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ad7d7769f7ae6b4e66a9be5d3bd4d596-huge-joIt's World Pharmacists Day. Today on the blog, a pharmacy student talks about why he wants to be a pharmacist clinician and a key player on the health care team. 

By Joe Oropeza

Eleven years ago my dream of becoming a soldier in the U.S. Army – to serve my country, my community and my family – was shattered. While training exceptionally hard on an early spring day in 2006, I endured two mini-strokes (TIAs) that nearly rendered half of my body completely useless. Doctors told me that the strokes were caused by a mass in my heart that would need to be removed through open heart surgery.  Now what could I do with my life? What I could physically do and how I could continue to serve my country, my family, my community?
 
A team of amazing health care providers were involved in my recovery, both generalists and specialists alike. Nurses tended to be the first and last people I saw. They always took the time to greet me with warmth and care, no matter how busy they were. My primary care physician, who originally sent me to the hospital, coordinated between all my specialists and facilitated my recovery. The physical therapists that helped me regain much of my strength and coordination were so kind and encouraging during my rehabilitation. However, the first visit to my PCP after being discharged was the most memorable during this timeframe as it set the stage for my future. Once the nurse finished taking my vitals she left the room with a smile saying, “the doctor will be in shortly.” Several minutes passed when I was greeted by two people in white coats. I assumed they were both physicians, but I quickly learned otherwise.
 
My PCP introduced his female colleague as a pharmacy resident. My initial reaction was ‘Why was there a pharmacist in the room?’ Were they going to dispense my medications here? Then the physician explained that the pharmacist was there to educate me about the slew of medications I was going to be on during recovery. How difficult could it be, I wondered. I just need to take the pills with some water, right? After my visit, my PCP left, I presumed to take care of his many other patients, leaving me and the pharmacist behind in the exam room.
 
Before talking about any specifics of medications, the pharmacist recognized my challenging situation and asked - “How are you feeling?” She followed that with, “This whole experience has to be scary for you, with all the procedures you’ve had and all these medications you have to take.” After about 10 to 15 minutes, the pharmacist had taught me all about what times of day I should take certain medications, how some medications work better with food in my stomach, what each medication did and how I could expect to feel on them. She even caught a duplication in my medications and was able to contact my cardiologist and cardiac surgeon, as both had ordered the same type of medication to be dispensed later that afternoon. She was able to serve as my advocate between the different specialists on my care team and make appropriate changes. This helped promote my well-being and facilitated my recovery.
 
That day, during my conversation with the pharmacist, I discovered my answer to how I could serve others, and a passion was ignited in me to become a pharmacist clinician. I was fired up to be a part of a team of health care professionals continually seeking to help patients attain their goals in a personalized way, while maximizing positive clinical outcomes. I entered my training with this vision in mind and soon realized that the typical health care world often doesn’t function this way. The classic, lone-wolf model, where we all work independently, is alive and well and continues to fall short of optimizing care while minimizing potential errors. Despite this, I have been able to work on some amazing teams, where we’ve collaborated to care for patients, just as my PCP and that pharmacist did in their encounter with me that day.
 
We need that type of collaboration to be the norm.  The journey to achieving that will require diverse, inter-professional teams in primary care, in which each member is willing to step up to not only be a liaison between each person involved in a patient’s care, but also an advocate to change the system. It has been over a decade since I decided to pursue my career as a pharmacist. My commitment to that vision, where we all work in teams, empowering patients and each other, remains strong. I am encouraged and hopeful by the change I have seen around me in my training, as we collectively move toward making that vision a reality.

Joe Oropeza is a third-year pharmacy student at Skaggs School of Pharmacy and Pharmaceutical Sciences. He completed his BS in biology at University of Colorado at Denver, where his passion to serve underserved populations was born. Joe is excited to work in and promote an interdisciplinary approach to patient-centered care and provide services to the underserved populations of Aurora Colorado.

Check out other posts by pharmacists.


 
Posted by Sonya Collins on Sep 22, 2016 1:36 PM EDT
More than 100 interprofessional students and faculty attended PCP’s 5th Annual Gregg Stracks Leadership Summit at the end of August. The two-day, hands-on training introduced attendees to PCP’s innovative relational leadership framework and the variety of impactful projects PCP chapters can use to revitalize primary care. Below are some takeaways: more...
Posted by Nate Leskovic on Sep 14, 2016 12:12 PM EDT
5d7572de75060ec69d546f064bfb5bc8-huge-ccIt's World Physical Therapy Day! Today on the blog, we share a post from our archives by then-physical therapy student Krista Eskay, who shows us the essential role physical therapists play in primary care - especially when seeing patients multiple times a week. As she explains, frequent patient visits enable strong relationship-building and an almost unrivaled opportunity to improve access to care.  
 
By Krista Eskay

“Who here is in medical school or a physician?” A multitude of hands fly up. “Who here is in nursing?” “How about pharmacy?” Cheers erupt and hands raise in the air. They worked through the ranks: physicians, nurses, pharmacists, physician assistants, public health professionals. And then they paused…

“Anyone else?” Two physical therapy students raise their hands, one being myself. Immediately I think, “We have two people here at the 2015 Gregg Stracks Leadership Summit, yes!”
 
