About the Journal

Journal Overview

The Permanente Journal is a peer-reviewed journal of medical science, social science in medicine, and medical humanities published quarterly by The Permanente Press. Journal subscriptions are entered for the calendar year. Advance payment in US dollars is required


The Permanente Journal welcomes requests for reprints and reproduction. Use of any and all material published in The Permanente Journal is copyrighted and protected. The Permanente Journal offers free full-text access for all online content. Although individual sharing of content is permitted, reprint permission is required for republishing or reprinting journal content.


Instructions for Authors and Manuscript Submssion Instructions are available along with a link to our manuscript submission center at www.thepermanentejournal.org/authors.html. Instructions for Artists and Artwork Submission Instructions are available along with a link to our submission center at www.thepermanentejournal.org/authors/artwork.html.


Physicians may earn up to 1 AMA PRA Category 1 Credit per article for reading and analyzing the designated CME articles published in each edition of TPJ. Each edition has four articles available for review. The Permanente Journal is happy to offer Continuing Medical Education credits for completing manuscript reviews for The Permanente Journal. Physicians are eligible to receive up to 15 AMA PRA Category 1 Credits per year (3 AMA PRA Category 1 Credits per manuscript).

Editorial Board

Tom Janisse, MD, MBA

Lee Jacobs, MD


Vincent Felitti, MD

Arthur Klatsky, MD

Scott Rasgon, MD

Gus M Garmel, MD,


Eric Macy, MD



James J Annesi, PhD,



Ricky Chen, MD


Gary W Chien, MD


Carrie Davino
-Ramaya, MD



Charles Elder, MD


Philip I Haigh, MD,



Lisa Herrinton, PhD


Robert Hogan, MD


Tom Judd, MS, CPHIMS,


Ashok Krishnaswami, MD,



David Riley, MD


Ruth Shaber, MD


John Stull, MD, MPH

Gretchen Summer, PhD,



KM Tan, MD


Calvin Weisberger, MD


Winston F Wong, MD, MS


Scott S Young, MD


Maher A Abbas, MD, FACS, FASCRS
Medical Director, Dubai Colorectal Center, UAE; Professor of Surgery, Case Western Reserve University, Cleveland, Ohio



Richard Abrohams, MD
Internal Medicine and Geriatrics, The Southeast Permanente Medical Group, Atlanta, Georgia



Fábio Ferreira Amorim, MD, PhD
Professor of Medicine, Escola Superior de Ciências da Saúde in the Department of Postgraduate and Extension Activities, Brasilia, Brazil



Stanley W Ashley, MD
Chief Medical Officer, Brigham and Women’s Hospital; Frank Sawyer Professor of Surgery, Harvard Medical School; Attending Surgeon, Gastrointestinal Cancer Center, Dana Farber Cancer Institute, Boston, Massachusetts



Thomas Bodenheimer, MD
Professor, Dept of Family and
Community Medicine, University
of California, San Francisco



Brian Budenholzer, MD
Associate Clinical Professor in the Department of Family Medicine at the Brody School of Medicine at East Carolina University, Greenville, North Carolina



Irene Carvalho, PhD
Clinical Neurosciences and Mental Health Department, School of Medicine, Oporto University, Porto-Portugal, Oporto, Portugal



Shamir O Cawich, MBBS, DM
Department of Surgery, St Augustine Campus, University of the West Indies, Trinidad and Tobago



Rita Charon, MD, PhD
Professor of Medicine, Founder and Executive Director of the Program in Narrative Medicine at the College of Physicians and Surgeons of Columbia University Medical Center, New York, New York



Pranab Chatterjee, MBBS, MD
Scientist, Indian Council of MedicalResearch, National Institute of Choleraand Enteric Diseases, Infectious DiseasesHospital, Beliaghata, Kolkata, India



Dan Cherkin, PhD
Senior Scientific Investigator, Group Health Cooperative, and Affiliate Professor, Dept of Family Medicine and School of Public Health—Health Services, University of Washington, Seattle



Mitsuro Chiba, MD, PhD
Department of Gastroenterology, Akita City Hospital, Kawamoto, Akita, Japan




Robert R Cima, MD, FACS, FASCRS
Associate Professor of Surgery, Division of Colon and Rectal Surgery; Vice Chairman, Department of Surgery, Mayo Clinic, Rochester, Minnesota



