RESUMEN
An 86-year old asymptomatic male was incidentally found to have a variant of levoatrial cardinal vein (LACV) forming a complete venous ring. This is the first report of this variant. Although rare, the ability to identify LACV in the adult population is clinically significant because it may result in bi-directional shunt and the development of symptoms is an indication for intervention.
Asunto(s)
Malformaciones Vasculares , Venas , Adulto , Anciano de 80 o más Años , Humanos , Masculino , Tomografía Computarizada por Rayos XAsunto(s)
Personal de Salud , Relaciones Profesional-Paciente , Terminología como Asunto , Humanos , Moral , Sociedades , ConfianzaAsunto(s)
Registros Electrónicos de Salud/organización & administración , Administración de la Práctica Médica , Mecanismo de Reembolso , Codificación Clínica/métodos , Planes de Aranceles por Servicios , Sistemas de Registros Médicos Computarizados , Evaluación de Procesos y Resultados en Atención de Salud , Estados UnidosRESUMEN
Current U.S. primary care workforce shortages and trainees' declining interest in primary care residency training, especially regarding primary care internal medicine, have many parallels with circumstances in the early 1970s, when modern adult primary care first emerged. Rediscovery of the lessons learned and the solutions developed at that time and applying them to the current situation have the potential to help engage a new generation of young physicians in the primary care mission.The author compares the internal medicine residency primary care track at the University of New Mexico, described by Brislen and colleagues in this issue, with the nation's first three-year primary care internal medicine residency track introduced at Massachusetts General Hospital in 1973. Strategies for addressing the challenges of primary care practice and improving learner attitudes toward the field are discussed. The author suggests that primary care physicians should be likened to "quarterbacks" rather than "gatekeepers" or "providers" to underscore the intensity of training, level of responsibility, degree of professionalism, and amount of compensation required for this profession. The advent of multidisciplinary team practice, modern health information technology, and fundamental payment reform promises to dramatically alter the picture of primary care, restoring its standing as one of the best job descriptions in medicine.