What does physical therapy have to do with primary care? It’s not an uncommon question as we roll out a new Primary Care Progress chapter at Shenandoah University, where our student body consists of physician assistant, physical therapy, occupational therapy, pharmacy and nursing students. The answer: a whole lot! In a world where 60 million people lack access to primary care, we all need to do our part to manage patient needs. In particular, as physical therapists move into the realm of direct access, where a patient can be seen directly by a physical therapist for a period of time without a physician’s prescription, it becomes more and more essential that we are able to screen patients appropriately, keep open dialogue with primary care providers to report our findings and refer when appropriate. As a first point of access to the health care system for a growing number of patients, it is increasingly crucial for us to embrace primary care ideals and our role in patient management. At the core, we need to foster collaborative relationships with our patients and other health care professionals and improve patient access to care.
 
For anyone who has ever been to physical therapy, you know the appointments are typically not short. This is the nature of PT, where one-on-one provision of care for 30-60 minutes, multiple times a week, over multiple weeks or months is common. This provides physical therapists with the unique opportunity to foster rapport and develop strong relationships with our patients. It provides time for patients to think of questions and it  facilitates discussion. It provides us with excellent opportunity to assist in chronic disease management, from monitoring vitals or other aspects of health over a consistent period of time to encouraging healthy and active lifestyles, offering tips and tools for prevention of disease and injury, answering health questions that the patient may not have thought of at other medical visits, and monitoring mental health changes - just to name a few! PT provides consistency, and the time to grow with the patient on their journey to wellness.
 
Because we have the privilege of spending such large amounts of time with our patients, it becomes our responsibility not only to monitor conditions for change but also to relay pertinent health information to the patient’s primary care provider and refer them to see their provider when warranted. What a great opportunity we have to contribute to primary care!
 
At the end of the day, it’s exciting to realize our potential as physical therapists and expand upon our role in primary care - from patient management to communication with patients and fellow practitioners - so that we may provide the optimal level of care to every person who steps through our clinic door.
 
Krista Eskay is a doctor of physical therapy based in Washington, D.C. As a physical therapy student at Shenadoah University, Krista was a leader of the school's PCP chapter.
Posted by Sonya Collins on Sep 8, 2016 11:26 AM EDT
eb598939914141499e1b6ec6455d1b99-huge-wif09ed67c95d936fb1cb58fae7870a553-huge-biThe emphasis on quantity over quality seen in our health care system has deep roots in our culture. See how a citizens group in Minnesota is trying to change it. 

By William Doherty, Ph.D., and Bill Adams

Primary care providers are keenly aware of the dangers and consequences of the “more is better” culture of our health care system. But too often when they push for quality over quantity of care, they are criticized for championing primary care over other specialties.  Government doesn’t fare much better getting the message out. Any campaign to cut unnecessary costs is met with public outcry about “health-care rationing” and “death panels.” When the health care companies and insurers try to curtail overuse, they are accused of profit mongering. When hospitals and medical specialty associations criticize excessive care, it’s often about what other hospitals and specialists are doing. That’s why a group of citizens took it upon themselves to launch Baby Boomers for Balanced Health Care.  

The organization was formed out of a conviction that unless everyday community members get involved in the conversation about medical overuse and cost savings, nothing meaningful will change. We are a small group of citizen Baby Boomers (including one primary care physician) who believe that health care spending is out of control and will bankrupt our country unless we all take responsibility for changing how we do health care.  Our goal is to create a public conversation about a neglected dimension of the problem:  the cultural belief that more health care is better health care, a belief that contributes to overdosing on health care: too many tests, procedures, and devices that can cause harm along with bankrupting individuals and communities.  We are calling for a new mindset that values balanced health care—“Goldilocks” health care—not too much, not too little, but just right.  

The project was initiated by Bill Doherty and Jim Hart, a primary care physician, using the Citizen Health Care model Doherty developed.  We approached citizen organizations in Minnesota to recruit engaged Baby Boomers to come together to reflect deeply on the more-is-better cultural dimension of the health care crisis in the U.S. Without new cultural norms, we argued, health care reforms, such as payment for outcomes instead of services,  will yield backlash. Citizens groups can lead the way where government and health care professionals cannot.

So why Baby Boomers? When we asked members of our group about their generation’s unique role in this issue, they said, “We came of age in abundance, witnessed medical miracles like the polio vaccine and heart transplants, and came to believe that more is always better in many areas of life, including health care. We were wrong. Now that we are elders, we want to lead a cultural conversation about restoring balance in health care: smarter health care, not more health care.”

So far we’ve developed community conversation guides (for small groups and larger community forums) and sponsored conversations around the Twin Cities and in Fergus Falls, Minnesota.  Three-month follow-up evaluations indicate that the average participant has talked with seven other people about medical overuse and the more-is-better culture.

We’ve also partnered with Consumers Reports and Choosing Wisely to make these conversation guides (including video demonstrations) available nationally. Doherty and Adams have given webinars on Choosing Wisely and citizen engagement, as well as presentations at Lown Institute and Institute for Clinical Systems Improvement conferences.