Ellen Cosgrove, MD
Vice Dean, Academic Affairs and Education, University of Nevada, Las Vegas School of Medicine, Las Vegas, Nevada



Quentin Eichbaum, MD, PhD, MPH, MFA, MMCH, FCAP
Associate Director of Transfusion Medicine; Associate Professor of Pathology; Associate Professor of Medical Education and Administration; Director, Fellowship Program in Transfusion Medicine; Member, Vanderbilt Institute for Global Health; Vanderbilt University School of Medicine, Nashville, Tennessee



Richard Frankel, PhD
Professor of Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis



James T Hardee, MD
Internal Medicine, Colorado Permanente Medical Group; Associate Clinical Professor of Medicine, University of Colorado School of Medicine, Westminster



Carol Havens, MD
Family Practice and Addiction Medicine, Director of Clinical Education, The Permanente Medical Group, Oakland, California



Arthur Hayward, MD
Assistant Clinical Professor, Division of General Medicine, Dept of Internal Medicine, Oregon Health Sciences University, Portland



Catherine Hickie, MBBS
Director of Clinical Training, Bloomfield Hospital, Greater Western Area Health Service; Conjoint Senior Lecturer in Psychiatry, University of New
South Wales, Australia



Gunver Sophia Kienle, Dr Med
Senior Researcher, University of Witten/Herdecke, Institute for Applied Epistemology and Medical Methodology, Freiburg im Breisgau, Germany



Anna Luise Kirkengen, MD, PhD
Department of General Practice Research, Institute of Community Medicine, Norwegian University of Science and Technology, Trondheim, Norway



Thomas E Kottke, MD
Medical Director for Well-Being, HealthPartners; Consulting Cardiologist, HealthPartners Medical Group; Senior Clinical Investigator, HealthPartners Institute for Education and Research; Professor of Medicine, University of Minnesota, Minneapolis



Tieraona Low Dog, MD
Fellowship Director, Academy of Integrative Health and Medicine, LaJolla, California; Director, Integrative Medicine Concepts, Pecos, New Mexico; President, My Own Health; Director, Scientific and Regulatory Affairs, Healthy Lifestyle Brands; Tempe, Arizona

Lewis Mehl-Madrona, MD, PhD, MPhil
Director of Geriatric Education, Maine Dartmouth Family Medicine Residency; Director of Education and Training, Coyote Institute, Augusta, Maine



Colin G Murphy, MCh, FRCSI
Department of Trauma and Orthopaedics, Galway University Hospitals, Newcastle, Galway, Ireland



Michel M Murr, MD, FACS
Director of Bariatric Surgery, Chief of Surgery, Tampa General Hospital, Florida



Sylvestre Quevedo, MD
Department of Medicine and Global Health Sciences, University of California, San Francisco



Ilan Rubinfeld, MD, MBA, FACS, FCCP
Director, Surgical Intensive Care; Associate Program Director, General Surgery Residency; Henry Ford Hospital, Detroit, Michigan; Assistant Professor of Surgery, Wayne State University School of Medicine, Detroit, Michigan



Marilyn Schlitz, PhD
Chief Executive Officer of Worldview Enterprises, LLC, and Senior Fellow and President Emeritus at the Institute of Noetic Sciences in Petaluma, CA; Professor in and the Chair of the Doctor of Philosophy in Transpersonal Psychology program at Sofia University in Palo Alto, CA



Tido von Schoen-Angerer, MD, MPH
Researcher, ARCIM Institute, Filderstadt, Germany, Attending Physician, Department of Pediatrics, Fribourg Hospital, Switzerland



Audrey Shafer, MD
Associate Professor, Dept of Anesthesia, Co-Director, Biomedical Ethics & Medical Humanities Scholarly Concentration, Stanford University School of Medicine, Palo Alto, California



Mark Snyder, MD
Specialist Leader, Electronic Medical Record Implementation and Physician Adoption; Deloitte Consulting, LLP, McLean, Virginia



Swee Yaw Tan, MBchB (Edin), MRCP (UK), ACSM, FAMS
Senior Consultant Cardiologist, National Heart Centre, Adjunct Assistant Professor Duke National University of Singapore Graduate Medical School, Singapore



William L Toffler, MD
Professor Emeritas of Family Medicine, Oregon Health and Sciences University, Portland





