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Archive for August, 2016
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
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Dear Penny, You give us another wake-up call. Boundaries can get loose and good habits can get worn down in the nursing home. As you say, the way that things get paid for affects the doctor-patient relationship. In my HMO, there are financial incentives to keep our patients at home. And some of our patients who need long-term care but still value the sociali...
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This looks intresting one and thanks for sharing. Any decision patient only input ant output important.
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Thanks for the full summary of events and new leadership directions we need to take in primary care. Student and resident leadership is vital to the future of primary care, especially Family Medicine, where many of our senior leaders are shifting into health system, regional, state and federal roles, thus creating large need for new and emerging leader...

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