BY TONI LAPP
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Perhaps it's symbolic that the Future of Family Medicine project, with its goal of transforming and rejuvenating the specialty, released its report and recommendations this spring -- in the season of renewal.
Topping the list of the project's recommendations: Develop a new model for family medicine. That model of care would be based on a relationship-centered personal medical home to serve as a focal point for patients' care. The transformation to this model would include office redesign, electronic health record systems and a team approach to care.
The project, a collaborative effort of seven family medicine organizations concerned that family medicine needed revitalization, began in 2000. On March 30, the FFM project issued its report and recommendations in a supplement to the March/April Annals of Family Medicine, online at http://www.annfammed.org. AAFP has mailed the supplement to active members who do not already receive Annals; it should arrive in early April.
Team effort
From the outset, the project was a team effort: One elected leader and the chief executive from each of the seven organizations sat on the leadership committee.
AAFP Board Chair James Martin, M.D., of San Antonio, who chaired the committee, called it a "once-in-a-generation opportunity" to fix what was broken with the specialty.
A consulting firm analyzed findings from interviews and focus groups to determine perceptions -- from the public, patients, FPs, medical students and other clinicians -- toward family medicine. The findings were released to five task forces, each with a charge fundamental to the specialty. Those task forces made recommendations, 10 in all.
Now that the report is out, it's time to act, Martin said.
"This report allows us to learn from the mistakes of the first 30 years," he said. "It also helps us affirm what we did that works and is still desired, but also to make the changes we need to make to be viable and properly positioned to lead health care into the future."
Action items
Each organization volunteered to take the lead on one or more of the 10 recommendations; the AAFP is taking the lead on seven items, including the top three -- a new care model, EHR systems and communications.
"We are the predominant member of the 'family' and have more resources to address these recommendations," said Martin. "It is logical for us to have these roles."
John Bucholtz, D.O., an FFM task force chair and immediate past president of the Association of Family Practice Residency Directors, said the project was structured to provide continuity through the officers of the sister organizations.
"Speaking for AFPRD, we have made this a front-burner item," he said. "We'll make that one of the presidency's responsibilities -- for our organization to do what we committed to do."
Bucholtz is residency director at Columbus (Ga.) Family Practice. His program has already begun implementing one of the recommendations -- instituting an EHR system -- and the FFM project was instrumental in gaining support for the implementation from his hospital's board of directors, he said. "I told them that this is going to be a national recommendation to train residents on electronic health records."
Real world
It became apparent by mid-2003 that discussion of the recommendations led to a common theme -- reimbursement. Thus, a sixth FFM task force was born.
"If you can't create a viable business model for the new model of family medicine, then it's not going to work," said AAFP President Michael Fleming, M.D., of Shreveport, La., a member of Task Force 6. "This is not an academic exercise. The focus is on the 'real world' practice of medicine."
Task Force 6 comprises representatives from within family medicine and from employers, insurers, and the Centers for Medicare & Medicaid Services.
"The payers agree" said Fleming, "they must find a way of paying us that values what we do." He predicts the improvements will take place "over a spectrum of about three to five years."
Spring is not only the season of renewal, but also the season of graduations, noted Fleming. "Publishing this report is just the beginning. The leadership committee's work is at an end, and this is the commencement."
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
BY J. MICHAEL BRODIE
WEB EXTRA! Tech firms support core
principles of Academy's EHR initiative  AAFP President Michael Fleming, M.D., shows off features of one electronic health records system as part of a briefing for congressional staff. |
The AAFP went to bat for family physicians recently as it sought to prevent Congress from creating unnecessary regulations for using electronic health record systems.
The topic: AAFP's new Partners for Patients initiative that brings FPs hardware and software for EHR systems at 15 percent to 50 percent discounts (prices have prevented many FPs from adopting EHRs, FPs said in a 2003 survey).
The site: Capitol Hill.
The audience: about 30 congressional aides, the folks who draft the legislation members of Congress enact -- or don't enact.
With that last thought in mind, Academy leaders, together with representatives of firms in AAFP's EHR partnership, presented their EHR vision to congressional aides Feb. 13.
The goal was to fend off burdensome regulations by showing Congress what is already being done without federal involvement.
David C. Kibbe, M.D., director of the AAFP Center for Health Information Technology, described EHR systems as "a hot topic." He and AAFP President Michael Fleming, M.D., of Shreveport, La., urged Congress to work with the AAFP and other groups to develop universal EHR implementation standards.
"People are looking at this as way too big of a problem," Kibbe said. "We have made enormous progress primarily because we have kept it simple."
"This is health care that is happening now," said Fleming.
FP makes it happen
Robert Collins, M.D., of Starkville, Miss., said in an interview after the briefing that his practice has used an EHR system for seven years.
"We did it (implemented an EHR system) because it was something we felt we needed to do," said Collins, director of the student health center at Mississippi State University, located near Starkville. "Time is money for anybody, and if you are trying to make a living in family medicine, you have got to be more efficient."
Collins agreed that cost could be a barrier to physicians considering the purchase of an EHR system. "If the government is going to mandate it, they had better have reimbursement because it is not cheap," he said. "If you're going to ask docs to cough up six figures for this, they are going to need help."
Collins' EHR system, he said, has helped cut down on mistakes. For
example, what he adds to a patient's record is clearer, he said. "There should
not be any doubt about what I was thinking with a particular patient."
Tech experts brief aides
Speakers at the congressional staff briefing included Alan Zuckerman M.D., director of primary care informatics in the family medicine department at Georgetown University, Washington, and Mark Leavitt, medical director for the Health Information and Management Systems Society.
"What we are looking at here is a big step beyond the paper charts," said Zuckerman. "We are trying to get rid of unnecessary work."
Leavitt said, "We don't have an optimal marketplace. We have chaos and it is crying out for leadership." But he quickly warned the gathering, "Regulation does not necessarily make things cheaper."
To reach writer J. Michael Brodie, e-mail mbrodie@aafp.org.
WEB EXTRA!
The AAFP's Partners for Patients initiative recently received a boost from health information technology companies wanting to go on record as supporting the Academy's electronic health records vision.
More than 20 companies have come forward, unsolicited, and asked to sign declarations of support, saying they too see value in developing EHR systems that encompass the AAFP's core principles of affordability, compatibility, interoperability and data stewardship -- principles that form the bedrock of the initiative.
The Academy's core group of IT partners are serving in an advisory capacity to the AAFP and have signed principled group purchasing agreements. The supporting companies are not expected to sign such agreements, and they do not have the same obligation to offer discounted prices on their products and services, although many may do so.
Why should members be interested in this news? After all, moral support is nice, but it won't help FPs equip their offices with EHR systems.
