BY TONI LAPP
Click on this icon to go directly to
online-only content.
Family physicians overall are happy with their career choice. Despite the lack of respect for family practice in academia, practicing subspecialists respect FPs and recognize the specialty's importance to health care. But patients don't always understand what an FP is.
These findings are highlights from preliminary data released in March by the Future of Family Medicine project, launched in 2001 to take an objective, comprehensive look at the discipline and develop a strategy for its future. The AAFP and six other family medicine organizations are partners in the project.
The preliminary data, available at http://www.futurefamilymed.org/, come from research coordinated by the national consulting firm Siegelgale of New York. The FFM Project Leadership Committee engaged Siegelgale to do quantitative and qualitative research to answer the question, "What do people want and expect from their doctor, and what is the role that family physicians could or should play?"
The results give family practice leaders something to work with, said Project Leadership Committee Chair and AAFP President James Martin, M.D., of San Antonio.
"The study indicates that the American people still want a personal relationship with a listening, caring physician. The study also indicated that we are more highly regarded by our subspecialty colleagues than we may have supposed," said Martin.
Patients' lack of understanding about family physicians was an especially interesting finding, said Martin. In focus groups of patients, 38 percent of participants erroneously thought their primary care physicians were not FPs when in fact they were. Similarly, 33 percent were seeing internists but thought their physicians were FPs.
To be sure, there are challenges, said Martin. "The public still does not understand the role and value of a family physician. Some patients do not have an appreciation of continuity relationships, and many patients do not see the family physician as scientifically and technologically astute."
But as the project's data analysis unfolds and its five task forces examine the output, the project will begin to tap into ways to rejuvenate the specialty and, in turn, health care, he said.
Family practice is the only specialty formed from social need, said Norman Kahn, M.D., AAFP vice president for science and education and staff executive to the FFM project.
"Our core values are still valued, but slightly differently than they were 30 years ago," Kahn said. "But we will have to transform and renew ourselves to be more responsive."
Some values FPs think are important may not rate highly with patients. Research data showed the areas of practice family physicians tend to give up are those that are not valued as fundamentally important by patients. For instance, Siegelgale data showed that providing maternity care ranked least important on patients' list of attributes they desire in a physician; seeing hospitalized patients ranked 30th out of 39 on the list.
Indeed, patients are wary of too much emphasis on comprehensiveness. "It's dangerous for anyone to try to know all of this," one patient said in a focus group. Another said, "They could miss something because they think they know as much as specialists and won't refer."
"Science has gotten so complex that it's not reasonable to expect someone to have the depth of knowledge necessary," said a consumer advocate.
Patients are divided on one core value: the "family" in family practice.
Idealistically, treating the whole family promotes a better understanding of the individual patient. However, for a majority of an FP's patients, the patient being treated is the sole family member being seen by that physician.
"The notion of 'family' is not universally accepted as being the epicenter of the specialty," said the Siegelgale report.
Some patients prefer it this way. "I wouldn't want my wife and kids to go to my doctor," one patient said. "I like to believe that what I talk to my doctor about remains between us."
The FFM project is now past its midpoint. Its five task forces are in the process of meeting to discuss data relating to topics such as education, systems of care and communicating the FP's role. Task force members are writing recommendations based on the Siegelgale findings.
Kahn says that the introspection in and of itself has been valuable.
"The most important findings are not the answers but the questions," Kahn said. "The discipline had the courage to ask open-ended questions, with the awareness that it might not like the answers it received," he said.
Doctors in other countries are taking notice: In Great Britain, a similar project is planned. Its name? The Future of General Practice project.
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
Click on this icon to go
directly to online-only content.
Despite the careful stewardship of the Academy and other family medicine organizations, preliminary results released March 20 by the National Resident Matching Program show that family practice continues to struggle to position itself as the specialty of choice among medical students.
The early data showed that of 2,940 family practice residency openings offered, 2,239 were filled, yielding an overall fill rate of 76.2 percent compared with last year's rate of 79 percent.
Yet it's the proportion of U.S. seniors selecting family practice that's most concerning. Of the 2,940 openings, only 1,234 were filled with U.S. grads -- a rate of 42 percent compared with last year's 47.4 percent.
Not welcome news, certainly, but not unexpected, either, for those who have tracked the specialty's progress through a quagmire of declining reimbursement, increasing regulatory burdens and flagging federal support of family medicine training programs.
"We realize those factors -- and others -- are going to influence medical students thinking about entering family practice," said AAFP President James Martin, M.D., of San Antonio. "That's why we initiated the Future of Family Medicine project, commissioned the University of Arizona study of student specialty choice, and continue to lobby on behalf of family physicians and their patients."
