Family Medicine Founders Interview: Tom Leaman, MD, Founding Chair, Dept of Family and Community Medicine, Hershey Med Ctr of Penn State University

Dr Synonymous Show November 16, 2010 8-9 PM ET  www.blogtalkradio.com/drsynonymous

Introduction and Disclaimer
Patient Blog: http://bit.ly/9F9uak

Medical Student blog:  The Future of Family Medicine  http://bit.ly/cYY861

Dr Synonymous: his training in the 70’s in Hershey, PA under Dr Leaman & Residency Dir Ted Kantner, MD

Introduction of Special Guest, Tom Leaman, MD Founding Chair, Department of Family and Community Medicine, Milton S Hershey Medical Center of Penn State University

Thanks again for an incredible experience for me and my family in Hershey, PA from 1976-1979!

How did you decide to start the first clinical department in the new Hershey Medical Center?  Why Family Medicine first?

What sort of practice did you have before moving into the Medical Center?

What was the feeling that lead to all this happening in the little town of Hershey?  How was the town before and after the arrival of the Med Ctr?

How did medical care in Hershey change during the transition? How did the local physicians respond?

Who were the people supporting this new adventure?

How did you get faculty for the Department?  How did everyone adjust to an academic environment?

How did the town react?  Your patients?  Your family?

How did it all evolve? (to deliver the wonderful training experience to me and my peers and many others)

What were the fun aspects of starting the Department and moving into the Med Ctr?

What kind of difficulties were there?  Was budget development fun?

How long did you continue in the Department?

You served as President of the Society of teachers of Family Medicine, too?  What was that like?

What other founders did you know?  Did they all share in the adventure?

Anything we should fix about family medicine or FM training?

How are the founders and their vision remembered?

What does it mean to you to have a career as a family physician?

Other comments or thoughts, Tom

Thanks again for your service to humanity, patients, students, residents, physicians, and your community!

We'll continue to introduce the Human Centered Health Home next week on Tuesday night at 8 PM on BTR

Family Medicine Leaders: Interview with Ken Bertka, MD: OAFP and AAFP Leader, EMR Expert, Family Man

http://blogtalkradio.com/drsynonymous

Dr Synonymous Show November 9, 2010

Introduction: I’m Dr Synonymous, a Family Physician in Beavercreek, OH

Veteran’s Day is 2 days away and we want to salute them and their endeavors.  A Dr Synonymous salute to all veteran’s, (including me, I’m blessed to have had the opportunity to serve in the Army)

Disclaimer:  We’re not practicing medicine here.  That’s best done by your own family physician in the context of an ongoing therapeutic relationship.

Patient Blog:  The Positive Medical blog- when Treatments End by Chrysalis http://feedproxy.google.com/~r/ThePositiveMedicalBlog/~3/lLuadTPsAFg/when-treatments-end.html

Physician blog:  Medical Students- Future of Family Medicine: Medical Student Burnout and Unprofessional Conduct by mdstudent31 http://futureoffamilymedicine.blogspot.com/2010/11/medical-student-burnout-and.html

Physician blog:  Is it the End of Private Practice? By Brian Vartabedian, MD

http://33charts.com/2010/11/end-of-private-practice.html

Dr Synonymous blog:  Saturday, November 6, 2010  

Family Medicine: Saturday Morning in the Office http://DrSynonymous.blogspot.com

http://drsynonymous.blogspot.com/2010/05/memorial-day-grief-and-vietnam-wall.html

A few comments about “The Wall”, The Vietnam Veterans Memorial 

Interview with Ken Bertka, MD

From Toledo, OH;  just finished service on the Board of Directors of AAFP and is a Past President OAFP, Past Medical Co-Editor, Core Content Review of Family Medicine, etc.

Welcome, Dr. Bertka

Would you describe your current professional activities and positions for our listeners?

Would you point out for our listeners special family doctors in the Toledo, OH area, please, such as your wife, Dr Vickie Bertka, now a hospice physician and the late Les Huffman, MD, who also served as OAFP President and later became AAFP President, (installed in Boston in 1976 at my first AAFP meeting when I was a resident in FM at the Hershey Medical Center).

