Mixing it up...Primary Care style

Yes, the chocolate fountain made another appearance...as did students, residents, faculty and alumni from Family Medicine, Geriatrics, General Internal Medicine, and Pediatrics!! Ken Nguyen (BUSM I) and Jonathan Hickson (BUSM I) are enjoying the chocolate fountain here while indulging in healthy fruits.


Thank you to Arthur Celestin (BUSM II) and Matt Tobey (BUSM II) for displaying their musical talent on the ivory (plastic?) keys as Mai Ngyuen, a family medicine resident, shares with Naima Khamsi (BUSM II).

Dr. Angela Jackson (Director of the Primary Care Residency Training, Internal Medicine): "We should do this again!" Marcel smiles and says, "Maybe next semester."

BUSM I students, Doreen Gidali and Ebony Lawson, listen attentively as a faculty member shares about primary care (of course!).


Dr. Ben Siegel talks about Pediatrics (or the delicious crab dip!) with BUSM II student David Epstein.


Thank y'all for a fantastic event! We'll be sure to let you know about the next one!

What is your Dosha?

This past weekend, the BUSM Family Medicine Interest Group, BMC Dept. of Family Medicine, HMS Holistic Medicine Interest Group co-sponsored a workshop designed specifically for medical students to learn more about Ayurvedic Medicine, a traditional medical system of India.


Students from BU, Harvard, and UMass came together for two days of didactic and interactive sessions designed to give a brief introduction to Ayurveda. These sessions featured Dr. H. S. Palep, the only faculty of Mumbai University recognized in both Western Medicine and Ayurveda. Drs. Palep (wife to H.S.), Anusha Sehgal (Ayurveda) and Rob Saper (Western, Family Medicine) also facilitated this unique exchange between medical systems.


During the workshop's didactic sessions, Dr. Palep spoke of the overlap of Ayurveda and Western Medicine. For example, he compared Ayurveda's understanding of information/knowledge inherent to our humanness to the understanding in Western medicine of DNA as the molecular substrate of genetic information.

The didactic sessions were complemented by a session on Ayurvedic therapeutic cooking, a guided meditation and a demonstration of the variety of herbal therapeutics used in Ayurveda.


On Sunday afternoon, the workshop was closed with delicious food catered by Kashmir Indian Restaurant.

Keep an eye out for a more personal account from one of the workshop participants, also a BUSM I student.

Making primary care "sexy": chocolate fondue

In a movement to make primary care more "sexy," we had tables in the lobby at lunch on Wednesday with information about primary care combined with a chocolate fondue sale. Fresh strawberries and other dried fruits were sold as a fundraiser for future FMIG activities. The table served as an opportunity to sign up students for membership in the American Academy of Family Physicians. Membership is free for students! Here is an interested student signing up for membership! We had 15 students sign up.

Membership in AAFP includes:

• free subscription to a twice-monthly peer-reviewed journal, American Family Physician
• weekly email updates about primary care
• scholarships to Family Medicine conferences
• discounts on various Family Medicine resources and products
  

Students can also sign-up online here.
Disclaimer: The online registration form says that you will be billed $15. However, the state chapter will actually pay for students' registration. So you will not be billed!

We gave out free Family Medicine water bottles, AAFP pens, and a factsheet about primary care.

Levon here is sharing with an interested medical student the health benefits of dark chocolate, which was provided on another handout. This is an example of how primary care focuses on prevention.

Ayurvedic Medicine Workshop Registration

Register here

Ayurveda, Sanskrit for "the science of life," is a form of traditional medicine practiced in India. This workshop is an introduction to Ayurvedic Medicine featuring guest scholar and practitioner, Dr. Hanumanthrao Palep (Founder, Dr. Palep’s Medical Research Foundation). Dr. Palep is the only recognized teacher at Mumbai University in both Modern Medicine and Ayurveda. Workshop activities include:

• Overview of Ayurvedic Medicine
• How to determine your Prakriti
• Training in Tongue/Pulse diagnosis
• Traditional herbal preparations
• Panchakarma Treatment
• Yoga or meditation exercise
• Cooking Lab: Nutrition for your Prakriti
• Final Dinner Celebration

October 11th 9:00am to 4:00pm
October 12th 9:00am to 4:00pm
Hiebert Lounge at Boston University School of Medicine

Space is limited to 30 medical students.

$15 registration fee payable to FMIG representatives upon completion of this online registration form and receipt of attendance confirmation.

