STFM Prez

Primary Care needs an Image Update

2009-11-14T03:55:00.000-08:00

Check out this recent article in the NY Times. All I can say is A-MEN!

Love the ending quote, "Primary care advocates for one patient at a time."

http://www.nytimes.com/2009/11/12/health/12chen.html?_r=1&hpw

Kansas City here I come...

2009-10-17T14:16:00.001-07:00

Are you going to the Practice Improvement Conference? Click here to learn more about it.

Posters to encourage youth to consider family medicine

2009-10-17T14:13:00.000-07:00

have you printed your posters yet?

At AAFP Assembly in Boston

2009-10-16T13:56:00.000-07:00

STFM Communications Director Traci Nolte shows the STFM Resource Library (FMDRL) to an attendee at AAFP's Assembly in Boston.

If you're in Boston, stop by the booth.

Remembering Our Heroes

2009-09-11T02:33:00.000-07:00

Eight years ago today, I woke up early and headed off to work to finish a grant that I was writing. I got a flat tire on the way to work and, after struggling to get the donut on, drove home slowly to change clothes. On the way home, I heard on NPR that something had hit the World Trade Center in NY. And then, sitting at home, I saw the 2nd plane fly into the WTC with my own eyes. Shock...sadness...did I believe what I was seeing. Then, the plane hit the Pentagon and finally Flight 93 crashed about 80 miles from my childhood home. It was so quiet as we all gathered with families and friends to try and make sense of the tragedy.

Then, late that night, my phone rang and the e-mails came. Did I hear that Paul Ambrose, a friend and family physician colleague, was on American Flight #77, the plane that crashed into the Pentagon?! NO!!! I had not...and sadly it was true. Paul was working for the Office of the Surgeon General and was heading to LA to present the results of a report on teen obesity. Paul and I worked together for the American Medical Student Association. Fatigue was never an issue when Paul was around and we stayed up many nights talking and trying to figure out how to improve our nation's health. Paul firmly believed that physician leadership was essential to making this happen.

As I watched President Obama two nights ago, I wonder what Paul would be thinking...or saying...about this most recent debate on health care reform. A civil discourse, I think, would have been important to Paul. Does that include having an elected official call our President a liar during his speech? Or does that mean that people should be fighting at town halls about health care reform? I think not. Does it mean that we should discuss all options and choose the ones that are best for our country? Does it mean that something has to change? And, probably the most important - Where are the physician leaders?

Paul was just 1 hero we lost on 9/11/01. My life was touched deeply by his. And multiply that by the 1000s that he knew and the 1000s of people that knew victims of 9/11. Today. let us pause to remember our heroes. But, let us remember them by rising to the challenge of what they stood for...what Paul stood for. LEAD THE WAY!

The 80s Lives!

2009-07-31T07:11:00.001-07:00

Am at the AAFP National Conference for Residents and Medical Students. Last night was a great night with the opening social in the exhibit hall. While it was difficult to talk to students in detail, it set a great opening mood for the conference. It should be fun and a place to network and get to know others. Because, after all, one of the hallmarks of family medicine is the relationships you develop with others. I was very impressed to see the volunteer leadership from the AAFP, STFM and other organizations on the floor meeting people and encouraging students and residents about the exciting potential that health care reform holds for family medicine. Over the next 2 days, STFM will be holding its summer board meeting and will generate some new policies and ideas for the Society. More postings to come...

CNN Money Focuses on Family Docs

2009-07-17T05:41:00.000-07:00

Great article in Money Magazine about family medicine and primary care specialties. Kudos to our colleagues at the University of Washington and to Dr. Ted Epperly for their work on this article for the mainstream. Take a look: http://money.cnn.com/2009/07/16/news/economy/healthcare_doctors_shortage/index.htm

There has to be a better way!