How was the recent wedding of your son, Brian?  Is your youngest son ready to follow suit?

What were the more interesting situations and issues you dealt with on the AAFP Board?

How does AAFP analyze the difficult decisions like how to relate to health care reform?

What’s going to help with the pipeline of medical students needed to enter family medicine training?

Are there other workforce issues of near and far future that are pressing for family medicine and our patients?

What are your thoughts about the PCMH?  The EMR and “Transformation”? How will it relate to Toledo?  AAFP?

Have you published the process and results of your transformation in the Mercy Hospital System?

Your ran for president elect of AAFP with a platform of 4 R’s, You weren’t  successful with your election campaign, but the four “Rights” sounded pretty good to me.  What are the 4 “rights” that the AAFP members should consider? Let’s discuss these a bit.

How will people in Ohio get good primary care?

What’s going to happen with funding for health care?   What is the future for family physicians?

You’re also into music through your church  what do you do in that area?

Next week on Tuesday at 8-9 PM, November 16,  we’ll  interview Tom Leaman, MD Founder of the Department of Family and Community Medicine at the Milton S Hershey Medical Center in Hershey.  The Founders of Family Medicine education were a special group of people.  Tune in next week to hear from a special founder, Dr Leaman who also became President of the Society of Teachers of Family Medicine. 

I’m Dr Synonymous, Good Night

Veteran's Day Reflections: Finding our Spiritual Center

"Doing what you do well within the framework of a system of values that you respect can constitute a spiritual center."  ...Frederic Flach, MD in Resilience

Being a military veteran gathers more meaning as the years go by.  Serving a country we believe in, doing the work that we do well in a group whose values we respect allows us to get close to, or find, our spiritual center.  God often seems to join in, anchoring the spiritual center with affirmation and Truth.
I remember in August, 1970 experiencing my first mortar attack on our Viet Nam Headquarters for the 45th Engineer Group in Phu Bai.  I was holding the winning hand in "High Chicago" (seven card stud, high spade in the hole splits the pot with the winning poker hand) when Bam! Bam! Bam!, mortar rounds landed a few seconds apart and were "walking" into our position.  Suddenly, everyone ran from the plywood officer's club into the various bunkers around our living quarters. I ran across the street from the club and dove into the bunker next door to my "hooch" (plywood hut) and came up praying the Lord's Prayer.  My spiritual center was refreshed quickly when motivated by mortars.   My brain and heart reminded me of God's role in my life as I finished the Lord's Prayer and moved onto the 23RD Psalm.

Two of the problems in the Viet Nam Conflict were  the lack of support by the American people and the misdirected strategy to use enemy body counts as a measure of success.  In part, this lead to atrocities, dishonesty and burnout that manifested as alcohol and drug abuse, disobedience and mental illness including depression and Post Traumatic Stress Disorder (PTSD) for many.  There were no parades to welcome us home.  The spiritual center was damaged for many.

Perusing my alumni magazine, The Assembly and Taps, from the West Point Association of Graduates,  I page back to the alumni news from the class of 1968 (my class) by Dave Gerard.  Many photos and updates of classmates/spouses activities follow as Dave tells our class story.  Starting with the wedding of the daughter of John and Gayle Frinak at the Plumbush Inn across the Hudson river, Dave next notes that John wrote the memorial article for classmate Johnnie Miller, a lifelong aviator who died in June, 2008.

Then more somber realities are noted with the death of Steve Bowman, PhD, a noted military historian and classmate who died in September, burial of Dick Flynn in April, 2010 attended by several classmates and the report from the Memorial Day Ceremony in Alexandria, VA.    Friend, classmate and fellow Cadet Glee Club alumnus Henry Spengler, who died when his helicopter was shot down in Viet Nam, was honored that day, among others.  Several smiling photos later, Dave notes "Sadly, we are one less, again.  "Bullet Bob" Henderson died peacefully on the morning of 15 July, 2010 in Salt Lake City of a horribly painful and debilitating disease- surrounded by those he loved and who loved him."
 
