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Palliative care isn't just for end of life. Patients can receive palliative care at any stage of illness and still continue with regular medical care, which can save money and improve outcomes. It can even prolong life. Today on the blog, a pre-med student and volunteer at a palliative care facility makes the case for integrating palliative and primary care so that patients can access palliative care sooner and with a doctor they know and trust.

By Claire Champion

“She is smiling again!” the daughter of one of our severely ill patients shouted to me as I entered the room. We were at Halquist, the inpatient hospice care center run by Capital Caring in the Washington, D.C., area. The patient started palliative care a couple of days before, and her severe pain was slowly fading. The difference was obvious and moving. Halquist is a special place full of love, empathy and caring. I volunteer there every weekend. I am grateful to learn from each interaction with patients, family members and staff. 

Posted by Sonya Collins on Oct 1, 2015 1:41 PM EDT
The primary care crisis is tied to a health care system that emphasizes treatment over prevention. Today on the blog, a public health expert explains why we must prioritize and fund prevention. This editorial was published first on Huffington Post and appears here courtesty of the author.

By Brian Castrucci

There is an 1895 poem by Joseph Malins entitled A Fence or an Ambulance. The poem recounts two opposing perspectives on what to do about a perilous cliff that had caused injury to many. Some said, "Put a fence 'round the edge of the cliff;" others, "An ambulance down in the valley." 

One hundred and twenty years later the debate between prevention and treatment still rages, but in the US healthcare system, the ambulance is winning -- and by a sizable margin. "A Sea Change in Treating Heart Attacks," a recent article in the New York Times by Gina Kolata, is wholly emblematic of our nation's focus on treatment over prevention.

Posted by Sonya Collins on Sep 29, 2015 10:45 AM EDT
National Primary Care Week is approaching! This annual event highlights primary care’s indispensable role in our health care system. In 2015, NPCW is Oct. 5-9, however PCP will celebrate all month and we encourage you to do so as well. This NPCW, PCP is looking toward the future of primary care, and we invite you to send us your posts about the future you envision for primary care. Here's a post from our archives about a future without primary care. Email Sonya to get more details about writing a blog post for us.

By David Margolius, M.D.

Why is primary care the future of health care?

Well, let’s first imagine if it weren’t.

In a world where primary care isn’t the future of health care, the current trend of our shrinking primary care workforce would continue. Medical schools would be applauded for graduating 5% of students into primary care careers. Overworked primary care providers would continue retiring early or changing careers so they could finally spend time with their families or maybe feel good about having the time to make a difference in their patients’ lives…as cardiologists. Until one day, maybe just twenty years from now, nobody would have access to primary care.

Posted by Sonya Collins on Sep 24, 2015 2:08 PM EDT
Too often, providers blame their own failures on their patients with terms like "non-adherent" and "non-compliant." In this favorite from our archives, then-med student Diana Tucci explains how patients sometimes fail to follow the treatment plan because providers fail to learn enough about the patient to tailor treatment and eductation to the patient's strengths and limitations.  

By Diana Tucci

“There – there’s a space between those two layers that you have to fold that edge into, do you see that?” I said to the older woman sitting next to me. I had never met anyone worse at following directions. It was a Lunar New Year celebration, and she wanted to learn how to make origami paper cranes. It had been a long and tiring day, and I was in a bad mood for most of that time. My friends had left without me and I was waiting for someone, anyone, to drive me home so I wouldn’t have to walk back in the cold of a Pittsburgh winter. She sat there, bent over her work, apparently ignoring the things I was showing her. I was really starting to get frustrated.

Posted by Sonya Collins on Sep 22, 2015 1:15 PM EDT
Overuse in the health care system, through unnecessary tests, procedures and ER visits among other uses, is one of the many symptoms of our primary care crisis. RightCare Action Week, an initiative of the Lown Institute, gives health care providers the opportunity to highlight overuse in health care and propose solutions to the problem. Today on the blog, Shannon Brownlee, senior vice president of the Lown Institute, explains. Join her Tuesday, October 13th at 7pm ET for PCP's webinar "Change Makers in Health Care." Details here.  

By Shannon Brownlee, MSc

When I was writing Overtreated in 2005 and 2006, I hated telling friends and colleagues about the book. Invariably, they looked at me as if I’d lost my mind. Forty million of us were uninsured, and here I was writing about unnecessary care. People waited for hours in emergency rooms. They couldn’t get an appointment with a specialist. Insurers routinely denied coverage and forced doctors to call for prior authorization, or 1-800-MOTHER-MAY-I, as one primary care doctor called it. Everybody knew the problem in U.S. health care wasn’t too much care but too little. 

