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Friday Sep 05, 2014

Called to Serve: Being Patient-Centered Puts Joy Back Into Practice

One of the exciting things about being president of the AAFP is the many opportunities to interact with medical students from all over the country. I have frequently said that students are not so much our future as they are our present. They have the ability to affect us in a positive way with their curiosity, fresh perspective and drive. And we, in turn, have the ability to make an impact on them and to influence their education and training.

Along those lines, I wanted to share two recent experiences and challenge each one of us to step up and build these critical relationships.

Our recent National Conference of Family Medicine Residents and Medical Students drew more than 1,200 students and nearly 1,100 residents to Kansas City, Mo.

I was honored to be asked to welcome all attendees to the National Conference of Family Medicine Residents and Medical Students a few weeks ago in Kansas City, Mo. This is the largest meeting of medical students and residents in the country, and this year we had record attendance, with 1,211 medical students and 1,092 residents.

For students in particular, National Conference is a critical leadership development opportunity. Obviously, we want to expose them to family medicine, and the experience of attending the conference often solidifies students' decision to pursue family medicine as their specialty of choice. But the conference has another important function: educating and challenging students to advocate and be part of our policymaking process.

One of my main messages at National Conference also was the focus of my closing main stage presentation. During that session, I challenged students to be patient-centered in all they do. I let them know that they have this opportunity, from the ground up, to be patient-centered even before they enter the workforce.  

National Conference is a great experience for attendees, but our engagement needs to extend beyond those three days each year. We can all look for other ways to reach out to medical students where they are. For example, we recently had our second Family Medicine on Air session using Google Hangout. This is an innovative approach to connecting people, and it is a technique the Academy likely will be using in other ways to connect with members.

The structure of the Google Hangout -- which you can view on Google Plus(plus.google.com) or YouTube(www.youtube.com) -- allowed people to actually see me, moderator Alice Esame (a fourth-year student from Howard University School of Medicine who also is the AAFP's student liaison to the Student National Medical Association), and AAFP student interest staff as we talked about the patient-centered medical home (PCMH). I gave a brief introduction in which I emphasized that the PCMH is truly about a philosophy and an attitude as well as about being patient-centered. Students need to understand the PCMH, yes, but most importantly, they need to be empowered to become patient-centered even if they don't yet understand all the aspects of practice transformation.

The opportunity to be patient-centered truly is a way to put joy back into a practice. It is a way for all of us to remember that we are called to serve, and that we can truly help our patients often just through the compassion we display in recognizing that they are dealing with difficult issues. This is especially important for students to understand as they consider choosing a career in family medicine that will be satisfying to them, as well as to their patients.

I was impressed with the quality of the questions that came from the students. For example, they were concerned about the administrative hurdles that come with practice transformation. This allowed me to emphasize our advocacy efforts to help streamline the process involved with PCMH recognition.

Another question acknowledged the important role of other members of the health care team, such as care managers, nurses and others. Specifically, the student's question addressed how to assemble a team in rural settings where there are fewer resources. This gave me a chance to talk about how at my first practice in Trenton, Ga., the small town's health care professionals (chiropractors, pharmacists, public health officials, etc.) worked together even though we weren't in the same building -- or the same business -- to make sure that we provided the care our community needed. The key was good communication as well as the recognition that we all were working together for our patients' well-being.  

The students were on top of recent evidence, too, quoting an article in JAMA (jama.jamanetwork.com) that found PCMH pilots from 2008-11 were not associated with health outcome improvements. I pointed out that this article described older PCMH models, and so was essentially similar to being concerned about a review of the iPhone 2 when we're actually using the iPhone 5. PCMH models now are significantly different. Those pilots did not have many of the patient-centered changes in place such as extended hours, and did not really study decreased ED visits, and hospitalizations which are clear improvements in current PCMH pilots.

Students keep us on our toes. They challenge us, in a good way, with their fresh viewpoints, inquisitive minds, and drive to do things the best way possible. And the questions these students asked amply illustrated that reality.

The challenge for us as educators is to recognize that our students need a different approach for many of these issues. If you are an educator, or involved with a family medicine interest group, consider watching the Hangout and sharing the link. You can also refer to or use supporting materials that are available to help our family medicine interest groups, faculty and others who influence medical students frame these critical issues for them.

For members who work with students -- even if you're not faculty, I challenge you to engage them in discussion about patient-centeredness. Talk about how you have been changing your practice to become more patient-centered. Take advantage of this chance for us to walk our talk and demonstrate to our students how much we love what we do.  

Although I still say students are our present, they are definitely also our future. We have a chance to give them a solid grounding in patient-centered education, and they can help to move us forward in our own processes.

Our next edition of Family Medicine on Air will address what medical students need to know about direct primary care. Stay tuned for more details about that event, which is planned for November.

Reid Blackwelder, M.D., is president of the AAFP.

Posted at 11:59AM Sep 05, 2014 by Reid Blackwelder, M.D.

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