We’ve developed and begun working with Minnesota-based HealthPartners to implement a “Clinician Guide for Conversations about Medical Overuse.”  This guide, spearheaded by Baby Boomer member and family physician Cate McKegney, will become part of continuing medical education and specialty re-certification training.  In a year, we hope the training materials will be available nationally.  HealthPartners will also begin sponsoring community forums using our conversation guide.

Finally, we are looking into ways to distribute our “Guide for Families and Loved Ones” for talking about overuse.

It’s still an open question whether Baby Boomers for Balanced Health Care will play any role in reducing out-of-control health-care spending in the U.S.  But this project illustrates a community and cultural change method of working together with other citizens to tackle a problem that cannot ultimately be solved unless we-the-people, not just we-the-professionals, get involved. We hope it will inspire your conversations with patients, friends and loved ones. And we hope our citizens’ movement will inspire your continued grassroots work to transform the health care system.
 
William Doherty, Ph.D., is Director of the Citizen Professional Center and Adjunct Professor in the Department of Family Medicine and Community Health at the University of Minnesota.  He has developed Citizen Health Care as a way to engage community members as co-producers of health care innovations.

Bill Adams is engaged in health care public policy issues. As an engaged citizen and patient voice, he focuses on local and national initiatives to transform health care by co-creating a health care system that works for both patients and providers.

 
Posted by Sonya Collins on Sep 1, 2016 1:42 PM EDT
183e6cbaf51bb2e4035cdd8bd4dd5b69-huge-aiA family physician early in her career is moved by the loss of a patient. Today on the blog, she shares a letter she wrote him after his passing. 

By Aimee English, M.D.

Dear Mr. C.,
 
There are a number of things I’ve been wanting to say to you since you died three years ago.  The first is I’m sorry.  Nobody knows what your final moments were like, but I know they were unexpected because you had been at dialysis just the day before plugging yourself into a machine that you hated, being poked by a needle that we had conditioned you to fear beyond reason, just so that your rather poorly functioning heart could keep on ticking for another day. 

When I came to work the Monday after you died, I learned of your passing in a way that illuminates the less humanitarian side of medicine—a message in my inbox from a call center representative I had never met stating I must call the coroner’s office to discuss your death and complete the necessary paperwork.  I stared at the screen paralyzed for a good minute, then realized I had ten patients on my schedule, buckled down my heartache, saw them, called the coroner, and drove home mourning your death in the privacy of my car. 
 
I am sorry, because you shouldn’t have died alone.  About two years after you had become my patient, you came to see me for chronic, intermittent chest pain.  You had previously had a coronary bypass and we knew your bypass vessels were obstructed.  You were already on the best medications possible to help your heart.  I drew a picture of your heart and labeled your blocked rerouted arteries, pointed to the nitroglycerin on your medication list, and tried to let my face show how sorry I was as I let you know there was nothing more I could do, waiting as the translator relayed each of these messages in Spanish.  I felt like a failure, notifying you of this truth.  You understood my disappointment, replying in English, “It’s okay.  You all take good care of me, more than my family.” Most people die with their families beside them if they can.  I knew you wouldn’t, but I hadn’t pictured you dying alone, and for that, I am so sorry.
 
Mr. C, the other thing I want to say to you is thank you.  Many hands helped shape me into the doctor I am today, and many of them highly trained and educated. Despite having only a sixth-grade education, you were one of my greatest teachers.  When you first became my patient during intern year of family medicine residency, you taught me so many lessons important to the early resident – how to manage diabetes, heart failure, end-stage renal disease, sick versus not sick,  and the value of provider-patient continuity.
 
As I became a better doctor, your lessons became more sophisticated.  We danced around tough topics like depression and end-of-life planning.  You taught me the importance of being honest when the news was bad, letting the unrealistically optimistic “there’s a slight chance” of intern year grow into the more respectable “what is most likely” of third year. 

You taught me how to use my team.  Our social worker helped you find housing.  Our psychologist helped you talk about depression and gave you exercises to reduce your fear of needles.  After months of sending off refills that you never received, our pharmacist discovered I had been sending them to a different Walmart several blocks down the same street as the one you were going to.  In fact, when staff around the clinic learned that you died, it was the front desk that took it hardest.
 
You taught me to be an advocate, asking your specialists to step outside of their guidelines to cater to your individual medical needs that I alone knew.  You taught me to look deeper when I realized your improved diabetes control was the result of you eating less because of worsening depression and dwindling money for food.
 
Above all, you helped me start to learn what it means to be a family doctor.  I say start to learn because now two years post-residency, I can see that understanding what family medicine is takes more time than a three-year residency.  Because of you, I know that continuity means better care, that lack of financial resources trumps recommended care, and that sometimes my job is about making a troublesome problem disappear, but mostly it’s about helping patients live with problems that don’t go away.
 
I know that you appreciated me being your doctor, because you thanked me at the end of each visit. I’m sorry I didn’t thank you back.  I think you deserved to know how much I appreciated what you taught me over the years and I think you deserved to have died with dignity.  I know that you will never read this letter, but other patients might, and I hope that in doing so, they get a glimpse of the profound effect you can have on us, even if we forget to say thanks.
 
