Thursday, October 9, 2008

Ayurvedic Medicine Workshop Registration


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.

Wednesday, October 8, 2008

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.

Tuesday, October 7, 2008

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

Monday, October 6, 2008

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:

Wednesday, October 1, 2008

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

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.

Tuesday, September 30, 2008

Register for the Primary Care Mixer


Register Here!

When: Friday, Oct. 10th, 2008 from 5:30-8:00pm
Where:
Boston Medical Center, East Newton Pavilion,
2nd floor, Conference Room C & D
Click Here for Maps



Are you...
  • a Medical Student interested in Primary Care?
  • a Resident in a Primary Care specialty?
  • a Faculty member in a Primary Care dept ?
  • an Alumnus practicing Primary Care?

You are invited to join us for the final celebration of a series of events for National Primary Care Week (Oct. 5-11th). This is an event for medical students, residents, faculty and alumni to network for and promote recruitment and retention in Primary Care medical practice. Casual attire recommended. Hors d'oeuvres, including a chocolate fountain, will be served (budgets are tight). Live music provided by generous and talented medical students.

Sunday, September 28, 2008

National Primary Care Week @ BUSM

Mon Oct 6 @ 5:30: "Crisis in Primary Care"
Speaker: Dr. John Abramson, family doctor & author of "Overdo$ed America"
Location: Hiebert
The two speakers will examine the critical shortage of primary care physicians and implications on health policy and patient health. Dr. John Abramson is an award-winning family physician, on the clinical faculty at Harvard Medical School. His publications include "Overdosed America." He will discuss the growing waste and comercialism in American medicine and identify health policy solutions.

Tue Oct 7 @ 12:00 Solutions- Patient-Centered Medical Home

Speaker: Dr. Charles Williams, Family Medicine
Location: R-109
The Patient-Centered Medical Home (PC-MH) is an approach to providing comprehensive primary care established by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association.

These groups, representing about 333,000 physicians, created a set of 7 principles for the PC-MH:

1. Each patient is entitled to a personal physician
2. The physician is the leader of a team of individual practitioners
3. Whole person orientation
4. Care is coordinated and/or integrated using the latest and most appropriate technology
5. Quality & safety
6. Enhanced access to physicians
7. Payment schemes that reflect the value of the PC-MH for patients' health.

Register here


Wed Oct 8 @ lunch: Primary Care Tables, Lobby
We will be selling fruits with chocolate fondue. Information sheets will be provided about primary care highlighting statistics, critical issues and ways to get involved. There will also be a membership sign-up for the American Academy of Family Physicians (FREE) for those interested. Membership includes subscription to American Family Physician, a twice-monthly journal, scholarships to conferences, and other discounts and benefits.

Fri Oct 10 @ 12: Global Health and Primary Care

Speaker: Dr. Thea James, Emergency Medicine
Location: L-112
Dr. Thea James is an Assistant Professor of Emergency Medicine at the Boston Medical Center. She graduated with an MD degree from Georgetown University School of Medicine in 1991, and finished her residency in Emergency Medicine right here at the Boston Medical Center. She has gone to Haitian hospitals to provide care with more modern technology, and is also the Co-Director of a BMC based Haitian Health Institute.

Fri Oct 10 @ 5:30: Primary Care Mixer
Location: BMC East Newton Pavilion, 2nd floor, Conference Room C/D
Come meet and talk with primary care residents, faculty, medical students and alumni.
Register here

Tue Oct 14 @ 5:30: Geriatrics Workshop
Hosted by Boston University Chapter of the American Geriatrics Society
Speaker: Dr. Won Lee
Location: L-414
How well will you function when you are 85?

Join Dr. 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.


Wed Oct 15 @ 6:00: Medical Activism Panel
Speakers: Dr. Michael Grodin (BUSPH), Dr. Felton Earls (Social Medicine, HMS), Dr. Joia Mukhergee (PIH, HMS), Dr. Jay Bhatt (PGY1 Cambridge Health Alliance, past AMSA president)
Location: Bakst
A multi-generational panel of physicians will reflect on the role activism plays in their medical careers and discuss the important of activism in medicine today.