"The growing support of a wide array of companies is encouraging because we've never had IT vendors calling us saying, 'We want to work with you,'" said Rosemarie Sweeney, AAFP vice president for socioeconomic affairs and policy analysis. "The IT vendor community is finally paying attention to family physicians."
Keep checking the AAFP's Center for Health Information Technology Web site at http://www.aafp.org/centerforhit.xml for updates.
To reach writer Sheri Porter, e-mail sporter@aafp.org.
Parents may be giving physicians an earful about a new guideline calling for selective use of antibiotics to treat acute otitis media in children ages 6 months to 12 years.
Treating an ear infection is a multifaceted issue, and evidence has shown that most cases resolve without antibiotic use, said Martin Mahoney, M.D., past chair of the AAFP Commission on Clinical Policies and Research and a member of the joint guideline panel of the AAFP and American Academy of Pediatrics.
It was important for FPs and pediatricians to collaborate on this guideline, Mahoney said. "It makes a lot of sense for medical specialty societies who treat the same population of patients to work together on guidelines. It sends a unified message to the public and to physicians. We can be assured that a large population of children can be cared for in a way that is supported by the evidence."
Treatment of AOM has been such a contentious issue that the lay press began publicizing the guideline before it was formally approved March 9. There was so much misinformation circulating, the groups released the guideline ahead of schedule.
Much early press coverage had focused on the recommendation regarding antibiotic use, excluding mention of pain relief.
Angry parents reacted. "You people are always trying to change things because of your 'opinions' ... come back to the real world," one mother wrote to the AAP.
In fact, the guideline states that AOM management should include treatment for pain, if present. Mahoney says careful counseling should alleviate confusion.
"If you step through the guideline in a logical way with parents, by the time you get to the end, a light bulb should go off," he said. "We're not saying 'don't prescribe antibiotics,' but there are certain things you can do: You can have close follow-up, or you can have an emergency prescription to use if the condition doesn't improve."
The guideline, available at http://www.aafp.org/x26481.xml, includes Q-and-A materials for physicians and parents.
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
BY SHERI PORTER
 John Patz, D.O., instructs a patient about to begin detoxification. Her name is the first to be entered in Patz's buprenorphine journal -- a record of his patients taking the drug. |
In the spring of 2003, FP John Patz, D.O., realized he was tired of squeezing patients at the medical clinic into 15-minute slots day after day. He was fed up with insurance company hassles, excessive paperwork, corporate rules and lack of control over his professional life.
"I needed to redefine my practice to try to find a renewed sense of purpose," says Patz.
Fast forward to Feb. 2, 2004, and welcome to Patz's new practice, Ballard Recovery Services Inc. (in the Ballard neighborhood just minutes from downtown Seattle). The practice is devoted to addiction medicine and pain management. Patz sets his own fees -- about 20 percent below the average in this neighborhood -- and he operates on a cash-only basis.
Office rates for new patients range from $50 for a level one visit to $200 for a level five visit. Opiate detoxification is billed at $500 a week. Most patients require two to three weeks of treatment and initially must be seen in the office every day.
In Patz's view, prescription pain medications have become a significant problem. "Any physician who is starting patients on chronic narcotic therapy should have a plan to get them off," says Patz.
Patz understands why many FPs are both weary and wary of treating patients with addictions or chronic pain. It's not unusual to encounter patients who have been "fired" by their primary care physicians for nonpayment or noncompliance, he says. "These patients' problems are multifaceted, and their treatment involves psychosocial overlays that involve significant time." All of Patz's addicted patients take counseling sessions with Vincent Ingarra, M.S.W., the psychiatric social worker and licensed counselor who sees patients part time at Ballard Recovery.
"It is a bit unnerving to know that I'm now trying to attract the sort of patients that many family physicians would rather not have in their practices," says Patz.
All in a day's work
On March 1, one day before Patz's one-month anniversary, the appointment book shows only two patients, and the first is late for her 9:30 a.m. appointment. "I'm worried about her," says Patz, and asks the office manager to give her a call.
He's relieved to hear that the patient's just stuck in traffic. She's scheduled to begin opiate detoxification this morning. Patz will start her on buprenorphine, a drug approved for treating opioid addiction.
When he was in a traditional for family practice, Patz says, his schedule couldn't tolerate patients being late. "Now, if I were to turn someone away who was 30 minutes late, I might have missed my only chance to see that patient," he says.
Today, an unscheduled patient, trying to taper off of benzodiazepines under Patz's supervision, wobbles into the office with a friend's help.
"The tapering is just not working for him. He needs inpatient treatment," says Patz after the patient leaves. Despite his best efforts at paving the way for admission to an inpatient facility today, Patz doesn't know if the man will go. "But I can sleep at night knowing that I've done everything I can for him," he says.
Follow the rules
 A patient undergoing treatment for an addiction settles up with office manager Brenda Gibons after his appointment. Although Ballard Recovery Inc. is a cash-only practice, patients have the option of filing claims with their health insurance companies. |
Up to 30 percent of patients at Patz's previous practice were in treatment for chronic pain or addiction -- so he knows the pitfalls that could ensnare his fledgling practice.
"We will not enable addiction here, and I'm sure we'll show many people to the door," Patz says.
Addiction and chronic pain share common threads, says Patz, which is why he requires patients being treated for chronic pain to sign a patient agreement. The 22-point document, adapted from materials of the American Academy of Pain Medicine, says the patient will go to only one prescribing physician and one pharmacy. The agreement includes statements such as these:
It also says if a patient can't comply with this agreement, there may be an addiction problem rather than a chronic pain problem.
Reap the rewards
Will his practice succeed? "It's too early to tell," says Patz. "But I do feel I'm in the right place at the right time. These are exactly the patients I want to help."
There's another factor that draws this FP to treatment of addictions: As patients begin to recover, Patz sees them regain their integrity. "I've not gotten that reward in treating many other chronic diseases," he says.
To reach writer Sheri Porter, e-mail sporter@aafp.org.
The Drug Addiction Treatment Act of 2000 paved the way for certain physicians to treat opioid addiction. Then, in October 2002, the drug buprenorphine received FDA approval for managing opioid addiction.
What's that mean to FPs? You can obtain a waiver to prescribe buprenorphine to patients undergoing detoxification or on maintenance therapy for addiction to opioids such as prescription pain medications and heroin. The only requirement is a minimal amount of special training. For more information on training opportunities, go to http://buprenorphine.samhsa.gov/training.html.
The waiver restricts a single physician -- or group of physicians -- from having more than 30 patients in opioid addiction treatment with buprenorphine at one time. (Waivers are issued by tax I.D. number.) The limit has created problems because the 30-patient ceiling includes both patients needing detoxification and those on maintenance treatment.