Since last year's match, Academy leaders and other FPs have made more than two dozen Capitol Hill visits, advocating the specialty's interests and seeking legislative support on key issues. AAFP officers have met with White House officials, and FP visits to statehouses across the country have numbered in the hundreds.
The FFM project (see front-page story) was created to ascertain patients' future health care and technology needs and to ensure the discipline stands ready and able to fulfill those needs. FFM initiatives include developing an open-source electronic health record to enhance quality, safety and efficiency; working with family medicine educators to provide a future-oriented residency curriculum; and continuing to offer cutting-edge, evidence-based CME.
The AAFP Board of Directors last month approved recommendations that address specific issues identified in the student interest study by the University of Arizona, Tucson. For more on the recommendations, developed jointly by the AAFP Commission on Education and Commission on Resident and Student Issues, go to http://www.aafp.org/fpr/20030400/2x.html.
"With the health care needs of millions of Americans at stake, our medical schools must provide a positive training environment for future FPs," Martin said. "The federal government must support family practice funding and initiatives.
"Family physicians are fundamental to a successful U.S. health care system. Current and future FPs must have the tools and training they need to serve their rural, urban and underserved patient populations. The AAFP is working to ensure our country doesn't lose its family doctors. I challenge patients, the federal government, medical schools and physician role models to do the same."
To reach writer Cindy McCanse, e-mail cmccanse@aafp.org.
|
ADDITIONAL INFORMATION |
Educated guesses are good; well-considered expert opinion is better. Good, solid research evidence is best. Thanks to a study on student interest commissioned by the Academy in 2001 and conducted by the University of Arizona, Tucson, solid evidence is exactly what the AAFP Board of Directors had to work with at its March meeting in Washington.
Click on the link shown at the right to go directly to the Arizona study. To view it, you'll need to login using your AAFP ID number.
The Board considered 11 recommendations submitted jointly by the commissions on Education and Resident and Student Issues -- all based on data from the Arizona study -- and gave nine of them the proverbial thumbs-up.
The Board's action comes at a time when the AAFP continues to build consensus with the other family medicine organizations on how to approach the shared goal of enhancing and supporting medical student interest in family medicine. These organizations have had the opportunity to provide input on the COE/CRSI Board recommendations. According to Norman Kahn, M.D., AAFP vice president for science and education, the Academy will continue to collaborate with each group as appropriate to achieve that mutual goal.
Here's a brief rundown of action the Board will take, based on what the two commissions requested:
BY SHERI PORTER
Click on this icon to go directly to
online-only content.
 Patient contact is a high point for high-school seniors Mayra Meija, left, and Elena Davila, center, shown here with MED-PREP preceptor Diana Ballesteros, M.D. |
Homegrown tomatoes are the best. Homegrown doctors are, too. That's why some family practice educators plant seeds of interest in their local high-school students, then nurture that interest with a good measure of mentoring.
The idea is to get kids into the medical school "pipeline" early, with the end goal of keeping those future doctors in their home states. The concept can work. Consider MED-PREP, a recruitment program sponsored by the Mexican American Physicians Association in San Antonio.
The 20-year-old program targets minority high-school students grades 9 --12. "Our goal is to try to produce minority doctors to serve in underprivileged areas," said FP Diana Ballesteros, M.D. "It's important to get these students early and to motivate them."
Jesse Tobias Martinez, sophomore biochemistry major at St. Mary's University in San Antonio, is a MED-PREP success story.
Martinez learned about MED-PREP as a high-school junior and was quickly hooked. Two years of Saturday morning classes were a "sacrifice," he said. But what won Martinez over to family medicine -- heart and soul -- was the unique opportunity, as a high-school senior, to participate in a MED-PREP preceptorship program started by Ballesteros five years ago. In the program, he observed the delivery of health care in an urban community hospital setting with his mentor, Ballesteros.
In the end, the experience cemented his resolve. "I want to be a family physician," he said. Martinez plans to practice in an urban Texas community someday because of his passion for disadvantaged and minority people.
|
Consider 'shadowing' requests an honor Don't forget the power of one. Even without a big university steering the boat, you can make a difference in a student's career path. "There are a lot of us who don't participate in an organized program, but have students who come and 'shadow' us on a fairly regular basis," said family physician Dale Michels, M.D., of Lincoln, Neb. "They may be college or high-school students, but they'll come and spend several afternoons or whole days seeing what I do." Michels said he isn't always sure how students find him. But when FPs participate in high-school career days and lecture in a school's health class, it tips students and counselors off to physicians who might be willing to invest a little time in a teen. "Sometimes it's a patient, sometimes it's one of my children's friends who asks if 'dad' would let them come and shadow," says Michels. "If we believe in what we do, it shows and prompts those kinds of requests." |
"Of the MED-PREP kids handpicked for the preceptorship team, we'll probably see an 80 percent matriculation to medical school," said Ballesteros. She is confident that a soon-to-be-instituted tracking system, funded by a grant, will prove her right.