Saturday, September 27, 2008

Patient-Centered Medical Home

The Patient-Centered Medical Home (PC-MH) is an approach to providing comprehensive primary care established by the...
  • American Academy of Family Physicians (AAFP)
  • American Academy of Pediatrics (AAP)
  • American College of Physicians (ACP)
  • American Osteopathic Association (AOA)
These groups, representing about 333,000 physicians, created a set of 7 principles for the PC-MH:
  1. Each patient is entitled to a personal physician
  2. The physician is the leader of a team of individual practitioners
  3. Whole person orientation
  4. Care is coordinated and/or integrated using the latest and most appropriate technology
  5. Quality & safety
  6. Enhanced access to physicians
  7. Payment schemes that reflect the value of the PC-MH for patients' health.
Indeed, since the development of this model, it has been touted as a potential solution to the challenges of providing quality health care for the entire US population. According to the Commonwealth Fund,
The Commonwealth Fund 2006 Health Care Quality Survey finds that when adults have health insurance coverage and a medical home—defined as a health care setting that provides patients with timely, well-organized care, and enhanced access to providers—racial and ethnic disparities in access and quality are reduced or even eliminated.
Find out more about this New Model for primary care at the following events at Boston University Medical School.

Upcoming Events

Tuesday, Sept. 29th, 2008 @ 12:00pm
BMC Family Medicine Grand Rounds
The Medical Home, physician reimbursement plans, and other solutions to the crisis Primary Care
Dr. Charles Williams
Dowling 1 Conference Auditorium
Free Food

Tuesday, Oct. 7th, 2008 @ 12:00pm
--National Primary Care Week--
Solutions: The Patient-Centered Medical Home
Sponsored by FMIG
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. Participants are encouraged to attend Dr. Williams' talk at the Family Medicine Grand Rounds.

Dr. Williams' Bio


References

Monday, September 22, 2008

Mass Crisis: Is This The Future of Health Care?

The recent Massachusetts legislation to mandate health insurance has been touted by many as a victory in health care reform. Implementation of this experiment in solving to US health problems, however, still presents many challenges.

Mandatory Health Insurance...plenty of patients but where are the doctors
?

A recent article in the Boston Globe (Sept. 22, 2008) highlights a few of the upcoming challenges that Massachusetts will face as a result of the upcoming implementation of the MA health insurance mandate. The most immediate of these is the lengthy wait times for receiving an appt. with a primary care physcician (PCP). The average wait time to see an Internist was 52 days and 46 days to see an OB/GYN.

These long wait times are the result of a shortage of PCPs, lack of focus on preventive health care, administrative burdon, and misdirected physician compensation schemes. According to MMS President Dr. Bruce S. Auerbach, who recently addressed a session of the National Congress on Health Reform in Wasington, D.C., there are severe labor shortages in:
  • Internal Medicine
  • Family Medicine
  • Vascular Surgery
  • Neurosurgery
  • Cardiology
  • Anesthesiology
  • Psychiatry
  • Gastroenterology
  • Urology

How to Increase PCP Supply?

In an attempt to increase the availability of PCPs, the federal and state government have funded a number of programs, including:

  • loan forgiveness programs
  • advanced medical home pilot projects
  • expanded primary care training
Medical school for free?!?!?!

From the Boston Globe article...
The Massachusetts law includes $1.5 million this year to help the University of Massachusetts Medical School expand its class size - from 103 students to as many as 125 - and to waive tuition and fees for students who agree to work as primary care doctors in Massachusetts for four years after they finish training.
This is indeed a crisis situation. If the state is moving towards free education for medical students interested in primay care, it is a clear sign of the dire circumstances facing the population of Massachusetts, and the rest of the United States.

So what can be done about this?

There are several proposed solutions. Together with AMSA, FMIG has planned a series of events for National Primary Care Week (Oct. 5-11) to highlight the challenges and potential solutions facing health care in the United States of America. Come and find out for yourself what we can do as future health professionals to best prepare for the difficult sitations waiting for us upon graduation.

References
Resources

Wednesday, September 17, 2008

Study showing fewer medical students intending to become primary-care physicians

Check out this new report and the corresponding JAMA article.
http://jama.ama-assn.org/cgi/content/full/300/10/1154

NBC Nightly News (9/9, story 10, 0:30, Williams) reported that a new study shows that few medical school students plan to become primary-care physicians. Most "are going into specialized fields instead."

USA Today (9/10, Rubin) reports that "medical students are shying away from careers in general internal medicine, which could exacerbate the U.S. doctor shortage expected by the time the youngest baby boomers head into their senior years," according to a study published in the Sept. 10 issue of the Journal of the American Medical Association.

In fact, "only two percent of graduating medical students say they" were considering practicing as primary-care physicians, the AP (9/10, Johnson) adds. By comparison, a similar survey conducted in 1990 showed that nine percent of medical students were interested in primary care. The data showed that "paperwork, the demands of the chronically sick, and the need to bring work home are among the factors pushing young doctors away from careers in primary care." Lead author Karen Hauer, M.D., of the University of California-San Francisco, pointed out that "it's hard work taking care of the chronically ill, the elderly, and people with complex diseases -- 'especially when...doing it with time pressures and inadequate resources.'"