Posted by Sonya Collins on Sep 17, 2015 12:55 PM EDT
In today's post, originally published by our friends at Costs of Care, a cardiologist makes the case for more coordinated care and a health care system in which the many providers that handle a single patient's care can easily communicate with one another and access that patient's records. We couldn't agree more! 

By Kevin Mikielski, D.O.

“I told them that I just had a stress test two months ago,” said one of my patients that I had been seeing for the past six years in my private cardiology practice. She is a 72-year-old with diabetes who had come in two months earlier with difficulty breathing. She underwent an exercise stress test with nuclear imaging and had normal results. She was then admitted at a local hospital with atypical chest and abdominal pain. The EKG was normal and cardiac enzymes x 2 were negative. The admitting physician, not knowing previous tests were already performed, ordered another stress test. Again, my patient told the attending she had just had this test two months ago. Subsequently, her pharmacologic stress test and nuclear imaging studies were normal and she was promptly discharged and advised to follow-up with her outpatient physicians.
Posted by Sonya Collins on Sep 15, 2015 10:26 AM EDT
This summer the University of Louisville School of Medicine launched a pilot that will help improve health professions students' competency in caring for LGBT patients. This post originally appeared on STFM's blog and appears here courtesy of the authors.

By Eli Pendleton, MD; Susan Sawning, MSSW; and Stacie Steinbock, MEd

My male-to-female transgender patient is in her mid-50s. She has a well-established relationship with a sex therapist, who has written a thorough letter of explanation and support. Her wife is engaged and supports her decisions. The patient comes to me hoping to begin her hormonal transition.

Why me? I’m not an expert endocrinologist, nor do I have formal training in transgender health. However, I do have two qualities that are important to her—I’m affirming and willing. She saw an endocrinologist about the issue, but they tried to talk her out of transitioning, which left her stunned and understandably frustrated.

Posted by Sonya Collins on Sep 10, 2015 12:35 PM EDT
In this post from our archives, a medical student describes an innovative program that teaches health professions students the role and value of the other members of the health care team.

By Paula Porter Griffith, MD 

The first time I presented a patient to Ty, I was nervous. I couldn’t remember Mrs. L’s complete past medical history, and I definitely added the vitals at the wrong point of the patient summary. But rather than demeaning me, Ty helped me through it- he pointed out things I did well and helped me understand how to mentally organize a patient presentation. Then he presented to our preceptor, Dr. T, in a perfect example of a concise yet thorough presentation.

Posted by Sonya Collins on Sep 8, 2015 1:53 PM EDT
This week, PCP begins accepting applications for its 2015 cohorts. Members of the cohort will receive coaching in teamwork that will help their chapter set and eventually achieve its strategic goals. Today on the blog, Michael Mattiucci, who participated in PCP's pilot of this program, shares his experience. Read all about it, then apply to be a part of PCP's next cohort.

By Michael Mattiucci

After spending an inhumane amount of time alone in the library studying for the USMLE Step 1, I’m now on the road, headed west, the exam behind me, a good friend beside me.  We are on a three-week cross-country road trip to recharge before our third year of medical school on the wards. The adventure of being on the road is recharging in and of itself. Exploring new terrain and traveling out of my comfort zone offer incredible rewards.

Posted by Sonya Collins on Sep 3, 2015 11:49 AM EDT
Last month PCP launched its 51st chapter! Emory University's PCP chapter introduced itself to the campus with a panel on primary care and a talk by Reid Blackwelder, M.D., board chair of the American Academy of Family Physicians. Here, in a blog post that originally appeared on AAFP's "Leader Voices" blog, Dr. Blackwelder talks about the event and the growing interest in family medicine and primary care at Emory. 

By Reid Blackwelder, M.D.

When I was a student at Emory University School of Medicine, it was a so-called orphan school, meaning it did not have a family medicine department. In fact, I was one of the few students in my class who chose family medicine after graduation, but that is a story unto itself

It was special, more than 30 years later, to be invited back to my alma mater recently to see what is happening in family medicine there and to be a part of the Atlanta school's new direction.

Posted by Sonya Collins on Sep 1, 2015 11:00 AM EDT
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