David Fiellin, M.D., associate professor of medicine at Yale University, New Haven, Conn., and chair of the American Society of Addiction Medicine Buprenorphine Training Subcommittee, estimates there are about 800,000 untreated heroin-dependent patients and as many as 2.5 million prescription narcotic-dependent patients in the United States. He estimates 1,200 physicians currently prescribe buprenorphine.
"There's a huge unmet need to provide treatment," he said. "I would guess 5 percent of family physicians' patients need this type of treatment service."
Patients can find a physician authorized to prescribe buprenorphine in their geographic area by logging onto the buprenorphine physician locator Web site at http://buprenorphine.samhsa.gov/bwns_locator/.
This year's National Alcohol Screening Day on April 8 offers free, anonymous screenings to the public through community-based programs operated by local health professionals. The nonprofit organization Screening for Mental Health Inc. is providing screening materials.
The federally supported effort is a good start, says the AAFP. But without appropriate follow-up, screening for alcohol or any other health problem has limited benefit.
The Academy took this view to U.S. Surgeon General Richard Carmona, M.D., Feb. 12 in Washington. AAFP President Michael Fleming, M.D., of Shreveport, La., and AAFP staff met with Carmona, officials from the National Highway Traffic Safety Administration, and other government and health organization representatives to discuss the screening initiative, now in its seventh year.
"We talked about this issue from an everyday, practicing doc perspective," Fleming said. "How much good does a single day of screening do? From the perspective of a practicing family doc, screening is just the beginning of the management process. We have to do the intervention and follow-up, as well.
"What we suggested to the group instead was a National Alcohol Screening Awareness Day that would allow us to focus on intervention and treatment. I think they really liked that."
An excerpt from the AAFP policy on substance and alcohol abuse and addiction, available at http://www.aafp.org/x7096.xml, summarizes the Academy's stance on the issue: "AAFP strongly urges its members to be involved in the diagnosis, treatment and prevention of alcoholism and diseases relating to the use of alcohol. Detoxification is only the beginning of treatment and must be followed by adequate rehabilitation under expert guidance."
A small study in the March Journal of Pediatrics offers a reminder of why detection and successful intervention are so critical.
Researchers with the National Institute of Child Health and Human Development used nerve testing to determine that 1-month-old infants born to mothers who drank heavily (four or more drinks per day) during pregnancy suffered peripheral nerve damage. Repeat testing at about 1 year found no improvement in nerve function, suggesting the damage might be permanent.
"Infants born to mothers who drink heavily during pregnancy are known to be at risk for mental retardation and birth defects," said NICHD Director Duane Alexander, M.D., of the study findings. "This is the first study to show that these infants may suffer peripheral nerve damage as well."
How widespread are drinking problems? About 14 million people in the United States abuse or are physically dependent on alcohol, says the National Institute on Alcohol Abuse and Alcoholism. That's one out of every 13 adults. Millions more are at-risk drinkers.
Go to http://www.nichd.nih.gov/new/releases/mothers_alcohol.cfm for a press release on the NICHD study. To learn more about National Alcohol Screening Day, funded by the National Institute on Alcohol Abuse and Alcoholism and HHS' Substance Abuse and Mental Health Services Administration, go to http://www.nationalalcoholscreeningday.org/alcohol.asp.
BY LESLIE CHAMPLIN
Family medicine may have reached a turning point. That notion, drawn from a 2.6 percent uptick in the March 2004 fill rate for family medicine residencies compared with last year's figures, bodes a more robust future for the specialty, say Academy leaders.
 |
Released March 18 by the National Resident Matching Program, the data showed a 78.8 percent fill rate for family medicine residency positions, up from 76.2 percent in 2003. Of the 2,864 positions offered this year, 2,256 were filled.
AAFP President Michael Fleming, M.D., of Shreveport, La., said the results indicated family medicine may have passed its recent nadir. "The increase, though small, is good news," he said.
Perry Pugno, M.D., director of the AAFP Division of Medical Education, agreed. "The decline in student interest in family medicine is about to turn around as a new generation of medical students comes to the forefront," he said. "We're hearing more and more that medical students today are more driven by a community focus."
Watchful optimism
Though good news overall, the 2004 match data still contain some cautionary elements. The percentage of family medicine positions filled by U.S. medical school seniors slipped by 0.2 percent, from 42 percent in 2003 to 41.8 percent this year. However, the decline represents the smallest decrease since 1996. In previous years, the percentage dropped far more precipitously -- by as much as 8.2 percent between 2000 and 2001.
Also, said Fleming, "it is important to note that 76 fewer family medicine positions were offered this year. Family medicine residencies are facing financial challenges, due in part to the reductions in payments that resulted from the Balanced Budget Act of 1997. Reduction in annual federal appropriations for health professions training is adding pressure. The number of positions offered in family medicine residencies has declined each year since 1998."
Family medicine's response
The family medicine fill rate rose from 77.3 percent in 1993 to a high of 90.5 percent in 1996. Then it began subsiding.
The specialty has responded. Armed with data from the student interest study by the University of Arizona, Tucson, the AAFP and other family medicine organizations have been developing initiatives to help enhance student interest in family medicine. In addition, the Future of Family Medicine project addresses student interest in the specialty.
"The Academy is working to ensure this country doesn't lose its family doctors," said Fleming. "We're happy the number of filled family medicine residency positions went up this year."
To reach writer Leslie Champlin, e-mail lchampli@aafp.org.
 Martin Lipsky, M.D. |
The University of Illinois at Chicago College of Medicine has named Martin Lipsky, M.D., of Chicago regional dean of its Rockford, Ill., campus.
Currently professor and chair of family medicine at Northwestern University's Feinberg School of Medicine, Chicago, Lipsky will assume his new position June 1.
Lipsky has a track record of establishing and building strong educational programs. Among his accomplishments: leading the development of the family medicine department at Northwestern.
"At the time, it wasn't a department; it was just me," Lipsky recalled of his early years at Northwestern. "We still have a way to go, but family medicine has a presence in the medical school, a large clinical enterprise, published research and a viable residency program. Credit goes to the people who were courageous, took a chance and took on a challenge."
As dean at the Rockford campus, Lipsky will oversee 171 full- and part-time professors. The campus is home to the Rural Medical Education program, which is planning construction of a $24 million, 72,000 square-foot National Center for Rural Health Professions.
Caring for special populations
BY LESLIE CHAMPLIN
WEB EXTRA! Web sites
provide disability information |
Dreams amid heartbreak. Setbacks before progress. People toting reams of medical records from subspecialist to subspecialist, often separated by hundreds of miles.
These stories, written by people living with disability and their families, appear on the message boards of Web sites dealing with disability. The authors want help from someone who can care for their family member with special needs and the family.
They want a family physician. But they may not know that.
