Category Archives: Education

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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Posted in Advocacy, Education

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We Do Not Interrupt Our Patients

Posted on July 5, 2012 by | 8 comments

Joseph Scherger, MD, MPH

Ever notice a patient wince when interrupted describing his or her problem? It is well known that physicians interrupt their patients much of the time and usually within 30 seconds of the start of the visit. One study in Family Medicine showed that residents interrupted patients 12 seconds into a visit 25% of the time (article pdf).  We even teach interruptions as part of “controlling the conversation” and “limiting the agenda” for the visit.

In a practice where there is ample time for visits, there is rarely if ever a need to interrupt a patient. I’m now in such a setting after more than 30 years of brief office visits, and I had to train myself to not interrupt patients. What a great feeling that is! At our practice, we sit back and let every patient finish what he or she has to say. Patients notice this, too, saying they have never had a physician listen to them like we do. We learn things about patients they have not had the chance to share with physicians before.

Since we have an hour for every new patient visit, early in the encounter I ask the patient to tell me his or her story. The patient often asks, “Which story?” I say, “Where were you born and what happened after that?” It is amazing to me how most patients finish this story in about 5 minutes. As a matter of fact, I’m impressed with how brief most patients are when giving their narratives uninterrupted.

Our physicians are now demonstrating an uninterrupted communication style to medical students in their family medicine clerkships. By the time they arrive at our practice, they have already been taught to interrupt patients, so we teach them otherwise. Often, this helps them love family medicine. We look forward to training residents in uninterrupted narrative next year when our residency program starts.

Interrupting patients is a part of the paternalistic culture of medicine where the physician’s time is more important than the patient’s, and the physician knows better than the patient what the problem is. Such paternalism is unprofessional and even dangerous and should not be a part of patient-centered care.

I admire professionals who let people have their say completely. Counselors are very good at this and so are good lawyers, realtors, designers, and many others. Interruptions seem to be mainly a physician behavior.

Visits with patient can be efficient without interruptions. When patients have been given the chance to say everything they want during the visit, they are more receptive to hearing our assessment and recommendations for managing their problems. After all, patients are in charge of their care. Our job is to serve them, respectfully and without interruption.

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Posted in Education, Family Medicine Stories

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The New Resident Work Hours—Are We Training Shift Workers?

Posted on May 29, 2012 by | 7 comments

Joseph Scherger, MD, MPH

Throughout my career, I have been in favor of restrictions on resident work hours. After watching how surgery residents worked in the 1970s, I wanted none

of that “prison sentence.” After choosing family medicine, I found a program with “civilized” work hours. I do not think much learning happens after working 80 hours in a week, and patients do get harmed by residents who are too fatigued to care or use good judgment.

I embraced the 2003 ACGME resident work hour restrictions since they had flexibility but limited the on-duty time to 80 hours a week and guaranteed some days off each month. Residents could still sit with patients who were going through a long labor and delivery process or who were in end-of-life care. These long experiences are some of the most memorable for residents and do not occur too often to cause chronic fatigue. They showed the resident how well they can work under occasional extreme circumstances, a skill that would be valuable in a crisis.

The 2011 ACGME work hour restrictions are much more specific and prohibit the time for any “work shift.” First-year residents may no longer work on any given day more than 16 hours. That means that if the resident is with a woman in labor or at the bedside of a critically ill patient they must end their work and turn the care over to another resident. Second- and third-year residents must do the same after 24 hours and must be able to have a “strategic nap” after 16 hours. Is this the continuity of care of a family physician? No family physician in practice would ever consider such an abandonment of their patient! This is how emergency room physicians work, and I wonder if these new work restrictions will transform family medicine into shift workers.

There is evidence that we become less effective in our clinical judgment after 12 hours of continuous work and certainly after 16 hours. With that being so, we should train for teamwork where another physician joins us in the care of the patients after we become less effective. That would reinforce that we are not superman and should ask for help but would not take us away from the very situations where we may be doing the most good and are having a great learning experience.

I hope our leaders in the ACGME will make an effort to revise the resident work restrictions again to allow for both continuity of care and teamwork, so we can balance both clinical experience and patient safety.

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Posted in Education, Family Medicine Stories

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