 Leader of the Pack: AAFP President Michael Fleming, M.D., leads the federal government's Get Fit With US campaign walk June 5 in St. Paul, Minn. |
Leading the way. That's what AAFP President Michael Fleming, M.D., was doing June 5 at the federal government's Get Fit With US campaign kickoff in St. Paul, Minn. Fleming led a one-mile walk and shared his personal story of changing to a healthier lifestyle. Several hundred walkers participated in the event.
Get Fit With US, an initiative of the Department of the Interior, pairs public health promotion with the use of public lands. It is part of a larger initiative, HealthierUS, announced by President Bush in June 2002. The goals of the federal programs dovetail nicely with those of the AAFP's fitness initiative, Americans in Motion. Fleming, of Shreveport, La., has been boosting his physical activity and has lost 35 pounds since he took the AIM challenge at the AAFP Scientific Assembly in October.
Commenting on the June 5 event, Fleming said, "We were the only medical organization there. Several people, including (Secretary of the Interior) Gale Norton, noted the importance of the physician community. Because if we're going to recommend getting fit to our patients, we need to get fit ourselves."
Fleming told participants that recreation should be the key to good health -- and that it's important for people to find an activity they enjoy. For information on how you and your practice can become involved in AIM, go to http://www.aafp.org/aim.xml.
BY SHERI PORTER
Twenty years ago, 300 people -- likely all labeled "computer nerds" by their co-workers -- attended a conference to discuss electronic health records. On May 17 - 21 this year, that same conference, TEPR, or Towards an Electronic Patient Record, drew about 4,000 people from 25 countries to Fort Lauderdale, Fla.
Electronic health records have become a big deal in 2004; this year's TEPR spotlighted areas where information technology implementation will make a footprint physicians and patients can't miss.
Boosting patient safety
 After a press conference at the TEPR convention in Fort Lauderdale, Fla., David Brailer, M.D., PhD., right, HHS' coordinator of national health information tehcnology, shares a light moment with David C. Kibbe, M.D., director of AAFP's Center for Health Information Technology. |
Lawrence Weed, M.D., has worked in the field of health informatics for decades. Delivering TEPR's opening address, he argued that the health care industry sorely needs a method of efficiently tracking errors to improve patient safety.
Look at the airline industry, said Weed. The pilot relies heavily on computerized equipment, and when something goes wrong, the data enables experts to trace the source of the problem. The system is set up to provide feedback, and that's what EHRs can do for health care. "A system without feedback goes wild, and medicine is going wild," said Weed.
Add to that the impossible amount of information physicians are expected to keep in their heads, said Weed. "What do you do when the task is quantitatively bigger than the human mind can handle? You get a new tool to master all the details, a knowledge compiling tool." Namely, you get an EHR.
All these years, "we've kept records on what was done, but not on why it was done," said Weed. No one knows what a physician is thinking while writing an order, and "every doctor plays with his own personal deck of cards and a different deck every day depending on how busy he is," Weed added.
Physicians have shortchanged data collection for years, said Weed. The time is perfect, in light of patient safety issues, for implementation of standardized EHRs.
Enhancing patient communication
E-mail. Web messaging. Practice Web sites. All are opportunities for physicians to communicate with their patients. And according to Daniel Sands, M.D., clinical director of electronic patient records and communication at Beth Israel Deaconess Medical Center in Boston, that's exactly what physicians should be doing. Why? Because every day, more people go online for health information than see a physician, according to Sands.
If that doesn't shock you, this might: More than half of those people will act on information retrieved online. Yes, patients are deciding whether to stop or start medications based on what they're reading on the Internet, said Sands.
Wouldn't a better alternative be for patients to access good health information at a trusted physician's Web site?
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Nearly a third of patients say they would switch physicians if they could find one who uses online communication, said Eric Liederman, M.D. |
According to Sands, patients want access to physicians' Web sites for patient education, test results, prescription refills, appointment scheduling and to discuss symptoms and treatments.
It's the physicians who are dragging their feet, said Eric Liederman, M.D., medical director of clinical information systems at the University of California, Davis, Health System. Physicians cite these fear factors:
If you're not convinced that patients want direct communication with you, chew on this statistic: Nearly a third of patients say they would switch physicians if they could find one who uses online communication, said Liederman.