Failure to seek care
Though 54 million Americans live with disability, many don't get good health care, says the Center for Universal Design at the University of North Carolina, Chapel Hill. The center's report "Removing Barriers to Health Care: A Guide for Health Professionals" says health care facilities often don't have the proper equipment for examining disabled patients. Or untrained staff may unintentionally frustrate or embarrass a disabled person.
 The Special Olympics hopefuls in the photos on this page receive a comprehensive assessment, including history and physical exam, before they ever take the field. |
"As a result, some people with disabilities only pursue medical attention for emergency or acute conditions, making primary and preventive health care services low priorities," the report says.
Logistics can contribute to the problems, says FP Jeffrey Zlotnick, M.D., of Phillipsburg, N.J. Zlotnick and the New Jersey AFP collaborated with Special Olympics New Jersey to develop MedFest, a program that enables developmentally disabled people to participate in sports competition (see story at right).
"Many developmentally disabled people don't see a primary care or family physician regularly because of their living situation, especially as they get older," says Zlotnick. "They might live in a group home where a doctor's visit is possible only when something is seriously wrong. Or they have a long list of specialists and never have the benefit of one doctor knowing them as a 'whole' patient."
Moreover -- thanks to medical advances -- many disabled people live well into adulthood. Their increased longevity requires lifetime involvement of family members who themselves require health care, says Ray Saputelli, executive vice president of the New Jersey AFP.
"It would be ideal if a family could come to a doctor and say, 'This is all of us,'" he says. "Caring for a special needs person can take its toll. A lot of parents are older and they are still caring for their child. They want to come into the doctor's office and be a part of the comprehensive (health care) equation."
Meeting special needs
With a little extra education, family physicians and family medicine residents are more than able and very willing to help special needs families, says Zlotnick. Among his tips:
"Despite all the special needs these patients have, never forget that 'common problems are common,'" Zlotnick advises. "Don't forget the obvious!"
Caring for special populations
WEB EXTRA! Web sites
provide disability information New Jersey AFP physicians, residents, students and staff "strike a pose" alongside Special Olympics New Jersey staff. Both groups worked long hours to make the 2003 MedFest event a success. |
Despite legal and medical advances that improve the quality of life for disabled Americans, logistical barriers often block their full involvement in society. One example: state-required preparticipation physicals for Special Olympics.
That barrier has come crashing down in New Jersey. There, Jeffrey Zlotnick, M.D., of Phillipsburg and the New Jersey AFP have developed MedFest in partnership with Special Olympics New Jersey. The first daylong MedFest brought 70 young people to the Special Olympics facility in Lawrenceville, N.J., last fall for medical evaluations by 40 family physicians and residents. A second Medfest is set for April 23.
The initiative's benefits are bountiful, says Zlotnick. In addition to providing preparticipation sports evaluations to athletes, MedFest shows families the value of family medicine in meeting their total health care needs. As a result of MedFest, FPs and residents are learning about caring for patients with special needs, and New Jersey has begun developing a network of medical, educational and allied health professionals to which FPs can refer patients for specialized care and therapy.
MedFest began when the New Jersey AFP learned that hundreds of potential athletes were barred from Special Olympics because few subspecialists felt comfortable certifying their overall capacity to participate. New Jersey AFP board members tackled the problem by appointing Zlotnick to the task.
Zlotnick hit the road with a CME program on caring for disabled patients. He met with 11 family medicine residency programs and practicing physicians. "The residents got fired up and wanted to come. The faculty got fired up and wanted to come. The community doctors got fired up and wanted to come," said Zlotnick.
In all, more than 100 physicians and residents received specific training in providing preparticipation evaluations to developmentally disabled people.
Family physicians, residents, medical students and nurses volunteered for the first MedFest. Arrayed in five stations at the Special Olympics facility, the volunteers took medical histories, blood pressures, temperatures and pulse rates. Then they conducted otolaryngological, cardiac, pulmonary and orthopedic health exams.
The medical teams' findings helped Special Olympics staff identify and, if necessary, adapt sports events for the athletes.
"We adapt the sport to the person, so there are very few sports that a person can't compete in," said Mathieu Nelessen, director of education and outreach at Special Olympics New Jersey.
Response all around exceeded expectations, said Zlotnick. "We're still getting calls telling us it was an awesome experience. One medical school called and asked us to reserve space for five students to participate in the next one."
"Meanwhile, MedFest built the foundation for a statewide clearinghouse by which families can connect to family physicians who have training and experience caring for special-needs patients," said Candida Taylor, New Jersey AFP office manager and MedFest coordinator.
"Special Olympics and the Academy have started a database that identifies family physicians in each region who have training and welcome special-needs patients and families," said Taylor. "So if a parent says, 'I want a doctor in Burlington who understands where my child is coming from,' Special Olympics and the Academy will have that information.
"One of our goals was to get these kids into medical homes if they didn't have one," she added. "A lot of people with special needs don't have one. They may have a doctor for their kidneys and a doctor for their bones, but they don't have a doctor who understands the patient as a whole."
Zlotnick agreed. "These families have many needs," he said. "The parents told me about times, for example, when their child had skin problems that were ignored. The parents themselves have their own health needs. I tell them that family physicians don't have an age range. If the parents have health problems, we can take care of them, too."
Caring for special populations
Physicians seeking information about access to health care for people with disabilities can turn to several Web pages for help. Among them:
The Medline Plus disabilities page at http://www.nlm.nih.gov/medlineplus/disabilities.html has many links to sites with topics ranging from research to pragmatic advice on working with people with disabilities.
For information on making offices accessible, go to the Web site of the Center for Universal Design at http://www.design.ncsu.edu:8120/cud/. The center is based at North Carolina State University, Raleigh, N.C.
To read "Removing Barriers to Health Care: A Guide for Health Professionals," go to http://www.fpg.unc.edu/~ncodh/rbar/. The guide is produced by the Center for Universal Design and the North Carolina Office on Disability and Health (one of the office's two locations is at the University of North Carolina, Chapel Hill).
The National Organization on Disabilities page on health care access is at http://www.nod.org/healthcare/index.cfm; information on access to health insurance for people with disabilities is at http://www.nod.org/content.cfm?id=135.
DisabilityInfo.gov at http://www.disabilityinfo.gov/ is a federal Web site of disability-related resources. Click on "Health" for links to specific topics, research and statistics, and consumer group information.
Caring for special populations
BY SHERI PORTER
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The numbers tell the story. According to the 2002 Yearbook of Immigration Statistics, 15,697,123 legal immigrants arrived in the United States between 1986 and 2002.
It's a safe bet many family physicians are seeing a least a few of these arrivals.
