To Isaiah, a Casualty of a Fractured System
In this narrative medicine essay, Donald M. Berwick shares the story of his patient Isaiah with the 2012 Harvard Medical School graduating class as an example of a patient who deserved the treatment that cured him of leukemia but whose life was lost to poverty and exhorts them to regard health care as human right that must be preserved in the clinic and in public. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Learning to Talk: Speaking the Language of Patients
In this narrative medicine essay, a resident physician recalls the joy she felt while learning the formal language of medicine as a student and anticipates the lifelong joy of learning to interpret that language in ways most helpful for her patients. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

John Lennon ’s Elbow: The Long, Winding Road of the EMR Progress Note
In this narrative medicine essay, an attending physician shares his observations of how the changing nature of electronic medical record (EMR) hospital progress notes —often entered out of sequence and becoming ever longer and more unreadable—can hamper interacting with patients and providing patient care. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Patient ’s Sister, Seeking Job: Toward More Patient-Centered Care
In this narrative medicine essay, the sister of a young man with Gardner syndrome reflects on the care her brother received over his nearly three decades of life and offers her observations on several things physicians and other members of health care teams can do to achieve true patient-centered care. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

The Road Back to the Bedside
In this narrative medicine essay, a group of physicians from an academic program in bedside medicine offer their observations on deficiencies in the assessment of US medical residents ’ clinical skills and suggest principles for enhancing the teaching and high-stakes assessment of these skills to improve diagnostic accuracy and achieve truly patient-centered care. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Crossing Boundaries —Violation or Obligation?
In this narrative medicine essay, a physician reflects on the rise of professional boundaries; on the ways in which such boundaries can in some instances foster uncaring patient-physician relationships; and on ways physicians might balance providing objective medical care and addressing social and economic injustices in the lives of their patients. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

EBM ’s Six Dangerous Words
In this narrative medicine essay, a physician shares his thoughts about how the phrase “there is no evidence to suggest,” commonly used in the medical literature, can lead to false inferences and suppression of clinical intuition, and suggests four alternative phrases for clarifying inferences and improving shared decision-making. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

What Would You Do, Doctor?
In this narrative medicine essay, an emergency medicine physician recalls an encounter early in her career when she was asked by parents to make a recommendation regarding ending life support for a young child, reflects on the way practice has changed from physician-centric to patient-involved decision-making, and discusses how her husband ’s pancreatic cancer diagnosis brought up a different perspective. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Pimping Socrates
In this narrative medicine essay, a medical student reflects on individualized teaching practices in medicine, such as “the Socratic method,” in the context of her intervening course work related to a PhD in ancient history. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

The $50  000 Physical
In this narrative medicine essay, a physician reflects on his father ’s experience, at the age of 85 years, of getting a physical examination from a new primary care physician that ended up setting off a cascade of examinations and treatments. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

The Nod
In this narrative medicine essay, an African American physician reflects on her experience one day with a white member of her ward team made up of two interns, three medical students, and a senior resident that sparked cultural and racial discussions throughout their month together that usually do not occur in such a diverse group. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Whose Autonomy?
In this narrative medicine essay, a physician reflects on an experience during his medical residency involving the family dynamics of a couple in an effort to treat the pain of the husband. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

What Gets Measured Gets (Micro)managed
In this narrative medicine essay, an attending physician reflects on the evolution of the role of the attending physician from a supervisor in the background to a micromanaging supervisor to ensure that the proper steps are followed to meet the quality metrics in place in the current health system. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

A Silent Curriculum
In this narrative medicine essay, a medical student reflects on the ways in which she has seen racism and implicit bias affect clinical practice and emphasizes the importance of examining and challenging these biases to address health inequalities. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

I ’m Sorry
In this narrative medicine essay, a physician recounts an error in which his patient received double the dose of a medication he prescribed, and what he learned from asking the patient for forgiveness. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Story as Evidence, Evidence as Story
In this narrative medicine essay, a physician describes the power of anecdotes and stories as tools for public communication, education, and advocacy. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

The Greatest Generation
In this narrative medicine essay, the author discusses the inaccuracies of generational stereotypes and unfounded criticisms about trainees, and the problems that faculty members who voice these criticisms can cause among physicians. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

The Unreasonable Patient
In this narrative medicine essay, the author describes his experience with a patient referred to as “unreasonable,” and what the experience taught him about the need for physicians to perhaps improve their communication skills with patients rather than jump to labelling them. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

My Name Is Not “Interpreter”
In this essay, the author relays his personal experience with ethnicity-based discrimination and discusses the “microaggressions” that medical trainees from underrepresented groups based on race/ethnicity, gender, or sexual orientation experience. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