Do you want to lose your best patients? "We don't want our baby boomer, computer-literate patients who care about their health going elsewhere," he said.
To reach writer Sheri Porter, e-mail sporter@aafp.org.
BY CINDY BORGMEYER
"Mentors and role models" topped several lists of factors influencing medical students' specialty choices developed during the Family Medicine Student Interest Summit May 21 - 22 in Overland Park, Kan.
Medical students, residents, family medicine educators, practicing FPs and others worked in small groups to zero in on factors -- many of them drawn from the University of Arizona, Tucson, study on student interest and Future of Family Medicine project recommendations -- they considered both important and modifiable.
"Good mentors can be trained; they need not be born," said Robert Raspa, M.D., of Orange Park, Fla., chair of the Commission on Resident & Student Issues.
Everyone's a role model
Although the two groups -- mentors and role models -- are related, they are not identical, pointed out Deborah McPherson, M.D., assistant director of the AAFP Division of Medical Education, in an interview after the meeting.
"In the truest sense, mentoring is a retrospective experience," McPherson said. "It's a relationship that develops over time." Often, it's only when students or residents reflect on their training that they recognize who served as their mentors.
On the other hand, McPherson added, "Everyone in family medicine is a role model to somebody. Students, especially, pay attention to our work and values." Exposure to a negative family medicine role model, agreed several summit attendees, is worse than having none at all. (See related story at http://www.aafp.org/fpr/20040700/4.html.)
Pick the right students
Summit participants also gave high priority to issues surrounding the medical school admissions process -- specifically, "getting the right people on the bus," as one attendee called it, using terminology from Jim Collins' book, Good to Great: Why Some Companies Make the Leap... And Others Don't.
That task, participants agreed, means identifying family medicine hopefuls -- students from lower socioeconomic backgrounds, for example -- at an early stage in the educational pipeline and then finding ways to help them navigate the path through medical school and into residency.
And then there's the issue of the medical school curriculum.
"It'd be nice if they (family medicine hopefuls) all walked around with 'family medicine waiting to happen' on their chests," said Michael King, M.D., of Lexington, Ky., a resident delegate to CRSI. "I was that person in medical school. I knew what I wanted to do; I just didn't know that was family medicine until I saw it in school."
By the end of the summit, the groups had devised a short list of strategies and action plans to tackle the key modifiable factors identified. A full report of the summit and resulting recommendations will be considered by the Academy and other participating or interested organizations and their leadership this summer.
BY LESLIE CHAMPLIN
Your potential peers are in your waiting room. They're at medical conferences. In restaurants or at dinner parties. In line for the movies or baseball games.
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"A bad role model is worse than no
role model." |
So, when you're discussing long hours and low pay, you may unwittingly dissuade medical students from embracing family medicine. At least that's what some students suggest.
Three students from Temple University School of Medicine, Philadelphia -- Sandy Green and Heather Kovich, in their third year, and Priya Mammen, in her fourth year -- described why they considered other specialties despite their initial interest in family medicine. Speaking at the Society of Teachers of Family Medicine Annual Spring Conference May 12 - 16 in Toronto, they offered their perceptions.
Where's the passion?
"When I talk to family practitioners, I hear them say they work hard, don't make a lot of money and don't have any respect," said Kovich. "I want to work in a career where people love their job."
Green agreed. "On the plane coming here, I met family physicians and all I heard was, 'We're not respected, we're not this, we're not that,' instead of what's being actively done," he said.
Every family physician should work to change that perception, said Joseph Blonski, M.D., director of the St. Cloud Hospital/Mayo Family Practice Residency Program in St. Cloud, Minn., after he attended the students' presentation.
"Those of us who love what we do need to help students see why they should choose family medicine instead of why they shouldn't," he said. "We need to see family medicine as a privilege instead of as a burden."
What about intellectual rigor?
Though family medicine rotations are difficult, the students said their residents and faculty showed little interest in evidence-based medicine.
"Family medicine doesn't foster the same culture of academic curiosity as the other specialties," said Kovich. "On my family medicine rotation, I was … told, 'Here are the books, but you won't need them.' I didn't see family medicine residents going home to read at night; if they had an extra hour, they played video games."