Sincerely,
Dr. Aimee English
 
Aimee Falardeau English, M.D., is a faculty family physician at University of Colorado. Her special interests include patient engagement in quality improvement and improving care for patients with complex needs.  She completed a practice transformation fellowship at University of Colorado in 2015 and completed residency at the University of Colorado after attending medical school at University of Massachusetts Amherst.

Related reading
"Relationships draw resident to primary care" by Eunice Yu
"My first patient" by Diana Wohler
"In the ER, the call to primary care is strong" by Jennifer Stella
 
Posted by Sonya Collins on Aug 25, 2016 11:46 AM EDT
Utah logoToday on the blog we feature a Q&A with one of our sponsors of 2016's Gregg Stracks Leadership Summit, which begins this Friday, Aug. 19. The University of Utah Department of Family & Preventive Medicine exists to optimize health and quality of life in home, work and community through scholarship in Utah and around the world. Its values include intellectual curiosity, a respectful working environment, integrity, collaboration, accountability and excellence.

Primary Care Progress: The University of Utah Department of Family & Preventive Medicine was founded in 1970, and is one of the oldest and most established family medicine departments in the country. What does this legacy provide?

University of Utah Department of Family & Preventive Medicine: The department was created in 1970 to train family physicians, physician assistants and public health professionals, and to advance knowledge and practice of primary care, public health and environmental and occupational health.
 
Since it began, the department has acted as a bridge between the community and the health care system by focusing on people in a real world context. The multi-faceted disciplines housed within the department examine biological, social, environmental and occupational influences on health and well-being. Department faculty implement systems of public and personal health care to address population and primary care needs. The department protects and improves the health of individuals and communities by advancing the science and practice of primary care and prevention.

PCP: How does your mentor program improve outcomes for your students?

Utah: Faculty in our department are involved in all levels of medical education. This gives students an exposure to what a family physician can do – not just see patients, but research, education and administration. Our faculty not only guide students as teachers, but as mentors in clinic and in research. Students achieve mentorship from our student groups including the Family Medicine Interest Group and the Utah chapter of Primary Care Progress. This chapter was one of the first to be interprofessional and continues to be so, not only in students, but also in faculty leadership. Students participate in research within our Family Medicine, Public Health and Occupational Medicine divisions, again demonstrating the breadth of the department. We have increased the length of our required Family Medicine clerkship from four to six weeks in the last year, providing our students with opportunities to experience Family Medicine in a rural or urban setting.

PCP: What is your vision for primary care in the future?

Utah: Primary care is foundational to achieving the “Quadruple Aim” in health care: better care, improved health, lower cost and sustainable, satisfied health professionals. Improving care and well-being for individuals and communities is essential to sustaining every nation’s economy and vitality. As a result, our department strives to help not just Utah, but communities across the nation and around the world achieve the quadruple aim. Our physicians, advanced practice clinicians and researchers are envisioning comprehensive health and payment systems. We are looking at ways to move away from narrow focus on sick care, to preserving and promoting health. However, a holistic approach cannot be achieved by clinicians alone. Health care, especially primary care, is a team sport involving many players: patients, public health professionals, physicians, physician assistants, nurse practitioners, health coaches, care managers, nurses, medical assistants, clinical pharmacists, social workers and many others to help individuals and communities thrive by improving health and lowering cost of medical care.

PCP: Why is leadership so important when making change in health care?

Utah: Leadership is key in any type of change, and especially in today’s health care it is essential. With an emphasis on teams and relationships in health care, leadership is what will move people forward to make change. Change in health care can be complex and scary with so many moving parts and people affected; but with positive leadership from all involved, real change is possible.  
 
As health care evolves to provide robust team based care, including everyone as part of the process, we all have an opportunity to be leaders in a revolution that will make the health care industry better by providing top-notch care, reducing cost and creating a better environment for patients and providers. As leadership author John Maxwell said, “A leader is one who knows the way, goes the way and shows the way.” A leader demonstrates how important everyone’s role is in helping to make changes essential to improving health care.

PCP: Thank you for your support of PCP’s Gregg Stracks Leadership Summit. What is it about PCP's work that encouraged you to invest?
 
Utah: The decision to invest in PCP’s Gregg Stracks Leadership Summit is an easy one for our department. PCP is training the future leaders in health care: the people that will work with teams to help primary care, and therefore health care overall, flourish. As a multi-disciplined and diverse department that focuses on optimizing the quality of life for all through collaborative scholarship, our mission fits directly into what PCP is doing for the future leaders of primary care. We are happy to be a part of this summit and we cannot wait to see the changes these future leaders are going to create to help make our health care system one of the best and most cost effective in the world. 


Learn more about the University of Utah Department of Family & Preventive Medicine here.
Posted by Nate Leskovic on Aug 15, 2016 8:21 AM EDT
OptumCare logoToday on the blog we feature a Q&A with one of our sponsors of 2016's Gregg Stracks Leadership Summit, which is almost two weeks away. OptumCare is a health care organization offering coordinated care for individuals, families and older adults: "Reinventing health care by putting you first."