Travel north to Nebraska to see the same "homegrown" concept at work.
Jeffrey Hill, M.D., associate dean of admissions at the University of Nebraska Medical Center College of Medicine, Omaha, snags some of the highest-ranking high-school seniors from rural communities across the state and enrolls them in his Rural Health Opportunities Program.
"It's a program designed to attract the top rural high-school students," said Hill. "We want to keep our best and brightest here."
Hill's link to the students is their counselors. For example, in Newcastle, Neb. -- population 300 -- public school counselor Karma Thomas keeps tabs on students as they progress through high school. "If I know they're interested in the medical field, I try to get them interested in applying for RHOP," she said.
High-school senior Becky Whipple is a case in point. Whipple, who graduates in May, recently won a spot in RHOP after a nudge from Thomas.
Next fall, Whipple will attend Chadron State College, Chadron, Neb., with a full tuition scholarship from the college and guaranteed placement at UNMC College of Medicine in 2007, provided she maintains a 3.5 grade point average.
Whipple says she's always had an interest in medicine -- but RHOP will make the path to becoming a doctor a whole lot easier.
"I want to live in a rural setting in western Nebraska," said Whipple. "If you love the state and don't have plans to move away, it's a great deal."
As part of RHOP's four-year curriculum, Whipple will have the opportunity to attend classes with medical students and shadow physicians in the medical center.
The RHOP students are required to go into a primary care field, and the hope, said Hill, is that they'll return to rural Nebraska to practice.
"A lot of these students are filling our family medicine accelerated program and rural training track program," said Hill, "and those programs place up to 12 students a year into the state.
"If this program went away, it would be a disaster. These students are critical to our rural programs, especially in light of the decreasing applicant pool in family medicine."
Here's info on other mentoring programs
FP Report recently posted a question to the Academy's Minority Issues E-mail Discussion List, asking for information on mentoring programs across the country. Family physicians and others were excited to share information about the following mentoring programs:
Florida State University College of Medicine,
Tallahassee --; program targeting minority and rural students
"It's a
unique and comprehensive program from the standpoint that intervention occurs
early. We have a full-time coordinator that works in the precollege and college
complement. We start at the middle school level and follow all the way through
the undergraduate years. We're preparing students to be competitive applicants
for medical school."
Thesla Berne-Anderson, health professions adviser
and director of pre-college and college programs
http://www.med.fsu.edu/outreach.asp
Venture Scholars Program
"The Venture
Scholars Program provides an educational pathway for high-achieving,
historically underrepresented students interested in pursuing math- or
science-based careers by linking this targeted population with a national
consortium of close to 200 undergraduate colleges and universities,
graduate/professional institutions, and associations and organizations.
Currently, more than 11,000 high-school students and 1,400 college students are
enrolled as Venture Scholars across the United States."
Jessica Arkin,
director, Venture Scholars Program, Ventures in Education Inc., New York,
N.Y.
http://www.venturescholar.org
Health Careers Pathways Program K-12, University of
Kansas Medical Center, Kansas City, Kan.
"The mission of HCPP is to
increase the number of underrepresented students in the primary health care
professions. The program targets economically disadvantaged students from all
racial backgrounds. Eighty students in grades seven through nine spend 30
Saturdays participating in applied learning science, math and technology labs
at Kansas City Kansas Community College. Forty-five sophomore and junior
students spend six weeks at the University of Kansas Lawrence campus and enjoy
a variety of intensive internships, including two weeks with multicultural
physicians. These experiences have resulted in higher PSAT scores and a larger
number of students choosing advanced math and science courses in high
school."
Marcia Pomeroy, associate director, Health Careers Pathways
Program
http://www2.kumc.edu/oced
Medical College of Wisconsin --; Apprenticeship in
Medicine
"I am involved in a mentor program run by the Medical College
of Wisconsin that recruits underrepresented minorities for a six-week summer
program called Apprenticeship in Medicine."
Kevin Izard, M.D., Milwaukee,
Wis.
This description of AIM comes from the Medical College of
Wisconsin Web site:
"To pursue a career in medicine or biomedical research,
academic preparation must begin as soon as possible at the high-school level.
The college maintains active programs for minority students at many levels. The
Apprenticeship in Medicine (AIM) and Research Opportunity for Academic
Development in Science (ROADS) programs give minority high-school students an
opportunity to explore careers in medicine and biomedical research during the
summer months."
http://www.mcw.edu/acad/mcsa/programs.htm
University of Missouri-Kansas City --; Summer
Scholars Program
"Have you looked at the University of Missouri Kansas
City School of Medicine Summer Scholars Program? This program has recruited
many high-school students in the Kansas City area, including
myself!"