Green agreed. "I'd ask a question, and the internal medicine resident could cite guidelines or refer to the most recent research in the Journal of the American Medical Association. If I asked a family medicine resident why he prescribed one drug over another, he'd say it was because that was the way they were taught. If they (the family medicine residents) said something like, 'I know the guidelines, but this choice is better for the patient because it's less expensive', then I would understand that they knew the guidelines and were considering the patient."
These words bode ill for family medicine, said John Smucny, M.D., associate professor of family medicine at State University of New York Upstate Medical University, Syracuse.
"We're in a bad downward spiral if the residents we have turn students off," he said after the students' talk. "We need more information on how students view family medicine residents and (need to) get a sense of how widespread this problem is.
Research seems soft
Family physicians study "soft" topics, focusing more on patient-physician relationships than on medicine itself, said Green.
Patient-centered research makes sense for a patient-centered specialty, according to Charles Christianson, M.D., a family physician in the office of medical education at the University of North Dakota, Grand Forks.
"We're proud of rebelling against the academic establishment and of focusing on patient care, but we do need research for academic legitimacy and intellectual growth," he said after listening to the students' presentation. "A good benchmark is the extent to which other primary care specialties, such as general internal medicine, conduct research."
More may not be better
Family medicine educators say students need more exposure to FP role models. But quality, not quantity, counts more, the students said.
"In my encounters with family physicians, I hear a lot of whining," said Green. "I don't want to spend my time with them in practice if that's the attitude that comes across to me as a student."
True, said seminar attendees. "Departments are judged by their weakest link," said Rick Ricer, M.D., professor of family medicine and vice chair for medical education at the University of Cincinnati. "A bad role model is worse than no role model. Predoctoral programs need to go weed out the bad role models. We cannot have the worst role models in our predoctoral education."
To reach writer Leslie Champlin, e-mail lchampli@aafp.org.
BY CINDY BORGMEYER
WEB EXTRA! Point-of-care learning:
'Nirvana of needs assessment'
Do you have what it takes to understand evidence-based medicine and to apply it to your practice? Before you respond, think about the two parts of the question.
The first part involves the ability to independently assess the research evidence on a given clinical issue. The second deals with translating that evidence into practice, with the goal of improving patient care.
The short answer: Yes, you've got what it takes.
Whether they realize it or not, physicians have the requisite knowledge and skills to learn and practice EBM, according to Jack Kues, Ph.D., assistant dean for CME and professor of family medicine at the University of Cincinnati.
Kues and Nancy Davis, Ph.D., director of the AAFP Division of Continuing Medical Education, discussed the respective roles of learners, teachers and CME providers during the 2004 CME Congress held here May 18.
In an increasingly sophisticated research environment, physicians' clinical experience and critical thinking skills form the cornerstone of their ability to integrate EBM concepts into patient care, Kues said. "Learners may not be able to read and understand all the evidence, but they bring these skills to the table, and that's a start."
"Pick out a good clock"
Do learners really need to critically review each new piece of evidence themselves? Certainly not, said EBM guru Allen Shaughnessy, Pharm.D., who sat in on the session.
An adjunct professor of family and community medicine at Penn State College of Medicine, Hershey, and director of medical education for PinnacleHealth System, Harrisburg, Pa., it was Shaughnessy who, along with FP David Slawson, M.D., of Charlottesville, Va., developed the concept of "patient-oriented evidence that matters," or POEMs.
"This equates to a notion that you don't have to be able to build a clock to tell time; it's OK to simply know how to pick out a good clock," Shaughnessy said. "You get to a point where you can say, 'Go out and buy a Swiss army watch.' Quartz movement is good; an atomic clock is better."
In other words, know where to go to get the best evidence.
It's impossible to keep track of all the literature and its implications, said Davis. In a later interview, she discussed how point-of-care evidence summary resources -- such as those listed at http://www.aafp.org/fpr/20040700/6x.htm -- can aid EBM learners.
What's an educator to do?
Kues reviewed the basic tasks confronting CME faculty wanting to incorporate EBM principles into their educational offerings.
