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Solo Practice Vs. Integrated Health Systems: What’s Best For Primary Care Reform?

The buzzwords of cutting-edge primary care reform – the medical home, coordination of care, electronic health records – have usually been associated with large integrated health systems such as Intermountain Healthcare, Group Health, and Kaiser Permanente. If you believe the arguments that economies of scale and financial resources give such organizations built-in advantages over the traditional small group practice, you may be inclined to believe that solo practice is going the way of the dodo. Indeed, immediate past AAFP President Roland Goertz, MD, MBA penned an editorial a few months ago, “Helping Small Practices Survive Health System Change,” that, while touting some services that the Academy offers family physicians in these practices, betrayed a decidedly pessimistic outlook on their long-term future.

Not everyone agrees, however. In the September issue of the Journal of Family Practice, Jeff Susman, MD cast solo practices as vital engines of primary care innovation: Read more »

*This blog post was originally published at Common Sense Family Doctor*

Organized Medicine Is Out Of Touch With How Practicing Physicians Feel About Obamacare

There is a widespread discrepancy between the opinions of organized medical group leaders in the American Medical Association (AMA), the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and  practicing physicians.  AMA, AAFP, and ACP are part of organized medicine.

These organizations supported the healthcare reform law in 2010 and continue to support the legislation. I believe they have taken this position because they want a seat at the table as implementation of the legislation moves forward. President Obama has not paid attention to them so far and there is little evidence that he will in the future.

In March of 2010, Speaker of the House Nancy Pelosi famously said, “We have to pass the [health care] bill so that you can find out what is in it.”

Most physicians are starting to realize the implications of President Obama’s Healthcare Reform Act (ACA) (Obamacare). They are terrified about the implications for the practice of medicine.

Organized medicine is still not disenchanted with President Obama’s Healthcare Reform Act. Charles Cutler, MD, chair of the ACP Board of Governors said recently,  “The medical community recognizes that so much of the ACA is good.” Read more »

*This blog post was originally published at Repairing the Healthcare System*

Why Family Medicine Needs Social Media

I wasn’t able to attend the Annual Leadership Forum (ALF) and the National Conference of Special Constituencies (NCSC) meetings in person this year. This is an annual meeting in Kansas City put on by the American Academy of Family Physicians (AAFP). I know that it can be hard to believe that someone actually likes going to a meeting. However, for me, these meetings always re-energize me and connect me with people with a passion for Family Medicine.

In 2010, there were only a few of us utilizing social media tools like twitter and facebook (including my blog posts from Thursday & Friday). However, just a year later, there seems to have been an explosion of people utilizing these platforms to a point yesterday when I saw a bunch of people signing up for the first time during the meeting. Even members of the AAFP Board of Directors were creating twitter accounts yesterday. Wow!

I really believe that this year, 2011, is when the Family Medicine community will more fully embrace social media, not only as a means of socialization, but also as a means of advocacy for our specialty. Here are some other reasons why I believe that Family Medicine needs social media: Read more »

*This blog post was originally published at Family Medicine Rocks Blog - Mike Sevilla, MD*

Ear Infections: To Treat Or Not To Treat?

Ear infections used to be a devastating problem. In 1932, acute otitis media (AOM) and its suppurative complications accounted for 27 percent of all pediatric admissions to Bellevue Hospital. Since the introduction of antibiotics, it has become a much less serious problem. For decades it was taken for granted that all children with AOM should be given antibiotics, not only to treat the disease itself but to prevent complications like mastoiditis and meningitis.

In the 1980s, that consensus began to change. We realized that as many as 80 percent of uncomplicated ear infections resolve without treatment in three days. Many infections are caused by viruses that don’t respond to antibiotics. Overuse of antibiotics leads to the emergence of resistant strains of bacteria. Antibiotics cause side effects. A new strategy of watchful waiting was developed.

Current Medical Guidelines

In 2004, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) collaborated to issue evidence-based guidelines based on a review of the published evidence. Something was lost in the transmission: The guidelines have been over-simplified and misrepresented, so it’s useful to look at what they actually said. There were six parts:

1. Criteria were specified for accurate diagnosis.

  • History of acute onset of signs and symptoms
  • Presence of middle ear effusion (ear drum bulging, lack of mobility, air-fluid level)
  • Signs and symptoms of middle ear inflammation: Either red ear drum or ear pain interfering with normal activity or sleep

They stressed that AOM must be distinguished from otitis media with effusion (OME). OME is more common, occurs with the common cold, can be a precursor or a consequence of AOM, and is not an indication for antibiotic treatment. Read more »

*This blog post was originally published at Science-Based Medicine*

Happiness In Life: Carrying The “H Card”

The most moving speaker at the American Academy of Family Physicians (AAFP) convention I went to in Denver a few months ago was a doctor with Stage 4 cancer who had survived well past all expectations for his disease. While talking about achieving happiness through balance in life, he pulled out of his wallet a card made for him by his daughter, a preschool teacher.

“This is the C card,” he told us. “It says: ‘I have cancer. I can do whatever I want.’”

What a great idea, I thought. As much as it resonated with me, though, I couldn’t help but feel there was more to it than that.

Recently I was comforting a dear friend who had lost her mother. Remembering this handout from the AAFP, I held her close and said: “You’re a mourner now. You can do whatever you want.” I might as well said: “You have the M card.”

There’s this crotchety old guy in his eighties whom I’ve known for years. He does whatever he wants. I don’t think he actually carries a card in his wallet that says: “This is the O card. I am old. I can do whatever I want,” but he might as well. He is indeed old, and so he is entitled. Read more »

*This blog post was originally published at Musings of a Dinosaur*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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