Primary Care Progress: Like Primary Care Progress, OptumCare is leading change in health care. Why is that so important today?

OptumCare: Our current health care system is in need of a major redesign to provide the coordinated, efficient and affordable care that people deserve. OptumCare, like Primary Care Progress, is making it easier for patients to get the care they need. We aim to keep people healthier and give them a positive health care experience. Physicians and clinicians across the health care spectrum are best equipped to intimately understand the challenges our health care system faces and to lead change. With strong and innovative leadership, we can create a better health care future for everyone.

PCP: OptumCare improves connections across health care to deliver better outcomes. What is your vision for primary care in the future?


OptumCareAt OptumCare, we recognize that primary care must have the necessary resources and infrastructure for success. We are actively working to redesign primary care to surround the doctor with a team of care providers who can help him or her get more done and deliver more personalized, attentive care. This care team may include case managers, care coordinators, social workers, behavioral health specialists, nurses and others. Through technology and workflow reorganization, we are connecting primary care to the rest of the health care system in a way that preserves the long term healing relationships that are the foundation of medicine. As this work matures, primary care will be able take its rightful place as the central principle of a health care system that works for people.

PCP: How do you utilize data and technology in pursuit of your goals?


OptumCareWe provide the latest analytics and IT support to turn vast amounts of patient data into actionable information that drives better care decisions and outcomes. This support helps identify those most in need of care and reduces the risk of illness in those who are well.

Today, there is a flood of data coming at us, while many of us on the frontlines are burdened with data entry chores. At OptumCare, we realize data means nothing unless it is served up at the right time, to the right person, and can be used to effectively change behaviors. We are redesigning information systems to create real intelligence out of unstructured data and to free up clinicians from data entry.

Digital technology also allows for new channels for communication and dialogue that can reconnect disparate venues of care, allowing primary care to realize its full potential to provide continuous, comprehensive care.

PCP: Why is leadership so important when making change in health care? What is it about PCP's work that encouraged you to invest?

Accountability is a top leadership attribute that OptumCare embraces and is in great need in health care today. We must all be accountable to the people we serve and for executing on the vision of a better system. 

Learn more about OptumCare here.
Posted by Nate Leskovic on Aug 4, 2016 12:55 PM EDT
f3abeb1495ea283f82d1ac19cec25873-huge-58PCP's 5th annual Gregg Stracks Leadership Summit is just a few weeks away. What can you expect? For one thing, an environment where students and practitioners in all disciplines are respected and embraced. Today on the blog, a nurse practitioner and summit moderator describes how she discovered PCP's interprofessional culture at the first Gregg Stracks Leadership Summit in 2012.

By Alana Rose, N.P.

I recently attended Primary Care Progress’s Gregg Stracks Leadership Summit. The summit brought together chapter leaders from around the country to get coaching in how to lead our chapters to accomplish our individual goals. 
 
I went to the summit knowing that PCP values teams – the team-based model of organizing to improve the primary care profession and the team-based model of primary care delivery.  In both cases, there would be a place for me, an RN and a nurse practitioner student.
 
But amidst the initial excitement and bustle of registering and sharing greetings with strangers, when I put on my name tag, I noted that it clearly identified me as part of an under-funded school of an under-respected profession: nursing. I recognized myself as part of a minority of non-medical students, and, despite what I knew about PCP, I wondered if I would be taken as seriously as my new weekend peers. Would medical students, residents, and doctors be as interested in networking or even just talking with a nurse?  I realized that I had internalized the historic tension between nurses and doctors and between nurses and nurses, and it occurred to me that this tension could be a possible barrier to PCP’s efforts to engage more nurses in its work. 
 
I am more of an anthropologist than a nurse or nursing student in my comments here. And I am neither the first to make this observation nor am in any way qualified to unpack the many layers of history that have colluded to keep these two groups at odds. Still, these tensions are worth bringing out in the open if the efforts of those of us involved in PCP are going to include a space for those who are not doctors or doctors in training, and in so doing, bring different perspectives and a history of (dis)empowerment to navigating the problems in health care.
 
Before I decided to go into health care, an oncologist friend cautioned me against nursing. “Do you want an M.D. or an N.P. after your name?” she asked. She warned me both as a woman from another generation and also as a clinician who greatly valued the power she saw as intrinsic to becoming an M.D. I believe many who choose medicine share my friend’s value, but ultimately I entered nursing because as a non-traditional student, I wanted to gain clinical skills and experience as quickly as possible.
 
