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FP Report
September 2001 • Volume 7 • Number 9

E/M documentation guidelines
HHS Secretary Tommy Thompson promises a fresh start

BY SHERI PORTER

It's too early to celebrate, but relief could be in sight for physicians who struggle daily with Medicare billing procedures tied to coding and the evaluation and management documentation guidelines.

In a statement made July 19 before the House Ways and Means Committee, HHS Secretary Tommy Thompson said he's taking a new approach to the development of EMDGs. The controversial guidelines have created havoc in physicians' offices.

"We know that the physicians' primary work is to provide clinical care, not documentation," said Thompson. "Physicians found the first two sets of guidelines, developed in 1995 and 1997, cumbersome." The latest attempt to improve the EMDGs included the development of clinical examples, "but physicians have continued to express concern that these guidelines are hindering, not helping, the delivery of appropriate patient care," said Thompson.

Those physician concerns led to a stop-work order from Thompson: "I have directed Aspen Systems Corp. to stop their work on this current draft while we reassess and retune our effort," he said.

The AAFP has stayed on top of the issue by providing feedback to CMS. In June, the Academy joined other medical specialty societies in signing onto a letter to CMS Administrator Thomas Scully, urging CMS to "re-examine its commitment to imposing burdensome documentation guidelines and clinical examples on physicians billing for E/M services."

On the same day, the Academy sent a letter to Aspen Systems Corp. commending the company for its effort to develop relevant clinical examples, while pointing out the irony: The fact that explanatory vignettes are needed at all "is as much an indictment of the EMDGs as it is a compliment to the clinical examples," said the letter.

At press time, CMS had not released a plan of action for its reassessment process, but in his July 19 address to the committee, Thompson indicated a desire to re-examine the billing codes. "For the system to work, the codes for billing these visits need to be simple and unambiguous," he said. Thompson also repeated his commitment to utilize the physician community "to help design constructive solutions."

AAFP Executive Vice President Douglas Henley, M.D., welcomed the news from Thompson. "Years of effort have gone into trying to develop adequate documentation guidelines, without significant progress," he said. "The Academy will do whatever it can to help CMS redirect its efforts toward creating workable documentation guidelines that do not interfere with the important interaction between family physicians and their patients."

Don't cause OxyContin access crisis, says AAFP

The Academy has warned state attorneys general of the possibility of an access crisis if FPs' OxyContin prescribing privileges were limited.

"The Academy is concerned about the illicit use of OxyContin and has addressed the potential for its abuse on many levels," wrote Board Chair Bruce Bagley, M.D., of Albany, N.Y., in an Aug. 15 letter to the attorneys general.

Most recently, Connecticut Attorney General Richard Blumenthal asked Purdue Pharma, the drug's maker, to institute a physician certification program for the drug and to limit distribution of the drug to physicians who have extensive experience or training in pain management.

Furthermore, the Drug Enforcement Administration might limit OxyContin prescribing to pain specialists -- but the American Board of Pain Medicine lists only 1,179 certified pain specialists nationwide, Bagley wrote. "The solution to the problem of the illegal activities and diversion of this drug is not to impose limits on physicians who are educated and trained to prescribe prescription medication."

Constituent chapter presidents and executives have received letters as well, informing them of the Academy's letter to the state attorneys general. Chapter leaders should share news of educational programs on diversion control or proper pain management with their state attorneys general.

On the national level, the FDA will hold a fact-finding meeting Sept. 13 - 14. Bagley will testify on behalf of the Academy, and AAFP President Richard Roberts, M.D., J.D., of Madison, Wis., will sit on the advisory panel for the hearing.

Academy concerned about sexually explicit entertainment and its impact on young people

The media influence the way young people think they're supposed to act in relationships, Marshall Kubota, M.D., of Santa Rosa, Calif., a member of the AAFP Commission on Public Health, said during a July 26 Senate forum on the impact of sexually explicit entertainment on children. Men are usually portrayed as dominant, Kubota said, and women are often shown as more concerned with image than achievement -- which has contributed to the explosion of eating disorders and cosmetic surgery. The Washington, D.C., event was hosted by Sens. Sam Brownback, R-Kan.; Joseph Lieberman, D-Conn.; and Byron Dorgan, D-N.D.

