In This Issue of Archives of Internal Medicine FREE

In today's tumultuous health care environment, conflict between physicians has become increasingly common, according to this article by Manian, which covers 4 areas of conflict: (1) attending or consulting physicians vs health maintenance organization medical directors; (2) attending or consulting physicians vs similar physicians; (3) hospitalists vs consulting physicians; and (4) attending or consulting physicians vs laboratory medical directors.

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Electron-beam computed tomography (EBCT) is a new, noninvasive method of detecting coronary calcification and is increasingly advocated as a diagnostic test for coronary artery disease. Before clinical use of EBCT can be justified, its overall diagnostic accuracy (which, according to the literature, varies widely) must be established. In this study, Nallamothu et al used weighted, pooled analysis and summary receiver operating curve analysis to combine sensitivity and specificity rates from 9 studies that included 1662 subjects. Based on their results, EBCT appears to be reasonably accurate for detecting obstructive coronary artery disease.

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In this article, Ramirez and Bordon report that hospitalized patients with community-acquired pneumonia can be switched from intravenous to oral antibiotics as soon as they reach clinical stability, even if they were bacteremic with Streptococcus pneumoniae at the time of diagnosis.

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Little is known about the personal characteristics, work-related attitudes, and professional experiences of hospitalists. These issues are important for physicians (primarily internists) in considering hospital medicine as a viable career choice. This study by Hoff and colleagues draws on responses from a mail survey of 820 hospitalists who are members of the National Association of Inpatient Physicians and who spend 50% or more of their time doing clinical work, teaching, or performing research related to hospital medicine. Their analysis is based on 393 responses. The results show a group of younger, mostly male individuals at the early stages of their careers who have high levels of job satisfaction and autonomy, low levels of burnout, and a long-term commitment to remain in the hospitalist role. Hospital medicine is currently a source of positive social and professional work experiences based on interaction with physician peers, patients and their families, and nonphysician coworkers in the hospital environment. Key components of hospitalists' jobs, practices, and workload appear to be coalescing. However, certain developments, such as changing patterns of compensation and an increase in general internists and women becoming hospitalists, merit further examination. This study complements research on hospitalists' performance-related outcomes and helps to better understand and assess the long-term potential of a new career path in medicine.

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This study by Laukkanen et al was designed to examine the association of cardiovascular fitness, as measured by maximal oxygen uptake, with overall cardiovascular and noncardiovascular disease mortality. The sample was 1294 randomly selected men in eastern Finland who had no cardiovascular disease, pulmonary disease, or cancer at the initiation of the study. During an average follow-up of 10.7 years, there were 124 overall deaths (42 from cardiovascular disease, 82 from noncardiovascular disease). The relative risk results did not change even when taking into account smoking habits, alcohol consumption, serum lipid profile, blood pressure, plasma fibrinogen, diabetes, and fasting serum insulin. Furthermore, the risk of cardiovascular and noncardiovascular disease-related death was the same as the risk of overall death. Low maximal oxygen uptake was as strong a risk factor as conventional risk factors for death, including elevated systolic blood pressure, smoking, obesity, and diabetes. This finding emphasizes the importance of low cardiovascular fitness as a risk factor for death. In this study, low cardiovascular fitness represents one of the strongest predictors of mortality.

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