I went to Salt Lake City, as did Jim Stanley and Malcolm Murray where we three L-2/E-4 alumni from USMA '68 met up with classmate and SLC retiree Bob Brace and his wife Jo, our friends and hosts.  We told stories about Bullet Bob, West Point, Viet Nam, etc. while consoling and partying with the Henderson clan.  Marguerite, Bullet's ex-wife was a "saint" for Bob.  His children and grandchildren are special people with some great memories of Dad/Grandpa, the SLC attorney known as the "Bull Dog" in the courts.  I'll always remember how Bob was against the Conflict in Viet Nam before Sen. Fulbright, not an easy position to defend at West Point where all of us expected to serve in the conflict.  We'll miss Bullet, his brilliance, his sarcasm and his incredible smile.  He had to run the Wasatch 100 Mile Endurance Race about 16 times to keep a balance in questing for the spiritual center that he seemed to solidify in his last days.

Over fourteen million Americans served in World War II.  Over 415,000 died in service to our great nation.

Pray for Peace.  Get it fixed in the spiritual center of America.

Thank you, Veterans, for your service.

f

Family Medicine: Saturday Morning in the Office

Patients are different on Saturday morning. Family physicians often have Saturday morning hours which serve many purposes, including timely service to patients and minimizing the total calls to the physician on call for the practice.  It also serves a quality enhancement purpose by allowing the "Saturday physician" to see the patients of the other physicians in a cross covering role.  This keeps us aware of how we compare in our treatment patterns of various conditions and diseases and allows us to become familiar with some aspects of the families of our colleagues.  I've been doing Saturday hours since I started my family medicine residency training at the Penn State Hershey Medical Center. 

We try do avoid doing complex disease management on Saturday due to limited staffing and partly out of consideration for the physician's need to focus on acute illness and recover from the sometimes more chaotic weekday work.  Complex thinking about multiple diseases and therapies is done all week, but less of a priority on Saturday when the acute illnesses, especially infections, abound.  A very sick person with pneumonia who "crawled through" a work week while having shaking chills and shortness of breath could present the doctor with a very satisfying encounter involving a blood test (cbc w/ differential white blood cell count and possibly a basic metabolic panel), nebulizer treatment with albuteral, injection of Rocephin and maybe an urgent chest x-ray to clarify presence or amount of pneumonia.  That's fun because of the opportunity for quick improvement and positive vibes for both patient and physician .

There is "special needs" time on Saturday also for more time consuming discussions with patients and families, such as end of life discussions with a roomful of people about grandma or "Pop" when more relatives are available to interact.  Sometimes this is the best time to see persons with quadriplegia who may need more time for a vast array of concerns.  A complex hospital follow up, due to list clarification of drugs and specialists, may best fit on Saturday AM. The type of visits are driven by staff availability to assist with patients and procedures.  Doctor engagement and thinking is balanced against staff availability and mental energy of all concerned.  One long family visit for detailed engagement fits nicely but two may exhaust the team and disappoint the participants.

Young athletes are another good group of folks to see on Saturday AM, since they usually need to know what's wrong, how to get better and when they can practice/play again.  They sometimes want to find a way to stop playing, if they are misplaced in a sport or not getting to participate.  In family medicine we help them to identify the meaning of their situation and to move ahead accordingly.  Parents "own" the young athlete and I enjoy helping the family with their need to understand the whole set of options relative to their "child".  Having x-ray availability can make this part of the practice even more fun with the diagnosis and management of simple fractures (or the ability to quickly rule them out when the doctor needs imaging help).

Each office of family physicians decides how they wish to address the opportunity for Saturday practice, hopefully deciding on strategies that are of mutual benefit to their patients, their family/career and their community.

Family Medicine: Innovation and "The Hershey Conversation"

The Dr  Synonymous Show November 2, 2010
Family Medicine:  Innovation and "The Hershey Conversation"
Listen on Blog Talk Radio at this link 24/7.

http://Blogtalkradio.com/drsynonymous

Introduction and Welcome

Congratulations to my hometown of Dayton, OH being named the Number One Worst City for Allergy Sufferers in the US.  
ALLERGY FOUNDATION RELEASES ANNUAL REPORT OF 100 “MOST CHALLENGING” U.S. CITIES FOR FALL ALLERGY SUFFERERS

Disclaimer- I am a practicing family physician, but we're not practicing medicine on the show.  Your best way to get good health care is through your personal family physician.

