Direct Primary Care is all the rage. It's been anointed in the "Health is Primary" initiative as a key business model for success by the AAFP (American Academy of Family Physicians). The initiative was launched by the AAFP last week in Washington, DC.
A keynote presentation by Erika Bliss, MD CEO of Qliance at the Family Medicine Education Consortium (FMEC) in Arlington, VA two days after the AAFP announcement wowed the students, residents and even some faculty at the FMEC meeting. One big question from the students and residents: Where can I get DPC training? One big question from the faculty types: How do you teach it?
Personal reflection as a DPC innovator, DPC Hybrid private practice owner and Family Medicine educator: Direct Primary Care is the only element in all of medicine that is moving ahead on the offensive. The rest of medicine is otherwise on the defensive, hunkered down waiting for the next mis-directed initiative. The AAFP is willing to take the risk of helping Family Physicians and their patients by going against the status quo and endorsing the DPC business model. The "Health is Primary" Initiative allows Family Physicians to get some reassurance about the Future of Family Medicine.
How do we teach DPC along the entire Family Medicine workforce pipeline?
1. Define our Dream (and help each individual to define theirs)
2. Have a burning desire to achieve it (and cheer for each other as we get "fired up")
3. Believe we can do it (and validate/reaffirm the belief of each other)
Dialog will be one of our powerful resources for spreading the word about DPC. We are good at it.
The DPC pioneers have paved the way for the model to be accepted, proven and recommended.
The "Health is Primary" initiative will add energy, deliver AAFP introductory workshops during the next year, and facilitate the DPC Member Interest Group which will help interested members to learn more.
Departments of Family Medicine can be pivotal in promoting DPC by updating faculty on the Health is Primary Initiative and the DPC elements in it. DPC oriented faculty and clinical faculty and preceptors should be asked to orient faculty and departmental staff to DPC. A Champion for DPC should be identified by interested Departments.
State Chapters of AAFP should be contacted for information or assistance with DPC resources and contacts. The state chapter web site should connect with the AAFP "Health is Primary" initiative and its DPC elements.
Family Medicine Interest Groups (FMIG's) should get DPC speakers to introduce DPC elements to the student members at FMIG meetings. FMIG advisors should find the online DPC info which is plentiful. Pre-doctoral directors in Departments of Family Medicine should identify their DPC resources such as preceptors, clinical faculty and full time faculty, and social media resources for medical student use.
Students could introduce the DPC business model to preceptors for discussion during their clinical rotations. A list of online resources explaining DPC and its variations should be available on FM Department and FM Residency web sites. Medical students could refer preceptors who are naive to DPC to these sites.
Residencies that identify how they will teach DPC should quickly add a DPC section to their web site and promotional materials. Similar to the sports medicine, geriatric, perinatal, genomic initiatives across the last couple decades, the DPC aspect of practice management could be in place within two months for aggressive programs.
A champion for DPC should be identified for each section of the "Family Medicine Pipeline" and connected via social media.
Objectives for practice management training should be quickly modified to add a DPC component. One key aspect of DPC in practice management is the learners attitude about business, money, commerce, ethics (business and medical), and the patient-physician relationship.
The Family Practice Model Units should explore a DPC track for patients and employers, which is doable (FYI-I was Medical Director of a University and a Community FM training practice- multiple payment models fit nicely. None of them are inherently evil, but some faculty wondered if something they were unfamiliar with was dishonest--like capitation or fee for service.)
Residencies: Students are hungry for this model.
All of us: We're part of the problem as a citizen of the Medical-Industrial Complex. Let's re-direct the ship around the iceberg with "Heallth is Primary", including DPC and what we learn as a result of having to teach about it. How will it fit with "The Dream".
What do you think?
Tuesday, October 28, 2014
Friday, October 24, 2014
Family Medicine: The Myth and the Tension
What do patients expect of their Family Physician? What do we expect of them?
As we relate to each other, one or the other may seek better connection. They may press to create more tension to enable a more meaningful engagement. Relationships, like poems, need tension.
Hopefully, patient or Family Doctor creates the tension to enhance the communication or someone may not get a fair consideration from the other. Creative tension may enhance the relationship, too. It can get toned over several engagements to allow high quality communication and better alignment with mutually beneficial values, goals and dreams.