Workshop sponsored by...
BMC Department of Family Medicine
Family Medicine Interest Groups (BUSM & HMS)
Association of Integrative Medicine (BUSM)

Health care crisis compared to current economic crisis - primary care touted as a solution

Tommy Thompson, former HHS Secretary, and Kenneth Thorpe, M.D., executive director of the Emory Institute for Advanced Policy Solutions in Atlanta, speaking at a media telebriefing conducted by the Partnership to Fight Chronic Disease (PFCD), argue that imminent action must be taken to prevent an impending crisis in health care similar to the one currently plaguing financial markets.



As we have been hearing for years now, the US health care system is in imminent danger of collapse. It is conceivable with the current growing costs of health care that no one will be able health care in 10-15 years.

Some current facts:

• increasing burden of chronic diseases: 95% of Medicare expenses is spent on chronic diseases
• this proportion is likely to grow: currently 21 million Americans are diabetic but 41 million more are pre-diabetic (this would increase expenses on diabetes from $145 billion to $400 billion annually if all these people became diabetic)
  
• 16% of the GNP is spent on health care, amount to $2.4 trillion per year; proportionally more than any other nation on the planet!
• 47 million people in the US do not have health insurance
• example: General Motors spends $5.5 billion/yr on providing health insurance to its employees more than it spends on steel for auto parts
  

Thompson and Thorpe argue that the economic crisis makes it even more urgent that we must redefine the ways we approach health care. They propose the creation of integrated primary care teams, focus on prevention rather than treatment in health care, and use of technology to better integrate patient tracking. The integration of patient care based in a primary care home will reduce redundancy and reduce the need for specialist care.

To read more details see:
http://www.aafp.org/online/en/home/publications/news/news-now/government-medicine/20081008pfcd-tele.html

Interactive Aging Workshop

How well will you function when you are 85?

Join Dr. Won Lee and the BU Chapter of the American Geriatrics Society as they host an Interactive Aging Workshop to explore and experience the aging process. The workshop will be a hands on experience based on Xtreme Aging programs found at other medical schools.

Location: L-414
When: Tuesday, October 14 @ 5:30 pm
Dinner will be provided!

Please RSVP to buags@bu.edu if you are interested.

In the Halls..."What makes Primary Care 'sexy' to you?"

We asked some BUSM medical students, "What makes Primary Care 'sexy' to you?" Here are their responses.

Anthony Lim (BUSM III) says:

I love that primary care takes a holistic approach to each patient rather than focusing on a single body part or system. Yesterday was my first day in primary care clinic at the Jamaica Plain VA. The first patient, Mr. D, came in with fatigue due to poor sleep patterns, concerns about the pain pills he's taking and the effect they may have on his liver, a non-healing lesion of three months on his right shin, blood and air in his urine, and a flare of his psoriasis. Only in primary care do you see patients who present with such a breadth of issues! The resident even managed to spend a few minutes encouraging Mr. D to quit smoking, which speaks to primary care's emphasis on prevention of disease rather than just treatment. Finally, Mr. D made a point of saying how only the resident really understood all his medical issues, and that he didn't want to see anyone else. His remark is a testament to the continuity of care that underlies primary care and the trust that develops between doctor and patient as a result. These are just a few of the reasons why I am so drawn to primary care!

Carly Grovhoug (BUSM I) says:

For something to be "sexy," it must arouse a certain level of intrigue and desire. "Sexy" can be transient, or it can be lasting. In dating, for example, we encounter attractive people who meet our fancy. After getting to know them, however, we come to realize that personalities do not mesh, timing is not right; the appeal fades away.

An attraction can only endure when the object of desire fits in to the framework of an individual's genuine interests.

The essence of primary care -- treating patients over time as individuals in a social and familial context -- excites me.

I want my career to challenge and fascinate me on a daily basis. I also want it to coincide with my interests and strengths. I love learning about people, their histories and their lifestyles. In order to address most of the major health concerns of our society and of our world, we must identify behavioral patterns contributing to morbidity so as to treat and advise patients appropriately. This is no easy task, especially given the economic, social and cultural diversity represented in every physician's office today. Establishing relationships with patients and educating and advocating for them so as to avoid further health complications is a crucial, yet often overlooked step.

On the surface, primary care may not stick out as the most glamorous branch of medicine. It does, however, stand alone in a number of factors -- intimacy of patient-doctor relations, emphasis on prevention and longevity of care. To me, that is more than sexy...that is something I would take home to mom.

The Patient-Centered Medical Home

Did you know that...

• 44,000-98,000 Americans die from medical errors annually?
• only 55% of patients receive the recommended care?
• there is a 17-year lag between the discovery of more effective treatments and implementation into routine patient care?