Linda Siy, M.D., Fort Worth, Texas
This information is
from the UMKC Web site:
"The University of Missouri-Kansas City instituted
its Summer Scholars Program in 1980 to identify minority and disadvantaged
high-school juniors and seniors in the Kansas City metropolitan area who have
the scholastic ability and interest to pursue a career in the health
sciences."
http://research.med.umkc.edu/prospective/default.html
To reach writer Sheri Porter, e-mail sporter@aafp.org.
Welcome to the first FP Report to be produced using a version of the electronic long -- print short concept, or ELPS. There are only four pages in the printed version of this issue, not the usual eight. But for some of the topics covered in print, there's expanded content that appears exclusively in FP Report Online. Those topics are marked with a mouse icon under the headline.
May's issue will return to the usual eight pages, with the entire content in print (except for any urgent online updates that occur after press time). This rotation between four pages/more content online and eight pages will continue for several months, then we'll ask for your preference via a reader survey. We look forward to hearing from you!
The Academy has forged four new online affiliations that can benefit you. Build your own clinical support network with these online affiliates, many of which offer special discounts to AAFP members -- but you must subscribe through http://www.aafp.org/onlinesubs.xml to save.
InfoPOEMs. Physicians have come to recognize POEMs -- Patient-Oriented Evidence that Matters -- as a valuable tool to help keep current with clinically applicable new research. Now you can receive the POEMs, via daily e-mail, at no cost. Sign up for DailyPOEMs through AAFP. And, save $20 on InfoRetriever, including the full POEMs database along with seven other databases, by subscribing through AAFP. This service is available for personal digital assistants and personal computers and via the Web.
MD Consult. This resource offers online access to 40 respected medical references, 50 clinical journals, a comprehensive drug database, MEDLINE searches, clinical guidelines, patient education materials and more. Save 10 percent on new or renewed subscriptions through AAFP.
PDxMD. A point-of-care tool with full desktop features as well as handheld downloadable components, PDxMD offers a differential diagnosis tool and continuously updated files on more than 450 medical conditions. Save 25 percent when you subscribe or renew through AAFP.
UpToDate. Coming soon, this clinical information resource is recommended by AAFP and six other medical associations. UpToDate will be available online, for PDAs and on CD-ROM. It is designed to answer the questions that arise in daily practice right at the point of care. UpToDate is peer-reviewed and will be updated every four months.
|
|||||||||
BY CINDY McCANSE
Click on this icon to go directly to
online-only content.
Underwhelming -- that describes the response so far to the federal government's call for emergency response team members to be vaccinated for smallpox. Fewer than 17,000 of the roughly half a million targeted for the vaccine had actually been vaccinated as of March 7.
In response to this lackluster showing, HHS Secretary Tommy Thompson announced on March 6 that states would be allowed to begin the second phase of the national smallpox vaccination program, in which as many as 10 million emergency and health care workers would be vaccinated. CDC staff and Public Health Service Commissioned Corps officers will also begin receiving smallpox vaccinations, he said.
Thompson reiterated that news during a March 7 telebriefing -- and then took it one step further. Together with CDC Director Julie Gerberding, M.D., he asked clinician leaders to support the smallpox vaccination plan and to assist other clinicians in "making informed decisions about their willingness to volunteer" to be vaccinated.
A major sticking point in getting the federal smallpox vaccination program off the ground has been guaranteeing adequate compensation for those injured by the vaccine or by contact with vaccinees. At press time, two compensation packages -- one proposed by the Bush administration and the other by Rep. Henry Waxman, D-Calif. -- had been introduced in Congress, with more scheduled to follow. Although lawmakers in both houses have pledged to move quickly on compensation legislation, the time frame for passage is anything but certain. Meanwhile, physicians remain wary about rolling up their sleeves.
"We recognize that this is unprecedented, and it represents an unusual situation for health care organizations," said Thompson. But he assured briefing participants that HHS plans to pull out all the stops on the issue, adding that he was to meet that day with White House officials for a strategy-planning session on the Bush proposal. "All I can tell you is we're putting a full-court press on it and hope to move it through Congress as quickly as possible," Thompson said.
New terrorism preparedness resources available from AAFP
You need look no further than the Academy’s Web site for up-to-the-minute terrorism preparedness information. Go to http://www.aafp.org/btresponse.xml to access the latest AAFP resources developed to help FPs serve as sentinel family physicians against bioterrorism and other public health threats.
At AAFP’s “btresponse” site, you can download the CDC’s Smallpox Vaccination Pocket Guide to answer those lingering how-to or what-for questions you may have about the smallpox vaccine and its effects.