The expectations of each party may be based on a mysterious myth about who the other person is and what has (or hasn't) happened before. Our profession has some mythical qualities with many patients, especially those with positive expectations. We may remind them of a TV Dr. like Marcus Welby, MD or Richard Kildare, MD (OK, these were a long time ago) or one of the newer physicians on Gray's Anatomy. Those myths may be helpful for the patient and the doctor to accomplish their goals. They believe in something beyond the current situation, and make it through.
What kind of tension do you create? Or run from?
What myths might you believe about patients, Family Medicine or your Family Doctor that may help or harm your health? Or your career?
More later from the FMEC meeting in Arlington.
As we relate to each other, one or the other may seek better connection. They may press to create more tension to enable a more meaningful engagement. Relationships, like poems, need tension.
Hopefully, patient or Family Doctor creates the tension to enhance the communication or someone may not get a fair consideration from the other. Creative tension may enhance the relationship, too. It can get toned over several engagements to allow high quality communication and better alignment with mutually beneficial values, goals and dreams.
The expectations of each party may be based on a mysterious myth about who the other person is and what has (or hasn't) happened before. Our profession has some mythical qualities with many patients, especially those with positive expectations. We may remind them of a TV Dr. like Marcus Welby, MD or Richard Kildare, MD (OK, these were a long time ago) or one of the newer physicians on Gray's Anatomy. Those myths may be helpful for the patient and the doctor to accomplish their goals. They believe in something beyond the current situation, and make it through.
What kind of tension do you create? Or run from?
What myths might you believe about patients, Family Medicine or your Family Doctor that may help or harm your health? Or your career?
More later from the FMEC meeting in Arlington.
Monday, October 20, 2014
FMEC Meeting: Reunion of "Geeks and Geezers in Social Media" #FMEC2014
Calling all Social Media Geeks and Geezers alumni. Starting at the Hershey FMEC meeting, several of us launched a social media era for FMEC with a session called, " Social Media for Geeks and Geezers". Mike Sevilla, MD and Kenny Lin, MD and I noted that, after our Seminar, several blogs were initiated. "The Future of Family Medicine" blog by Kevin Bernstein (then medical student on the AAFP Board) MD and "The Singing Pen of Dr Jen" by Jennifer Middleton, MD were among them. Numerous persons started a Twitter account at that meeting. It was a nice start. After two similar sessions at subsequent FMEC meetings, including Jennifer Middleton, MD, Michael Smith, MS, Kenny Lin, MD and I in various faculty roles more people started to Tweet and blog and use social media in all sorts of venues.
In Arlington, VA, we're inviting Geeks and Geezers to be Social Media Ambassadors via Twitter, Blogs, Facebook, LinkedIn, and Internet Radio, etc. throughout the FMEC meeting.
We'll have a breakfast discussion table for Geeks and Geezers on Saturday morning to celebrate and launch interested persons with their own Twitter, Blog, etc.
The hashtag for the meeting will be something like #FMEC2014.
Many of our tweets will also be sent to #FMRevolution #DirectPrimaryCare and others.
As we turn the corner to become "Solutionists", think about what might be the next hashtag for
what's happening in Family Medicine. We'll discuss #the nexthashtag at the meeting, maybe in the bar Saturday night.
Who's a Geek and who's a Geezer? Your mirror has the answer. Mine said, "You are a geezer."
Onward to #FMEC2014
Pat
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In Arlington, VA, we're inviting Geeks and Geezers to be Social Media Ambassadors via Twitter, Blogs, Facebook, LinkedIn, and Internet Radio, etc. throughout the FMEC meeting.
We'll have a breakfast discussion table for Geeks and Geezers on Saturday morning to celebrate and launch interested persons with their own Twitter, Blog, etc.
The hashtag for the meeting will be something like #FMEC2014.
Many of our tweets will also be sent to #FMRevolution #DirectPrimaryCare and others.
As we turn the corner to become "Solutionists", think about what might be the next hashtag for
what's happening in Family Medicine. We'll discuss #the nexthashtag at the meeting, maybe in the bar Saturday night.
Who's a Geek and who's a Geezer? Your mirror has the answer. Mine said, "You are a geezer."
Onward to #FMEC2014
Pat
FMEC Northeast Regional Meeting: "Health for the Nation and the World: Putting People First"
Come to Arlington, VA October 23-26 and learn with the Family Medicine Education Consortium team of educators. Medical students, residents, faculty and others involved in Family Medicine Education will celebrate together the challenge of transforming the health care system in a way that better serves individuals, families and communities.