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Thank you to our 2017 reviewers:

Randal Aaberg, MD; Maher A  Abbas, MD; Kaja Abbas, PhD, MPH; Antoine Abcar, MD; Nishat Abdul Khader, MDS; Armen Aboulian, MD; Barry Abrams, MD; Richard Abrohams, MD; Annette Adams, PhD, MPH; Sean Adelman, MD; Alan Adelman, MD, MS; Vanita Ahuja, MD; Andrea Altschuler, PhD; Al’ai Alvarez, MD; Fabio Amorim, MD, PhD; Shubha Ananthakrishnan, MD; James Annesi, PhD; Diana Antoniskis, MD; Christopher Aquino, MD; Sharisse Arnold Rehring, MD; Stanley Ashley, MD; Vikram Attaluri, MD; Rajeev Attam, MD; Andrew Avins, MD; Brittany Bachmann; Vernon Barnes, PhD; Matthew Barth, MD; Rowena Bartolome, RN, BSN, PHN, MHA; Joshua Barzilay, MD; Arne Beck, PhD; Sarah Beekley, MD; Mayer Bellehsen, PhD; John Benson, MD; Jane Benton, MD; Ruth Ann Bertsch, MD, PhD; Shelley Bobb, MDiv, MDR; Ritin Bomb, MD; Kimon Bonadie, DM; Lucienne Bouvier, MD; Megan Boysen Osborn, MD; Sherry-Ann Brown, MD, PhD; Kimberly Brown, MSOM, LAc; Delilah Bruskas, PhD, RN; Louis Cantor, MD; Nathan Carlson, MD; Kiersten Carter, MD; Robert Casillas, MD; Maurice Cates, MD; David Cawthorpe, PhD; David Chadwick, MD; Garrick Chak, MD; Christine Chang-Halpenny, MD; Srini Chary, MBBS, CCFP (PC), FRCSEd; Rebecca Chasnovitz, MD; Pranab Chatterjee, MBBS; Vinod Chaubey, MD; Faisal Cheema, MD; Ricky Chen, MD; Puneet Chhabra, MD, MBBS, DM; Eric Chiang, MD; Deborah Chiarucci, MD; Gary Chien, MD; Homer Chin, MD; Reema Chugh, MD; Linda Chun, MD; Colleen Chun, MD; David Clarke, MD; Charles Clemons, MD; Kathryn Clift; Mark Cohen, MD; Felicia Cohn, PhD; Jeff Convissar, MD; Sarah Corathers, MD; Douglas Corley, MD; Alan Cortez, MD; Ellen Cosgrove, MD; Alberto Coustasse-Hencke, PhD; Roxana Covali, MD; Peter Crooks, MD; Thomas Cunningham, MD; Peter Cvietusa, MD; John Damrose, MD, FACS; John Davenport, MD; Carrie Davino-Ramaya, MD; Nancy Davis, PhD; Richard Dell, MD; Richard Della Penna, MD; Jack Der-Sarkissian, MD; Andrew DiFronzo, MD; Ronald Domen, MD; Jonathan Doris, MD; Sara Doster, MD, PhD; Shanta Dube, PhD, MPH; R James Dudl, MD; Ashley Duggan, PhD; Andrew Dutka, MD; Quentin Eichbaum, MD, PhD, MPH, MFA; Charles Elder, MD; Gabriel Escobar, MD; Donna Ettel, PhD; Adriano Facioli, PhD; Gavin Fairbairn, PhD, MEd; Jessie Fan, MD, MBA; Shireen Fatemi, MD; Vincent Felitti, MD; Iva Ferreira, MD; Claudia Finkelstein, MD; Carol Forster, MD; Carlos Franco-Paredes, MD; Deb Friesen, MD; Pascal Fuchshuber, MD, PhD, FACS; Geoff Galbraith, MD; Les Gallo-Silver, LCSW-R; Gus Garmel, MD; Hernando Garzon, MD; Joseph Gascho, MD; Kamal Gera, MD; Derenik Gharibian, PharmD; Lana Gimber, MD, MPH; Louise Glaser, MD; Marcia Glass, MD; Harry Glauber, MD; Paul Glen, MD; Daniel Glor, MD; Richard Godfrey, MD; Robert Goldfien, MD; Ellen Goldstein, PhD; Alexandra Gordon, MD; Shel Gottlieb, MD; Sarah Greene, MPH; Casey Grover, MD; Kern Guppy, MD, PhD; Philip