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General lnternal Medicine Physician-Assisted Death In physician assisted suicide, death occurs when the physician provides a means for the patient to terminate his or her life (lethal prescription is legal in some states). In euthanasia, the physician directly terminates the patient's life (for example, by lethal injection). Euthanasia is illegal in all states. Disclosing Medical Errors When patients are injured as a consequence of medical care, regardless whether error is involved, they should be informed promptly about what has occurred. An apologz should be given if it was a result of error or system failure. Data do not support concerns that disclosure of an error promotes litigation. The lmpaired Physician Physicians are ethically and in some states, legally-bound to protect patients from impaired colleagues by reporting such physicians to appropriate authorities, including chiefs of service, chiefs of staff, institutional committees, or state medical boards. Conflict of lnterest A conflict of interest exists when physicians' primary duty to their patients conflicts or appears to conflict with a secondary interest, which may consist of another important prof'essional responsibility, a contractual obligation, or personal gain. Physicians are obligated to avoid significant conflicts ofinterest whenever possible. For less serious or unavoidable conflicts of interest, disclosure is appropriate. Chronic Cough Diagnosis Chronic cough lasts >B weeks. Upper airways cough syndrome (UACS) caused by postnasal drip, asthma, and GERD are respon sible for approximately 90'1, of cases of chronic cough but are responsible for 99% in patients who are nonsmokers, have a normal chest x-ray, and are not taking an ACE inhibitor. All patients should undergo chest x ray. Smoking cessation and discontinuation of ACE inhibitors are indicated for 4 weeks before additional evaluation.

Chronic Cough Diagnosis Chronic cough lasts >B weeks. Upper airways cough syndrome (UACS) caused by postnasal drip, asthma, and GERD are respon sible for approximately 90'1, of cases of chronic cough but are responsible for 99% in patients who are nonsmokers, have a normal chest x-ray, and are not taking an ACE inhibitor. All patients should undergo chest x ray. Smoking cessation and discontinuation of ACE inhibitors are indicated for 4 weeks before additional evaluation. STUDY TABLE: Causes and Therapy of Chronic Cough lf you see this... Diagnose this... Choose this... Postnasal drainage, frequent throat clearing, UACS First-generation antihistamine-decongestant combination nasal discharge, cobblestone appearance of or intranasal glucocorticoid (for allergic rhinitis) the oropharyngeal mucosa, or mucus dripping down the oropharynx Asthma, cough with exercise or exposure to Cough-variant asthma Methacholine or exercise challenge if diagnosis is cold u ncertain Standard asthma therapy GERD symptoms (GERD may be silent) GERD-related cough Empiric PPI therapy without testing Taking ACE inhibitor ACE-inhibitor cough Stop ACE inhibitor, substitute ARB Normal chest x-ray findings, normal spirometry, Possible nonasthmatic Sputum induction or bronchial wash for eosinophils or and negative methacholine challenge test; eosinophilic bronchitis exhaled nitric oxide testing failed empiric PPI therapy Treat with inhaled glucocorticoids; avoid sensitizer If a cause is not determined after initial evaluation, a stepwise approach is pursued, beginning with a 2-week trial of empiric treatment for UACS. 118