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Marshall Kubota, M.D., left, of Santa Rosa, Calif., presented the family practice viewpoint at the July 26 Senate forum on the impact of sexually explicit entertainment on children.		 photo
Sens. Joseph Lieberman, D-Conn., left, and Sam Brownback, R-Kan., right, hosted the event, along with Byron Dorgan, D-N.D.

AAFP Congress to review proposal on coverage for all

Last year, the Congress of Delegates asked the Board of Directors to seek widespread input on the Academy's proposal for health care coverage for all and to fine-tune the document.

The Board, after receiving about 1,200 written responses to the proposal, has revised it, and the Congress will consider it Oct. 1 - 3 in Atlanta. To review the proposal, go to http://www.aafp.org/members/unicov/ with your AAFP ID number. Or request it via fax (see "Quick Fax").

Share your comments on the proposal in any or all of these ways:

First, do no harm ...
Genetic counseling: To test or not to test?

BY CINDY McCANSE

It's an ordinary day in your practice -- until a patient blindsides you.

"Doctor, I've been reading about these new genetic tests," she says. "I'd like to be tested for Huntington's disease. It killed my father, and I can't stand not knowing for sure if I have it."

Training the trainers

Genetics in Primary Care: A Faculty Development Initiative sprang from a three-year contract to the Society of Teachers of Family Medicine from the Maternal and Child Health Bureau and Bureau of Health Professions of the Health Resources and Services Administration. The National Human Genome Research Institute and Agency for Healthcare Research and Quality co-fund the initiative.

GPC provides genetics training for 20 primary care faculty teams nationwide, with an eventual goal of integrating genetics as a major component of undergraduate and postgraduate-level medical training.

Each GPC program is highly individualized, using a diverse mix of teaching methods. Examples range from presentations during grand rounds to inclusion of clinical geneticists on primary care rounds.

One tool used at the University of Maryland, Baltimore, to stimulate discussion is a series of case-oriented "trigger tapes." The video presentations emphasize the impact of genetic issues on multiple family members.

The GPC program at East Carolina University, Greenville, N.C., uses a technique called the observed structured teaching exercise. OSTE allows faculty members to interact with so-called standardized patients using a case-based approach. It's fashioned after the observed structured clinical exam model developed in 1974.

Provision of reliable Internet resources physicians can search for up-to-date genetic information is a key component of many of these programs.

Visit http://bhpr.hrsa.gov/dm/genpc.html for more information on the initiative.

LOOK BEYOND THE HARD MEDICINE

So now what? What if testing reveals she doesn't carry the gene? Will she feel guilty about evading the diagnosis that claimed her father's life?

And what if she tests positive? How will she react to the pronouncement of that death sentence?

"This (genetic) information has a tremendous potential to harm as well as to help and stands to affect a broad number of family members," said John Lammie, M.D., associate professor of family and preventive medicine at the University of South Carolina, Columbia. Lammie spoke during a presentation at the recent Workshop for Directors of Family Practice Residencies in Kansas City, Mo.

"There's a tremendous amount of uncertainty about what this all means and the possible harms involved," he said. "It's up to us to help guide our patients through an interpretation of genetic testing."

To that end, Lammie and other presenters at the June session described training programs at their respective institutions aimed at educating primary care physicians about the medical, social and ethical aspects of genetics. It's all part of Genetics in Primary Care: A Faculty Development Initiative. (See the box at right for more on GPC.)

DIFFERENT METHODS, SIMILAR FINDINGS

The training mechanisms they described are diverse -- but applying that training during patient encounters has yielded some common observations, the presenters agreed.

"Even well-educated patients are often ill-prepared to deal realistically with, or even understand, the results of testing," observed Niharika Khanna, M.D., assistant professor of family medicine at the University of Maryland, Baltimore.

"One thing we found was that people are actually coming in asking for tests that can harm them," said FP Janice Daugherty, M.D., of East Carolina University, Greenville, N.C. "For example, there's the false reassurance that a negative amnio test for cystic fibrosis can bring. People have a limited knowledge of what probabilities mean. They don't understand that the next pregnancy wipes the slate clean."

