American College of Physicians: Internal Medicine — Doctors for Adults ®


New vaccines, recommendations can make keeping up a chore

From the September ACP Internist, copyright 2013 by the American College of Physicians

Managing adult vaccination has gotten even trickier recently, with new vaccines coming on the market and recommendations changing all the time. In addition to vaccines for herpes zoster, hepatitis B, and many other diseases, physicians can now offer a high-dose influenza vaccine to certain elderly patients, the human papillomavirus vaccine to young women, and the pneumococcal conjugate 13 vaccine to the immunocompromised. But although many vaccines are available, maintaining ideal vaccination rates can be difficult, and problems related to cost and access can complicate matters too. Our story turns to leading experts in the field for an update on the latest vaccines, the most recent changes in recommendations, and ways to boost vaccination rates.

Most physicians at one time or another have probably wished they could dismiss a particular patient from their practices. Sometimes it might even seem like the only option. But experts say that if you find yourself in this situation, think twice and maybe even longer before you act. Dismissing patients can be illegal under some circumstances and can also be considered patient abandonment. Our story details reasons why you might want to dismiss a patient, what other options you should try beforehand, and how to protect yourself and the patient if all efforts to work it out still fail.

This issue also features coverage from two of this spring’s biggest conferences, the American Society of Clinical Oncology’s annual meeting and the American Diabetes Association’s 73rd Scientific Sessions, both held in Chicago. First, we offer tips on communicating with cancer patients, including the most effective way to present risk information and how to discuss prognosis. Next, get a summary of the latest in diabetes research, including the pros and cons of sulfonylureas, the relationship between diabetes and bone health, and the future of concentrated insulin.

Finally, two readers in our Letters section debate the merits of Maintenance of Certification, the benefits of accountable care organizations, and the pitfalls of EHRs, while another reader shares how one of our columns struck a chord due to his and his family’s medical history.

Whether you’ve particularly enjoyed one of our articles or whether there’s one with which you disagree, we always love to hear from you. Feedback is welcome.

Jennifer Kearney-Strouse


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