Haigh, MD; Joel Handler, MD; Douglas Hanes, PhD; Ramy Hanna, MD; James T Hardee, MD; Jeffrey S Harris, MD; Paul Hartman, MD; Carol Havens, MD; Arthur Hayward, MD; Christopher Hebert, MD, MS; Ann Hellerstein, MD; Stephen Henry, MD; Lisa Herrinton, PhD; Catherine Hickie, MBBS; George Ho, Jr, MD; Dieter Hoffmann, MD; Robert Hogan, MD; Anthony Holden, MD; Aram Hovanessian, MD; Gary Huffaker, MD; Robert Hughes, MD; Steven Isenberg, MD; Lee Jacobs, MD; Sharon Jakus-Waldman, MD; Marc Jamoulle, MD; Monica Jarrell, NP; Samir Johna, MD; Ping Johnson, PhD, RN; Kermit Jones, MD, JD; Tom Judd, MS; Renate G Justin, MD; Joseph Kahwaji, MD; Michael Kaplan, MD; Alex Kemper, MD, MPH, MS; Laura Kerr, PhD, IMFT; M Kamal Khalid, MD; Afshin Khatibi, MD; Jennifer Khoe, MD; Dimple Khona, MD; Ian Kimmich, ELS; Anna Luise Kirkengen, MD, PhD; Daniel Klaristenfeld, MD; Arthur Klatsky, MD; Nicola Klein, MD, PhD; Vallerie Kolasinski, MPH; Mike Kositch, MD; Thomas Kottke, MD, MSPH; Michael Krall, MD; Ashok Krishnaswami, MD, MAS; Archana Kudva, MD; Dean Kujubu, MD; Jennifer Kuntz, PhD; Howard Kushner, PhD; Karen Kwan, MD; James Lake, MD; Myles Lampenfeld, MD; Ellen Langley; Jens Langsjoen, MD; Sandra Lapham, MD, MPH; Rebecca Larson, PhD; Mark Lassoff, MD; Peggy Latare, MD; Lisa Law, MD; Tam Le, MD; Eric Lee, MD; David Lee, MD; John Lee, MD; Lonnie Lee, MD; Jeffrey Leftwich, MD; Sharon Lehman, MD; Leslie Leighton, MD; Laurie Leitch, PhD; Pamela Lemke, CNM, MS; Martha Levine, MD; Joel Levis, MD, PhD; Gerald Levy, MD; Catherine Lewis, MD; Evelyn Lifsey, PhD; Alice Lin, MD, FACS; George Longstreth, MD; Cindy Lopez, BSN, RN; Teng Lu, MD; For-Shing Lui, MD; Robert Lundstrom, MD; Waleed Lutfiyya, MD; William Lynes, MD; John Maa, MD; Eric M Macy, MD; Gregory Maletis, MD; Christina Mangurian, MD; David Margolius, MD; Peter J Martin, MD; Lindsay Mazotti, MD; Walt McDonald, MD; Ryan McDonough, DO; Michael McFarlane, MBBS, DM, FRCS, FACS; Elisabeth McLemore, MD; Max McMillen, ELS; Donald Mebust, MD; Lewis Mehl-Madrona, MD, PhD; Charles Meltzer, MD; Albert Mikhail, MD; Amy Miller, MS, DrPH; Pooja Mittal, DO; David Moiel, MD; Richard Moldawsky, MD; Kenji Morimoto, MD; Lisa Morrise, MArts; David Mosen, MD; Stephen Munz, MD; Colin Murphy, FRCSI; Sean Murphy, MD; John Murphy, PhD; Arian Nachat, MD; Craig Nelson, PhD; Ruth Neubauer, MSW, LCSW; Carter Neugarten, MD; Kimberly Newell Green, MD; David Newhouse, MD; Emilie Nguyen, MD; Julie Nyquist, PhD; Ahmed Obeidat, MD, PhD; Resmiye Oral, MD; Chun Ouyang, MD; Ashli Owen-Smith, PhD, SM; Gurpreet Padam, MD; Ted Palen, MD; Jo Paluzzi, PhD; Malvinder Parmar, MB, MS; Hetal Patel, MD; Pawan Patel, MD; Jonathan Peng, MD; Cathriya Penny, DNP, FNP-BC, GNP-BC, ACHPN, BC-ADM; Patrick Pezeshkian, MD; William Pfeiffer, MD; Jennifer Phillips, MD; Gregory Plotnikoff, MD, MTS; Suresh Pola, MD; Andrew Pourmoussa, MD; Karlo Quadros, MD; Sylvestre Quevedo, MD; Javier