In the end, it's the hands-on approach -- a hallmark of family practice -- that stands to benefit patients the most, said Nancy Stevens, M.D., M.P.H., associate professor of family medicine at the University of Washington, Seattle.

"There's genetics culture and there's primary care culture, and they're different," Stevens said. "Geneticists tend to develop an overall, several-tiered pedigree and extend that out. Primary care doctors tend to approach this issue in a tightly focused, highly patient-oriented manner by asking, 'What specific aspects of a genetic approach to this health problem or potential health problem are likely to benefit this patient?'"

Covering Kids unveils aggressive campaign, toll-free number

BY JODY McAULAY

A nationwide effort to enroll all eligible children and their families in the State Children's Health Insurance Program recently received a big boost: A toll-free number has been established to connect inquiring callers from around the country to their state's coalition for SCHIP.

Covering Kids, an advocacy group that includes the Academy, announced the new number -- (877) KidsNow -- Aug. 8 in a back-to-school campaign kickoff in Washington, D.C. When someone calls that number, an answering system detects the state from which the person is calling and forwards the call to the local coalition for SCHIP.

But wait. There's more.

photo
Yvonne Anderson, principal of Garrison Elementary, welcomed everyone to the kickoff of this year's campaign to enroll kids and their families in SCHIP. The event was at her school.

In this year's expanded enrollment campaign, Covering Kids also is buying advertising in seven targeted cities: Albuquerque, N.M.; Baltimore; Boise, Idaho; Fresno, Calif.; Miami; New Orleans; and Springfield, Ill. These cities are known to have a multitude of working families who don't realize they are eligible for SCHIP.

Other efforts will occur during school sign-ups. Special attention is being given to families who have one or more children enrolled in free or reduced-cost school lunch programs. Recent research shows 3.9 million uninsured children participate in the lunch programs.

Although millions of children are enrolled in SCHIP, Covering Kids representatives believe 7 million more children and their families are eligible for coverage. The Academy and many state chapters promote the Covering Kids campaign with lobbying efforts and strategic partnerships that have helped reduce the number of uninsured children and family members.

For example, the Washington AFP helped establish a statewide telephone number that parents and others eligible for SCHIP could call to get information and enroll in the program, a precursor to the national toll-free number. And the Iowa AFP garnered a federal grant to work with one county to offer medical treatment, dental care, and developmental and preventive screenings for people using SCHIP. Information distributed at the campaign kickoff described these and other chapter efforts backing SCHIP.

The campaign kickoff featured the announcement that New York state had committed $20 million this year toward making sure its eligible children get signed up for SCHIP. And Georgetown University, Washington, D.C., displayed its Kids Medical Clinic, a mobile clinic that offers health care information and screenings as well as SCHIP enrollment assistance.

Check out the campaign Web site at http://www.coveringkids.org for more information about Covering Kids and free promotional materials, including action kits to put on local public awareness events. With your AAFP ID number, log onto the Academy's site at http://www.aafp.org/members/coveringkids/ for materials such as a sample letter to the editor and an opinion column for your local newspaper, and add yourself to the back-to-school campaign listserv by e-mailing a request to coveringkids@gmmb.com.

AMA initiative aims to heighten awareness of gift-giving guidelines

BY CINDY McCANSE

A rep from XYZ Pharmaceuticals just stopped by your office with some interesting news: The company will reimburse you for your time and travel expenses if you attend a weekend educational seminar on the firm's newest drug, Ambiguvax.

Before you ask your assistant to call the travel agent, you may want to consult the AMA Council on Ethical and Judicial Affairs "Guidelines on Gifts to Physicians From Industry."

If you're scratching your head and asking yourself, "What guidelines?" the AMA has a Web site for you.

The new site, http://www.ama-assn.org/go/ethicalgifts/, was created as part of a comprehensive AMA-led initiative to educate physicians, medical students, and representatives from pharmaceutical and medical device and equipment firms about appropriate gift-giving practices.

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Coming next month: Check out how the AAFP is addressing this issue -- watch for the October FP Report.

