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A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma.

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma. The violaceous color and configuration of the skin lesions suggests which of the following? 

Clinical Topics

Hard Purple Nodules: Your Dx?

A 9-year-old boy presented with a 1-week history of pruritus and rash on his elbows, knees, back, and legs. Several areas of excoriation were noted. He had recently run through a field of tall grass but denied any other exposure history.

A 9-year-old boy presented with a 1-week history of pruritus and rash on his elbows, knees, back, and legs. He had recently run through a field of tall grass but denied any other exposure history. Your Dx?

What Cause of This Itchy Rash?

No labs, no biopsies . . .  you can make this Doorway Diagnosis just by looking.

Pictured is the posterior right knee of a 69-year-old woman showing a rounded protuberance at the popliteal fossa.

No labs, no biopsies, no imaging -- only your seasoned clinical judgement is required to make a diagnosis in this case. 

Bulge Behind the Knee 

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. She has a history of multiple non-melanoma skin cancers.

Squamous cell carcinoma in situ (Bowen  disease)

Lichenoid keratosis (an inflammatory variant of seborrheic keratosis)

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. What does this look like to you?

What's This "Red Spot"?

Dr. Matthew Press shares actionable steps for primary care physicians to adopt the Collaborative Care Model (CoCM), including how to start small, partner with other practices, and leverage existing resources to improve mental health care delivery.

Bringing Behavioral Health Into Primary Care: A Collaborative Care Roadmap

At the ACP Internal Medicine Meeting 2025, Matthew Press, MD, offered practical guidance on how primary care physicians can help close the mental health care gap through the collaborative care model (CoCM). In this interview with 

, Dr Press explains how clinicians can use existing resources, adapt electronic medical records, and collaborate across practices to implement this evidence-based approach. With tools and training readily available through the 

, CoCM can be a scalable solution for improving mental health care access—without adding to clinicians’ already heavy workload.

Dr Press, is an associate professor of medicine in the division of general internal medicine in the department of medicine at Perelman School of Medicine at the University of Pennsylvania, in Wynnewood, PA.

The following transcript has been edited for clarity, style, and length.

In your presentation at ACP Internal Medicine 2025, you highlighted the shortage of mental health professionals in the US. How can primary care physicians effectively implement collaborative care models to address this gap in care?

: The good news is that there’s a clear framework for implementing collaborative care. I encourage everyone to visit the AIMS Center website—AIMS stands for Advancing Integrated Mental Health Solutions—run through the University of Washington. They really pioneered this model and offer excellent tools and guidance on how to set it up. It’s not overly complicated. There’s a step-by-step “recipe” outlining the roles, the necessary training, and how to operationalize the model.

It does take some initial work to implement, but the structure is there—you just have to follow it.

If you’re part of a larger health system with some infrastructure, especially around IT, it’s ideal to make a few modifications to your electronic medical record to support the program. You'll also need to hire a care manager and identify a psychiatrist. The psychiatrist’s role is limited—you only need a small fraction of their time—but it's essential. Fortunately, many psychiatrists are now familiar with this model and understand the expectations of the consulting role.

For larger systems with resources, you can generally implement the model independently. If you’re in a smaller practice, I recommend partnering with a few nearby practices. That way, you can share resources—like the care manager and psychiatric consultant—since an individual practice likely won’t require full-time support from either.

To any primary care clinician who feels intimidated by the idea of starting this, I’d say: You’re already seeing these patients. This model doesn’t change who’s in your office—it simply gives you the tools to better support them and takes some of the burden off your shoulders. The upfront effort is absolutely worth it, because it pays dividends down the line.

For more of our conversation with Dr Press at ACP 2025 check out:

Bringing Mental Health into Primary Care: A Conversation with Matthew Press, MD

Collaborative Care for Mental Health: A Scalable, Team-Based Model for Primary Care

Matthew Press, MD: How Penn Medicine’s CoCM Model Helps PCPs Treat Mental Health—and Avoid Burnout

For more 2025 ACP Internal Medicine Meeting coverage, please click here.

ACP 2025: Matthew Press, MD, shares actionable steps for primary care physicians to adopt a collaborative care model, including how to start small and partner with other practices. 

Some vaccinations for adults are recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) for all adults, regardless of health, lifestyle, or occupational factors. Others are highly recommended for specific populations that may be at greater risk for a vaccine-preventable disease. A simple mnemonic from 

guides clinicians to consider factors related to health, age, lifestyle, and occupation, or HALO, when making an initial decision about vaccination for a specific adult. A definitive decision, the organization says, should be based on the more detailed information published in the complete vaccine recommendations of the ACIP.

The short slide show above summarizes the HALO factors most relevant to consider for 17 adult vaccines. 

A review of 4 factors can help primary care clinicians with an initial decision about adult vaccination: Health, Age, Lifestyle, and Occupation, or HALO. 

17 Adult Vaccines: Who to Consider for Each 

Robert P. Blereau, MD

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