FP Kim Yu, M.D., of Novi, Mich., said at least 30 percent to 40 percent of her patients are immigrants. "It makes my practice really wonderful," she said, while acknowledging that immigrants do present special health care challenges.
Barriers to health
Some of the challenges -- such as lack of insurance -- mirror those of the general U.S. population.
Other situations are unique to immigrants.
Patients often bring medications with them from other countries, said Yu. Unfamiliar drugs, generic brands and herbal remedies cause concern, especially when the accompanying product information isn't in English.
Yu also has patients who come to her for care but return to their home countries for some tests and procedures. "It's not the best situation for continuity of care," she said.
Cultural differences, such as holiday eating habits, may require patient education. For instance, how does a physician help a Muslim patient with diabetes control the disease during Ramadan, a time of fasting? "Teaching the patients without offending them is sometimes difficult," said Yu.
Chinese New Year presents the opposite problem. "Everyone eats and eats and eats. I try my best to get my diabetic patients to listen, but it can be hard to break those cultural traditions," said Yu.
Emotional and mental health issues loom large for immigrants, said FP Viviana Bianchi, M.D., of Davenport, Iowa, who sees many of these patients in her practice. Depression brought on by leaving one's native country can cause hard-to-trace physical symptoms.
Communication challenge
Estimates from the 2000 U.S. Census show that 17 percent of U.S. residents speak a language other than English at home. Hundreds of languages are spoken in the United States.
"I think I'm in a small rural place, yet I have patients from Korea, China and Vietnam," said Sabine Maas, M.D., of Banner Elk, N.C.
Understanding a non-English speaker's description of symptoms and making a diagnosis take time, she said. A Vietnamese patient brought a translating computer to her appointment to help her describe her symptoms. "It took 15 minutes," said Maas. "Finally a voice comes out of the computer and says, 'Pimple.'"
You may have questions about your obligation to patients with limited English proficiency, or LEP. For example, are you required to provide translation services? How do you provide them? Who pays for them?
Jane Perkins, J.D., M.P.H., who works for the National Health Law Program, prepared a 2003 report for the Kaiser Commission on Medicaid and the Uninsured about ensuring linguistic access in health care settings.
"The guidance that the federal government has provided over the past three years has recognized that one size doesn't fit all. What different providers receiving federal funding need to do will vary," said Perkins. (Physicians paid for services under federally funded programs are considered to receive federal funding.)
Try these resources
Perkins suggested that physicians go straight to the HHS guidance at http://www.usdoj.gov/crt/cor/lep/hhsrevisedlepguidance.html. Scroll down to Section V (page 47,314), "How Does a Recipient Determine the Extent of Its Obligation to Provide LEP Services?"
Another useful resource is a field report Perkins helped write, "Providing Language Interpretation Services in Health Care Settings: Examples from the Field," available as a PDF file at http://www.cmwf.org/publist/publist2.asp?CategoryID=11. Scroll down to the report title. For help using PDF files, go to http://www.aafp.org/pdf.xml.
Perkins said physicians should remain hopeful. "There is work going on, there are examples to be followed, there are funding sources to be tapped, and there is the recognition that this isn't going to happen overnight."
To reach writer Sheri Porter, e-mail sporter@aafp.org.
Caring for special populations
BY SHERI PORTER
Linda Stogner, M.D., medical director of Hope Medical Center in Estancia, N.M., has experience treating and locating services for immigrant patients. Her message to family physicians is this: "Take a hard look within your own community, and you'll find resources you never dreamed were there." Stogner offers these suggestions:
Think outside the box if you're having translation problems, said Stogner. She discovered that the health department in her city had a Spanish-speaking receptionist trained in privacy issues. "When we need a Spanish translator, we call the health department and set up a conference call with the receptionist," said Stogner.
Finally, consider this option. When a community has a large immigrant population, local churches sometimes offer translation services. "If the patient contacts the church, the church might provide a volunteer translator to accompany the patient to an appointment with you," said Stogner.
Caring for special populations
BY CINDY BORGMEYER
Ask John O'Handley, M.D., how he came to spend most of his waking hours providing health services to homeless people in and around Columbus, Ohio, and he'll modestly ascribe it simply to being in the right place at the right time.
 FP Sharon Lee, M.D., dons a hard hat while giving a tour of
her Kansas City, Kan., clinic. The renovations, which include new patient exam
rooms, counseling offices, a legal aid clinic and an auditorium for health
education activities, should be completed this summer. |
"I sort of fell into it back in 1995," O'Handley says. "I was director of the family practice residency program at Mount Carmel, and they were looking for a volunteer medical director for the outreach program, which goes out to the indigent populations around Columbus. Our residents were involved in the program, and I agreed to see patients and to be the volunteer director."
What began as a part-time obligation has, for O'Handley, evolved into a calling. He's now the full-time medical director of the Mount Carmel Health Systems Community Outreach Program, having stepped down from directing the residency program to devote more time to his outreach activities.
For FP Sharon Lee, M.D., of Kansas City, Kan., the decision to care for indigent patients was made long before she earned her medical degree.
"I went to medical school to acquire skills I could use to help people who were falling through the cracks," she says. "That was my goal from the get-go."
Fifteen years ago, Lee opened a practice in a squat cinder-block building set in one of the city's industrial areas. Originally a gas station, the building had at one time housed the offices of a notorious local purveyor of adult entertainment.
"I started with my mom and dad on the phones," says Lee. Today, her practice, Southwest Boulevard Family Health Care, still has that sense of family, she says.
O'Handley's and Lee's stories put a face on the many caregivers (perhaps many in the AAFP) serving the indigent in America.
Scope of the problem
Depending on who's doing the counting, estimates of the number of uninsured U.S. residents run as high as 44 million. The National Survey of Homeless Assistance Providers and Clients in the late 1990s estimated that in the course of a year, between 2.3 million and 3.5 million individuals in the United States were homeless at some point.
Figures from the 2000 U.S. Census show about 16.5 percent of the residents of Wyandotte County, in which Lee's clinic is located, live at or below the federal poverty level. Although her clinic serves whoever walks, crawls or wheels through the door, the majority of her patients come from the surrounding Rosedale District.
"I was amazed to find that Rosedale was considered an underserved area, as close as it is to KU," Lee noted, referring to the University of Kansas Medical Center, a few blocks from where she works. That's one of the reasons Lee says she chose the area to set up her practice.
In the Columbus area, says O'Handley, "We're probably talking fewer than 4,000 homeless people, maybe closer to 2,000 at any one time. It's hard to document the numbers because a lot of them live out in the woods and it's hard to count them." Area shelters can house only about 1,000 folks, he adds.
