With passage of the Affordable Care Act, affordable health insurance for all Americans is in sight, yet politics could cause it to slip away. A resurgent Republican Party will mount a sustained challenge at the federal and state levels, but the new Congress will not bring about the Affordable Care Act's repeal. More likely, the law's effectiveness could be undermined by congressional restrictions on its implementation, underfunding of programs to improve public health and train more primary care physicians, and resistance by many states to its mandates. Congress could instead seek a bipartisan accord on improving the law, such as by giving the states more options, but this is unlikely in the current polarized environment. This debate is occurring even as the United States faces an unprecedented crisis in access to health insurance coverage, affecting nearly every demographic group, yet the uninsured have largely become an afterthought. Medical professionalism requires a commitment to improving access to care, and physicians could play a crucial role in informing lawmakers that providing all Americans with affordable health care coverage is a moral and medical imperative to prevent needless suffering and death, and must not be allowed to slip away.

National guidelines recommend that primary care providers discuss the risks and benefits of prostate cancer screening with their patients but give little guidance on how to fit such a complex discussion into a busy clinic encounter. The authors propose a process-oriented approach (Ask-Tell-Ask) that promotes tailored conversations and value-based recommendations. The Ask-Tell-Ask approach includes diagnosing a patient's informational needs, providing targeted education based on those needs, and making a shared decision about testing. This time-efficient model emphasizes the provider's role as an interactive guide rather than a one-way supplier of information. Although there is no way to make these discussions simple, this streamlined strategy can help patients and providers efficiently negotiate the complex and important decision of screening for prostate cancer.

The response of medical students, young physicians, and other health professionals to the February 2010 earthquake and tsunami in Chile provides important lessons about health care delivery during disasters and about the development of professionalism. Tertiary and secondary care of victims of these disasters was possible because local and national resources were available and field hospitals provided by Chile's armed forces and foreign countries replaced damaged hospitals. However, primary care of persons living on the outskirts of towns and in small villages and coves that were destroyed and isolated by the disaster required the involvement of volunteer groups that were largely composed of students and other young members of the health professions, all of whom were motivated by solidarity, compassion, and social commitment. This experience, similar to previous catastrophes in Chile and elsewhere, reinforces that medical and other health professional schools must instill in graduates an understanding that the privileges of being a health professional come with responsibilities to society. Beyond providing high-quality scientific and technological education, curricula in these schools should include training that enables graduates to meaningfully contribute in the setting of unexpected disasters and that nurtures a sense of responsibility to do so.

The review system for human subjects research in the United States has been widely criticized in recent years for requirements that delay research without improving human subject protections. Any major reformulation of regulations may take some time to implement. However, current regulations often allow for streamlined ethics review that does not jeopardize-and may improve-protections for research participants. The authors discuss underutilized options, including research that need not be classified as human subjects research, categories of studies that can be exempt from ethical review, studies that need only undergo expedited review by 1 institutional review board (IRB) member, and simplifying reviews of multicenter research by using the IRB of 1 institution. The authors speculate on multiple reasons for the underuse of these mechanisms and exhort IRBs and researchers to take advantage of these important opportunities to improve the review process.

Osteoarthritis is a leading cause of pain and disability, and self-management behaviors for osteoarthritis are underutilized.

The epidemiology of pain during the last years of life has not been well described.

Warfarin reduces the risk for ischemic stroke in patients with atrial fibrillation (AF) but increases the risk for hemorrhage. Dabigatran is a fixed-dose, oral direct thrombin inhibitor with similar or reduced rates of ischemic stroke and intracranial hemorrhage in patients with AF compared with those of warfarin.

Nosocomial transmission has been described in extensively drug-resistant tuberculosis (XDR-TB) and HIV co-infected patients in South Africa. However, little is known about the rates of drug-resistant tuberculosis among health care workers in countries with high tuberculosis and HIV burden.

Resource barriers complicate diabetes care management. Support from peers may help patients manage their diabetes.