The AAFP was one of more than 30 organizations asked to participate in developing the initiative. Norman Kahn, M.D., vice president for science and education, represented the Academy on the Working Group for the Communication of Ethical Guidelines for Gifts to Physicians from Industry.

The campaign is divided into two phases. The first phase, launched last month, is designed to provide information about the AMA guidelines to physician organizations and industry. In addition to the new Web site, a free booklet titled "What You Should Know About Gifts to Physicians From Industry" and other resources are available from the AMA. Physicians can obtain copies of these materials by calling (312) 464-5101, or simply download them from the new Web site.

The second phase, to be launched in early 2002, will highlight additional educational resources available on the AMA Web site. Materials on the site will include case histories, documents outlining relevant legal issues and suggestions for developing pertinent CME programs.

The AMA's effort springs in part from recent study results and media stories suggesting that many physicians, physicians-in-training and industry representatives are unaware of the AMA gifts guidelines and similar ethical guidelines from other groups, says Alan Nelson, M.D., a former AMA president and chair of the working group.

In an opinion column produced as part of the campaign, Nelson points out that "some gifts serve an important and beneficial function for both physicians and patients. Still, gift-giving should be carefully limited, and physicians and industry representatives should accept certain responsibilities in adhering to these limitations."

It's true: Industry representatives are a significant source of useful information. But physicians must keep in mind the obvious -- it's the rep's job to sell his or her product. And like it or not, research shows that many physicians' prescribing habits are influenced by these interactions.

Even for those who can objectively say that their prescribing behavior does not change as a result of pharmaceutical detailing, that may be a moot point if their patients believe that it does.

Perception is key, says Kahn. "Look at it from your patients' perspective. If you would be uncomfortable trying to explain your actions to one of your patients, perhaps you need to look more closely at what you are doing."

Resident and Student News

National Conference celebrates many faces of family medicine

BY TONI LAPP

Some of them have gone into research. Others have gone into academics. Still others have gone into medical editing. Even politics. Sports medicine. What do they have in common? They all represent the many faces of family medicine.

Six panelists described their beginnings and what led them into family practice in a forum at the National Conference of Family Practice Residents and Medical Students July 25 - 29 in Kansas City, Mo. However, their shared background was just about the only commonality among the speakers at "The Many Faces of Family Medicine."

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Her work with patients keeps her centered, said Denise Rodgers, M.D., one of six panelists at a forum titled "The Many Faces of Family Medicine" at the National Conference on July 25 in Kansas City, Mo.

The panelists were Patrick Harr, M.D., of Maryville, Mo., an AAFP past president and chair of AAFP's former Task Force on Student Interest; Richard Roberts, M.D., J.D., of Madison, Wis., AAFP president; Denise Rodgers, M.D., of New Brunswick, N.J., president of the Society of Teachers of Family Medicine; Susan Schooley, M.D., of Detroit, chair of the family practice department at Henry Ford Health System; Jay Siwek, M.D., of Washington, chair of the family medicine department at Georgetown University Medical Center and editor of American Family Physician; and Bernard Ewigman, M.D., M.S.P.H., of Columbia, Mo., a professor in the family medicine department at the University of Missouri and associate editor of The Journal of Family Practice.

One common theme emerged in the discussion: No matter where their careers have led them, no matter what frustrations they've encountered, panelists agreed that taking care of patients has kept them grounded.

"Through it all, I've been centered by the work that I do with patients; I have been both centered and humbled," said Rodgers, who went on to describe how she has learned from her patients.

After the discussion, the panelists answered questions from the audience, including how to tell whether family practice is the right career choice. Students don't need to know "everything about everything," Roberts said. "But you have to be good at what's common and important." Plus, he added, "We're the only discipline that emphasizes ambulatory care. We're where the action is."

In this year's expanded enrollment campaign, Covering Kids also is buying advertising in seven targeted cities: Albuquerque, N.M.; Baltimore; Boise, Idaho; Fresno, Calif.; Miami; New Orleans; and Springfield, Ill. These cities are known to have a multitude of working families who don't realize they are eligible for SCHIP.

Other efforts will occur during school sign-ups. Special attention is being given to families who have one or more children enrolled in free or reduced-cost school lunch programs. Recent research shows 3.9 million uninsured children participate in the lunch programs.