2009-06-12T05:25:00.000-07:00

I am finishing up my week as course director of our annual CME program for family physicians, PAs and NPs. Originally developed 30 years ago as a way to allow physicians to review for the Board, the program is primarily the same as most CME courses: didactic lectures followed by Q&A with those who have specific questions waiting in line in the lobby as the next presentation begins. However, next year there will have to be a change: It will be at that point in the ABFM cycle where most people have 10 years on their certification, not 7. So...board review will not be needed. What will be needed are help with SAMs, teaching how to do QI projects in practice, and learning how to translate the speaker's didactic information into hands-on care in their practices. There has to be a better way to do this and for us to maintain our quest for life long learning. I think panels followed by audience response quizzes (think Who Wants to be A Millionaire translated to CME...ask the audience!?) and breakfast tables with expert speakers may be the way to go. But, there has to be a better way!

Speaking of "a better way," the House and Senate are revealing details of their health care reform proposals this week. Senator Kennedy's HELP Committee came out with the first bill. Admirably, it was not as long as the Clinton Bill, but still weighed in at 615 pages. The full bill can be read at: http://help.senate.gov/BAI09A84_xml.pdf There is some controversy in this bill, of course, but this is the first proposal...more to come. Is this a better way to provide health care? Is this the right way to reform the system? Or, is there a better way?

Pomp and Circumstance

2009-06-01T19:10:00.000-07:00

Last week, my youngest son graduated from kindergarten. One of the many milestones of his life, I know, but a big one all the same. I watched him play a pebble in the Tale of The Hermit Crab, sing and dance with his classmates, walk in wearing one of my white dress shirts as his "gown" (Good thing he has broad shoulders too!) and then watched him get his graduation gift: The Laffy Taffy Award, for always making his teachers laugh, and an alarm clock - to help him get to school on time in 1st grade! At the end of the day, he gave me and his mom a hug and then thanked his teachers.

It reminded me of graduation days in my life: High School - when I thanked Mrs. (Joanne) Tano for helping me to envision my life in medicine; College - where I thanked Steve Bowser and Professor LoBello (It was never Tony, it was always Professor!) for helping me survive a Batchelors degree in math (what was I thinking); Medical School - so many mentors to thank including Jack Mediale, Sim Galazka, Kent Smith, Mark Komar, Scott Frank, George Kikano, Susan Wentz and so many more; Residence - where Mark Knudson showed me how to be a consummate family medicine educator. The list could go on, but the sentiments are the same.

So, as we are surrounded by medical school and residency graduations, maybe we should each take the time to say "Thank You" to one mentor who helped us to get where we are today. And we should each strive to be that mentor that one learner wants to say "thank you" to when they graduate this year.

Why We Need a Patient Centered Medical Home

2009-05-13T12:51:00.001-07:00

Sometimes, I have an encounter in practice that reminds me of why we need a patient centered medical home. I want to share a recent encounter with you that demonstrates the need and why I feel so passionate about what I do.

Ms X. came in to see me after a five year absence. She had been seeing me previously for her high blood pressure and osteoarthritis. We had been making some headway on her obesity and then I lost track of her. Turns out, that she lost her job and went without health insurance. To help save money, she sought care at a local community health center. They did a good job managing her hypertension and arthritis, but neglected, for a variety of reasons, issues of preventive care.

When she came back to see me, she now was insured with Medicare. She wanted a mammogram, but didn't let me know until I was getting ready to exam her that she had found a mass in her breast "a while ago." Sure enough, on exam I felt a mass that concerned me and within a week the diagnosis of metastatic breast cancer came to my desk.

I can't say that she wouldn't have had that diagnosis if she had continued her care with me. But, I wonder if having mammograms on an annual basis (which our system tries to insure) would have caught it earlier? Or, would having a relationship with a regular provider have allowed her to come in for an exam earlier? I don't have an answer, but it makes me think...

What do you think? Do you have similar stories? Let me know...and let's continue to work towards a family physician (and a patient centered medical home) for every American.

Back To Reality!

2009-05-05T09:24:00.000-07:00

I got home last evening after an exciting and invigorating STFM Annual Conference. I learned a lot, made new friends, relaxed with old friends, and had a great time. But now, the rubber meets the road. How do we take challenges, like the one Jeanette South -Paul offered on the last day - and incorporate them into our everyday lives? Well, this afternoon, I will be seeing patients and I want to try and understand how their culture and socioeconomic status affects their interaction with our clinic - their patient centered medical home. For some, I know that our appointment system is hard to navigate. For others, the bus just can't get there on time. What barriers have their insurance companies placed on our interaction today? I know that there will be many things to achieve today and I hope that I can meet that challenge.

