Category Archives: Residency

What Will Family Medicine Look Like in 10 Years?

This blog post is a finalist in the STFM Blog Competition.

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Megan Chock, MD

This year, instead of receiving a written invitation to my 10-year high school reunion, I got a Facebook invite. My classmates from Honolulu, Hawaii are scattered across the US, overseas, and work in countless different fields. When I think of what family medicine will look like in 10 years, I imagine what this year’s Class of 2017 is going to do in the world. They will be the family physicians that will shape our specialty’s direction, and I am very excited to see what they do.

Every summer, our residency program sponsors a pipeline program for high school students interested in health care careers. Many of them are considering family medicine. These students are from a high school near the San Diego/Mexico border with traditionally low graduation rates, and most are bilingual and the first in their families to even think about college. Daily activities are run by undergraduates in pre-medical studies and a second-year medical student from the community. We residents get to present to the students on topics they request. One of these was “health issues affecting teens” and I chose to talk about mental health and suicide prevention.

Stepping into that classroom energized me. The students were engaged and open. They asked questions and shared personal experiences about friends and family members with mental illness. At the end of the lesson, when we discussed how to recognize and help a suicidal peer, many asked about volunteering in suicide hotlines. They demonstrated insight into the issue of mental illness in their community, a desire to help, and awareness of how to make that impact.

Using that microcosm, I believe that family medicine in 10 years will be open to sharing ideas and engaging patients, communities, and other medical professionals to improve health. The Class of 2017 has grown up in an era of increased global and national awareness and changing demographics. Technology is a natural extension of relationships and they have learned to communicate through text, e-mail, Facebook, Instagram, Skype, Snapchat, YouTube, Twitter, Reddit, and more. In a 2015 Pew survey, 92% of teens reported going online daily.1 The result is a constant sharing of ideas, and a recognition that this world is both larger and smaller than previous generations realized. Celebrities and world leaders share their inner thoughts and everyday routines, while millions view viral videos of baby animals sneezing and police shootings. These virtual channels reveal a shared human experience that has shown future family physicians that we are all connected. More than that, these channels give family medicine a unique mechanism to better care for our patients and communities.

In 10 years, family medicine will be pioneering better ways to bring prevention and health maintenance to everyday life. Others in this blog have written about technology in the form of the electronic medical record and big data, which are important in optimizing our healthcare system. However, the Class of 2017 will change health culture as well. They will e-mail patients, share healthy recipes on social media, and weigh in on public health issues by writing blogs and doing video interviews. The culture of health will be one of openness that recognizes that healthcare is only responsible for 10% of health; people’s social networks, everyday routine, and resources matter much more.

Our residency’s summer program is one of many pipeline projects that will bring more diversity into our field. These future physicians from different backgrounds will recognize shared issues affecting patients and seek solutions based on interconnectedness, searching for possible solutions through peer networks or building on pilot projects involving health care teams. The awareness that a single physician or a single patient is not insular already exists  and the next ten years will be full of learning on how to harness the capability of social networks to improve health and healthcare.

Family medicine will always be primary care. In 10 years, we will still act as the first person patients touch within the medical system, and serve as the principle coordinator of medical activities. What will continue to evolve is our awareness of the many factors affecting health and our willingness to engage with patients outside of 15-minute visits. In ten years, I see family physicians sharing ideas worldwide from California to New Zealand, and better understanding our patients’ lives through increased communication. And, at the Class of 2017’s ten-year reunion, I would love to hear their predictions for the Class of 2027.

What I Want Family Medicine to Look Like in 2026

This blog post is a finalist in the STFM Blog Competition.

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Stephen Carek, MD

It is the year 2026, “Triple Aim Hits the Bullseye: Health Care System Rises in Access and Quality While Lowering Costs” flashes across the screen of a daily new show. In this moment of reflection, I take the time to remember where the American health care system was 10 years prior and view the current landscape of healthcare with optimism. It had been a long, arduous battle, but after years of reform, cooperation, and evolution, the United States health care mega-complex had undergone such tremendous reform that the world no longer viewed the US as a model of big spending and inefficiencies, but as a model of reform and innovation.

But why? What had become of the system fraud with inequities, corruption, overspending, and compromised patient care? It was no more, thanks to an established network of primary care physicians who took a corrupt model of healthcare, flipped it upside down and created a system that no longer served the interests of insurance companies, hospital systems, pharmaceutical companies, and bureaucracies.  

