Categorization and compartmentalization evolved in medicine to help clinicians in the daunting work of specifying a diagnosis and dispensing appropriate treatment. Such organization can make sense, safety, and efficiency out of what may seem vast and chaotic. However, can this impulse to order go too far, and can the rigid containers that result become hindersome walls that block seeing the larger whole? The poem “Cardiology in a Field of Wildflowers” demonstrates poetry’s contrasting ability to blur boundaries and expand thinking, to incite instead a more holistic vision of healing. Drawing from a deep well of imagination, the speaker whimsically daydreams about what can happen when the “boundaries of self” are “dissolve[d]” in the clinical encounter. Poetry allows the contemplative clinician to step beyond the constrained space of the examination room and into the creative, turning the static identity of “doctor” in the active verb form of the word, thus conjuring the lost magic in daily clinical work. Poetry enables exploration of this forgone realm, as the repetitive acts of palpating the pulse and auscultating the heart, while remaining essential aspects of the physical examination, become conduits of transcendent interpersonal connection. We can feel that thrilling “rush,” typically sought outside of the clinic, accessed via poetry’s reimagining of our closeness to patients, even when we routinely examine them. Roaming colorful fields and indulging in fairy tales, the actively doctoring doctor becomes a reminder of the very real liberating value of the arts in medical practice.
Science Journals
In Reply I thank Dr Tang and colleagues for the questions they raise. The study reported the effect of proactive symptom assessment led by lay health workers on reductions in emergency department and hospitalization use among older adults with cancer. While proactive, frequent assessment and algorithm-driven access to timely interventions are underlying mechanisms of action, patient engagement is a foundational determinant. The success of any proactive cancer symptom assessment intervention relies heavily on patient engagement—patients must actively report their symptoms and symptom burden over time. Current modalities, such as electronic-based approaches alone, are fraught with high attrition, especially over time, thereby diminishing the reach and effectiveness. Furthermore, the engagement of older adults in these approaches is difficult to ascertain, given that few older adults were included in the studies that established effectiveness of electronic-based approaches.
Kratom use in the US has increased significantly over the past decade, as have severe medical outcomes, a study published in Addiction found.
In this episode of JAMA+ AI Conversations, Associate Editor Yulin Hswen and JAMA Health Forum Editor Sandro Galea discuss the issues surrounding AI’s move from the laboratory into health policy.
In Reply The 2025-2030 DGAs recommend higher intake of dietary protein (1.2-1.6 g/kg per day or approximately 16%-21% of calories). This change may seem inconsequential given that the average person already meets this target, consuming approximately 16% to 17% of calories from protein. However, this new major emphasis on protein from the DGAs and the accompanying media messaging from the US Department of Agriculture and the US Department of Health and Human Services are likely to spur a significant further increase in protein consumption.
To the Editor Sibling comparison designs have reemerged as an important analytical approach for addressing unmeasured familial confounding in observational studies, particularly in perinatal and life-course epidemiology. The recent JAMA Guide to Statistics and Methods by Dr Ahlqvist and colleagues emphasized a renewed need for this study across pregnancy, environmental, psychiatric, and neurological research and discussed its potential utility in strengthening causal inference.
Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA.
Daytime naps were associated with mortality in older adults, according to research published in JAMA Network Open.
This study aimed to assess whether intravenous tenecteplase before endovascular treatment (EVT) improves outcomes in patients with ischemic stroke due to proximal middle cerebral artery occlusion presenting 4.5 to 24 hours after symptom onset.
A 52-year-old man had 2 days of cough, dyspnea, and fever. Physical examination showed a rash on the trunk and back with clear vesicles on an erythematous base, imaging showed pulmonary infiltrates, and results of laboratory testing were positive for varicella zoster virus DNA and negative for herpes simplex virus 1 and 2. What is the diagnosis and what would you do next?
This cohort study compares financial, operational, and quality-of-care measures among US nonprofit hospitals that used a management consultant firm for the first time from 2009 to 2023 with observations among matched hospitals that did not use management consultants.
This JAMA Patient Page describes keratinocyte carcinomas and their risk factors, signs and symptoms, diagnosis, and treatment.
Patients with syphilis may have an increased risk of adverse cardiovascular outcomes, according to a study published in JAMA Network Open.
To the Editor The recent Perspective highlights the metabolic hazards (such as visceral adiposity) implicit in the recommendation from the 2025-2030 Dietary Guidelines for Americans (DGAs) to double protein intake. Yet, regarding stone disease, we see an important omission in the risk of nephrolithiasis.
This review discusses current evidence on the epidemiology, virology, pathogenesis, clinical presentation, diagnosis, treatment, and prevention of hepatitis B virus infection, with a focus on evidence applicable to clinical practice.
This Perspective describes the challenges of prescribing exercise for weight loss, with and without the use of glucagon-like peptide 1 (GLP-1) receptor agonists, and discusses strategies clinicians can use to improve adherence to exercise recommendations.
In Reply We thank Dr Hswen for her thoughtful engagement with our recent JAMA Guide to Statistics and Methods on sibling comparisons in observational studies. In that guide, we outlined the principles underlying this design, along with its key assumptions and potential threats to validity. Sibling comparisons leverage the fact that family members often share genetic and environmental factors that may confound associations in conventional observational analyses. By comparing exposed and unexposed siblings within families, the design can address confounding due to shared, often unmeasured, confounders. However, as with any other observational method, it rests on strong assumptions.
Virtual visits may be appropriate for first-time neurology evaluations, new research suggests.
This JAMA Insights examines the efficacy of different management strategies for anterior cruciate ligament rupture, including surgical reconstruction and structured rehabilitation.
A new study found that acetaminophen use during pregnancy was not associated with increased risk of autism.
In a well-publicized case that stoked public outrage, Providence, a nonprofit health system headquartered in the state of Washington, implemented a program in 2018 called Rev Up to increase revenue collection from patients. Following enforcement action by the state’s attorney general, Providence was ultimately forced to refund or forgive nearly $160 million worth of payments and outstanding debt, but not before throwing the management consultants behind the program squarely under the bus. “The intent of Rev Up, a program developed with the consulting firm McKinsey & Company, was not to target or pressure those in financial distress…We recognize the tone of the training materials developed by McKinsey was not consistent with our values.”
This JAMA Medical News story discusses multicancer early detection (MCED) tests, a handful of which are already on the US market despite a lack of evidence about their utility.
This phase 3 randomized superiority trial conducted in China assesses the adverse events and efficacy of tenecteplase prior to endovascular treatment (EVT), vs EVT alone, in patients 4.5 to 24 hours after onset of ischemic stroke due to proximal middle cerebral artery occlusion.
In patients with acute ischemic stroke undergoing endovascular thrombectomy, guidelines recommend achieving near-complete or complete reperfusion (defined as an expanded Thrombolysis in Cerebral Infarction score of 2c or 3) whenever safely achievable. Yet even after successful recanalization of the target vessel, many patients do not have excellent functional outcomes, raising the question whether macrovascular patency fully reflects the adequacy of tissue-level reperfusion.