Although millions of children are enrolled in SCHIP, Covering Kids representatives believe 7 million more children and their families are eligible for coverage. The Academy and many state chapters promote the Covering Kids campaign with lobbying efforts and strategic partnerships that have helped reduce the number of uninsured children and family members.

For example, the Washington AFP helped establish a statewide telephone number that parents and others eligible for SCHIP could call to get information and enroll in the program, a precursor to the national toll-free number. And the Iowa AFP garnered a federal grant to work with one county to offer medical treatment, dental care, and developmental and preventive screenings for people using SCHIP. Information distributed at the campaign kickoff described these and other chapter efforts backing SCHIP.

The campaign kickoff featured the announcement that New York state had committed $20 million this year toward making sure its eligible children get signed up for SCHIP. And Georgetown University, Washington, D.C., displayed its Kids Medical Clinic, a mobile clinic that offers health care information and screenings as well as SCHIP enrollment assistance.

Check out the campaign Web site at http://www.coveringkids.org for more information about Covering Kids and free promotional materials, including action kits to put on local public awareness events. With your AAFP ID number, log onto the Academy's site at http://www.aafp.org/members/coveringkids/ for materials such as a sample letter to the editor and an opinion column for your local newspaper, and add yourself to the back-to-school campaign listserv by e-mailing a request to coveringkids@gmmb.com.

Resident and Student News

Don't lose sight of what matters

BY CINDY McCANSE

"Be connected to high-tech, but don't ever cease to be high-touch." So urged AAFP President-elect Warren Jones, M.D., of Ridgeland, Miss., July 27 at the National Conference. Jones delivered the Stephen A. Jackson, M.D., Memorial Lecture at the conference.

He described one patient encounter during which he had occasion to take his own high-touch advice. The patient had made the rounds, presenting to one physician after another with nonspecific symptoms. Physical exam findings were within normal limits, as were the results of previous diagnostic studies.

Seeing nothing overtly wrong with the patient's physical health, Jones asked him what was going on in his life. That, Jones recalled, opened the floodgates.

"He pretty much collapsed in my arms, and I embraced him," said Jones, citing personal setbacks the patient had suffered. "That's all he needed.

"There's not a CPT code for that, but I would urge you to make it a big part of what you do."

NOT AN EASY ROAD

The road ahead may not be easy for the specialty, Jones acknowledged. But he expressed confidence that family medicine will not only survive, but thrive.

"I am not worried about family docs," he said. "I am not worried about the specialty. I am worried about some of the issues we face."

One of the more obvious issues, Jones said, is the decline in family practice residency match numbers over the past few years. But even that's not necessarily all bad news, he said.

"Let's not bury us just yet," said Jones. "We still have a pulse; we're still vibrant. We've separated the wheat from the chaff. We've focused on quality, not quantity."

MEETING AMERICA'S NEEDS

That quality sets FPs apart from other medical specialists, Jones said. "That's why family physicians best meet America's needs -- because we offer state-of-the-art care and compassion."

And they offer it where it is most needed, Jones added. Unlike many specialists who are tied to large, urban medical facilities, FPs routinely practice in the trenches, going where their patients are, according to Jones.

"Whether they're in urban America, suburban America or rural America," he said, "that's where we are."

The willingness to practice in the communities that need them most enables FPs to provide care over the entire life continuum -- an ability largely unmatched by any other medical specialty. FPs are truly the only specialists who practice prenatal care to end-of-life care, said Jones, and everything in between.

REACH OUT, COMMUNICATE, CONNECT

Just look at family medicine's past triumphs to renew your confidence in the specialty's future, Jones said. He pointed to the women in the audience as an example, rattling off statistics illustrating their growing role in medicine in general and family practice in particular. "I salute you, and I look forward to working with you as we knock down further barriers," he hailed.

Jones closed by sharing a personal tale of an FP he credits with saving his life. The FP diagnosed and initiated treatment for blastomycosis Jones contracted as a young adult.

"He's a family doc who made a difference in my life," said Jones. "If you've had a hard week, go home and ask yourself, 'Have I made a difference?'

