Category Archives: Education

A Case for Interprofessional Exchange in Family Medicine

Posted on August 16, 2012 by | 5 comments

Courtney Kasun, RN, MNSc

One year ago, I began teaching in an interprofessional student clinic.  The student clinic itself had been around for decades, staffed by students in our family medicine clerkship.  However, after a recent campus-wide push for more interprofessional education across health care disciplines, we began adding nursing and pharmacy students to our clinic and having all the students see patients as an interprofessional team.

I was slotted in as the nursing faculty at the last minute when it became evident the previously planned upon faculty member had too many obligations to manage.  Having not been in on the planning meetings,  I had no idea what to expect from the whole experience.  I was nervous and hoped I would be able to contribute something meaningful to our team and to the education of our students.  Little did I know how profoundly this experience would change my life.

One of the first insights we try to give our students in this clerkship is the chance to learn about the other’s professional training,  education,  scope of practice, and ethics.  In the first ever clerkship of interprofessional clinic, we too, as faculty, were learning things we never knew about our professional colleagues, despite having been licensed practitioners for years.  I gained a better understanding of the nuances of medical education, which has been helpful.  More importantly,  I learned from family physicians what makes family medicine different.

In formal nursing education we don’t learn much about physicians, their training, or the differences between specialties. Really, we don’t learn much formally about physicians at all. What we learn about you as a profession is what you teach us. The attitudes of nurses and the ways in which they collaborate with physicians are largely shaped by the early career encounters they have with doctors.

Nursing graduates leave school with a basic understanding of different medicine specialties; we know cardiologists deal with hearts, orthopods with bones, and so on and so forth. However, we don’t graduate with a knowledge of the subtleties or ethos of different specialties. Among the least clear distinctions for nursing is the difference between internal and family medicine. Most of us would be able to tell you that family medicine takes care of kids in addition to adults. Beyond that the distinction is vague.

Imagine my excitement and surprise when I found out how much family docs care about prevention and social determinants of health. Beyond just caring for your patients, you are concerned with public health and that, often, family physicians make their medical practice an extension of social justice principles. These are things that nurses dig. These are aspects that are foundational to to nursing’s world view.

Learning about and aligning with family medicine has renewed the purpose and passion in my professional nursing career. I was previously opposed to pursuing my advanced practice degree in family practice, perceiving that a family nurse practitioner (FNP) degree was only for nurses who want to work in “Minute Clinics” at chain pharmacies. However, since spending time working with family physicians, I decided an FNP is the advanced practice route for me and that I wanted to get the background in prevention and public health that would help prepare me to stand up with family docs and work for change in our health care system.

In addition, I have become a vocal advocate for the specialty of family medicine, as have many of my nursing students who have come through our interprofessional clinic. Three of our nursing students from last year are new graduates who are helping to open a brand new inpatient family medicine unit at our academic health center. Their lives have been changed through exposure to your mission, and they tell everyone who will listen — and even some who don’t want to— about how amazing family medicine is.

What we, as nurses, learn about medicine, or family medicine, is what you teach us. In taking the time to show us the soul of family medicine, you will mobilize your greatest advocates.

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Posted in Education, Family Medicine Stories, Public Health

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Climate Change: What Is Our Role As Family Medicine Educators?

Posted on August 1, 2012 by | Leave a comment

Colleen Fogarty,
MD, MSc

I coordinate and plan our annual community medicine rotation, a 3-week rotation for our interns at the very end of their year. This year, for our environmental health session, I invited a friend who has been making a film about the local effects of climate change. Kate Kressmann-Kehoe is a geologist by training, who literally suffered insomnia from worries about climate change. She successfully channeled her insomnia into the film, “Comfort Zone,” due for release this fall.

The film proved an excellent jumping off point for a multi-leveled discussion among our group of 13 residents. Some residents noted the regional economic effects of our very warm winter on our neighbors who clear snow or work in winter recreational activities. Others focused on the economic injustices of environmental change and noted that the large farmers — those with more economic resources — are more likely to adapt to a changing climate, while smaller farmers are at higher risk of total economic loss.

A startling piece of data that continues to haunt me is that if we do nothing to change our carbon footprint/CO2 emissions, Rochester, NY will experience a 10 degree F increase in temperature over the next century, and if we engage in some reduction of CO2 emissions, the temperature will increase by 5 degrees over that same time period. These changes would make the climate of Rochester like that of Georgia, or Virginia, respectively. While many local residents might enjoy a winter with less snow, the change in the climate will result in the loss of species and have an impact on the growing season and suitable crops.