First, faculty must identify and assess the available evidence -- all of it. Then, they should develop CME activities around the best evidence. Finally, they must be able to distinguish evidence from opinion.
Although some learners would be satisfied with -- or even prefer -- so-called expert guidance, said Kues, "Do we give learners more fish, or do we send them to www.FishRUs.com?"
Faculty development activities offered by CME providers should focus on teaching educators to actively engage learners, he said. Learners don't need to be spoon-fed; passive learning cuts the likelihood that physicians will actually change their practice behavior.
CME faculty and planners can greatly enhance their chances of successfully reaching -- and teaching -- learners by following a few guidelines, said Kues:
"A lot of learners leave a session thinking it's incredible information," Kues said, "they just have no idea how to apply it."
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
WEB EXTRA!
In January 2002, the Academy launched its initiative to gradually incorporate evidence-based medicine into CME clinical content -- and from there, into physicians' practices. Since then, Nancy Davis, Ph.D., director of the AAFP Division of Continuing Medical Education, has investigated how to facilitate this process for AAFP members.
Her conclusion? It's hard to beat learning at the point of care. She calls it "the Nirvana of needs assessment."
"When you've got a patient in front of you, and you can go straight to the evidence and then apply it right there, that provides reinforcement," she says.
Various point-of-care decision support tools now available make the clinician's job easier by "predigesting" that evidence and presenting it in a readily usable format, says Davis.
The following options available by subscription and offer discounts or other perks to AAFP members (learn more at http://www.aafp.org/x20862.xml), and some can be loaded onto your personal digital assistant.
Stay tuned. The AAFP is well down the road to designating point-of-care learning activities as eligible for Prescribed CME credit. In fact, the Commission on Continuing Medical Education approved a motion on this topic at its June 19 - 20 meeting. Specifically, commission members recommended awarding 0.5 Prescribed credit for each point-of-care learning experience, up to a maximum of 15 credits per year.
The COCME recommended that the CME providers for such activities -- the decision support tool vendors -- obtain accreditation from the Accreditation Council for Continuing Medical Education. The providers would also need Academy accreditation to offer AAFP Prescribed credit for these activities.
To qualify for credit, physicians must document the three elements of the point-of-care learning process:
The AMA, said Davis, is working on a parallel project that would enable its members to earn AMA Physician's Recognition Award Category 1 credit for point-of-care learning activities using the same criteria as those specified by the AAFP.
The AAFP Board of Directors will consider the proposed changes at its August board meeting.
BY SHERI PORTER
 With her living room as a backdrop, Michele Toussaint, right, says "ah" as Andrea Brand, M.D., investigates a complaint of swollen glands. |
"If the patient has an office sitting there waiting for you, why rent space for $5,000 a month?"
That's the question FP Andrea Brand, M.D., of Longboat Key, Fla., asked when she found herself out of work in late 2002. A New York native, Brand was squeezed out of the position that brought her to Florida. Brand wanted to set up a solo practice but knew she couldn't afford the overhead expense of maintaining an office.
So in January 2003, after 27 years in traditional-style practices, Brand launched a house-calls-only practice on this 10-mile-long island. Her first patient suffered from an ingrown toenail.
Physician interest grows
Brand isn't the only doctor starting a house-calls-only practice. Constance Row, executive director of the American Academy of Home Care Physicians (online at http://www.aahcp.org), said her organization has nearly 700 members. She estimates that more than 50 percent of them are doing house calls full time. Eliminating the office overhead "is what makes this an economic model that works," said Row.
Some physicians have come up with innovative ways of drastically reducing overhead, agreed FP Fredric Leary, M.D., M.B.A., of Oak Park, Ill. "Even the best-run practices are finding that overhead now eats up far more than 50 percent of their gross revenues. As this financial noose tightens, physicians are forced to drive volume through the office in order to cover costs," he said. A high volume of patients can cause havoc with unfettered patient access and patient safety, added Leary, and for some physicians, housecalls are the answer.
Take Robert Shannon, M.D., an internist in Bear Lake, Mich., who's been running his home-care practice for nearly a year. "Most office doctors are paying a lot of money to keep their offices open," said Shannon. For 20 years, he worked 12 - 14 hours a day. Now, he travels the back roads of this rural area for three to four hours each afternoon seeing patients. He said he enjoys practicing medicine again.