The Quick Physical Exam
In this narrative medicine essay, a teaching physician uses the fictitious characters Holmes and Watson to dispell the belief held by many physicians —that a thorough physical examination is an unnecessary art of the past. His emphasis: taking time to gather data and observe can avoid unneeded tests and guide accurate diagnosis. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Questioning a Taboo
This narrative medicine essay summarizes ways in which physicians can use polite and scripted interruption to help patients effectively communicate their medical concerns, encourage further details, improve accuracy of the diagnosis, and set the agenda for the medical visit. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

A Death in the Family
In this narrative medicine essay, an anesthesia resident describes his feelings of loss and unease when a coresident is admitted as a patient and dies of an overdose of fentanyl; this article emphasizes the importance of prioritizing physician wellness programs to help avoid burnout and substance use disorder. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Moral Choices for Today ’s Physician
In this essay, Don Berwick considers moral choices physicians face personally, organizationally, and globally and exhorts them to understand that the health of humanity depends on their speaking out against the social injustice of overpricing drugs and services, mass incarceration, and the lack of environmental responsibility. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Physician-Parents Whose Children Have Rare Diseases
In this essay, a critical care pediatric hospitalist finds herself on the other side of the office table advocating for the specific medical care needed to address her son ’s rare skeletal dysplasia and her search for a pediatric specialist with whom to travel on this quest. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

A Medical Student Shares Her Struggle With Depression
In this essay, a young medical student describes her struggle with depression and how the experience of vulnerability has bred a deep compassion for her patients and peers. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Mentoring in the #MeToo Era
In this narrative essay, the author wonders what effect the #metoo phenomenon will have on mentoring between male mentors and junior female trainees and faculty and recalls male mentors who were supportive of her and other women colleagues ’ professional development in a plea for diversity and inclusion among leaders in medicine that supports the entire academic medical community. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

How to Mentor Millennials
In this narrative medical essay, the authors present 3 scenarios exemplifying the collision between mentoring expectations among millennials and older generation faculty and proposes strategies to bridge generational divides and engage the next generation of physicians. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Advice for Starting Medical School
In this narrative medical essay, an internist offers three basic lessons not taught in medical school that he learned about practicing medicine based on his experiences from a patient with whom he has built a trusting relationship over the years. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Grief After Suicide
In this narrative medicine essay, the author mourns the suicide of young adult of a friend and relives his brother ’s suicide 30 years earlier in a stream of consciousness montage of grief and advice to succor for those left behind. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Friendships Across Cultural Barriers —We Are All the Same
In this narrative medicine essay, a family practitioner tells the story of how her relationship with an old-order Mennonite woman whose newborn son she examined and took to the hospital for cardiac surgery one Christmas day turns to friendship and a relationship with her broader community when the woman stays with her during her newborn daughter ’s cardiac surgery. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Full Circle: How Medicine Enabled Avoidance and Acceptance
In this narrative medicine essay, a psychiatrist used her residency to avoid grieving the loss of her brother to suicide but through participation in a grief support group during training she began to thaw enough to remember her brother, watch videos of ephemeral moments like celebrating his fourth birthday, an act that allowed her to see him and her family again. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Systole and Diastole: A Metaphor for Living
In this narrative medicine essay, a physician finds in the motion of diastole, the process of letting go and filling up, an apt metaphor for how to handle the burnout, anxiety, and depression of medical training. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Reflections on Women in Leadership —Holding up Half
In this narrative medicine essay, a medical school dean talks about the reticence most women feel when considering leadership roles and urges women to work out of their comfort zones, seize diverse opportunities, and step into leadership roles. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

The Sound of Silence —When There Are No Words
In this narrative medicine essay, a surgeon and palliative care physician describes the isolating silence that she felt her after the slaying of her father in Egypt when she was 18 years old and how that lingering silence has come to guide her when sitting with patients, when there are no words. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

You Did Not Teach Me What You Thought You Did
In this narrative medicine essay, a clinical educator uses her experiences enduring the aftermath of treatment for acute myeloid leukemia to reflect on the difference between physician-teachers and patients ’ experience of illness and to locate meaning in what she can offer her colleagues and trainees despite persistent disability. (Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - May 5, 2020 Category: General Medicine Source Type: research

Typographical Error
This article was corrected online. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