"If you know of FPs struggling, reach out, communicate and connect with them. Follow your heart. Don't let the obstacles you face dampen your enthusiasm for our specialty."

Resident and Student News

Prolific year for resolutions at national congresses

A ttendees at this year's National Congress of Family Practice Residents and National Congress of Student Members -- which met during the National Conference -- had a lot to say about the "state of the specialty." A sampling of resolutions generated by the congresses follows. The source of each action -- NCFPR and/or NCSM -- is indicated.

photo
Theresa Garcia, M.D., a resident from University of Missouri-Kansas City, was among the voices heard at the National Congress of Family Practice Residents on July 28 in Kansas City, Mo.

The congresses asked AAFP to do the following:

Resident and Student News

Residents, students choose new leaders

The National Congress of Family Practice Residents and the National Congress of Student Members elected the following new leaders July 28 during the National Conference in Kansas City, Mo.

Members of AAFP Board of Directors: English Gonzalez, M.D., M.P.H., of Silver Spring, Md.; Jaime Hartung of Rootstown, Ohio

Resident National Conference chair: Jameelah Gater, M.D., of Ellenwood, Ga.

Student National Conference chair: Russell Kohl of Oklahoma City

Alternate delegates to AAFP Congress: Erika Bliss, M.D., of Seattle; Michael Coffey, M.D., of Malden, Mass.; Marc Carey of Portland, Ore.; Carla Cesario of Providence, R.I.

Representatives to Society of Teachers of Family Medicine Board of Directors: Deborah Gilboa, M.D., of Horsham, Pa.; Eddie Turner of Memphis, Tenn.

Resident member of Residency Review Committee for Family Practice: Nancy Pandhi, M.D., of Alexandria, Va.

National family medicine interest group coordinator: Christine Degnon of Hershey, Pa.

Observer to Association of Family Practice Residency Directors Board of Directors: Marguerite Duane, M.D., of Lancaster, Pa.

photo
Gonzalez		 photo
Hartung		 photo
Gater		 photo
Kohl

National Conference mixes education with jubilation

The 2001 National Conference of Family Practice Residents and Medical Students sported some 3,040 attendees, beating last year's total of 2,869 registrants. This year, 719 students and 665 residents participated in the many lectures, clinical procedures workshops and other activities offered. And there was no shortage of fun to be had!

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Residents and students relaxed and feasted at the opening party July 25 in Union Station. 		photo
Information on residencies, medical products and job opportunities -- the exhibit hall had it all.
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Helen Steele, M.D., of Chicago practices drawing insulin into her needle during "Gadgets and Gizmos for Diabetes Education and Management."		 photo
Vicki Haussman of Williamsport, Pa., goes for an impromptu ultrasound in the exhibit hall.

Academy members get satisfaction

illustration

A whopping 85 percent of AAFP members say they are satisfied with the Academy when it's compared with other medical organizations.

More significantly, half of all members say they are "very satisfied" with the Academy, a percentage that's been growing since it was 31 percent in 1995. In fact, members who are "very satisfied" have outnumbered those who are "satisfied" for the past six years.

The results come from the Academy's 2001 Member Attitude Survey, which was presented recently to the Board of Directors. This annual survey, started in 1992, gives officers and staff an overview of how members feel about the Academy and its services as well as other medical issues.

Enthusiastic about their career choice, 74 percent of members say if they had to choose again, they would still become family physicians.

Most members say the Academy's CME activities constitute its most valuable service. Political lobbying efforts rank second, followed by American Family Physician. Although CME and political lobbying have always ranked among the top three services, the number of members listing lobbying efforts has declined sharply since 1995.

CME and AFP also made the "top three" list of the Academy's best and most appreciated accomplishments during the past year. New to the list is AAFP's public awareness campaign.

Letters to the Editor

OxyContin

To the editor:

The August FP Report cover story about OxyContin notes that West Virginia's attorney general has filed a complaint charging that the drug's maker used coercive, inappropriate tactics to encourage physicians to prescribe the drug. But in the story, Kevin Burke of AAFP's Government Relations Division says such developments imply that "physicians are merely tools of pharmaceutical companies" when they are not.

