Category Archives: Leadership

Aligning Our Efforts to Transform the System

Robert Cushman, MD

As a longtime member of the Society of Teachers of Family Medicine (STFM) and the incoming president of the Collaborative Family Healthcare Association (CFHA), I am both excited and a bit anxious about taking on this role at this time, because we are truly at a critical juncture. As health care providers and educators, we offer clinical services in a “system” that is about to either continue making important strides forward toward becoming a true system achieving meaningful outcomes or to slip backward into the free-for-all chaos that has complicated delivering good, patient-centered care for decades. We need to work together as members of STFM and CFHA to navigate through these twists and turns, or plow through some obstacles, so that we, our trainees, and our patients and communities, come out in better shape on the far end.

I want to share one of the “clinical pearls” I learned in my residency, which has served me well as a “compass,” and which I have quoted (with attribution!) many times to my own trainees as I precept them in the hospital and the office. I offer it now because it is applicable beyond the direct patient care process. I can still hear Tom Campbell saying, “When you’re stuck, expand the system.” He of course meant to explore more into the patient’s family and community context, gathering the perspective of some of those folks that make up that social network or enlisting their assistance in changing parts of that context to achieve change for the patient. He also meant to ask for input and additional, new, and different perspectives and suggestions from one’s professional colleagues, both diagnostically and for interventions. This approach has proved hugely valuable to me, repeatedly. And I think the current emphasis on team-based care is a result of a collective recognition that this systemic approach is valuable and more effective than “going it alone.”

I want to challenge us all to continue to “expand the system” in three ways. I want us to expand our concept of teams, to expand our measurements of what we’re doing, and to expand our reach. Let me elaborate briefly on each of these.

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As Rosie the Riveter Says: We Can Do It—Collaborative and Facilitative Leadership

Jeri Hepworth, PhD,STFM Past President

What a fortunate path I have been on. But it is a path that more of us can take, and that is the core message of this blog post. As a behavioral scientist in family medicine for more than 30 years, I grew up in parallel with the discipline of family medicine and have been part of the community of behavioral science faculty who help family physicians know what it means to care for real people, for families, and to do so collaboratively with other health care professionals. Over time, I felt included and valued in my department, in my medical school, and in our national organizations, especially the Society of Teachers of Family Medicine (STFM). So what a thrill it was to be elected STFM president. But it was not without trepidations.

As STFM President-Elect, I attended my first meeting of CAFM and Working Party. Forgive the funny names, but they represent the Council of Academic Family Medicine organizations (STFM; ADFM, the organization of departments and chairs; AFMRD, the residency directors; and NAPCRG, the primary care researchers). The Working Party includes the CAFM organizations, plus the American Academy of Family Physicians (AAFP), the American Board of Family Medicine, and the AAFP Foundation. Together, the organizations work to ensure coordinated positions and grapple with vision and leadership of family medicine. These meetings represent ideal examples of Covey’s work of being both important and not urgent, of taking the time to consider what family medicine is accomplishing, and very powerfully, what should be the next steps.

Not surprisingly, attending my first meetings of these groups was intimidating. But, on the first morning, I received this email from my husband, Robert Ryder: “You are not a non-physician. You were elected to represent the educators in family medicine. So you represent the future of family medicine. Go do good work.” I must say, I walked a bit taller after that email, and over the last couple of years of leadership within national family medicine, I take these statements very much to heart. And I want others to recognize these truths.

Behavioral science clinicians and educators have the skills needed for leadership in our departments, in our health care systems, in our agencies and policy-making arenas, and in our national organizations and advocacy efforts. We know how to listen and include others. We can elicit divergent views and withstand conflict. We know how valuable it is to include the views of those who feel less powerful in systems. We can tolerate the anxiety that emerges in systems under stress or facing change. We know how to help groups create goals and vision, though we sometimes need help determining whether differences actually emerged. So we know we need collaborators, and generally we know how to play well with others. If we have been successful in working in settings in which our professions were the minority, we have learned these skills. And they are exactly the skills needed for effective leadership.

I truly enjoyed giving talks as president of STFM. Unlike presentations about my work, I learned that I didn’t need to hold back, because I wasn’t talking about me. I was representing something greater than me. To be grandiose, and also accurate, I was able to talk about a future and vision of compassionate, effective health care. It wasn’t a form of bragging about my work or ideas; it became a responsibility to do the best I can to help achieve our common goals. I was given a wonderful platform and support to do so.

And the beat goes on. I will still take the opportunities to advocate for family medicine, for primary care, for integrated health care systems that are focused first on patients and families and that require the collaboration and skills of many. But I also have a commitment to encouraging others to stand up and participate in advocacy and leadership for our common visions. The Collaborative Family Healthcare Association and STFM create wonderful platforms for us to do so. Let’s not waste these opportunities.

This is the first in a series of collaborative blog posts between the Collaborative Family Healthcare Association and the Society of Teachers of Family Medicine.

Should Students Be Introduced to Family Medicine Sooner?

Carllin Man STFM Student Representatve

I often laugh when I reflect on what my vision of a family doctor was before I started medical school. To me, family doctors were “cough and cold” physicians who would see routine, uninteresting patients every 5 to 10 minutes, earning a minimal salary compared to their specialist colleagues. They had a broad scope of practice and, because of that, needed to refer complicated cases to specialists.

What was I thinking?

Having no formal exposure to family doctors in my preclinical curriculum, I received a broader introduction to family medicine during FMIG lunch hour sessions. While indulging in a free lunch, I came to realize that family medicine is not what I thought it was. I learned that family doctors are competent in a multitude of procedures, from incision and drainages to IUD insertions to mole excisions. They do all this while also delivering babies, treating coagulopathies, and managing chronic pelvic pain.

But unexpectedly, what struck me during these seminars was the sheer enthusiasm expressed by the family doctors. They looked truly happy and made it clear that they enjoy what they do. Many of them spoke of the great work/life balance they’d achieved and how family medicine allows them to be flexible in their professional lives, while still providing vital clinical services to their community.

What other specialty can boast all these things?

I often wonder if I would have chosen family medicine if I hadn’t attended the FMIG lunches. Gaining a true understanding of family medicine in my first year definitely affected how I looked at the other specialties during my clinical rotations. I have to believe that interest in family medicine would increase somewhat dramatically if medical students learned the true nature of family medicine earlier in their preclinical years.