At the end of her Guest Commentary, "The Virtual Patient" (CONSULTANT, July 2007), Dr Faith Fitzgerald asks: "How shall my students experience the things that cannot be taught but only learned through the sometimes inconvenient, potentially time-consuming, emotionally disquieting, and generally non-remunerative interactions with real patients?"

When you need to jot down the name of a medicine, condition, or specialist for a patient and you're in a hurry, just grab a tongue depressor.

Within the past 7 years, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infections has significantly increased. Risk factors for MRSA infection include previous antibiotic therapy and living arrangements such as prisons or military barracks that involve close, frequent contact with infected persons. Treat stable patients with MRSA skin infections with oral antibiotics in addition to incision and drainage; hospitalization and intravenous antibiotics are recommended for patients whose condition is unstable or who are unlikely to adhere to an oral regimen. A new strain of C difficile, BI/NAP1, has been associated with recurrent infection; more severe disease that mandates urgent colectomy; and dramatically higher mortality in vulnerable populations, such as older adults. Although oral metronidazole has been the mainstay of treatment of C difficile infection, oral vancomycin may be slightly more effective in patients with severe disease.

I end my review of systems with 3 questions that help patients reflect constructively on the state of their health.

An 89-year-old man reported that this lesion began developing on his left forearm 11 days earlier. It is a keratoacanthoma, a rapidly growing but benign neoplasm that occurs predominantly on the extensor surfaces of the hands and forearms of white men over age 50.

Although many lacerations are treated in the emergency department, primary care clinicians still see their share of such wounds. Most lacerations are incurred on the face and head (as a result of falls or altercations) or on the hand or lower arm (caused by tools, broken glass, or other sharp objects).

Presidential candidates might consider proposing a health care reform package that relies on a single-payer system, if results of a MedPage Today poll reflect the country's mood.

BALTIMORE -- Patients with rheumatoid arthritis who meditated were measurably less stressed after six months than those given standard care, but the disease was no better, said investigators here.

TORONTO -- For high-risk bladder cancer, a decision on aggressive versus conservative therapy depends on age and quality-of-life preferences, according to investigators here.

MELBOURNE, Australia -- Physical activity strengthens cartilage in the knee and protects older patients against osteoarthritis, researchers here found.

ROCKVILLE, Md. -- The FDA today ordered makers of more than 200 unapproved hydrocodone-containing cough syrups to remove them from the market.

SALT LAKE CITY -- Forecasts that physician-assisted suicide and euthanasia would be practiced disproportionately on vulnerable groups, such as the poor, the elderly, and women, did not prove accurate, according to researchers here.

BILBAO, Spain -- For calcific tendinitis of the shoulder, ultrasound-guided percutaneous needle aspiration and lavage can improve range of motion and provide both short- and long-term relief of pain, reported investigators here.

MADISON, Wis. -- Symptoms of autism, including maladaptive behaviors and impaired social interactions, appear to lessen over time in a significant percentage of patients studied over nearly five years.

ANN ARBOR, Mich. -- The reason that opioids seem to fizzle for fibromyalgia may be because of reduced receptor activity in regions of the brain that process and dampen pain signals, researchers here found.

ELIZABETH, N.J. -- Nearly two dozen illnesses from frozen hamburgers apparently tainted with Escherichia coli O157:H7 have prompted a meat company to recall more than 300,000 pounds of beef.

TORONTO -- Stopping heavy drinking can significantly reduce the risk of esophageal and head-and-neck cancers, primarily squamous-cell carcinomas, researchers here said.

VALENCIA, Spain -- Capsule endoscopy diagnosed more patients with Crohn's recurrence after surgery than did colonoscopy and was better tolerated, researchers in Spain reported.

BOSTON -- In blood glucose responses to a white bread challenge, individual patients have significant variations from test to test, said investigators here.

ROCHESTER, NY-Breast cancer patients with a history of traumatic or stressful life events have a significantly increased risk of recurrent disease, investigators here have found.