org/10.1007/s11606-026-10862-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110710","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":"Price Transparency Is Not the Same as Affordability and Adherence.","authors":"Catherine S Hwang, Michael A Steinman","doi":"10.1007/s11606-026-10886-6","DOIUrl":"https://doi.org/10.1007/s11606-026-10886-6","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110791","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":"Videographic Analysis of an Intervention to Improve Patient-Centered Care for People Living with Type 2 Diabetes: The QBSAFE Randomized Trial.","authors":"Victor Montori V, Felipe Larios, Satya Sai Sri Bandi, Ana Cristina Proano, Kerly Guevara, Luis Vilatuna, Shubhangi Bagewadi, Anka van Gastel, Megan E Branda, Anne W Camp, Mel Montosa, Rozalina G McCoy, Victor M Montori, Kasia J Lipska","doi":"10.1007/s11606-026-10849-x","DOIUrl":"10.1007/s11606-026-10849-x","url":null,"abstract":"<p><strong>Background: </strong>Clinical encounters between people living with type 2 diabetes and their primary care clinicians often emphasize metabolic control over self-management concerns.</p><p><strong>Objective: </strong>To determine whether QBSAFE cards were used as intended, their effect on the topics of discussion, and whether they enabled clinicians to notice and respond to patients' situations.</p><p><strong>Design: </strong>At a federally qualified primary care clinic, participants were randomly assigned to usual care with or without QBSAFE cards. Visits were video recorded.</p><p><strong>Participants: </strong>Eleven clinicians and 155 of their patients with diabetes and HbA1c > 8%.</p><p><strong>Intervention: </strong>Fourteen QBSAFE cards addressing issues related to quality of life, burden of treatment, safety, and prevention of diabetes complications.</p><p><strong>Main measures: </strong>Eight trained reviewers analyzed videos using a structured codebook to capture encounter characteristics, assess fidelity, and to record domain-specific discussions and degree of clinician responsiveness to issues raised by patients.</p><p><strong>Key results: </strong>Of 143 eligible encounters (12 of 155 were found to have HbA1c  ≤ 8% post-randomization), 137 (65 usual care, 72 QBSAFE) yielded evaluable videos. QBSAFE cards were used as intended in 61 (85%) QBSAFE arm encounters. Compared to usual care, conversations about burden of treatment related to nonpharmacological interventions (17 vs 33, OR 2.38, 95% CI 1.11-5.12) and to taking medications (11 vs 33, OR 4.29, 95% CI 1.78-10.37) and about the patient's challenging environment (2 vs 10, OR 5.08, 95% CI 1.05-24.50) were more prevalent in the QBSAFE arm. There were no between-arm differences in metabolic control discussions or new care plans or in encounter duration. QBSAFE encounters were more likely to be considered unhurried.</p><p><strong>Conclusions: </strong>QBSAFE cards led to small patient-centered changes to encounter conversations, promoting ones about treatment burden, without displacing metabolic control discussions. Future work will focus on assisting clinicians in responding more effectively to patient issues so that raising these could change plans of care.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05553912, registered 9/21/2022.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110869","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":"How Much Peer Review Is Enough? Rethinking Scholarly Service in Academic Medicine.","authors":"Emma M Tillman","doi":"10.1007/s11606-026-10875-9","DOIUrl":"https://doi.org/10.1007/s11606-026-10875-9","url":null,"abstract":"<p><p>Peer review is widely regarded as the cornerstone of scientific publishing, yet it depends on the voluntary efforts of a limited portion of the academic workforce. For clinician-scientists in academic medicine, peer review represents an essential but largely unrecognized component of faculty workload, competing directly with research, clinical care, teaching, and administrative responsibilities. Despite its central role in ensuring scientific rigor, peer review is rarely formally measured, incentivized, or incorporated into promotion and evaluation processes. This commentary examines the growing burden of peer review from the perspective of a mid-career clinician-scientist and journal editor. As publication productivity increases, so do invitations to review, often concentrating requests among a subset of highly active investigators. At the same time, editors report difficulty recruiting reviewers, sometimes requiring numerous invitations to secure adequate peer review. These dynamics may delay publication, affect dissemination of clinically relevant knowledge, and influence the career progression of authors. This system reflects a misalignment between institutional priorities and the labor required to sustain scholarly publishing. Addressing this imbalance will require greater recognition of peer review as scholarly work, clearer expectations for participation, and broader engagement to ensure sustainability.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110617","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}