A 58‑year‑old patient was diagnosed with stage II colon cancer after routine screening.

I needed to inform the patient of the diagnosis and discuss treatment options while maintaining empathy.

I followed the SPIKES protocol: I set up a private space, assessed his understanding, delivered the news clearly, addressed emotions, provided information about treatment, and offered support resources.

The patient expressed gratitude for the compassionate approach, asked informed questions, and agreed to a multidisciplinary treatment plan, leading to timely surgery and adjuvant therapy.

A 45‑year‑old woman presented with persistent abdominal pain; initial labs suggested gallstones, but imaging was inconclusive.

Re‑evaluate the diagnosis after the patient’s symptoms worsened post‑cholecystectomy.

I reviewed the imaging, consulted radiology, and ordered an MRCP, which revealed a pancreatic duct stricture. I discussed the findings with the surgical team and adjusted the treatment plan to include ERCP.

The patient’s pain resolved after stent placement, avoiding unnecessary repeat surgery and improving her recovery.

In a fast‑changing specialty like internal medicine, staying updated is essential.

Integrate continuous learning into daily practice.

I allocate 30 minutes each morning to read key journals (NEJM, JAMA), subscribe to specialty newsletters, attend monthly CME webinars, and participate in hospital journal clubs. I also use an evidence‑based app to flag guideline updates relevant to my patients.

My patients benefit from the latest evidence‑based therapies, and I have maintained board certification without lapses.

A 62‑year‑old male with a 10‑year history of hypertension presents with BP 180/100 mmHg despite three antihypertensives.

Develop a comprehensive plan to achieve target BP <130/80 mmHg.

I reviewed medication adherence, lifestyle factors, and secondary causes. I ordered labs (renal function, aldosterone-renin ratio) and a home BP log. I simplified his regimen to a single‑pill combination, added a thiazide diuretic, and referred him to a dietitian for DASH diet counseling. I scheduled follow‑up in two weeks.

At 6‑week follow‑up, his average home BP was 128/78 mmHg, and he reported improved adherence and lifestyle changes.

A terminally ill patient requested physician‑assisted death, which is illegal in our state but aligned with his expressed wishes.

Navigate the patient’s request while adhering to legal and ethical standards.

I explained the legal constraints, explored his goals of care, involved the palliative care team, and facilitated advance care planning. I ensured he understood all options, including hospice and symptom management, and documented the discussion thoroughly.

The patient chose hospice care, achieved symptom relief, and expressed satisfaction with the compassionate support, avoiding legal conflict.

A 70‑year‑old diabetic patient was repeatedly admitted for foot ulcers.

Reduce readmissions and promote wound healing through coordinated care.

I led a weekly multidisciplinary round with endocrinology, podiatry, nutrition, and wound‑care nursing. We created a care pathway: optimized glycemic control, off‑loading footwear, nutrition supplementation, and patient education. I coordinated home health visits for dressing changes.

Readmissions dropped by 60% over six months, and the ulcer healed completely, improving the patient’s quality of life.