USPSTF Recommendations for Prevention and Cessation of Tobacco Use in Children and Adolescents
In this issue of JAMA, the US Preventive Services Task Force (USPSTF) presents updated recommendations on prevention and cessation of tobacco use among children and adolescents seen in primary care settings. The USPSTF recommends education and brief counseling with a clinician to prevent initiation of tobacco use (B recommendation). The USPSTF also concludes that evidence is insufficient to assess the balance of benefits and harms of primary care –feasible interventions for the cessation of tobacco use among school-aged children and adolescents (I statement). These recommendations reflect the accompanying Evidence Review. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Using 2 Prostate Biopsy Techniques Optimizes Cancer Diagnosis
Combining a traditional biopsy with a magnetic resonance imaging (MRI) –targeted biopsy more accurately diagnoses clinically significant prostate cancer than either technique alone, according to a recent study by National Institutes of Health (NIH) researchers. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

New AHRQ Patient Safety Guidance
The Agency for Healthcare Research and Quality (AHRQ) recently issued a review of 47 practices that can improve patient safety in various settings. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Lower Out-of-Pocket Insulin Costs for Medicare Plan D Beneficiaries
The Centers for Medicare& Medicaid Services (CMS) recently announced it will test a voluntary model for Medicare Part D plans to lower out-of-pocket expenses for insulin. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

The Influenza Outbreak
As set forth elsewhere in this issue, widespread outbreaks of acute respiratory infection have occurred at irregular intervals for many centuries. The general clinical manifestations and the complications have been always practically the same. Owing to conditions that are far from being adequately understood, such infection now and again spreads over the world with great rapidity and in a manner that was altogether mysterious and disconcerting until we learned that it never spreads faster than human travel. It seems as if in the course of evolutionary processes there suddenly is liberated a form of infectious agent against...
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Quality Measure Development and Associated Spending by the Centers for Medicare & amp; Medicaid Services
This study uses data from the publicly available Centers for Medicare& Medicaid Services (CMS) Inventory Tool to determine the proportion of CMS quality measures that are used or finalized for use in a CMS program, under development or consideration for use, or not in use. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Premature Menopause and Risk for Cardiovascular Disease
To the Editor The cohort study by Dr Honigberg and colleagues found that natural and surgical premature menopause were associated with increased risks of cardiovascular diseases among postmenopausal women. Some important issues were not addressed. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Premature Menopause and Risk for Cardiovascular Disease
To the Editor Venous thromboembolism (VTE) is a global health concern because of its significant morbidity and mortality. To our knowledge, few studies have investigated the associations of reproductive life characteristics with VTE risk in women. Analysis of UK Biobank data by Dr Honigberg and colleagues highlights the role of premature natural or surgical menopause in increasing both atherosclerotic and nonatherosclerotic cardiovascular risk, including VTE risk. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Health Outcomes With Vitamin D Supplementation
To the Editor In an Editorial, Drs Lucas and Wolf stated that randomized clinical trials (RCTs) of vitamin D and health outcomes have failed to confirm observational study findings. However, that is not the case for several health outcomes. Secondary analyses of the Vitamin D and Omega-3 Trial (VITAL) revealed significant reductions in overall cancer incidence with supplementation with 2000 IU/d of vitamin D3 in participants with a body mass index (BMI) of less than 25 and in black individuals and reduced overall cancer mortality when the first 1 or 2 years of data were omitted. Secondary analyses of the Vitamin D and Type...
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Premature Menopause and Risk for Cardiovascular Disease —Reply
In Reply Dr Scarabin highlights our finding that menopausal hormone therapy use at study enrollment was not associated with incident VTE. At enrollment, women in the UK Biobank reported whether they had ever used menopausal hormone therapy, the age at which they started and (if applicable) stopped using therapy, and whether they were currently using hormones. In our postmenopausal cohort, it is unlikely that women who were never users of menopausal hormone therapy at enrollment subsequently started using it after the study began —particularly in the era following publication of the Women’s Health Initiative res...
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Health Outcomes With Vitamin D Supplementation —Reply
In Reply Our Editorial accompanied the report of the VITAL-DKD trial. The focus of that article and our Editorial was the lack of benefit of vitamin D supplementation over placebo for prevention of chronic kidney disease end points. We concluded that the VITAL-DKD and D2d trials “provide strong clinical trial–grade evidence against … kidney-protective effects of routine vitamin D3 supplementation in the vast majority of patients with prediabetes or established type 2 diabetes,” and emphasized the discrepancy between the “negative” results of these trials relativ e to previous observatio...
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Long-Acting Injectable HIV Therapy Noninferior to Daily Pills
A pair of trials in the New England Journal of Medicine found that long-acting monthly injectable therapy for HIV-1 infection was noninferior to standard daily oral regimens for maintaining viral suppression. (Source: JAMA)
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research