I was both haunted by and propelled towards health care by experiences I had while working as an English-Swahili interpreter for a group of American doctors and nurses in Tanzania. There, I saw the harm that can come from efforts “to do good” through the stasis of hierarchy and at the exclusion of others. In one typical clinic, a nurse stood before a long line of Masaai tribal members seeking care outside of the handmade community structure that they had built years ago, hand prints baked into the clay walls. The doctor and resident sat within the cool spacious building and saw one patient at a time, while the nurse worked outside, assessing vital signs and watching as people, weary from many miles of travel under the hot sun, grew frustrated with such a slow and inefficient use of space and personnel. The doctors had essentially recreated the design of their offices back in the U.S. and, like they may have done back home, greatly underutilized the expertise of the nurse. In the end, the clinic ended abruptly, as the numbers of hot and tired patients kept growing and reached a crescendo when a doctor slammed a young man’s hand in the car door while trying to leave the site in haste.  Although the nurse commented throughout each and every clinic about other (perhaps better) ways to utilize space, provide care, or understand a given  problem, she rarely spoke up to express her views to the doctors. I can only assume she felt she would not be listened to or respected.  In part through this experience, I saw nursing as an opportunity to be of use to another human being in some of the most concrete ways possible. After all, the nurse was outside with the patients all day; few saw the doctor. We see in the U.S. health care system as well that nurses (and CNAs) are more often able to be at the bedside when it matters, addressing our most basic human needs. The work can be as humble as assessing a patient’s urinary or fecal output, or as profound as attending to someone in their final hours of life.
 
I knew little of the deep professional rift between nursing and medicine, and I knew even less about the complex way in which this legacy has impacted not only the way doctors and nurses work together, but also how nurses treat one another and undervalue themselves. Nurses are notorious for “eating their young,” and will not only often ignore their own needs but they also have an unfortunate legacy of hazing new nurses in ways that emphasize a culture of workaholism, co-dependency, and fear. In most clinical settings, doctors’ and nurses’ worlds are so deeply divided despite their interdependence. Even socially these divisions are maintained by many in choices as simple as with whom to sit at dinner.
 
You can imagine my relief at the summit when, during our first break-out group, I met a young med student who introduced himself by way of a story of meeting an RN at a homeless shelter and expressed his humility and respect for the clinical knowledge she had. This was one of many experiences during the weekend that opened me to the possibility that the hot buzzword of interprofessionalism is actually a living force and exists in genuine collaboration and creative exchange between diverse constituents.
 
The weekend helped me to step outside the isolation of my education program and of my future career path. The patterns of division and reactivity that have kept students and practitioners of medicine and nursing separate seemed absolved for a few days. Learning of new generations of programs that truly foster collaboration between health care trainees was radical and nourishing.
 
There is no need to reiterate the fact that our current primary care system in the United States needs a thorough overhaul. We all have stories and evidence of this need. I was heartened, however, to see that PCP chapter members I met at the summit seem to value the interprofessional matrix that primary care requires to survive this difficult time. It is my hope that all PCP members reflect that value. And I hope they do so without becoming lost in a quest for power that is equivalent to their peers in sub-specialties, but rather begin to assert an entirely new value system. As we begin our work to recreate health care delivery in the United States, it is not only good practice to bring all health care professionals to this drawing board, it is essential if we are to catalyze a new story of primary care.
 
Alana Rose wrote this piece in 2012 as a nurse practitioner student at University of Southern Maine, where she helped found a PCP chapter. Today she is a Family Nurse Practitioner.  She is committed to supporting innovations in the training and delivery of primary care and believes this can only be accomplished through rich communication and collaboration within interdisciplinary teams. She lives in Belfast, Maine.

Read archived blog posts from other members of the summit training team. 
Kat Barnes
Victoria Boggiano
Jonathan Jimenez
Michael Mattiucci
Stephanie Nothelle
David Choi
Kyle Turner

 
Posted by Sonya Collins on Jul 28, 2016 1:31 PM EDT
22069c27baec2f32b385876c2039e5de-huge-daPCP's 5th annual Gregg Stracks Leadership Summit is just one month away. Led by an interprofessional training team, the summit introduces chapter leaders to PCP’s innovative leadership framework and the variety of high-impact projects PCP chapters have used to revitalize primary care. Today on the blog, meet a member of the training team, David Choi. In this blog post from our archives, David shares his experience helping his PCP chapter open the DAWN clinic. 

By David Choi

As I write this, the DAWN Clinic will open for its first patients in 18 days, two hours and 28 minutes. The leadership team anxiously buzzes around each another at our meeting where we’re tying up loose ends and generating solutions. The tangible excitement in the room is felt by all as we finish up our respective projects. 
  
At the risk of sounding cliché, it really does seem like just yesterday that our Colorado PCP chapter held the first meeting to discuss the clinic. Students of the medical, nursing, pharmacy, physical therapy, and dental schools convene at our meetings to bring change to our surrounding community, educational institution, and the greater field of primary care.
 
At one of our early meetings about the clinic, we divided into different workgroups to take on the various tasks involved in opening a student-run free clinic. It was just an idea, that became a movement which garnered the support of the Dayton Opportunity Center and the Fields Foundation. And now we are days from opening the doors of the Dedicated to Aurora’s Wellness and Needs (DAWN) Clinic to the underserved.
 
Back then, we were a group of many students from many professions. I am amazed at how little I understood about my colleagues’ professions back then – before we became a high-functioning, interdisciplinary team.  
 
As the leader of the Pharmacy and Procurement workgroup, I was tasked with obtaining all the essential items for the clinic. How was I supposed to do this? I was a second-year pharmacy student. I didn’t know what a primary care clinic needed in order to function. I remember sitting with my co-leader Katie, trying to develop a list for the clinic, we sat there thinking “exam room table… otoscope… stethoscope… cotton balls… that’s it, right?” We knew we had a challenge and that we had to overcome it.
 