FP Jim Van Hare, M.D., of Kalamazoo, Mich., said he retired in May 2003 because "I basically couldn't make a living at it anymore." He cited malpractice insurance, high overhead and decreasing payments from third-party payers. "Trying to extract some profit was like trying to eat soup with my fingers," he said. He donated his office equipment to a church that was setting up an indigent clinic and kept his doctor's bag. "I now have a part-time home-visit practice of slightly over 100 patients," said Van Hare. "I love it, and my patients love it."
Practice particulars
 Squatting behind the trunk of her car, Andrea Brand, M.D., double-checks to make sure she has the medical instruments and paperwork she needs to see her next house-call patient. |
On Longboat Key, Brand said she can produce the same income seeing four to six patients a day as when her daily patient load topped 25. Brand runs a cash-only practice, although she does provide forms for patients to file their own insurance. "I have no accounts receivable; my patients are 100 percent payers," said Brand.
She had to opt out of Medicare because Medicare requires documentation that proves the necessity of a home visit. However, her Medicare-eligible patients that need additional tests, x-rays and procedures can have those billed by the entity that provides the services, said Brand.
She offers patients online consultations (perfect for tracking chronic illnesses and offered at a reduced fee) and secure online messaging. She also follows up every acute patient visit with a phone call within 48 hours, even the out-of-state visitors. "Most patients are shocked and say they've never had a doctor do that," said Brand.
"I also have no piles of paper," she said. When a lab report is faxed to her, Brand calls the patient with the results, even if it's 7 p.m. on Saturday. Brand cut nearly $25,000 in overhead when she dropped malpractice insurance (she meets Florida's criteria for doing so). "Going bare is scary, but I had no choice," said Brand, whose largest overhead expenses are her cell phone and advertising. "My idea is to simplify as much as possible," she said.
This house-call practice is growing as Brand targets the baby boomers that flock to the Florida coast. She has a full-time panel of patients numbering close to 125 and an equal number of temporary charts -- seasonal visitors who need a visit from the doctor when they're away from home. When she reaches 500 patients, she'll have met her goal.
Patient care a priority
Brand says her practice model is more about patient care than about making a profit. She doesn't see more than six patients a day, so she can spend more time -- 30 - 45 minutes -- with each patient.
"This is my personal answer to how health care can and should be delivered," said Brand. She has a cadre of physicians to refer to, including a surgeon, a rheumatologist, a gastroenterologist and a hospitalist. Her networking system has worked without a glitch. Patients in serious pain -- one with polymyalgia rheumatica and one with appendicitis -- were seen promptly by Brand (both on weekends) and then were put on proper medication or began surgery within hours.
"For getting immediate service, you can't beat this model," said Brand, who offers 24-hour care seven days a week. "I have 100 percent open access," she said. Brand doesn't do invasive procedures, stitching or injections. She carries everything she needs, including a portable EKG with a computerized readout, in the trunk of her convertible.
Queries coming in
This house-call doc has received e-mails from physicians around the country who are intrigued by her practice (read more about Brand's practice at http://www.DrBrand.medem.com).
New York: "I couldn't help but admire your newest enterprise. I've been looking for a way to get off the treadmill for some time."
Virginia: "I see your style of practice as a possible innovation to the traditional office-based setting."
Washington, D.C.: "Patients deserve more than a quick 'in and out' visit."
Illinois: "I'm very interested in an alternative practice situation. I sure have been feeling at odds lately, and I'm only out of residency since 2000."
As for Brand, she said she hasn't felt this good about doctoring for decades. Gone are the hassles -- bureaucratic and economic -- that created barriers between physician and patient. "I've found here what has been missing since my residency in the '70s. I feel like I'm a family doctor again."
To reach writer Sheri Porter, e-mail sporter@aafp.org.
BY J. MICHAEL BRODIE
WEB EXTRA! Legislators share views
with family physicians  FP Cathleen London, M.D., right, chats with Dora Hughes, legislative aide to Sen. Edward Kennedy, during the AAFP's Family Medicine Congressional Conference May 19 - 20 in Washington. |
Making health care issues visible on the political landscape in an election year -- that was the goal of about 80 family medicine leaders and AAFP members as they converged on the nation's capital for the newly named Family Medicine Congressional Conference May 19 - 20. It was the largest turnout of FPs on the Hill since the visits began as small legislative receptions in 1969.