Unfortunately, this assertion is contradicted by a substantial body of evidence. As Henry Barry opines in the April 2001 issue of Evidence-Based Practice, "American physicians are gullible shills for the pharmaceutical industry."

A far more credible, effective, responsible and ultimately respectable response would be to acknowledge the scope of the problem and begin an Academy-wide effort to address it. The fact is that our prescribing patterns are indeed affected by industry advertising -- and to an alarming degree. This has been amply demonstrated and documented.

Kenneth Sperber, M.D.
Pawtucket, R.I.

To the editor:

I'm responding to the August FP Report's informative article concerning the Drug Enforcement Administration's efforts to limit OxyContin's prescribing to "pain management specialists." DEA's effort will certainly be a huge step backwards in medicine's current efforts to provide excellence in patient pain control and end-of-life care.

As medical director of St. John's Hospice, an AAFP life member and a long-time member of the American Academy of Hospice and Palliative Medicine (over 1,500 members), I'm sure I join the AAHPM's more than 350 family practice members who feel their ability to appropriately prescribe OxyContin is essential to providing compassionate and pain-free care to our terminally ill patients.

Certainly intensive educational efforts regarding OxyContin's possible abuse to both medical and non-medical audiences are essential. But limiting prescribing ability to a small group of "specialists," who may have problems providing continuity of care and accessibility to many patients, is not the answer to the problem.

John Holland, M.D.
Springfield, Ill.

To the editor:

I am bent out of shape. The Drug Enforcement Administration is essentially proposing that a physician with four years of college, four years of medical school and a three-year family practice residency is incompetent to prescribe a narcotic analgesic. Our training certainly qualifies our competency. We prescribe much more dangerous drugs, requiring considerably more expertise, such as insulin, glucophage and digitalis. I hope that AAFP Board Chair Bruce Bagley, M.D., strongly refutes any effort of the DEA to proceed with its ridiculous, irrational proposition.

Now I will call my family physician and see if he will prescribe something for hypertension. I need it.

Bruce Jacobson, M.D.
Fort Worth, Texas

Drug company influence

To the editor:

In the August FP Report, AAFP President-elect Warren Jones, M.D., is quoted as saying, "We need to develop tools to help guide physicians in their interactions with pharmaceutical representatives."

That's baloney. Most of us physicians are intelligent, hard working, ethically unchallenged folks who can be trusted to do the right thing for our patients and don't need any committees to help us with our moral compasses.

Rocky Khosla, M.D.
Pueblo, Colo.

Feds continue health funding

To the reader: Write us letters of 200 words or fewer (subject to editing), using the FP Report addresses at the bottom of page 2.

To the editor:

I am writing as a clarification to the article "When One Door Closes ..." (June FP Report). The article indicated that in 1995 the federal government "washed its hands of" two community health centers in the District of Columbia, when the Healthcare for the Homeless project became responsible for them. In fact, the federal government provided and continues to provide funding for these community health centers both before and after the change of management. The community health centers rely on the federal funding to be able to provide medical services to the indigent.

Aviva Zyxkind, M.D.
Washington, D.C.

Preventive health care
Are young men tuning out?

Number of office visits (in thousands) by sex and age of patient to all physicians and to general and family practice physicians (GFP).
  Male Female
Age All Physicians GFP All Physicians GFP
3 - 17 years 58,672 13,720 55,215 13,526
18 - 24 years 12,706 3,928 35,899 9,652
25 - 44 years 66,948 22,660 144,827 32,740

Source: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics, 1998 data.

BY SHERI PORTER

Where have all the young men gone? Chances are they're not in your exam rooms. The boys that routinely reported for back-to-school checkups and high-school sports physicals probably haven't set foot in your office since Mom last scheduled an appointment.

Their disappearing act is a national phenomenon. Figures published in AAFP's 2000 Facts about Family Practice show a definite dearth of male patients from 18 to 24 years of age (see table).

Is this a worrisome trend -- a precursor to a lifetime of doctor ducking? It's no secret that men are at least 25 percent less likely than women to visit a doctor and are significantly less likely to have regular physician checkups and obtain preventive screening tests for serious diseases.