We were presented with something we were not comfortable with. But as we were taught in pharmacy school and through our work with PCP, we sought out resources and contacts to help us. We started off with the WHO guidelines for primary care clinic supplies and continuously adjusted it as we compared it to other clinics’ lists. For example, after A.F. Williams Family Medicine Center provided us with the inventory list of their current supplies, we sat down as a small group to update our own list. After one week, we had a complete list. But now we had to actually find donors to give us the items on the list. We approached clinics asking if they would be willing to donate any items. They in turn referred us to other clinics and organizations. Then we were introduced to ClinicNet and Doctor’s Care. They put us in contact with the vast network they had established to get us the items we needed. A clinic that was closing in Littleton, CO, donated roughly $15,000 worth of equipment to us. When we met with the doctor to pick up the donation, he stopped us before we left and told us he believes in our cause and our initiative. It is these experiences that demonstrate what we are capable of as students and as a team.
 
The problems of the underserved community around us are within our reach, and as health care professionals, we have a social responsibility to rise to the challenge and enact change. As students of diverse disciplines, we have the combined resources to bring together the knowledge, skills and, yes, equipment and supplies necessary to care for this population. This has truly been an interdisciplinary project. While moving closer to opening this clinic, I have learned more every day about what the different health professions are capable of. Together, we are bringing change to our campus and our community.

David Choi is a fourth-year pharmacy student at University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. David has been part of Colorado's PCP chapter since 2014. During his third year of pharmacy school, he and others worked to set up a student-run free clinic at University of Colorado called Dedicated to Aurora’s Wellness and Needs (DAWN) Clinic. David aspires to bring change to the curriculum at University of Colorado to promote primary care. He loves photography and plays piano when he has time.

Read archived blog posts from other members of the summit training team. 
Kat Barnes
Victoria Boggiano
Jonathan Jimenez
Michael Mattiucci
Stephanie Nothelle
Alana Rose
Kyle Turner



 
Posted by Sonya Collins on Jul 21, 2016 3:47 PM EDT
8ab6e4087f15be4cdc51c0e79e718ef1-huge-1ePCP's 5th annual Gregg Stracks Leadership Summit is coming up. Today on the blog, PCP's president tells the story of Gregg Stracks and why the summit is named for him. 

By Andrew Morris-Singer, M.D.

My junior year of Internal Medicine residency was a difficult, confusing time. A trainee committed to a career in outpatient primary care, I found myself spending a great deal of time on inpatient hospital wards with some of the sickest, most complicated patients I’ve ever encountered. While the medical conditions were fascinating, most were preventable exacerbations of chronic problems or late outcomes of diseases that could have been caught earlier with screening. It felt like we were perpetuating a failed health care system that did little to manage and protect patients’ health but rather waited until they got really sick, and then dumped everything we had in our medical armamentarium on them. It seemed divorced from good economic sense and completely at odds with both the skills that I wanted to learn to keep patients out of the hospital and the values that brought me into health care in the first place.

Despite the dysfunction in the system, my job was to care for those patients, manage the team of house staff and students, and strike the right balance between my clinical, educational and managerial responsibilities – a significant leadership challenge for anyone, let alone someone feeling as conflicted as I was. 

My disdain for the disconnect between the care we delivered and what patients actually needed came across to everyone I supervised. “It was impossible to see this coming,” I’d sarcastically mutter to my team as we’d re-admit a heart failure patient who’d fallen through the cracks due to non-existent communication between the previous inpatient team and the outpatient providers.
 
This is how Gregg Stracks found me when he arrived to offer leadership training to a handful of residents in our program. He found someone who was overwhelmed and jaded; someone for whom team leadership meant modeling unyielding perseverance and determination, with no allowance for emotion or vulnerability.
 
“The stuff we’re seeing is so upsetting, so backwards, I’m afraid if we let any emotions out, we’ll be unable to work,” I told him at our first meeting.
 
Get done. Get out. Keep the emotions in. That was my game plan for surviving my ward time and helping my fellow residents survive.
 
One day Gregg observed our interdisciplinary care rounds on the medicine wards. The members of our large care team were overwhelmed by a particularly difficult patient and his family. We were tired of jumping through hoops to get him the best care only to be rebuffed and manipulated by him and his family. We were also frustrated with each other, convinced that members of the team from other disciplines were making the situation worse. On rounds that day, a social worker said the situation made her question going the extra mile for any patient and their family. After a long silence, to everyone’s surprise, a nurse on the team, who was typically quite contrarian, agreed with her and said she too was having a difficult time and was also questioning her values. But, concerned about “staying on track,” I interrupted and encouraged the team to focus on concrete tasks so we could “get the work done and all go home.”
 
After the meeting, Gregg pulled me aside and in his usual kind, curious, yet direct style, he asked why I had shut down the most intimate interaction he had ever seen our team have. It was the closest we had come to connecting and building real relationships with one another. Connections around values and personal experiences, he said, are the glue that binds team members together to get their work done in a sustainable way.
 