Academy members came to urge congressional action on issues such as Title VII funding, Medicare graduate medical education funding and health care for the uninsured. You can help, too -- backgrounders on these issues are online for your use in contacts with your federal lawmakers (see end of story).
Unlike last year, when a possible Medicare reform bill loomed on the horizon, no blockbuster medical reforms were in the offing this spring. In an election year, when war and concerns over the growing federal deficit occupy policy-makers' attention, the Academy's conferees came to keep health care on the political radarscope.
Academy leaders saw this year's sessions with legislators as a positive next step toward having the Academy considered a permanent fixture in Washington policy-making. "It is important that we understand the process and develop relationships with key legislators," said AAFP Board Chair James Martin, M.D., of San Antonio, commenting on the annual conference co-sponsored by the Academy and the Organizations of Academic Family Medicine.
"This is a long-term proposition," agreed FP Cathleen London, M.D., of Brookline, Mass., after she met briefly with Rep. Barney Frank, D-Mass.; a staffer to Sen. Edward Kennedy, D-Mass.; and a senior health fellow from the office of Sen. John Kerry, D-Mass. "Family physicians need to be at the forefront of creating health care policy. To do that, we have to be present."
London pressed for beefed-up funding for Section 747 of Title VII of the Public Health Service Act, funding that supports family physicians' training programs. During her Hill sessions, she stressed the importance of keeping the FP pipeline open.
"I work in Brookline -- hardly a shortage of physicians; however, there is a shortage of primary care physicians there," London told Kennedy aide Dora Hughes. "We are already stressed to the limits trying to meet the needs of our patients. I could add two more docs in my practice if I had the room, and that would be a short-term solution. But what happens in five years?"
London also made a plea for action to ensure universal health coverage, adding, however, that access hinged ultimately on whether Congress can tackle tort reform. "Universal coverage won't matter if there are no doctors," she told Hughes. "Liability reform needs to happen. Right now we have an absolute crisis as premiums skyrocket out of control."
Osman Sanyer, M.D., of Salt Lake City also pleaded the case for continued Title VII funding. Sanyer, director of the family medicine residency program at the University of Utah, Salt Lake City, told Amber Secrest, an aide to Sen. Robert Bennett, R-Utah, that the loss of Title VII funding would have a dramatic effect three to five years down the road.
"One of the challenges I face as an academic family physician is that the funds to train (future family physicians) are relatively limited," he said.
Legislators and their aides welcomed the family physicians' presence in Washington. "You need to be here," Rep. James Cooper, D-Tenn., told Academy members at a luncheon meeting May 20. "You should be here because the pharmaceutical representatives are already here."
The Academy encourages you to take your own views to your lawmakers in visits and phone calls. For background on this year's leading legislative issues for family physicians, go to the AAFP's "Background on Federal Issues" page at http://www.aafp.org/x623.xml.
To reach writer J. Michael Brodie, e-mail mbrodie@aafp.org.
WEB EXTRA!
Two topics -- the new Medicare law and health care for the uninsured -- sparked political leaders' comments to AAFP members and family medicine leaders during the Family Medicine Congressional Conference May 19 - 20.
Rep. Nancy Johnson, R-Conn., touted last year's passage of the Medicare Prescription Drug, Improvement and Modernization Act as a positive first step in fixing the health care system, adding that the next step is solving physician reimbursement problems. "Every aspect of the (Medicare) program is, frankly, in as near a state of collapse as any program I've ever worked on," she said during a May 20 breakfast at the conference.
Rep. James Cooper, D-Tenn., argued that the current funding to provide health care to the uninsured amounts to little more than window dressing.
"It's just talk unless you can dig up the money from national parks or transportation, agriculture or education," he said.
Rep. John Dingell, D-Mich., said there were major holes in the landmark Medicare law. Dingell chatted briefly with several Michigan AFP members on May 20 immediately after announcing in a congressional hearing that he and other key House leaders would introduce legislation to automatically enroll low-income Medicare beneficiaries for the $600 subsidy offered under the new Medicare prescription drug card program. The Michigan AFP members overheard Dingell's statements at the hearing.
