Dan Nguyen, MD
I think it’s time for family medicine to rock the boat. Family physicians, and especially family medicine residents, are uniquely qualified to promote quality improvement by standardizing patient care processes.
As a family medicine intern at an urban academic institution, these past 6 months have been a blur of rotations. Every 4 weeks, we start a new service and drink from a fire-hose of learning the intricacies of “how-to-be-a resident.” Our intern training is the most diverse; we rotate through inpatient services in OBGYN, pediatrics, family medicine, internal medicine, general surgery, intensive care, and the emergency department.
For inpatient services, there are common tasks that all residents perform. We answer pages, place admission orders, write progress notes, discharge patients, sign-out the patient lists, etc. We have access to the same electronic medical record, the same resources, and are unified by an academic institution.
What dawned on me is that every service seems to coordinate patient care completely differently. Every 4 weeks, I would re-learn how to do the same types of tasks but with different methodology. The most glaring disparities I noticed were in how different services handle transitions of care, especially patient sign-out.
Kathleen Rowland, MD, MS
Change is here, and more is coming. In medicine, we often perceive change, especially external change from hospital systems or payers, to be a threat. We feel a loss of control, which can lead to anger, resentment, and burnout.1 A survey of 3,000 US physicians done by a staffing company found that 58% of physicians who left medicine in 2013 reported doing so because they didn’t want to practice in an era of health care reform. This is more than stated they left because of economic factors such as malpractice insurance or reimbursement concerns (50%).2 The changes we face can feel overwhelming, and we have to take measures to make the changes less daunting.
Being resilient does not mean that we become pushovers. The goal of teaching resilience to change is to increase the sense that we are able to react to, triage, and adapt to changes while maintaining the core of who we are: physician teachers and healers. We can fight unwinnable battles or choose good ones. We can hold out on changing until the demand to do so is punitive, or we can adopt the change at a comfortable pace. We often do not choose the changes we face, but can choose the way we respond. As we restore that independence, we can reduce our risk of burnout and increase our satisfaction with practice.
Winston R Liaw, MD, MPH
Research is to see what everybody else has seen and to think what nobody else has thought.
Each year, my colleague, Alex Krist, and I sit down with our Virginia Commonwealth University family medicine residents to brainstorm potential research topics for their scholarly activities, and each year, we encounter a similar series of events. Initially, there is silence (frequently prolonged and often deafening) followed by musings about their lack of research experience. Then, a brave soul offers a question that has been plaguing her. A classmate asks a similar but related question. The conversation reminds a third resident about a different question he always wanted to answer. By the end of the hour, we have a list of fascinating, important questions.
- Do calorie counters improve patient outcomes?
- Why do our patients use the emergency room next door when our walk in clinic is open?
- Has the new patient portal affected the volume and type of phone calls we receive?
- Are patients at the community health center interested in doing video visits?
Your STFM Research Committee thought that family medicine residents and faculty nationwide may similarly have pressing questions to answer but lack the means to do so. Initially conceived by STFM Research Committee members Tammy Chang and Rob Post, we launched a session at the 2016 STFM Conference entitled: “Shark Tank for Family Medicine: Real-time Feedback for Primary Care Research Ideas”. During the workshop, seven participants pitched research ideas to three “sharks” (well-established primary care researchers). The sharks provided real-time feedback and then selected participants to mentor over the year. For those of you not tuned in to pop culture, our workshop is based on the TV show Shark Tank where contestants pitch business ideas to established entrepreneurs and winners receive funding and mentorship.