And for your patients with questions about the smallpox vaccine and the federal vaccination plan, AAFP’s award-winning patient education Web site — familydoctor.org — has a new downloadable handout at http://familydoctor.org/handouts/740.html. The handout describes the vaccine, explains who should and who should not receive it, and lists other online resources patients can consult for more information.
Also new at the Academy’s terrorism Web site is a PDF version of a flyer ready for downloading and posting in your office, urging patients to talk with you about any terrorism concerns they may have (information about accessing and reading PDF files is at http://www.aafp.org/pdf.xml).
And you can now link directly to the following sites from the AAFP “btresponse” site:
• U.S. Department of Homeland Security Web site. This site offers detailed information on how to prepare for terrorist attacks, such as instructions for assembling a supply kit and issues to consider when developing a family communications plan.
• American Red Cross Web site. This site provides resources in both English and Spanish on what the Homeland Security Department’s five threat conditions for possible terrorist attack mean. The information provided by the Red Cross is tailored for individuals, families, neighborhoods, schools and businesses.
The CDC on March 3 began mailing information packets on smallpox and the smallpox vaccine to 3.5 million clinicians nationwide. A press release on the CDC mailing is at http://www.aafp.org/x19907.xml.
“Ensuring clinicians have accurate information about smallpox is critical as we continue to work to enhance our nation’s preparedness for a possible terrorism attack,” said CDC Director Julie Gerberding, M.D. “This mailing is unprecedented, and the information in these packets is a valuable resource to those health care providers on the front lines who would be the first ones to recognize smallpox cases.”
The packet contains:
Also included in the packet is an invitation to join a CDC-sponsored online registry enabling you to receive regular e-mail updates on terrorism preparedness and training opportunities. You don’t have to wait for the packet to arrive to sign up; go to http://www.bt.cdc.gov/clinregistry/ to find out how to begin receiving updates right away.
To reach writer Cindy McCanse, e-mail cmccanse@aafp.org.
|
|||||||||
|
ADDITIONAL
INFORMATION Pre-Vaccination Information Packet, updated March
27 Review of the Centers for Disease Control and
Prevention's Smallpox Vaccination Program Implementation: Letter Report 2
|
The CDC on March 25 took the precaution of calling for temporary deferral of potential smallpox vaccine recipients with a history of heart disease. This CDC action came in response to the March 23 death of one smallpox vaccine recipient from myocardial infarction and reports of cardiovascular complications in at least six others.
"We promised to closely monitor this program and to put safety first, so we are exercising exceptional caution," said CDC Director Julie Gerberding, M.D. "If our investigation shows this precautionary measure should become permanent or the need for other changes or enhancements in the civilian smallpox vaccination program, we will take immediate action."
For now, the CDC is recommending that persons with known cardiac disease -- such as cardiomyopathy, previous heart attack, history of angina, or other evidence of coronary artery disease -- be temporarily deferred from receiving the vaccine. CDC will provide states with simple questions about heart problems; health professionals may use the questions when screening volunteers for smallpox vaccination.
Click on the links at the right to read more about the CDC's action and additional information resources for health professionals involved in the vaccination program. Also listed is a link to the second letter report to the CDC from the Institute of Medicine's Committee on Smallpox Vaccination Implementation Program.
The woman who died March 23, a Salisbury, Md., health care worker in her 50s, had been vaccinated five days earlier. A second woman, Florida resident Virginia Jorgensen, 57, died of a heart attack March 26 -- the day after the CDC announcement. Jorgensen's death came 17 days after she was vaccinated against smallpox.
Both women, said Gerberding, along with one other vaccinee who subsequently suffered a heart attack but survived and two more who experienced angina after vaccination, "had a history of factors that are associated with an increased risk of coronary artery disease."
Several reports of cardiac-related problems had been received from among the 25,645 health care workers vaccinated as of March 25, said Gerberding. Although it is unknown at this time whether this incidence varies from the norm that would be expected in any other age-matched patient population, she noted, the CDC will continue to investigate the incidents and will maintain the cautionary deferral as long as it is indicated.
While acknowledging the pall these recent deaths could cast over a federal vaccination program already struggling for legitimacy among health care and public health professionals nationwide, "We continue to believe that it is important and necessary to vaccinate health care workers to prepare our nation in the event we have to respond to a smallpox outbreak," said Gerberding. Health officials in several states don't seem to agree, however, and have called for the temporary suspension of all smallpox vaccinations until more is known about the cardiovascular risks.
Even more recently, the Department of Defense announced March 28 that a 55-year-old male National Guard member, who had been inoculated as part of the U.S. military's smallpox vaccination effort, had also died of a heart attack.
