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It's National Primary Care Week! Today on the blog, we talk to Bruce Gould, MD, associate dean for primary care at University of Connecticut Health Center, where he has been a part of the UCONN's National Primary Care Week (NPCW) activities since 1995. In a Q&A with Progress Notes, Dr. Gould talks about the history of NPCW and how it contributes to the making of a primary care provider. (This post comes from our 2011 archives.)

Tell us about the history of National Primary Care Week.

Primary Care Week, originally Primary Care Day in 1994, rose out of the first primary care crisis in the early 90’s when the rise of managed care, which depended on a robust primary care workforce, caused us to recognize that not enough students were going into primary care.
The realistic goals were to improve the visibility of primary care and community-oriented primary care within the academic health professions and to reinforce the commitment of students already interested in primary care. The unrealistic goal was to get half the class interested in primary care.  Students’ deciding on and following through with a primary care career is multi-factorial.  We can assist with some of those factors, but others we cannot.
NPCW does not affect the reimbursement rate for primary care services. It does not change the complexity of caring for a chronically ill patient that lives in poverty or is less literate or has fewer resources. But it does put work with those populations on the radar, where faculty can shed a noble light on it and students can examine to see if there’s a fit.

Posted by Sonya Collins on Oct 9, 2015 8:04 AM EDT
It's National Primary Care Week, and we're looking to the future of primary care. We think teamwork is a crucial element of that future. Today on the blog, a fighter-pilot-turned-med-student talks about choosing the best team for your primary care practice. Chris works in the student-run DAWN Clinic in Colorado, which was co-launched by PCP's Colorado chapter. This post originally ran on Chris's personal blog, Fighter Pilot to Physician.

By Chris Varani

The 2008 summer Olympics had one of the most amazing team finishes in history! Jason Lezak chased down the Frenchman Bernard in an unbelievable final leg to the men’s 400m freestyle for a team gold! He also helped crush the world record. The US women’s soccer team had another awesome finish that year. Gold! These were both great wins by two very different types of teams. As a pilot, when I think of teamwork, I remember a mission-planning room filled with aircrew and intelligence airmen collaborating in small groups to prepare for an urgent international mission. I think of the aircrew that took off the next day and made that mission successful. These are vastly different types of teams and teamwork, but all are committed to the win.


Posted by Sonya Collins on Oct 8, 2015 12:01 PM EDT
It's National Primary Care Week and National Physician Assistant week! Physician assistants are crucial members of the care team. Today on the blog, Cynthia Lord, director of the physician assistant program at Case Western Reserve University,  discusses the history of her profession and its role in expanding access to and revitalizing primary care. 

By Cynthia Booth Lord, MHS, PA-C

Last month I was in a store and I saw a young child fall to the ground after appearing to have fainted. I approached the crowd that quickly gathered and introduced myself to the child’s parents and said I was a P.A. and I could help. Immediately the crowd moved back as I proceeded to evaluate and help the child until EMS arrived. I gave a report, the parents thanked me profusely, and I wished the little girl and her parents well and went on my way. As I drove home that day I thought about the fact that no one asked me “What is a P.A.?” or “Are you qualified to help?” Instead, they said, “A P.A., that’s great, would you mind helping us?” 

Posted by Sonya Collins on Oct 6, 2015 12:40 PM EDT
It's National Primary Care Week, an annual event to highlight the indispensible role of primary care in our health care system. At PCP, we celebrate NPCW all month long. During this time, we're looking to the future of primary care. We think teamwork and advocacy are crucial elements of that future. We'll talk teams later this month in the webinar "Transforming to Team" with Christine Sinsky and Margaret Flinter. Today on the blog, in a Q&A with Progress Notes editor Sonya Collins, Dr. Sinsky discusses the value of teamwork in primary care. 

SC: As part of your research, you've traveled around the country observing innovative models of primary care. When you're out on the road visiting practices, what have you seen that's made you the most excited?

CS: First, my heart breaks when I see bright, well trained physicians spending most of their day on non-physician-level work. Many physicians spend a significant portion of their day doing work that in an ideal clinic would be re-engineered out of the practice or delegated to a more appropriate person on the team. When a doctor doesn’t have enough support staff, he tends to do a lot more on his own: getting supplies, keyboarding orders, typing the visit note, retyping portions of the note into the after-visit summary, then running down the hall, grabbing the note from a printer and taking it back to the patient.  

Our time with patients could be more patient-centered as well. Many of us walk into the exam room, look at a computer screen, glance at the patient, and then as we ask questions, we start typing. We are furiously multi-tasking, trying to record the information, while periodically looking over at the patient. Some things get lost.
As I observe other physicians, oftentimes the patient is communicating something really important but the physician misses it, perhaps the depression or the depth of worry, because at that moment his attention is on the computer screen.  
But that didn’t happen at a family practice residency program in Quincy, Illinois, where they are piloting “The Office of the Future. ”  In this model there are two medical assistants always working with the same doctor, and they have developed an effective model of collaborative care, including collaborative documentation.
One medical assistant (MA) records the initial patient history during the pre-visit rooming process, comes out and tells the physician what she has learned, then they go back into the room together. The physician is able to attend directly and completely to the patient, while in the background the MA records the notes. While the doctor examines the patient, he verbalizes the findings, which the MA also records.
The physician tells the patient and MA the assessment and plan, which the MA records, along with the meds, upcoming labs, appointments and whatever else is required. When the doctor leaves, the MA stays with the patient, prints up all the instructions and reinforces the plan while the doctor goes on to the next patient who is already in an exam room with the second MA. This system allows the doctor to bond with each patient. He has a relaxed visit and a calm clinic day.

Posted by Sonya Collins on Oct 5, 2015 11:06 AM EDT
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
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