For the study, researchers surveyed "1,177 medical students last year, found just 24 wanted to practice primary care, while 23 percent were interested in internal medicine, whose subspecialties include cardiology and cancer care," New York's Newsday /Bloomberg News (9/10) notes.

Salaries in primary care dissuade medical students from the field. The Columbus Dispatch (9/10, Hoholik) reports that "fewer U.S. medical students are choosing careers in family medicine because of long work hours and low pay," according to a research letter published in the Sept. 10 issue of the Journal of the American Medical Association.

Mark H. Ebell, M.D., of the University of Georgia, "examined whether there is an association between specialty selection and anticipated incomes using current data," MedPage Today (9/9, Groch) added. He used "residency information...from the National Residency Match Program," and "mean annual salary in 2007 came from the annual American Medical Group Association survey of physician salaries."

Dr. Ebell found that "family medicine had the lowest average salary ($185,740), and the lowest percentage of filled residency positions (42.1 percent)," Modern Healthcare (9/9, Robeznieks) noted. And, "internists, with the third-lowest salary of $193,162, had the third-lowest residency fill rate: 55.9 percent." In contrast, "radiologists -- whose average salary was $414,875 -- had a residency fill rate of 88.7 percent; and orthopedic surgeons -- whose average salary was $436,481 -- had a fill rate of 93.8 percent." Dr. Ebell wrote that "the correlation between salary and primary-care physician shortages -- which, in turn, may be tied to higher all-cause cardiovascular, cancer-specific, and infant mortality rates -- has persisted since his original research on this issue was published" in 1989.

Researchers say racially diverse medical schools may better prepare students. HealthDay (9/9, Preidt) reported that "attending medical schools with high levels of racial and ethnic diversity may better prepare white medical students to care for minority patients," according to a study published in the Sept. 10 issue of the Journal of the American Medical Association. Somnath Saha, M.D., of the Portland VA Medical Center, and colleagues, "analyzed data from a Web-based survey of 20,112 graduating medical students from 118 medical schools." The researchers "found that white students at medical schools with the highest quintile (one-fifth) for student body racial and ethnic diversity, measured by the proportion of underrepresented minority (URM) students, were 33 percent more likely to rate themselves as highly prepared to care for minority patients than white students at medical schools in the lowest diversity quintile -- 61.1 percent vs. 53.9 percent, respectively." Notably, "this association was strongest in schools in which there was positive interracial interaction."

The study also showed that "students from under-represented minorities were significantly more likely (at P<0.001) than either white or non-white/non-URM students to plan to work with the underserved, at 48.7 percent, versus 18.8 percent, versus 16.2 percent, respectively," MedPage Today (9/9, Smith) added. The authors of an accompanying editorial argued that these findings "might persuade medical schools to do more to encourage diversity." The St. Louis Post-Dispatch (9/10, Bernhard) also covers the story. This week's JAMA Report video features the study.

Monday, September 8, 2008

Sports Medicine Series

Dear all,

The Family Medicine Interest Group is presenting a year-long workshop series in Sports Medicine, featuring Dr. Alysia Green, a Sports Medicine doctor at BMC.

Dr. Green will be giving an Introduction to Sports Medicine talk on Wednesday, September 10th from 11:30-12:30 in room L-110. Lunch will be provided!

Each month, Dr. Green will be presenting on a different aspect of her practice as a Sports Medicine physician. Students will be able to learn about these exams and practice interactively on each other with assistance from Dr. Green. Workshops and seminars include:
-boarding
-joint exams
-taping
-concussions

If you are interested in going to any of the workshops this year, you MUST attend this Wednesday's talk! Each workshop will be open to sign-up on a first-come, first-serve basis after that.

Thursday, September 4, 2008

FM Scholars program

Dear FMIG members,

Marcel suggested I post here to be sure you all know about our Family Medicine Scholars program. You can learn about it at:

http://www.bu.edu/familymed/medstudenteducation/scholars.html

We currently have 4 active scholars, and more joining shortly. If you are interested in learning more about this program, which is unique to our department, please contact me. My email is: John.Wiecha@bmc.org


John Wiecha, MD, MPH

Director of eLearning / Director of Predoctoral Education
Department of Family Medicine, Boston U. School of Medicine
eLearning website: www.bu.edu/familymed/distance/index.htm
Second Life: http://slurl.com/secondlife/Teaching%209/21/132/23