The CDC's Advisory Committee on Immunization Practices met the same day to consider the new developments. Richard Clover, M.D., of Louisville, Ky., a member of the AAFP Commission on Clinical Policies and Research, represents the Academy on the committee.
The upshot of the meeting was a recommendation that the CDC expand its list of those ineligible to receive the smallpox vaccine to include persons with three or more major risk factors for heart disease, such as smoking, high blood pressure, high cholesterol and diabetes. If the CDC adopts the ACIP's proposal, an estimated 6 percent of health care workers and 10 percent of the overall U.S. population would be ineligible to receive the vaccine.
|
|||||||||
BY TONI LAPP
The outbreak of severe acute respiratory syndrome -- or SARS -- underscores the need for better disease surveillance and improved methods to transmit data, say CDC officials.
Researchers are working to identify the cause of the illness; preliminary findings have suggested the presence of a paramyxovirus, a member of a family of viruses known to cause respiratory illness in humans, in three patients diagnosed with SARS.
The CDC held a March 17 telebriefing to provide the latest information on the illness that's been spreading through China and Southeast Asia. The CDC issued a health alert March 15, and a document with interim information and recommendations for health care professionals has been posted at http://www.aafp.org/x20033.xml.
"There is no evidence to suggest that this can be spread through brief contact or assemblages of large numbers of people," CDC Director Julie Gerberding, M.D., said in the telebriefing. Likely, transmission has occurred through direct contact with respiratory secretions or body fluids of an infected person, said Gerberding.
At press time, of the 306 suspect and probable cases reported worldwide, 10 patients had died. According to CDC statistics through March 20, Chinese officials had reported suspect and probable cases from Guangdong province and were still updating figures.
Health officials urge isolation of persons with suspicious symptoms. Case findings include a fever greater than 100.4 degrees, signs or symptoms of respiratory illness, and either recent travel to areas reporting cases of the syndrome or close contact with someone who's been diagnosed with SARS.
Physicians who suspect the illness in patients should contact their state or local health department. Go to http://www.cdc.gov/ncidod/sars/ to read more about the illness.
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
|
|||||||||
The identification in the United States of 39 cases of severe acute respiratory syndrome -- or SARS -- indicates the illness is a global problem, said CDC Director Julie Gerberding, M.D., in a March 24 teleconference.
Recent research suggests that a previously unrecognized virus, a member of the family of coronaviruses, may be the cause of the illness, said Gerberding.
"We are continuing to collaborate with the World Health Organization and the other international investigators to understand the modes of spread, the causes of illness, and what really is the best way to prevent spread and treat the patients," Gerberding said. Of the 39 U.S. patients with SARS, 32 had traveled to parts of the world where the syndrome is prominent, she added.
An interim travel advisory, at http://www.cdc.gov/travel/other/acute_resp_syn_multi.htm, has been issued for Hong Kong and Guangdong province in China and for Hanoi, Vietnam. To read the latest information on SARS, go to http://www.cdc.gov/ncidod/sars/index.htm.
An exciting opportunity is coming your way if you plan to attend the 2004 AAFP Scientific Assembly Oct. 13 - 17 in Orlando, Fla.That Assembly will be held in conjunction with the 17th World Conference of Family Doctors, to be hosted by AAFP and sponsored by Wonca, the World Organization of Family Doctors -- and U.S. family physicians are encouraged to consider hosting an international delegate before, during or after the meetings. Physicians are sought in Florida as well as in U.S. cities where international physicians may enter the country or where they may choose to visit.
"We hope America and Americans will be the best hosts ever for visitors from abroad," said Daniel Ostergaard, M.D., AAFP vice president for international and interprofessional activities. "Involvement could include such activities as exchanging e-mail correspondence before the meeting, getting together for a meal at the meeting, or inviting an international guest to your home or office."
To learn more, go to http://www.aafp.org/woncahosting.xml. If you decide you'd like to be a host, complete a brief questionnaire that can be found at http://members.aafp.org/members/surv7/woncahost.htm. Once registration information is received from Wonca attendees, you will be contacted regarding your "match."
 The Georgia AFP announces the candidacy of Richard Wherry, M.D., of Dahlonega for AAFP president-elect. |
 Medical error reporting systems must be voluntary and confidential, says James Martin, M.D. |
BY J.M.BRODIE
Click on this icon to go
directly to online-only content.
AAFP leaders and staff made the case for confidential, voluntary medical error reporting systems in primary care March 13 on Capitol Hill.
In presentations before congressional aides and the media, the AAFP representatives reinforced action the House took March 12. It passed H.R. 663, the Patient Safety and Quality Improvement Act, by a 418-6 vote.