Patient honoring: We're only doctors because there are patients.  Let's always honor them.
Patient Blog:  That's What She Said "Inflammation and My Hippie Ways"
http://snc-thatswhatshesaid.blogspot.com/2010/11/inflammation-and-my-hippie-ways.html

Physician Blog:  Musings of a Distractable Mind by Dr Rob 11/2/10.  Election Reflection.

http://distractible.org/2010/11/02/different-lunatics-same-asylum/

My blog: Surprised at the geography covered by readers. 

The Family Medicine Education Consortium NE Regional Meeting in Hershey, PA

www.fmec.net

The Healthcare Innovators Network- a Pre-conference session
Several speakers with special messages from :
Alan (Chip) Teel, MD Elder Power to help Seniors remain in their homes www.Lincme.net
     started in Damariscotta, ME. High Touch, High Tech Senior Support.
Seven Dollars Can Change Lives by Edward G. Zurad, MD. Improving employee health and saving health dollars.
Patient Broadcast Network by Shawn Moyer, MD of Pinchot Med Center, Pinchot, PA (Small,  successful family practice using OX Bow EMR- unique and family medicine friendly)
http://www.pinchotfamilymed.com/

Co-Ops for Medicine by Cathy A. Smith, Using Farm Concepts to help people survive together- one vote per person.
Patient Centered Medical Home Presentations abounded.  Geisinger Health Center and others.

TV coverage of FMEC Meeting:  Notice the medical students. Emphasis on the pipeline to deliver good family doctors.

http://www.whptv.com/mediacenter/local.aspx?articleID=145699

Challenged kids dance and arts program:  Reach USA with 400 youth involved.  Enthusiastic group danced at FMEC meeting. See photos below

www.site.reachusainc.com

More Reach USA photos

http://www.facebook.com/ajax/share_dialog.php?s=7&appid=2344061033&p[]=105019159550266&action_link=

Other Important Presentations:  Social Media by Kenny Lin, MD; Doctor Anonymous, Dr Synonymous well attended, well received update on various uses for social media in Family Medicine.  PAFP students started a blog, tweeted and used facebook and YouTube at the meeting.

http://www.youtube.com/watch?v=hw0g2g5YkgM&feature=related 
Roland Goertz, MD, MBA President of AAFP "The Time Has Come" A great leadership talk with emphasis on where we're headed.  Special comments for medical students about a career in family medicine.

Coaching for Performance by Anton Kuzel, MD and Will Miller, MD Great leadership session about coaching and leading.

Beyond the PCMH: the Consumer-Oriented Human Centered Health Home (HCHH) by Steve  Deal, MS; Rosemary Ramsey, PhD; and Pat Jonas, MD.  A step in the right direction.


Aligning Primary Care Workforce and Infrastructure in an Era of Reform:  New Data and Online tools from the Robert Graham Center. Important data about primary care workforce from each medical school and residency.

http://www.graham-center.org/online/graham/home.html

Book Signing by authors in attendance:  Behavioral Medicine in Primary Care by Julie Shirmer et al.  The section on physician burnout is compelling. We need to take better care of ourselves.

So many great aspects to FMEC NE Meeting 2010. Overall a highly motivating experience and a breath of fresh air about the future of family medicine and health care.  It seems like we've started "The Hershey Conversation" about hope for health care and for people, like our patients and our selves.

My opinion of FMEC:  Important Organization. Stay tuned.

http://fmec2010.blogspot.com/2010/10/fmec-pat-jonas-md.html

Go to twitter.com and search for #fmecnet  for tweets from the meeting.  Notice the tweets from med students, especially those from the PAFP.

Next week at 8-9 PM Tuesday night on BlogTalk Radio, I'll interview Ken Bertka, MD past president of the Ohio Academy of Family Physicians (OAFP) and recently a Board member of AAFP about family medicine, healthcare reform,etc.