"It is not that I find these cards evil. I do, however, find them often misleading, consistently confusing and of dubious workability," Dingell said.
Johnson told conference participants the health challenges facing the country are too important for physicians not to be involved. "It's important that physicians know what the debates are," she said. "If you don't stand up as professionals and be part of the debate, we will act anyway."
More than 35 million people of Hispanic heritage now live
in the United States, some of them probably your patients.
Realizing that there are medical implications to changing demographics, the AAFP has collaborated with the National Hispanic Medical Association to produce Caring for Hispanic Patients. The journal, hoped to be an annual publication, is scheduled to mail to active members of both organizations on July 29.
AAFP Publications Division Director Joetta Melton, publisher of Caring for Hispanic Patients, said the journal will blend a mixture of editorials, clinical review articles and practice management articles to fill a growing need.
"The Academy has long been interested in overcoming the negative effects of health disparities, and this publication speaks to that issue," Melton said.
The first Caring for Hispanic Patients will include content on such topics as cultural issues, translation requirements and disparities. Patient education pieces in English and Spanish will cover diabetes and HIV.
This is the first such collaborative project between AAFP and the National Hispanic Medical Association. NHMA was established in 1994 to represent licensed Hispanic physicians in the United States.
The Centers for Medicare & Medicaid Services has affirmed AAFP's work in the electronic health record arena with a $100,000 grant for the Academy's EHR pilot project.
"This grant will help support technological changes to enable family practice doctors to participate fully in a more modern and efficient health care system," said CMS administrator Mark McClellan, M.D. "Our support for the AAFP initiative is an important part of HHS' broader program to promote the use of information technology to update our health care system and organize it around the best interest of patient care."
The pilot project, under way since January, recruited six family physicians to test EHR hardware and software to help find and fix the glitches that come with EHR implementation in a family medicine setting. Go to http://www.aafp.org/fpr/20040600/1.html to read a story about the EHR pilot project.
David C. Kibbe, M.D., director of AAFP's Center for Health Information Technology, said the grant is significant beyond the dollar amount. "This is a double win for all of us," he said, and signifies "the train is leaving the station."
"We will get increasing attention and support from a variety of places, including CMS, for work that is done implementing standards, equipping practices with affordable EHR systems and finding solutions to barriers that have slowed down market growth," said Kibbe.
"We also win because we may prevent legislators and governmental agencies, who are frustrated with the slow pace of IT adoption, from mandating standards and programs that might halt progress or increase costs of production and sales."
To read a May 28 HHS press release about the grant, go to http://www.cms.gov/media/press/release.asp?Counter=1075.
WEB EXTRA!
To the editor:
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To the reader Write us a letter of 200 words or fewer (subject to editing). Send your letter to: FP Report, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672; fax it to (913) 906-6089; or contact fpreport@aafp.org via e-mail. |
(This letter responds to a story in the June FP Report -- "ABFP Strives to Put Best Foot Forward on MC-FP" -- about the American Board of Family Practice's Maintenance of Certification Program for Family Physicians.) I have to agree with Dr. (Richard) Feldman. Additionally, I think certificates of added qualifications are a mistake. These, too, send the message that "what we have been doing is meaningless."
MC-FP is unnecessary. What about the 50 credits we need yearly to maintain our licenses? This will be another fee and another piece of paper that does nothing to get to the root of poor outcomes.
If we really want to improve the quality of medical care, let's work for the millions of uninsured. Why are we being so civilized about the seriousness of tobacco's effects on the nation's health care? The national effort of the AAFP (Tar Wars®) is a kind and gentle way to introduce this subject to children in the schools of this country. Use the national spotlight that our organization enjoys to really go to WAR with this national tragedy and to address other fundamental health issues.
Why are medications so expensive in this country? We all have patients who could go hungry if they took all the medications they needed. So what happens? We give them samples or they go without. Why is this happening? These drug companies give "discount" cards and then raise their prices.