Making the rounds
|
Learn how to adapt your practice Homeless people are disproportionately affected by certain health conditions, says the National Health Care for the Homeless Council. Communicable diseases, including HIV infection and tuberculosis, ravage this population. Injuries due to trauma and exposure to foul weather are common. Mental illness and substance abuse disorders are rampant. In short, these patients need regular medical care. They need a personal medical home. The national council offers physicians
resources on adapting their practices to manage the special needs of homeless
patients. Visit http://www.nhchc.org/network.htm #adapting_your_practice to
learn more. |
Mount Carmel's outreach program operates a state-of-the-art mobile coach that travels to area shelters for the homeless and other community sites. The coach sports two fully equipped patient exam rooms and visits some 30 sites throughout Columbus and central Ohio.
In any given week, O'Handley sees between 75 and 100 patients, many of them at Columbus' Friends of the Homeless shelter. But the coach makes other stops, as well.
“We go to some of the Hispanic areas around Columbus,” O’Handley says. “Most of the Latino and Hispanic populations here are uninsured -- they're the working poor. We also go to the YMCA, where many people don't have insurance and are just sort of scraping by."
Medical problems O'Handley frequently sees include diabetes, hypertension, chronic obstructive pulmonary disease, asthma, bronchitis, skin conditions, sore joints and injuries. "We do minor surgery in the coach," he notes. "We take out foreign bodies, take off growths, or incise and drain abscesses."
For Lee, a typical day may have her explaining -- with pictures and color-coded stickers -- a complicated pill regimen to an illiterate patient with HIV infection. Or handing out drug samples to hypertensive patients who can't pay for their medications. Or counseling a teen patient about safe sexual practices.
Every Wednesday evening, Lee's daytime clinic is transformed into the JayDoc Free Clinic -- where medical students from the University of Kansas (think Jayhawks) have a chance to practice what Lee preaches. Although the focus is on helping uninsured teens, no one is turned away, and the clinic is always jam-packed, says Lee.
Here, a single primary care visit can spell the beginning of an ongoing medical relationship, she says. JayDoc staff refer many patients to other clinics around the area for continuing care. The most difficult cases -- patients with HIV infection or those with poorly controlled chronic conditions -- are referred right back to Lee's full-time clinic for follow-up.
Keeping an open mind
|
Be part of nationwide effort This year's Cover the Uninsured Week, May 10 -
16, is intended to draw attention to the plight of the millions of Americans
who lack health coverage. At the same time, the initiative offers physicians a
chance to participate hands-on. To learn how you can be part of this nationwide
effort, visit http://covertheuninsuredweek.org/
and click on "What You Can Do." |
Caring for patients who spend most of their time searching for food and shelter rather than tending to their health care needs is challenging, to say the least. The bottom line, says O'Handley: Keep your eyes, ears -- and your mind -- open. It's a point he drives home when precepting medical students.
"I try to give them an overview of homelessness," O'Handley explains. "A lot of it is choices: We're not blaming people, but we do have choices we make, and not everyone makes the right ones. These choices can lead to homelessness and some bad things.”
For example, he says, "We also see a lot of ex-convicts. Many times they're sent to the shelters after they're released from prison, and they end up on the streets. There is support for them, there are social workers trying to get them jobs and housing -- there's an ongoing process that they can get into if they want to take advantage of it. But again, you can't force them into it."
The nature of the mobile outreach program doesn't permit true continuity of care, O'Handley notes, although he's certainly seen some of the same patients more than once. To help patients obtain that continuity, he says it's important to know what resources are available in the community.
"Some of the area doctors take charity cases," O'Handley says. "We try to divvy them up, not overburden anyone. Also, with the opening of a new neighborhood health center on the city's east side, we can refer patients there who don't have insurance or any means of paying.
"We also try to get them into Health Care for the Homeless, a program with neighborhood health centers around the Columbus area. Basically, we try to get them a medical home."
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
Caring for special populations
BY CINDY BORGMEYER
Stanley Harper, M.D., of Chicago says that even in the early days of his medical training, he never envisioned himself in a traditional private practice. Worrying about overhead or insurance hassles -- it wasn't for him, Harper says. "I just wanted to treat patients -- whether it took 60 hours a week, 80 hours a week or 30 hours a week."
But it wasn't until after Harper had put in some time at the Cook County Hospital Family Practice Residency that all the pieces fell into place.
Landing him, so to speak, in jail.
"When I chose to be a family physician -- actually, when I decided to go to medical school -- I knew I wanted to work in the public health sector," says Harper. "When I finished my residency, there was a new director, a visionary, at Cook County Jail, and they were recruiting. Given the nature of my residency at Cook County Hospital, where we were serving a certain type of client, it happened naturally."
The hospital has a longtime record of caring for the medically indigent, as spelled out in the hospital's current mission statement: "To provide a comprehensive program of quality health care with respect and dignity to the residents of Cook County, regardless of their ability to pay."
Respect and dignity
According to Harper, the same principles apply to caring for patients in a correctional setting.
"You learn to respect them, call them "Mr." or "Mrs." just like in the 'free world,'" he says. "By and large, if you give patients respect, they’ll respect you."
It's a philosophy Harper says has served him well in his career, which has shifted him from the Cook County facility to Joliet Correctional Center in Joliet, Ill., and later to the District of Columbia Central Detention Facility. Now back home in Chicago, he's also worked outside the correctional system. So he knows exactly how health care provided "behind the walls" impacts the health of those outside the facility.
"You see the kinds of medical problems you would see in almost any urban situation," Harper says. In patients with chronic conditions, he says, previous lack of access to health services clearly shows. And the problem isn't restricted to physiological illness. According to a 2003 report by Human Rights Watch, one out of every six prison inmates in the United States has a mental illness -- that's three times the rate for the general population.
Managing inmates' health starts with an intake evaluation, including a history, physical exam and various screening tests. Screenings are done to look for health problems commonly seen in incarcerated patients, as well as for diseases circulating in the community. Often included are a reactive plasma reagin assay for syphilis, X-rays for tuberculosis and a dip stick urinalysis for pregnancy in female inmates, says Harper. "Most jails," he adds, "screen for chlamydia and gonorrhea."
Matter of public health
Health care delivered in correctional settings, Harper points out, is key in protecting the health of the public once inmates are released -- a fact not lost on former U.S. Surgeon General David Satcher, M.D., Ph.D., himself a family physician. Following a study begun during his tenure, the CDC last year issued guidelines for the prevention and control of infections caused by hepatitis viruses in juvenile and adult correctional facilities.
The AAFP also has weighed in on the issue of appropriate care, encouraging correctional facilities to seek accreditation by the National Commission on Correctional Health Care and encouraging health professionals working in these settings to seek NCCHC certification.
Go to http://www.aafp.org/x6839.xml#x6840 to read the Academy's policy on correctional health care. You'll find more information about NCCHC accreditation and certification on the commission's Web site at http://www.ncchc.org/.