Gregg showed me that by avoiding the emotional, I was missing the opportunity to truly lead the team. Focusing exclusively on the technical and not allowing the team to publicly voice their emotions and values, I couldn’t harness the greatest motivations that had brought every member of the team into health care in the first place: commitment to helping others; to making a difference in someone’s life; to easing unbearable symptoms when there was no hope for cure. Deep connections between team members would only form when we identified our shared motivations and values.
 
Gregg taught me the importance of tapping into the heart.  He assured me that it didn’t make our team less professional. In fact, it allowed us to expand our professional selves to bring all our values, strengths and passions to our work.
 
With Gregg’s guidance, teaching and unremitting support, my notion of leadership transformed. No longer was my job about getting the work done, the boxes checked. It was about helping each team member harness the full spectrum of their intellect, passion, commitment and values for the challenge at hand. Evoking the non-technical or non-analytical wouldn’t slow us down or take us off track. Rather, it would energize us, connect us, and keep us true to the values that seemed to frequently run counter to the system in which we worked.
 
Despite the profound impact Gregg had on my approach to clinical team leadership, the greatest gift he gave me was confidence that we could take these same team-building approaches into the world of primary care advocacy to do things that many of us never thought possible. We could use this leadership style to build new teams that could push for family medicine divisions at institutions where they didn’t exist, accelerate innovation in primary care delivery, or advocate for curricular reform.
 
Many people in primary care at the time knew that we needed a new approach to advancing the field. At Harvard, my own medical school, the primary care division had recently been defunded. At other academic medical institutions around the country, primary care and its practitioners faced constant devaluation and marginalization. We needed to bring our diverse community of primary care professionals together and depart from the traditional siloed approach that only increased animosity among primary care disciplines and professions. We needed to pull average primary care health professionals or trainees out of primary care despondency syndrome. We needed an antidote to the helplessness many of us felt. Most importantly, we needed an approach that harnessed our full potential power and raised a united voice.
 
Starting in Boston, we adopted a grassroots organizing approach that essentially builds mini-campaigns to promote careers in primary care, advance innovation in care delivery and accelerate reform in training. Three years later, over 26 chapters of this network have taken root. What unites us is a commitment to building powerful relationships between individuals and using those connections to spawn action.
 
Just like Gregg taught us, we now see that when we bring a group of people together to fix a difficult problem, we must spend as much time eliciting people’s emotional response to the problem as we do their logical response to have the best chance of creating and sustaining a new team that can solve the problem. The head steers us, but the heart is the engine that makes us go. Just like I discovered on the wards, our job as primary care leaders is to create spaces where like-minded individuals not only can brainstorm solutions to the problem, but where they can express and subsequently harness their emotions and values as well. 
 
Sharing ourselves with others and inviting others to do the same is at the heart of PCP’s effort to lead change in primary care. In my travels around the country and my communication with many of you, it warms my heart to see this leadership approach manifest in all of your great work. Your commitment to this practice has grown the network. Others join us not because their heads tell them to, but because their hearts compel them to.
 
As one faculty member recently confessed to me while we were watching a group of interprofessional students share their values and experiences at a PCP meeting, “It’s not only inspiring to watch this…it’s totally intoxicating.”
 
Gregg Stracks passed away in January of 2012, at the age of 40, from metastatic ocular melanoma, years after he had been told he had months to live. All of the work we did together – all of which occurred after he was suffering from metastatic disease – was the greatest gift I’ve ever received.
 
I believe two things helped Gregg survive so long. First, the deep love, devotion and companionship of his wife Sara and his family and friends. And second, his work with Primary Care Progress and others, helping people like me share our emotions and values and exercise our responsibility to enable others to do the same. Simply put, Gregg was energized by helping people connect with one another. It helped him survive and helped spawn a primary care movement.
 
Gregg’s passing was a great loss to everyone who knew him. He took a piece of our hearts with him, but he left a piece of his heart with us, too. He left us with an approach to leadership, connecting with others, understanding ourselves and building teams that can help each of us do our best work during whatever time we’re lucky enough to have in this life.
 
Please join me in reflecting on our collective luck at being a part of a network and movement connected to such an amazing person as Gregg Stracks, who gave so much of himself, at such a difficult time. Let’s commit to using his leadership summit to reconnect with the values that brought us into primary care. Through those values, we can connect with one another to build new visionary teams to fight for the health of our patients,  our families, our communities, and this nation.
 
Andrew Morris-Singer is a physician and former community organizer and trainer. As president of Primary Care Progress, Dr. Morris-Singer has been instrumental in igniting an interprofessional trainee-led grassroots movement to reform primary care delivery and training.  Dr. Morris-Singer writes and speaks regularly on the topics of primary care community advocacy, utilizing organizing strategies to advance primary care clinical innovation and the critical role of trainees in the revitalization of primary care. Dr. Morris-Singer is board-certified in internal medicine and is an affiliate instructor at Oregon Health and Science University. He lives in Portland, Oregon.

Read more about the Gregg Strack's Leadership Summit.
 
Posted by Sonya Collins on Jul 14, 2016 2:17 PM EDT
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