Given the complexities of climate change, we centered much of our discussion on the public health threat of heat waves. The Chicago heat wave of 1995 resulted in the deaths of over 700 Chicagoans, the majority of whom were poor, elderly, and isolated. There were so many bodies that the city morgue needed to rent out a fleet of refrigerated semi-trucks in which to store the bodies. More recently, in 2003 a European heat wave killed an estimated 30,000.

Our discussion convinced me that heat waves, especially in urban areas, represent a growing threat. In fact, 2 weeks after our educational session, New York State Governor Andrew Cuomo announced the availability of air conditioning units to medically eligible low-income persons with written physician documentation that states that air conditioning assistance is “critical to prevent a heat emergency.”

Climate change warrants our awareness and involvement in planning. Family physicians can begin to assess patients for risk factors for heat-related morbidity and mortality and provide education about the importance of hydration and low exertion during heat waves.

How isolated are our patients? How mobile? How can our patients and their families access community resources, such as libraries, community centers, beaches, and spray parks? How many of our patients have air conditioning or easy access to family members with air conditioning? How about those with respiratory diseases? How can we work with our local public health and community officials to prevent the scale of death that occurred in Chicago in 1995?

Our community health curriculum must begin to raise our awareness as physicians of local effects of climate change and mobilize us to take action to prevent harm to our communities.

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Family Medicine Should Be a Prominent Voice in Social Media

Posted on July 16, 2012 by | 4 comments

Mark Ryan, MD

In this post on my Social Media Healthcare blog I described why I think physicians benefit from being active in social media. The combined benefits of enhanced partnerships and new connections, keeping up with current clinical and health policy information, and expanding one’s understanding of health care from the perspective of patients and other health care providers are valuable outcomes that all physicians should value. After all, why do we read journals, attend CME, watch webinars, and listen to conference calls? To keep our clinical

knowledge up to date in order to provide the best care for our patients and to learn from each others’ experiences. Active participation in social media can provide these same benefits.

Over the last couple of years, I have seen more and more family physicians becoming active on social media, especially on Twitter.  I have been trying to keep a list of all the family physicians (and GPs) I have encountered on Twitter, though I know that this must be incomplete. A quick scan of the list, however, shows the breadth of perspectives and opinions held by family physicians and gives insight into the challenges and rewards of being a family doctor.

I believe that family medicine can, and should, be even more active on social media. In fact, I believe that family medicine should be the prominent medical specialty in social media and especially on Twitter. Here’s why:

  • Family medicine believes in empowering patients to take active roles in their care. Social media is a prime venue for patients who are seeking to learn from each other and share experiences.Through the e-patient movement, patients use social media to inform themselves and each other about health, wellness, and specific illnesses. Physicians are rarely part of the discussion. With the breadth of knowledge family physicians have, we can join in to help ensure patients have accurate and reliable information. Family medicine’s bio-psycho-social approach to care, which enables us to provide capable and effective care for patients with chronic illness, would also be valuable in discussions with engaged and empowered patients who are seeking to improve their health.
  • Too many people don’t understand family medicine. As noted in this recent post, primary care and family medicine are not usually given starring roles in the media and are often confronted with the argument that the role of family physicians can be easily assumed by nurse practitioners and physician assistants. By talking about our careers, our practices, and (within the bounds of patient privacy and confidentiality) our patients—their illnesses, struggles, and victories—we can control the message and we can show the public what it means to be a family physician.
  • Family physicians are taught to educate and inform patients and to be a resource to those who seek information about their health. The Pew Internet Project has noted that even though many Americans don’t consider themselves e-patients, large numbers of people with health concerns are looking for information online and are using peer-to-peer connections to find answers. Our patients are using social media; why aren’t we? Given family medicine’s whole-person orientation and patient-centered approach to care, we should strive to meet our patients where they are. Increasingly, they are online.
  • For many years, it has been difficult to recruit US medical students into family medicine. Now that more and more medical students are using social media, we could act as virtual role models and mentors. If there is a robust and vibrant family medicine community online, and if we discuss what we love about being family physicians, we might encourage medical students (and premedical students) to look at careers in family medicine.
  • Social media provides an opportunity to unite to advocate for change. As seen in Mike Sevilla’s #SaveGME campaign, when family docs organize, we can have notable reach. The #SaveGME initiative was a short-notice, one-time effort to point out the importance of protecting GME funding. Even with limited preparation, the group was able to reach tens of thousands of people. Imagine if all family physicians on social media organized to advocate on key positions: I suspect we could reach hundreds of thousands of people.

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