What are the challenges you were issued at this year's meeting? How are you going to respond to them in your practice? your teaching encounters? your daily life?

STFM Annual Conference Firsts

2009-05-02T11:52:00.000-07:00

Its the next to the last day of the STFM annual meeting - that day when you are exhilarated, but fatigued. Excited, but ready to go home and implement what you learned here. On this day, I want to reflect on some firsts for me at this meeting:

-- I met a PA who teaches family medicine residents and is a member of STFM.

-- I met an orthopedic surgeon whose home base is a family medicine residency.

-- I served as a council member in the STFM Village.

-- I watched as our members contributed over $10,000 to the STFM Foundation.

-- I attended my first meeting as the STFM Board liaison to the STFM Foundation's Board of Trustees.

-- My sons saw snow for the first time in their lives (deprived, I know!)

-- My wife networked with STFM staff for over 2 hours (We're all family!)

What were your firsts at this conference? What was your favorite part? Your least favorite? Let us know!

Time for Pre-Doc Submissions

2009-04-23T06:42:00.000-07:00

I know we are all getting ready for the annual meeting in Denver, but start thinking about your submissions for the STFM Pre-Doctoral Education Conference to be held in Jacksonville in January 2009. I mention this now because 1) Abstracts are due June 15 and 2) You may hear/see an idea in Denver that would be perfect as a presentation at Pre-Doc. Also, tap your medical students for ideas that would make good presentations. The Pre-Doctoral Conference Steering Committee is especially looking for presentations with the following themes:

Integration of technology into medical education
Interdisciplinary and inter-professional education
Teaching students about improving health care delivery
Evaluation of learning outcomes

Thanks for your submissions...we look forward to reviewing them all!!

Physician Burnout - The Surgeon's Perspective

2009-04-22T05:58:00.001-07:00

In this month's Archives of Surgery, faculty from Johns Hopkins University and the Mayo Clinic described "Stress and Burnout Among Surgeons" in a special article. The authors define burnout as, "[a clinical syndrome] characterized by emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment." (1) The authors then list possible causes of burnout. These include:

Length of training and delayed gratification
Limited control over the provision of medical services
Long working hours and enormous workloads
Imbalance between career and family
Feeling isolated or loss of time to connect with colleagues
Financial issues
Grief or guilt about patient death or unsatisfactory outcomes
Insufficient protected time research time and funding
Sex- and age-related issues
Inefficient or hostile workplace/environment
Setting unrealistic goals or having them placed upon oneself (1)

This started me to think: What are the causes of family physician burnout? Are they the same as surgeons? Are they different? What can we do to prevent burnout?

Here is my list of possible causes, in addition to those above, that might cause family physicians to burnout:

Inordinate amounts of paperwork to do what is right for a patient
Financial issues as they relate to our procedurally-based financing system
Lack of loan-repayment options and overwhelming medical school debt
Frustration from patient's inabilty to comply with our recommendations (financially, physically, etc.)

What would you add to this list? Take away? Is burnout a problem for family physicians? I welcome your comments. I also look forward to seeing many of you at our annual meeting in Denver next week...there we can eliminate one potential cause of burnout -- Feeling isolated/loss of time to connect with colleagues.

References
1. Balch CM, Freischlag JA, Shanfelt TD. Stress and Burnout Among Surgeons. Arch Surg. 2009;144(4):371-376.)

Welcome to the STFM Prez blog!

2009-04-20T17:08:00.000-07:00

As my time approaches to become the next president of STFM, I wanted to find ways to reach out to members (and others) that haven't been used before. This blog is the one of those methods. I don't know yet what will get posted here - STFM news and events for sure. But probably some patient stories, teaching moments, a funny story, a sad tale, and, of course, news from the political world. Plus, you may just get some of my random thoughts when they need to be released...and those tend to be the most interesting. But let me know what you want to hear...and see...in this blog. I hope that this will be the start of something big...but only time will tell!!

Welcome

2009-04-20T13:47:00.000-07:00

Welcome to "STFMPrez," the official blog site of Dr. Terry Steyer, the 2009 - 2010 President of the Society of Teachers of Family Medicine.