Wake up Medicare, please. It is killing family medicine. Young doctors are avoiding our specialty, and we're kidding ourselves if we think otherwise. If nothing changes -- if we're not paid more -- it won't matter if we're asked to do more CME credits, because there won't be a specialty to care about!
James Goodwin, M.D.
Washington, N.J.
To the editor:
(This letter responds to "A Trend? Other Specialists Crowd Primary Care Picture, Study Says " in the June FP Report.) I sadly watched my neighbor, a 50-year-old wife and mother of three, carried from her home three days before Christmas after dying in the arms of her husband. The autopsy proved coronary artery disease. Six weeks before her death, her gynecologist -- doing primary care -- advised her to repeat her cholesterol in April. The woman's personal and family histories were full of red flags.
Earl Carstensen, M.D.
Aurora, Colo.
To the editor:
The recent launch of the National Breastfeeding Awareness campaign will go far in helping women understand the importance of breastfeeding their infants. However, I am concerned about the nearly simultaneous FDA warning against the use of domperidone to increase breast milk supply.
There was no scientific basis for this warning, and no new or urgent data require a new warning at this time. Many drugs have language in their commercial materials saying that breastfeeding women should not take this drug or should consult their physicians; this is a product liability rather than medical issue. Domperidone is the safest, most effective galactagogue available. Many of us who focus our practice on breastfeeding medicine use it to assist our patients. Most of us use American compounding pharmacies, though occasionally I have patients choose to order it from outside the country due to cost.
The FDA announcement includes the comment that women should consider using formula instead of using domperidone for low milk supply. Some of us in the breastfeeding medicine community are concerned that this announcement, and particularly the timing of it in close proximity to the start of the National Breastfeeding Awareness campaign -- despite the fact that there is no new evidence about domperidone-- stem from a political agenda, possibly related to formula company lobbying with profits threatened by the campaign, rather than from truly health-related goals.
Anne Montgomery, M.D., FAAFP, FABM
Member of the
AAFP Breastfeeding Advisory Group
Olympia, Wash.
WEB EXTRA!
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All active members should have received in the mail a copy of the latest CME Bulletin, B-Type Natriuretic Peptide in Congestive Heart Failure -- Diagnosis & Management. This bulletin gives an overview of the utility of B-type natriuretic peptide, a simple blood test that may offer an effective tool in diagnosing and managing congestive heart failure. Free CME credit is available. Go online to complete the self-assessment quiz and evaluation (visit http://www.aafp.org/cmebulletin.xml and follow the links), or submit the answer sheet by mail or fax as directed in the bulletin. |
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The WorldPointsSM Platinum Plus® MasterCard® credit card program is a benefit of AAFP membership. Use your card and get one point for every dollar you spend. The reward? You can earn cash, brand-name merchandise, travel and more. The card features competitive rates with no annual fee. Go to http://www.aafp.org/x19611.xml for an easy online application for this MBNA America Bank credit card. Call (800) 932-2775 for more information and mention priority code YUED. |
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Proven value: Have you registered for the 2004 AAFP Scientific Assembly to be held Oct. 13 - 17 in Orlando, Fla.? Online registration is open at http://www.aafp.org/assembly.xml and the early-bird discount applies until July 14. You won't want to miss this year's keynote speaker, Francis Collins, M.D., Ph.D., director of NIH's National Human Genome Research Institute. Enjoy four and a half days of quality CME provided by national experts teaching current disease treatments, clinical techniques and practice management tips. Note that this year's Assembly runs in conjunction with the 17th World Conference of Family Doctors, sponsored by the World Organization of Family Doctors, or Wonca. Learn more at http://www.wonca2004.org. |
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Proven value: Knowledge in the field of geriatric medicine is becoming ever more important as American's baby boomers age. AAFP's Geriatric Medicine for the Family Physician course Sept. 29 - Oct. 3 in Waikoloa, Hawaii, will help you stay current in the care of your elderly patients. This course focuses on topics such as pharmacology, chronic pain management, cardiac disease, common infections and depression in the elderly. The course may assist physicians preparing to earn a certificate of added qualifications in geriatrics and will help prepare physicians taking the geriatric module of the American Board of Family Practice recertification exam. Go to http://www.aafp.org/x14336.xml to register online; register by Aug. 30 for the early-bird discount. |
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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.
