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The Development and Maturation of STFM

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Roger Sherwood

Roger Sherwood, past STFM executive director

When 105 family medicine educators signed on in 1967 to become a part of the newly formed Society of Teachers of Family Medicine, little did they realize the impact they would have on educating medical students and residents in this new medical specialty. These pioneers spread the message of family medicine education and they and their successors affected the lives of countless students, residents, physicians, and patients.

In its early days, STFM administratively was essentially a file drawer in the president’s office. The Society received a major boost when the American Academy of Family Physicians offered to provide administrative services in the early 1970s. Growth and success during the 1970s led STFM to build its infrastructure and hire its own staff, though the AAFP provided support through 1980, both financially and by providing office space in the AAFP headquarters.

in 1981, when I became the STFM Executive Director, incoming president F. Marian Bishop, PhD, MSPH,  initiated an outreach program to the members by introducing the concept of special interest groups. The initiative invited STFM members to develop groups to address their special areas of interest. This outreach program marked a new stage of development — the creation of an infrastructure to involve members in new ways.

Building and growing the Society resulted in a number of initiatives that enabled the Society to develop a stronger base before moving to its next stage—outreach to other organizations and the larger world of medical education.

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Three Patients Who Helped Me Realize How Special Family Medicine Is

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Ashley Boerrigter, Medical Student

Come, be a shadow with me – I’ll show you three patients who helped me realize just how special family medicine is.
A woman in her late 50s is seated in the chair across from us. Her husband, who was not present, had been diagnosed a few months prior with terminal cancer, and his treatment was palliative, not curative. She breaks into heaving sobs when the doctor asks how she is doing with such a burden. He listens to her, hearing her out and giving her space to be completely honest about what she is feeling, and then speaks encouraging words. He hugs her and she holds on for a long time. This interaction taught me about the value of providing safe space for emotional release.

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LGBT Health Is More Than HIV and STIs

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Adam Lake, MD

When it comes to LGBTQ+ health, the first topic that I often see is related to HIV and STIs.

While this is certainly one of many health disparities that emerge when comparing the LGBTQ+ population to the population as a whole, overdoing the focus on this topic can be divisive. The health disparities extend to mental health, cardiovascular risk, and use of preventative care.

As a family doctor and HIV care provider, I see this bias leading to an earlier diagnosis in a young gay man who had a sore throat that wouldn’t quit, but missed completely in the straight married woman with unexplained low cell counts despite extensive testing and multiple subspecialist referrals. This pattern is borne out in many, many, many studies.

True, sexual (and/or romantic) identity is what can be used to define the LGB population, though same-sex sexual activity is not always the defining factor for self-identification. As a juxtaposition, Trans*, queer, and gender non-conforming populations generally are defined by their non-cis gender identity and not sexual identity. The impact we have on Trans* patients seeking health care is especially striking with 28% putting off care due to discrimination and disrespect even when sick or injured.

The challenge here is deeper than where we may immediately recognize. The hard part is not seeing the nuance in the population prevalence: this is about being a safe space for all patients.

As teaching family doctors, we have a great opportunity to demonstrate empathy and to teach appropriate care for all. I encourage my learners to find a way to add sexual history inquiries into standard questions and to create a safe space to have candid dialog between provider and patient.

I will never forget a true conversation I had with a 60-year-old man in our more rural practice:

Me: Do you smoke cigarettes?

Patient: Nah, quit that years ago.

Me: Any alcohol?

Patient: Here and there, you know, nothing on a regular basis.

Me: Any other drugs?

Patient: Nope.

Me: Are you currently sexually active?

Patient: Yep.

Me: With men, women, or both?

Patient: Both, but I generally only have sex with guys when my wife and I are doing coke…

As you can imagine, more questions followed. While this patient identified as straight, I have found again and again that simply asking about sex will often lead to more accurate histories from patients in other domains of information. Questions about this have helped me break down my own preconceived notions of sexuality, especially when encountering unexpected answers in patients who challenge our assumptions.

To change the health care system as a whole is not within the power of a single one of us, but affecting that which is within our influence is possible. You may have the ability to affect curricular development or develop community educational activities. Or you may have the ability to personally open the eyes of your students, residents, or colleagues.  Whatever your power may be, go out and make the change.
We owe it to all our patients. For patients invisibly attracted to those on the same side of the gender spectrum who have never revealed that to a provider. For the transwoman who just wants to talk to you about her shoulder pain and not her genitals. For the straight woman with the sore throat that won’t go away. For the queer teen who just can’t take it anymore. I want our patients to know that we care.