Harper says that officers within correctional facilities are trained to recognize potential exacerbations of chronic health problems, such as asthma, and report them to health care staff. In most NCCHC-accredited facilities, inmates sign up for "sick call." In some housing units, sick call may be available every day; in others, once a week.
Usually, nurses perform triage and schedule patients to be seen by the
physician.
All in all, Harper says, treating patients in a correctional
health care setting is really no different from working out in the
community.
"I've managed thousand of patients behind bars, and when I'm examining a patient, it's basically the same as when I'm examining someone in the free world," he says. "You have the same relationship with the patient as you would anywhere else -- you close the doors for privacy, for example."
Harper's had only one unexpected incident with an incarcerated patient, a man with some psychological problems who was escorted to the medical unit. "I could see that he was not stable, and he lunged," he says. "The officers there restrained him. That was the only time I felt at all uncomfortable. The rest of the time, it's like seeing any other patient at an inner-city community health center."
Gauging impact
"One of the things about working in corrections is when you do make an impact on someone's health status or life, you usually don't know what impact you’ve had," Harper observes.
Of course, there are exceptions to every rule, and this one's no different.
"Every now and then," he says, "I see someone I've cared for, and they remember me." Often, that recognition is little more than a second glance or a brief nod. But when you get it, it sticks with you.
"I remember a dialysis patient I took care of at Joliet," says Harper. "I had gone to renew my license here in Illinois years later and saw him while I was standing in line. He was a very intelligent man -- very articulate -- and we exchanged greetings and talked. He'd done his full sentence, and he was doing OK.
"Occasionally, I've encountered folks and -- very rarely -- they've said 'thanks.' That makes you feel pretty good, not only as a physician but as a person."
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
BY LESLIE CHAMPLIN
 Voting is the route to political power, Jay Lee, M.D., tells patients at Long Beach (Calif.) Memorial Family Medicine residency, where he is a resident. Lee established a voter registration area in the clinic's waiting room. |
Thirty-four states are slashing about 1.6 million names from Medicaid rolls. A 48 percent explosion in health insurance premiums between 2000 and 2003 overshadowed the 12 percent to 30 percent spike in deductibles last year.
The scenario worries and angers patients, and they often complain to Jay Lee, M.D., a resident at the Long Beach Memorial Family Medicine residency program, Long Beach, Calif.
That's when he hands them the power. He points to the voter registration table in the waiting area.
"When people would complain, I'd ask, 'Do you vote?'" said Lee, who recently established the voter registration area. "They would give me a puzzled look and say, 'No,' and I'd tell them that's one way they can make a change."
Easy, simple procedure
Providing the registration area was simple, he said. With faculty approval and a little legwork, "We got going the next day," said Lee. "It was a lot easier than I thought."
Installed near a rack filled with patient education material, the registration box stirred spontaneous interest -- and voter registration -- among patients. Lee estimates he's delivered 300 voter registrations to the county elections office so far.
Political paradox
Lee's idea reminds people they have the power to change the system. When individuals feel disenfranchised, they behave, as a group, in ways that do disenfranchise them.
Harris polls in May 2003 and February 2004 found health care ranks among Americans' top three concerns.
"One of the most striking findings in this survey is that much of health care ... (is) paid for out of taxes," wrote Humphrey Taylor, chair of the Harris Poll, in an analysis of 2003 data at the Harris Interactive Web site http://www.harrisinteractive.com/harris_poll/index.asp?PID=382. "A visitor from outer space ... would be puzzled by the popularity of politicians who favor tax cuts and, by implication, less money for the segments of the economy which the public believes should grow the fastest."
Getting people's attention
"People -- especially younger patients -- don't see a connection between voting and their access to health care," said Lee.
When Medicaid or private insurance restrict access by limiting physician panels and covered procedures or charging higher copayments or deductibles, patients begin to pay attention. They want to act.
"But for many, the biggest barrier is lack of a convenient way to register to vote," said Lee.
By helping people register and educating them about the link between voting and their personal welfare, physicians can make a difference, said Lee. FPs can refer patients to the Academy's "Policy & Advocacy" Web page at http://www.aafp.org/policy.xml for background on health care issues and how patients can influence political outcomes.
"In this age when organized medicine is really trying to bring back the voice of physicians through grassroots efforts, fewer physicians are interested in participating," said Lee. "It's almost a learned helplessness. But there is room for social change in medicine."
And with a little initiative, physicians can make it happen, he said. First step: Call your local board of elections. The staff there can help you get started.
To reach writer Leslie Champlin, e-mail lchampli@aafp.org.
For four days this summer, the future of family medicine will congregate in Kansas City, Mo., to focus on the heart of family medicine. The meeting -- the July 28 - 31 National Conference of Family Medicine Residents and Medical Students -- lets you hone your clinical skills and influence AAFP policy. This year's theme is "Compassion, Advocacy, Innovation: The Heart of Family Medicine."
"Any medical student with an interest in family medicine would benefit from the National Conference," said Christie Laming, student chair of the conference. "For students trying to decide if family medicine is right for them, attending this conference will provide valuable information about the specialty. For students gathering information on family medicine residencies, what better conference could they attend? About 300 family medicine residencies from around the country will exhibit there."
Whether you're a student or a resident, make your mark on AAFP policy by joining special-issue discussion groups, generating resolutions to address problems, testifying on proposed resolutions, and discussing issues at the resident and student congresses.
Immerse yourself in a workshop on medical Spanish or get a close-up look at applying to residencies. Participate in clinical workshops and procedural skills courses on topics ranging from interpreting chest X-rays to suturing and treadmill testing.
You'll find unparalleled networking opportunities, as well as resources for finding the right job and for transitioning into practice. To learn more about the conference, go to http://www.aafp.org/x22268.xml.
Mrs. Jones, 78, may have diabetes, hyperlipidemia, hypertension, degenerative joint disease, chronic obstructive pulmonary disease, depression and memory problems. "That's a typical older patient," Thomas Weida, M.D., of Hershey, Pa., vice speaker of the AAFP Congress of Delegates, said in an interview recently.
Weida presented AAFP testimony on managing chronic care patients to the Practicing Physicians Advisory Council Feb. 23. PPAC makes recommendations about Medicare to the HHS secretary.
Weida told PPAC the Academy wants the Centers for Medicare & Medicaid Services to develop a chronic disease management model for primary care physicians. The model, he added, should also test the use of a fee for the services.
At first, PPAC members resisted the idea. Then they switched gears. PPAC tabled AAFP's recommendation but requested two hours be set aside at the council's May 17 meeting to discuss pilot projects in which CMS currently is engaged and whether the AAFP proposal would apply to any of those projects.