Or does the dip in numbers merely reflect the reality that this generally healthy population requires little more than acute care treatment with a dash of healthy lifestyle counseling on the side?

MEMBERS WEIGH IN

FP Report asked members of two AAFP e-mail discussion groups to weigh in on this topic -- and they were all over the board in their responses. A sampling of their comments follows.

photo
The boys that routinely reported for back-to-school checkups and high school sports physicals probably haven't set foot in your office since Mom last scheduled an appointment.

THE BOTTOM LINE

"Because most young men don't come in specifically for well-person exams, every acute care contact -- whether it's a minor injury or a respiratory infection -- offers an important opportunity to provide clinical preventive services," said Theodore Ganiats, M.D., of La Jolla, Calif., chair of AAFP's Commission on Clinical Policies and Research. Use these opportunities judiciously, he said, because identification of risks "is critical in providing the appropriate tests and counseling that should be a major focus in this age group."

Inside the Beltway

Title VII still threatened; ask Congress to vote for funds this month

Federal support for family practice training may be an endangered species. Forces are converging to wipe out the support provided under Section 747 of Title VII of the Public Health Service Act -- funding that has bolstered family practice training programs since 1972.

The U.S. Congress is slated to vote this month on health-related appropriations for 2002. So you still have time to ask your lawmakers to maintain the specialty's funding -- which has been about $50 million in 2001.

FUNDS BESIEGED

Threats to the federal support:

JOIN THE CAMPAIGN

New For You
Order from AAFP at (800) 944-0000 unless otherwise noted.

Be knowledgeable about Keystone III, the Colorado conference that grappled with the specialty's future last fall, by ordering Keystone III, the conference proceedings (#R1600, $20). The 341-page book is intended to stimulate additional discussion, planning and action.

Tar Wars all-ocassion cards




23rd Annual Conference on Patient Education

The new sets of Tar Wars® all-occasion cards convey tobacco-free messages from fourth- and fifth-graders. A 15-card set costs $20. To order, go to http://www.aafp.org/catalog/ and search for Tar Wars notecards. Or e-mail tarwars@aafp.org. Also, the free 2001 - 2002 Tar Wars curriculum can be printed from the program's Web site. Go to http://www.tarwars.org and click on "Tar Wars Program Curriculum" or call (800) TAR WARS [827-9277].

Proven value: Use the AAFP's sample certification/recertification press release to inform the community about your status with the American Board of Family Practice. Download a free copy at http://www.aafp.org/members/cert/ (AAFP ID number required for access) or use AAFP Express (see "Quick Fax").

Proven value: The 23rd Annual Conference on Patient Education Nov. 15 - 18 in Seattle will feature close to 100 CME sessions. Early-bird registration ends Oct. 20 and costs $395 for individuals, $375 for each team member and $195 for a one-day registration. To request a brochure or to register, go to http://www.aafp.org/pec/. To obtain faxed materials, see "Quick Fax".

Proven value: During the 2001 Scientific Assembly in Atlanta, check out the redesigned AAFP Marketplace. Learn about AAFP services and products, visit with AAFP Board members and shop for AAFP gift items at booth 2132 in the exposition hall from 9 a.m. to 4 p.m. Oct. 4 - 6.

A shipping fee may apply; Kansas residents pay a 7 percent tax.
Quick Fax

Available on AAFP Express

Call the AAFP Express toll-free number -- (800) AAFP EXP [223-7397] -- and supply your AAFP ID number to have selected materials sent almost immediately to your fax machine for free. Some documents available:

Description of document Doc. no.
2001 Recommended Childhood Immunization Schedule 7001
Proposal on health care coverage for all 8007
Press release on board certification/recertification 1010
Title VII press materials 1003
   
Information on the 2001 conferences
  
Infant, Child and Adolescent Medicine
Oct. 22 - 26, Washington, D.C.
 2012
Emergency and Urgent Care for the Family Physician
Oct. 29 - Nov. 1, Paradise Valley, Ariz.
 2009
23rd Annual Conference on Patient Education
Nov. 15 - 18, Seattle
 7004
State Legislative Conference
Nov. 15 - Nov. 17, Bernalillo, N.M.
 8006

FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.

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