In a time of disruption, no one knows where the healthcare system is headed or how to get it going the "right" way. It costs too much and is misdirected, mired in "Meaningless Use" and "Transformationitis".
Who cares enough to risk anything to do what's right? The FMEC for one. The meeting includes preconferences such as the Innovators Network which already has played a key role in upgrading the Direct Primary Care movement.
I love this meeting. Medical students from the northeastern United States, Residents from fifty or more programs with displays about their programs and Family Medicine faculty from the Northeast- like five hundred people who are excited about Family Medicine.
Breakfast tables to discuss interest areas and solutions, keynoters about healthcare solutions and educational dilemmas, space to sit down and talk with others who have common interests, book authors to sign and discuss their book, Door prizes for students at the Residency Fair.
FMEC 2014 Meeting Facts Final Program FMEC 2014 Annual Meeting
Check it out!
In a time of disruption, no one knows where the healthcare system is headed or how to get it going the "right" way. It costs too much and is misdirected, mired in "Meaningless Use" and "Transformationitis".
Who cares enough to risk anything to do what's right? The FMEC for one. The meeting includes preconferences such as the Innovators Network which already has played a key role in upgrading the Direct Primary Care movement.
I love this meeting. Medical students from the northeastern United States, Residents from fifty or more programs with displays about their programs and Family Medicine faculty from the Northeast- like five hundred people who are excited about Family Medicine.
Breakfast tables to discuss interest areas and solutions, keynoters about healthcare solutions and educational dilemmas, space to sit down and talk with others who have common interests, book authors to sign and discuss their book, Door prizes for students at the Residency Fair.
FMEC 2014 Meeting Facts Final Program FMEC 2014 Annual Meeting
Check it out!
Monday, October 13, 2014
Is CVS too Aggressive? Customers or Patients?
Just got a call from a CVS pharmacist in Dayton, Ohio. She identified a "gap in therapy" for one of my patients with diabetes. "Don't you want to protect their kidneys with an ACE or an ARB?"
The patient did not meet any criteria for a "mandatory" ACE or ARB. Preventing kidney disease from ADA : "Diabetic kidney disease can be prevented by keeping blood sugar in your target range. Research has shown that tight blood sugar control reduces the risk of microalbuminuria by one third. In people who already had microalbuminuria, the risk of progressing to macroalbuminuria was cut in half. Other studies have suggested that tight control can reverse microalbuminuria."
I pointed out to the pharmacist what the medical literature says about kidney considerations for diabetics, after she told me "there is one study" that said an ACE or ARB might be indicated.
I told her about guidelines and considerations and mandates and policies and the practice of medicine and the actual medical literature which is fairly vast in the area of diabetes.
She said, "I want my patients to get the best care possible" After asking that "her patient" be prescribed an unnecessary drug.
What's up with CVS? Are they foisting partially informed pharmacists on their customers (or "patients") to enhance sales? Clearly CVS would have been the benefactor of the sale of the unnecessary drug.
Isn't there a slight conflict of interest in CVS pushing unnecessary drugs onto persons with chronic diseases in the name of "a gap in therapy"? Or is it really a "gap in profits"?
What do you think?
The patient did not meet any criteria for a "mandatory" ACE or ARB. Preventing kidney disease from ADA : "Diabetic kidney disease can be prevented by keeping blood sugar in your target range. Research has shown that tight blood sugar control reduces the risk of microalbuminuria by one third. In people who already had microalbuminuria, the risk of progressing to macroalbuminuria was cut in half. Other studies have suggested that tight control can reverse microalbuminuria."
I pointed out to the pharmacist what the medical literature says about kidney considerations for diabetics, after she told me "there is one study" that said an ACE or ARB might be indicated.
I told her about guidelines and considerations and mandates and policies and the practice of medicine and the actual medical literature which is fairly vast in the area of diabetes.
She said, "I want my patients to get the best care possible" After asking that "her patient" be prescribed an unnecessary drug.
What's up with CVS? Are they foisting partially informed pharmacists on their customers (or "patients") to enhance sales? Clearly CVS would have been the benefactor of the sale of the unnecessary drug.
Isn't there a slight conflict of interest in CVS pushing unnecessary drugs onto persons with chronic diseases in the name of "a gap in therapy"? Or is it really a "gap in profits"?
What do you think?
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