"Although I was disappointed by the council's decision to table, I was heartened the discussion regarding reimbursement for managing multiple chronic illnesses in Medicare has started," Weida said after his testimony. "We must overcome the inflexibility of a reimbursement system based on 'one illness, one visit' when dealing with Medicare patients with multiple illnesses that need to be addressed during and between visits."
A good care management system would make his practice more holistic and patient-centered rather than illness-centered, Weida said. "A good system would allow me to take more time with patients to handle their multiple problems, thus reducing the number of revisits. It would allow my staff or me the opportunity to coordinate their care when they are not in my office, such as by making calls to consultants, home health agencies and indigent medical programs."
In his testimony, Weida explained, "Family physician practices are at the front line of managing the multiple chronic diseases that beset America, and particularly its seniors."
He referred to data from the 1999 Medicare Standard Analytic File showing that Medicare patients without chronic conditions saw an average of 1.3 physicians in 1999. By contrast, those with a single chronic illness saw an average of 3.5 physicians, and those with two chronic conditions saw an average of 4.5 physicians. Seniors with six chronic conditions saw an average of 9.2 physicians.
"These figures argue for a single primary care physician who can provide cost-effective and coordinated care," he told PPAC.
Weida's testimony is available at http://www.aafp.org/x26272.xml.
 The Oklahoma AFP announces the candidacy of Steven Crawford, M.D., of Oklahoma City for AAFP director. |
 The Idaho AFP announces the candidacy of Ted Epperly, M.D., of Meridian for AAFP director. |
The AAFP
Foundation is calling on U.S. family physicians to help their colleagues from
around the world attend the 17th World Conference of Family Doctors. The
meeting, sponsored by Wonca, the World Organization of Family Doctors, will be
held Oct. 13 -17 in Orlando, Fla., in conjunction with the AAFP Scientific
Assembly.
The foundation has established the Wonca Bursary Fund to help pay registration, travel and accommodations expenses for international family doctors who would otherwise be unable to attend the meeting.
Former AAFP President Richard Roberts, M.D., of Madison, Wis., in December was among those who helped get the ball rolling with a $5,000 donation earmarked for the fund. Roberts has pledged another $5,000 this year. And AAFP President Michael Fleming, M.D., of Shreveport, La., has donated his entire President's Grant -- $10,000 -- to the fund. Fleming challenges other FPs in the United States to avail themselves of this opportunity to help spread the mission and message of family medicine around the globe.
"As an American family physician, I understand how fortunate I am to be able to attend meetings such as the AAFP Annual Assembly and Wonca 2004," Fleming says. "I want family physicians just like me from all over the world to have that same opportunity. I hope others will accept the challenge and help fund these international opportunities to share our Academy."
To learn more, go to http://www.aafpfoundation.org/x319.xml and click on "Wonca Bursary Fund." You can also contact the foundation's executive vice president, Sandra Panther, at (800) 274-2237, Ext. 4450, to make a donation.
WEB EXTRA!
To the editor:
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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. |
I'm writing in response to the article "Group Medical Visits Enhance Residents' Educational Experience" in the February FP Report.
As a second-year resident currently working on a research project involving group visits with diabetic patients in an indigent population, I have found group visits to be educational for both patients and residents. There is a certain satisfaction gained from seeing a group of patients finally understand their disease after so many years.
My patient population is predominantly Hispanic. Using an interpreter, group visits allow us to communicate effectively and efficiently with an underserved population.
It is also interesting to observe the group's dynamic -- their sense of accountability and compassion for one another. They are able to share problems knowing that others may have similar struggles.
I have been asked to do similar group visits with young patients, talking about sexually transmitted diseases and sexual education. I hope to one day incorporate this educational tool into my practice. This may be a useful model for treating patients with chronic illnesses such as asthma, chronic obstructive pulmonary disease, hypertension, obesity and congestive heart failure.
Andy Le, M.D.
Tulsa, Okla.
To the editor:
The February FP Report informed AAFP members of the Congress of Delegates' recommendation to the FDA regarding Plan B, the emergency contraception pill.
As a medical student, I have no prescription rights, no license at risk and no patients currently depending on me for immediate care. Having said that, I would like to focus on the ramifications of FDA approval of Plan B as an over-the-counter medication in the near future. I am concerned that this medication is being shuffled away from the hands of licensed, trained and properly educated physicians down to the public for the wrong reasons.
By pushing the pill OTC, physicians seem to be wiping their hands and happily remaining laissez-faire on the issues that demand their attention. This pill does not enjoy the long-term safety record of most prescription medications that have been made available OTC. This pill has very significant risks, especially if the directions are not followed -- risks that will no doubt be overlooked by the general public until it is too late.
I would like to strongly urge the Academy to reconsider its opinion on such a critical issue.
David Miller
Davie, Fla.
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A new online Video CME program, "Aging and Health Issues: The Family Physician's Role," will help FPs provide health care to aging patients. The monograph was mailed to all active members in February. The program is now available as a videotape (#1847) or DVD (#1884) -- each for $17.95. The program includes prevention and screening tools, and topics include nutrition and exercise counseling, immunizations, mental status, heart disease, stroke, arthritis, diabetes, osteoporosis, and cancer. Don't want to purchase? View the video online at http://www.aafp.org/x26384.xml and complete the post-test for AAFP Prescribed credit ($8). This program is a core element of AAFP's 2004 Annual Clinical Focus: Caring for America's Aging Population. |
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Want to improve your clinical processes and outcomes in the treatment of skin disorders? Here's a CME course you won't want to miss -- Skin Problems & Diseases, June 15 - 20 in Myrtle Beach, S.C. Topics include acne, melanoma, benign skin growths, cutaneous anthrax, and basal and squamous cell carcinomas. Consider brushing up your technique with optional hands-on procedural sessions such as microdermabrasion, skin biopsy and sclerotherapy. Go to http://www.aafp.org/x14388.xml for quick online registration. Register before May 17 for the early-bird discount. |
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Get your hands on a broad spectrum of patient education materials through the AAFP Foundation's Health Education Program for Patients. All materials have been rigorously reviewed for scientific accuracy, content and usefulness in a family medicine setting. Hundreds of topics are covered in such clinical areas as cancer, diabetes, mental health, nutrition and pain. Go to http://www.aafpfoundation.org/x433.xml and click on "HEPP Database" for a list of clinical areas, then click on specific topics. Materials available include books, brochures, fact sheets, posters, newsletters, computer software and videocassettes. If you need help searching the database, call (800) 274-2237, Ext. 4406. For help downloading PDF files, go to http://www.aafp.org/pdf.xml. |
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A shipping fee may apply; Kansas residents pay a 7.525 percent tax. |
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FP Report is published by the
AAFP News Department.
Copyright © 2004 by
American Academy of Family Physicians.
