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Monday Nov 06, 2017

Get a Clue: Pandemic Board Game Runs Risk of Snubbing FPs

I was taking a much-needed break from my cardiovascular readings, sitting at my friend's kitchen table playing a game of Settlers of Catan. I also was explaining to him my study schedule and the routine I had created to help me prepare for my (U.S. Medical Licensing Examination) Step 1 exam in the spring. I crafted this demanding schedule to keep me on task throughout the year and to prevent myself from taking too many game breaks.

[Character cards and player pieces from board game Pandemic: On the Brink]

The generalist physician in the game Pandemic: On the Brink is not one of the more powerful -- or popular -- characters. Is that because game developers, and many consumers, don't understand the importance of prevention?

My friend got a big grin on his face and asked, "What if you could study while we were playing a game?" He walked into the next room and came back with Pandemic.

For those not engrossed in the world of board games, Pandemic is a strategic, cooperative team game where the objective is to save the world from four disease strains. The game begins with cities across the world in various stages of infection. Each player draws a character card and tries to use that character's powers and abilities to stop the diseases from spreading and, if possible, eradicate them.

Diseases spread at the end of each player's turn with the threat of an epidemic card being drawn from the deck throughout the game. An epidemic brings an infection to a new city and increases the risk of an outbreak for that turn. If there are seven outbreaks across the world before all the diseases are cured, the game ends.

Clearly, this game had epidemiologic, infectious disease, and immunologic implications, so I gladly incorporated it into my busy "study" schedule.

Pandemic's characters are meant to reflect specific roles that would be involved in controlling a pandemic, most of them endowed with special powers. In the first edition of the game, the characters included a quarantine specialist, who can prevent the spread of disease in the city in which she resides and in all the connecting cities; the dispatcher, who can move any character on the board; and the scientist, who can cure diseases with only four cards rather than the usual five.

As the game advanced into the Legacy and On the Brink versions, more characters were added. One of them was the generalist, the game's equivalent of a family physician. She looks like a jack of all trades on the card. She can make fives moves per turn, rather than the four allotted to others. This is fitting for the family physician, as it reflects our ability to fit more into a busy day or meeting more of our patients' needs in a single visit.

However, the game does not pride itself on being realistic. It glorifies other characters with larger-than-life actions, such as the medic who can cure entire cities merely by passing through.

I understand the value of prevention and know that the generalist is the true prevention specialist, but my friends who play the game do not see the advantage of the character. They tell me she can't do as much as the others, and players in online forums say things like, "She's boring!" and call her "one of the most worthless players in the game."

These are hurtful words. Although in this case I know they are talking about a character in a game, I have heard similar comments from my professors, fellow medical students and others when I discuss my desire to go into family medicine.

Even with strong data and evidence proving the value of primary care,(www.ncbi.nlm.nih.gov) the culture of medicine perpetuates a negative -- and false -- perception that students going into family medicine are less intelligent or less hardworking. I have also heard such opinions from nonmedical acquaintances, who are confused about the need for or value of family medicine.

These perceptions are due, in part, to the glorification of other medical specialties in popular culture. At the same time, ignorance about primary care and the importance of prevention is due, in part, to the lack of family physicians in the media.

In a recent open letter to television producer Shonda Rhimes,(www.statnews.com) Elizabeth Métraux of Primary Care Progress asked, "Can you make primary care as sexy as Grey's Anatomy?" Métraux cautioned that our nation needs more primary care physicians, but added that people won't "start talking about the crisis of primary care until primary care gets sexy."

Hollywood seems unlikely to be much help, so how do we show students what family medicine offers?

Having attended the AAFP's National Conference of Family Medicine Residents and Medical Students multiple times, I have witnessed outstanding main-stage presentations, procedural workshops and an expo hall filled with residency programs. There is plenty of inspiration. By inviting students to explore the specialty and its broad scope, the conference makes it clear that the life of a family physician is "sexier" than the perception of it in our larger medical culture.

Along with efforts by the AAFP, individual practitioners such as Zubin Damania, M.D. -- aka ZDoggMD -- have highlighted the trials and tribulations of medical school and our health care system(www.youtube.com) through entertaining videos that encourage students to consider working in primary care. These efforts are realistic portrayals of family medicine targeted at medical students rather than the public at large.

Seeing a generalist with awesome powers in Pandemic: On the Brink or a thrilling TV medical drama set in a family medicine practice likely would not have convinced me to choose family medicine if I hadn't already done so. I would have loved to see strong media portrayals of family physicians throughout my training, but we have our own power that can guide students to family medicine: Relationships. Through relationships with mentors and patients, students see the great strength, power and value of primary care that to date has eluded the imaginations of game creators and TV writers.

John Heafner, M.P.H., is the student member of the AAFP Board of Directors.  

Posted at 02:56PM Nov 06, 2017 by John Heafner, M.P.H.

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