"The bill would continue the patient safety work of the Agency for Healthcare Research and Quality," said AAFP President-elect Michael Fleming, M.D., of Shreveport, La. "It would allow patient safety reports to be gathered from physicians instead of limiting reports to hospitals and facilities."
Fleming shared this story as a case in point: "Last week, a patient came in for a urinary tract infection. I asked her what medicines she was taking, and she didn't tell me she had seen a rheumatologist who put her on methotrexate. I prescribed a sulfa drug. There was obviously potential for great harm. Thank goodness the pharmacist called me."
AAFP President James Martin, M.D., of San Antonio mentioned the misfiling of a lab report showing a patient had uterine cancer. It took a week for that mistake to be identified. Martin explained how a medical error reporting system could help track and reduce errors in primary care.
 H.R. 663 would allow patient safety reports to be gathered from physicians, says Michael Fleming, M.D. |
"The question we have is: How often does this happen in America? We know a lot about patient harm and liability, and we are starting to learn a lot about what happens inside the hospital," Martin said. "But the majority of health care in this country takes place in an outpatient setting."
He said AAFP's goal regarding patient safety is threefold: to help create a system for error reporting, to ensure that system is voluntary and confidential, and to identify ways to correct errors.
Staff members from the Robert Graham Center in Washington shared results of studies on medical errors in primary care in the United States and five other industrialized countries. Two-thirds of the treatment or diagnostic errors actually started as communication glitches -- a cascade of errors starting with information that was not communicated effectively, leading to treatment or diagnostic mistakes.
During one of the Capitol Hill presentations, AHRQ senior advisor Larry Patton lauded the idea of an error reporting system. "An analysis of near misses is critical," he said. "There will be a spectacular increase in errors reported at first. That would be a major success. What the Academy and AHRQ are trying to do is drive those things out from underground."
Patient safety resources
This list of resources includes articles and studies on medical errors, as well as pending legislation on patient safety.
"Enhancing Patient Safety One Change at a Time," FP Report, September 2002 -- http://www.aafp.org/fpr/20020900/13.html
"From Lab Reports to Wrong Vaccinations, Most Medical Errors Count as 'Process' Mistakes," FP Report, September 2002 -- http://www.aafp.org/fpr/20020900/16.html
To Err Is Human: Building a Safer Health System, Institute of Medicine, 1999 -- http://www.nap.edu/catalog/9728.html
Crossing the Quality Chasm: A New Health System for the 21st Century, Institute of Medicine, 2001 -- http://www.nap.edu/books/0309072808/html/
"Prescription Writing to Maximize Patient Safety," July/August 2002 Family Practice Management -- http://www.aafp.org/fpm/20020700/27pres.html
Family Practice Management, July/August 2002 (entire issue focuses on preventing errors in family practice) -- http://www.aafp.org/fpm/20020700/
"Medical Errors: 20 Tips to Help Prevent Them" -- http://familydoctor.org/handouts/736.html
"A Preliminary Taxonomy of Medical Errors in Family Practice" -- http://www.graham-center.org/x352.xml
"An International Taxonomy for Errors in General Practice: A Pilot Study," July 15, 2002, Medical Journal of Australia -- http://www.mja.com.au/public/issues/177_02_150702/mak10269_fm.html
"Family Physicians' Solutions to Common Medical Errors" -- http://www.graham-center.org/x396.xml
"Consequences of Medical Errors Observed by Family Physicians" -- http://www.graham-center.org/x395.xml
"Types of Medical Errors Commonly Reported by Family Physicians" -- http://www.graham-center.org/x394.xml
"The Patient Safety Grid: Toxic Cascades in Health Care Settings" -- http://www.graham-center.org/x162.xml
"Toxic Cascades: A Comprehensive Way to Think About Medical Errors" -- http://www.graham-center.org/x161.xml
H.R. 663, the Patient Safety and Quality Improvement Act -- http://www.theorator.com/bills108/hr663.html
To reach writer J.M. Brodie, e-mail mbrodie@aafp.org.
Effective March 1, the Centers for Medicare & Medicaid Services implemented a 1.6 percent increase in the Medicare conversion factor. Make note of the following details that will affect your reimbursement.
• You have until April 14 to make your 2003 Medicare participation decisions, and you can reverse any participation decision made earlier. If you're satisfied with your participation status, no action is required. (Go to http://www.aafp.org/mcareoptions.xml to review your Medicare participation options.)
• Because of a glitch in the Medicare claims processing software, claims filed on or after March 1 for services provided in January and February will be incorrectly paid at the 2003 rate. For such services, if the 2003 rate is greater than the 2002 rate, physicians can avoid a subsequent carrier request for a refund by using the 2002 Medicare allowance as the actual charge on the claim.