Rangel, MD; Scott Rasgon, MD; Andrew Rassi, MD; Tom Ray, MBA; Albert Ray, MD; Brian Raymond, MPH; Kimberly Reece, MD; David Riley, MD; Alexander Rivero, MD; Craig Robbins, MD, MPH; Joseph Rosen, MD; Lisa Rossignol, MA; Nareg Roubinian, MD; Ilan Rubinfeld, MD, MBA, FACS; Firoozeh Sahebi, MD; Gerald Saliman, MD; Michael Salinsky, MD; Danny Sam, MD; Jonathan Samuel, MD; Hope Sasek, RN; Candice Sauder, MD, MEd; Kimberly Schertzer, MD; Joanne Schottinger, MD; Andrew Schreffler, MD; Lisa Schuman, ARNP; David C Schwebel, PhD; Theodore Scott, FNP; Elizabeth Scruth, RN, PhD; Ruth Shaber, MD; Vishal Sharma, MD; Andrew Shim, EdD; Veronica Shim, MD; Gregorio Sicard, MD, FACS; Dan Siegel, MD; Joana Silva, MD; Matthew Silver, MD; John Sim, MD; Kurt Smidt-Jernstrom, DMin; Herbert Sorensen, MD; Ricardo Spielberger, MD; Odette Spruyt, MBChB, Dip Obs, FRACP, FRAChPM; Bradley Steele, MD; Jill Steinbruegge, MD; John Steiner, MD, MPH; Bradley Steinfeld, MD; Matt Stiefel, MPA; Anne Stone, PhD; Joshua Strait; Hal Strough, PhD; Gina Sucato, MD; Marie Suga, MD; Gretchen Summer, PhD, RN-BC; Clifford Swap, MD, MS; Jean-Luc Szpakowski, MD; Vishwas Tadwalkar, MD; Karen Tallman, PhD; Michael Tam, MD; KM Tan, MD; Dorothy Tarrant, LCSW, MPA; Sara Yee Tartof, PhD, MPH; Talar Tejirian, MD, FACS; Mark Thanassi, MD; Anil Thomas, MD; Micah Thorp, DO; Maria Thurston, PharmD; David Tieu, MD; Ian Tofler, MD; Marco Tomassi, MD; Eric Tong, MD; Sandra Torrente, MD; Shirin Towfigh, MD; Han-Mou Tsai, MD; Joseph Turban, MD; Leah Tuzzio, MPH; Rob Unitan, MD; Sachin Vaid, MD, MS, MRCS; Kees van Boven, MD; Sonja Van Laar, PhD; Tido von Schoen-Angerer, MD, MPH; Daniel Weberg, PhD, RN; Joshua Weil, MD; Allan Weiland, MD; Calvin Weisberger, MD; Wayne Westcott, PhD; Tom Williams, LPC, LISAC; David Witt, MD; Lucia Wocial, PhD; Warren Wong, MD; Winston Wong, MD; Ed Yian, MD; Hyo-Chun Yoon, MD; Zhou Zhang, MD; Sijie Zheng, MD, PhD, FASN



By Barry Abrams, MD


This is the story of a physician with hypertrophic cardiomyopathy being managed by an implantable cardioverter-defibrillator. In the middle of a snowstorm, he receives his first of many staggering shocks from his runaway defibrillator. Learning to live in this new reality includes learning to live with the strong magnet that blocks the defibrillator signal, much to his own chagrin and the amusement of others. (The first Graphic Medicine book.) Available at: www.permanentepress.com.




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27,000 print readers per quarter, 11,225 eTOC readers, and in 2017, 1.5 million page views on TPJ articles in PubMed from a broad international readership.

The Permanente Journal

The Permanente Journal is a peer-reviewed journal of medical science, social science in medicine, and medical humanities published quarterly by The Permanente Press.


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