(Institute of Medicine, Chasm in Quality)

As part of National Primary Care Week, Dr. Charles Williams (BMC Dept. of Family Medicine) spoke - at a lunchtime discussion with Thai food - about how the proposed Patient-Centered Medical Home (PCMH) attempts to make the quality improvements that are lacking in the US health care system. The discussion went through the features of the PCMH model and how they attempt to make improvements. Dr. Williams mentioned Dr. Gordon Moore's "Ideal Medical Practice" and how he borrowed from Toyota's famous "Lean Manufacturing" process to create a medical practice that would reduce the seven types of waste (Muda):

1. Defects
2. Overproduction
3. Conveyance
4. Waiting
5. Inventory
6. Motion
7. Overprocessing

For example, Dr. Williams said, to reduce the waste of "Motion", Dr. Gordon placed his office as close to the parking lot as possible so that patients would waste as little energy as possible getting from their cars to the bed.

Questions from students included:

• Is the Patient-Centered Medical Home a physical building?

"It could be," said Dr. Williams. He further explained that the PCMH is more of a model for looking at a medical practice and measuring it's many different properties to make improvements.

• Would this receive opposition from medical insurance companies?

Dr. Williams mentioned a project in Boston that is trying to show that by implementing the model they can make improvements in both quality and cost. This, in theory, should make it more attractive for insurance companies.

• Isn't this already being implemented by Community Health Centers?

Yes, in fact there are some local CHCs that are using this, or something similar, to do reviews of their current practices.

References

• TransforMED

Crisis in Primary Care: Making Primary Care Sexy?

At this evening's "Crisis in Primary Care" event, we heard from Dr. James Petros (Director, BUSM General Surgery Residency Program) and Dr. John Abramson (Family Doctor & author of "Overdo$ed America") on the challenges facing the health care field as the result of a lack of focus on Primary Care.

Dr. Petros gave an overview of the physician workforce shortages from the perspective of a residency director. He mentioned that although there have been overall increases in residency placements, the number of new Primary Care practitioners graduated every year has actually decreased as more people specialize. He can see the results of this trend in the clinic as more advanced cases are seen than before...cases that should have been screened had the person had access to a primary care provider. "People just don't die on the bed anymore." said Dr. Petros, but surgical patients today are dying because of a paucity of post-operational follow-up.

He mentioned that while data indicate that the lack of recruitment to Primary Care practice is due to perceived differences in lifestyle, compensation, and general support, anecdotally, it may also be due to perspectives within medical institutions of a lack of "sexiness" of primary care practice. Students asked whether this isolationism was being resolved by increased communication and cooperation in the physician community. They also wanted to know what kind of initiatives were being pursued to make Primary Care a more attractive option for students/residents.

Dr. Abramson extended the points made by Dr. Petros. He outlined an argument that today's "evidence-based" medical environment is too-heavily influenced by the pharmaceutical industry. He emphasized that, as stated by the American Law Institute, "the fundamental purpose of a corporation is to maximize profits and return those profits to its shareholders." He showed us a shift in the early 1980's where pharmaceutical companies became the major funders of clinical trials. Because of the now pervasive influence of the pharmaceutical industry, academic medical institutions place much more emphasis on the biomedical solutions (i.e. pharmaceuticals) even though evidence shows that in many cases these are just as much or less efficacious than non-biomedical treatments (i.e. diet and exercise).

In responding to Dr. Petros' remarks on the perceived "unsexiness" of Primary Care, Dr. Abramson said that it is the non-biomedical aspects of the patient-physician relationship that are the "sexy" part of Primary Care. The trust, compassion, and respect that can be shared between a PCP and her patient are the very soul of medicine, and shifting our "folk medicine" to embrace these approaches to health care (in addition to the REAL evidence-based practices) is what makes Primary Care so "sexy."

We want to hear from you!! Add your comments about...

• What makes Primary Care "sexy" to you?

Related Links:

• Overdo$ed America
• Abramson et al. Are lipid-lowering guidelines evidence-based?. Lancet (2007) vol. 369 (9557) pp. 168-9
  

Primary Care Brown Bag Lunch: What is the Patient-Centered Medical Home?

Register Here!

Dr. Charles Williams (BMC Family Medicine) will facilitate a lunchtime discussion on the Patient Centered Medical Home as a potential solution to the crisis in primary care.

Tuesday, Oct. 7th @ Noon in McNary R-109
Space is limited to 10 students.
Lunch will be provided, bring your own brown bag.