The final rule for the 2003 Medicare physician fee schedule can be downloaded as a PDF file at http://cms.hhs.gov/regulations/pfs/fr2003qa.pdf. A Q-and-A document on the fee schedule is at http://cms.hhs.gov/regulations/pfs/cms1204f2.pdf. Check out http://www.aafp.org/pdf.xml if you need help accessing PDF files.
To the editor:
I am grateful for the articles in the February FP Report on the Florida State University College of Medicine. Maybe they will help keep the dream alive here.
Joseph Scherger, M.D., M.P.H.
Tallahassee, Fla.
Editor's note: Scherger, a family physician and founding dean of the college, was removed from that position right after the February FP Report went to press. Visit http://www.aafp.org/fpr/20030200/3.html to read the February coverage; click on "Update" to learn more about what happened after the issue was printed.
To the editor:
I never respond to articles, but I always get worked up when I read about trial lawyers in places where they have so much power, as pointed out by David Avery, M.D., of Vienna, W.Va. (quoted in the February FP Report story, "FPs in West Virginia Dare to Hope for Tort Reform").
The governor and all Supreme Court judges in that state are trial lawyers. That's enough to send shivers up my spine! The keynote speaker at the San Diego AAFP annual meeting last year pointed out that each trial lawyer can easily contribute $10 million to fight any court reform. At least one presidential candidate (a senator from North Carolina) is a trial lawyer, and I think there may be others. We as physicians are doomed if more trial lawyers are elected or appointed to positions of power. Dr. Avery phrased it well when he identified some of them as "very anti-physician."
Bill Ogg, M.D.
Satellite Beach, Fla.
|
To the reader Write us a letter of 200 words or fewer (subject to editing). FP Report, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672; fax them to (913) 906-6089; call (800) 274-2237, Ext. 5230; or contact fpreport@aafp.org via e-mail. |
To the editor:
I enjoyed the article on patient assistance programs in the February FP Report.
Since a significant percentage of my patient population lacks insurance coverage, we frequently access these programs for our patients. Unfortunately, the paperwork involved can be onerous. One of my nurses has thanklessly accepted the task of sorting out the various programs and trying to keep track of different patients.
Also, we have noticed that subspecialists refer patients back to us for the express purpose of enrolling them in patient assistance programs for medications that the subspecialists have prescribed. Accepting a solely clerical role, especially as it is not reimbursed, is difficult to swallow.
Although it would be somewhat satisfying to charge patients for these services, it would be ridiculous to do so in my practice. If the patients had the money to pay for these medications or the insurance to cover their cost, we wouldn't need the patient assistance programs in the first place!
Kristin Elliott, M.D.
Marquette, Mich.
To the editor:
In response to Dr. Fearon's letter in the March FP Report, I couldn't disagree more! His plea to further train nurse practitioners in our profession, if heeded, would only lead to a more rapid demise of the family physician, not help to preserve our profession. His fear that we may end up in direct competition with midlevel health providers if we don't train them is already a reality. Read any nurse practitioner journal, and it is clear they view FPs as competition and have no qualms about representing themselves as "physician equivalents." We are partly to blame for this situation, as we have elevated midlevel professionals to the stature of medical doctors in the eyes of our patients, insurance payers and colleagues. It's no wonder medical students shun our discipline when we teach them that you don't really have to be a medical doctor to practice family medicine! Midlevel providers do not have the education, training or experience of medical doctors and should not be supported in their attempt to replace family physicians.
Allen Roberts, M.D.
Denver, Colo.
|
|
|
Save time -- pay your AAFP dues online. Here's how: Go to http://www.aafp.org/myacademy and sign in using your ID number and your password. Click on "Check My Dues" and provide your credit card information (site is secure). Questions? Call (800) 274-2237 and ask for your AAFP membership coordinator. |
 |
|
Several lectures from AAFP's 2002 Scientific Assembly in San Diego are available online. Go to http://www.aafp.org/x17593.xml to access the lectures -- then take the online post-tests and earn CME credit. |
 |
|
Proven value: Join the Academy in recognizing April as National Minority Health Month. AAFP online resources include: Cultural Proficiency Guidelines, at http://www.aafp.org/x13891.xml; information on the "Quality Care for Diverse Populations" video, at http://www.aafp.org/x13887.xml; and Volunteering and Caring for the Uninsured, a list of resources at http://www.aafp.org/x14230.xml. Also check out "The Provider's Guide to Quality and Culture" at http://erc.msh.org/mainpage.cfm?file=1.0.htm&module=provider&language=English |
|
|
A shipping fee may apply; Kansas residents pay a 7.525 percent tax. |
|
||||||||||||||||||||||||||||||||||
FP Report is published by the
AAFP News Department.
Copyright © 2003 by
American Academy of Family Physicians.