Family medicine changed everything. The collective momentum of insightful minds who put the system in a new perspective and created a model of healthcare where patients’ interests and well-being were prioritized through a system of primary care physicians and preventive care models that promoted well-being.

Why Family medicine? Why was this the specialty that pushed itself to the forefront in a sea of confusion and uncertainty?

Because we offer a perspective unlike any other, caring for all patients, regardless of age, gender, ethnicity, income, or education.

Because our relationships with patients are like no other. Just as much as we may impact our patient’s lives, they impact ours.  

Because we introduced the model of shared decision making, allowing patients a vested interest in their own care, simplifying communication and tailoring decisions on the wants and needs of our patients.

Because we created quality metrics that were meaningful and improved outcomes, allowing for a greater understanding of our community at an individual level and in the frame of an entire population.

Because we expanded the concept of the ‘end of life’ discussion with our patients and their families in our clinical environment, building on a relationship of trust and care to prevent pain and uncertainty for the patient and their family, creating peace and closure when the time comes.

Because we continued to improve medical education, training world-class students and residents to pursue the challenge of healthcare reform to serve as advocates for our patients and the needs of all physicians.

Because we built a system that utilized novel technologies through virtual care, internet based communications and social media to connect with patients in ways that had never been seen. Increasing access and strengthening relationships.

Because we provided clarity and leadership in the age of ‘alphabet soup’ of healthcare reform, the age of the ACA, ACO, HMO, and MACRA, and created modern models for delivery of care that put the patient first.

Because we reached out to those who needed care the most, giving everyone in this country a chance to pursue their American dream and live a happy, healthy life.

Family medicine became the foundation for healthcare innovation and improvement in the 21st century. Not only did we revolutionize healthcare, but together, we saved it.

Innovating Connections in Family Medicine

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Brian Champagne, MD

This blog post is a finalist in the STFM Blog Competition.

Two years ago I chose family medicine not only to develop a diverse skill set and knowledge to handle almost any patient concern, but also to build a connection with numerous patients of different ages to learn from them as they learn from me.  

Fast-forward to now, I’m in the depths of a busy clinic, stabilizing a crying baby’s ear and desperately searching for a reflective hue amid a narrow tunnel of earwax. I’m not finding it.  I glimpse for 2 seconds before the child’s war cries rattle my own tympanic membranes and I abort the mission. On my third try, I hit the jackpot and visualize a reflective drum. My job is done. I instill some confidence in the mom that her baby will do fine without a goodie bag of antibiotics. We share a bonding laugh at the absurdity of spending over an hour out of her day for a one-second examination with a magnifying glass.

I scamper to my computer and slam in some orders for vaccines, glance at my schedule, and then briskly walk to the next room down the hall. Behind the door is a 70-year-old woman seated in the infamous tripod pose, hunched over with retracting neck muscles, swollen legs and appearing worried. She was discharged just 2 weeks ago for heart failure. I examine her and order 40mg of IV Lasix. A half of an hour later she’s still retracting. I kneel to tell her she’s going to get through this and she nods appreciatively, hoping I’m right. I send her to the hospital for more diuretics as I tap on the door of my next patient.

It’s a wiry 60-year-old man who describes brief spouts of right upper quadrant pain so severe that he swears it’s worse than childbirth. I examine him and explain the possibility of a problem in his liver or gallbladder. After ordering some labs and a right upper quadrant ultrasound, he thanks me for my care.  Days later, my suspicion is confirmed. Gallstones are present and off to surgery he goes.  

While I enjoy these hectic days and the meaningful connections I find through them, I also understand that in 10 years, my family medicine clinic will likely run differently.   

For the screaming baby with possible otitis media, if mom had sent in photos of her baby’s eardrum with a smartphone, perhaps a 10-minute video call would have provided all information that supportive care is appropriate.  

For the 70-year-old woman with persistent CHF exacerbations, perhaps if she were plugged into a system of communicating nurses trained in heart failure management, maybe she wouldn’t be in need of another hospitalization.  

For the 60-year-old man with right upper quadrant pain, if a quick bedside ultrasound by the physician were possible, perhaps he could have been referred to surgery that day.  

With small improvements in patient care, we have the opportunity to develop a more efficient and inexpensive health care system with better health outcomes.  While I delight in new technology that enhances our care for patients, some aspects of family medicine won’t change. Technology won’t change the reassuring words we can offer to a worried parent or acutely ill patient. It won’t alter the power of our receptive ears being present for a scared patient. And it definitely won’t replace the wisdom, laughs, perspectives, and connections we encounter with our patients each day. And that’s good thing.