FPs Can Shape Social Determinants of Health Outside Clinic
Social factors can influence health more than medical advances. Stewart Decker, M.D., writes that family physicians have the perspective and influence needed to address social determinants of health beyond the exam room.[Read More]
Delta Incidents, Film Underscore Need for More Black Female Doctors
Two black female physicians recently said their offers to help ill passengers were rejected by flight crews because of race. Sadly, their stories aren't uncommon. AAFP Speaker Javette Orgain, M.D., M.P.H.; and Director Ada Stewart, M.D., write that black female physicians are doing vital work in our country, and more of them are needed.[Read More]
FPs Are There for Patients in Wake of Disaster
Hurricane Matthew recently claimed the lives of at least 25 people in North Carolina. Total damage to homes and businesses (including more than 100,000 damaged structures), as well as to crops in the state, is estimated at $1.5 billion. In the storm's aftermath, Mott Blair, M.D., reflects on family physicians' unique ability to care for their communities every day and in times of crisis.[Read More]
Prescribing for Opioid Addiction Is My Responsibility
Federal law requires physicians to pass an eight-hour course and apply for a waiver to prescribe buprenorphine. Alan Schwartzstein, M.D., explains why he thinks it's a worthwhile investment.[Read More]
Help Patients Conquer Obesity With Education, Empathy -- Not Shame
Roughly two-thirds of U.S. adults are overweight or obese. How physicians broach the subject with these patients may determine whether or not they can help.
Right Thing to Do: Making the Case for Drug Pricing Transparency
Vermont recently became the first state to require drug manufacturers to justify large price increases. Will any other states -- or the federal government -- follow?
Men's Health Campaign Offers Opportunity to Tout Family Medicine
A report on men's health the AAFP released on Aug. 9 gave Academy leaders an opportunity to tell the media about the importance of having a family physician. Two AAFP officers conducted interviews with 39 media outlets in less than six hours.[Read More]
Leveling the Playing Field: AAFP Tackles Flu Vaccine Supply Issues
Family physicians often receive their flu vaccine weeks after retail clinics get theirs. The AAFP is talking with vaccine manufacturers and other stakeholders to resolve the disparity.[Read More]
Let's All Commit to Reverse the Opioid Epidemic
Last week, AMA President Steven Stack, M.D., issued a letter entitled "Confronting a Crisis: An Open Letter to America's Physicians on the Opioid Epidemic." We have been working closely with the AMA and other physician organizations on this issue through the AMA Task Force to Reduce Opioid Abuse.
As family physicians, we see the havoc opioid abuse is causing families and communities across the United States. That's why we're working hard to provide adequate pain management for our patients who need it, while at the same time, raising awareness that addiction to opioids is a national health crisis.
© 2016 Sheri Porter/AAFP
I am discussing the nation's opioid crisis with Surgeon General Vivek Murthy, M.D., M.B.A. We met April 18 in Washington to discuss possible collaborations between the Academy and the surgeon general's office.
A recent AAFP study showed that opioids are not our first choice when we're treating patients with chronic pain -- four other treatment methods (physical and occupational therapy, oral non-aspirin nonsteroidal anti-inflammatory drugs, acetaminophen, and antidepressants) are prescribed or recommended for our patients dealing with non-malignant chronic pain before opioids. While this is not a surprise to you, it is important to share this information with patients, payers, legislators and policy makers.
Please know that your AAFP is working closely with other organizations to combat the scourge of opioid abuse -- the White House, HHS, the surgeon general of the United States, and the CDC to name a few. And we have multiple resources readily available to you -- with more to come in early June.
We all need to do our part to end this epidemic. Showing our resolve, by voluntarily increasing our individual CME hours dedicated to opioids and pain management, is a step that we can each take. The AAFP has collated the CME on this topic to make it easier for you to locate, complete and report your hours. Please log in and refresh your knowledge on these critical issues.
Family physicians are dedicated to being a part of the solution to help slow this national crisis. Please join me. Together, we can address this devastating epidemic -- balancing pain relief for our patients in need with our sincere desire to always do no harm.
Wanda Filer, M.D., M.B.A., is president of the AAFP.
FPs Can Be Trusted Guides When the Dying Don't Specify Wishes
Each day when I walked into his hospital room, I greeted him with, "Hello there, Mr. Gold! How are you?" His cerebral amyloid angiopathy, resulting strokes and severe dementia had left him chronically debilitated and nonverbal, but his gazing eyes were enough for me to acknowledge our shared humanity.
For nearly a month, I took care of him on our inpatient service, treating him through seizures, aspiration pneumonias, intubations and extubations. I learned at his funeral service that he had gone by the nickname "Cuz," and when asked by the pastor to give a few words, I admitted that I had not had the benefit of knowing my patient in his prime. However, I had the distinct honor of helping him through his final days. And I was inspired by the love his family showered on him.
Every day, I sat down with Mrs. Gold (not the family's real name) and discussed the care plan, hopeful that her husband could return home to her capable care. But as his situation progressively worsened, it became clear that he might not ever make it home from the hospital.
She struggled with granting an "allow natural death" status that would forfend the high-caliber interventions that were becoming more and more futile. The only direction she had received from her husband on this difficult topic before his illness was that if his heart stopped, he wanted to be brought back.
Never mentioned in their conversations was a scenario in which he had progressive dementia and organ failure. Never discussed was the option of withdrawing care in the context of loss of dignity and quality of life.
So, in this situation neither of them had foreseen, she was doing her best to extrapolate what his end-of-life preferences would be from the minimal information he had imparted.
Reluctantly, she agreed to press on with full code interventions. By the second intubation, the palliative care team and I discussed with her the option of in-hospital hospice, where he could be extubated and spend his final days in the company of family without invasive tubes, lines, bells and whistles. He passed there peacefully, but his family's ordeal may have been less traumatic if he had made his wishes clear.
The Health is Primary campaign released patient materials earlier this year that discuss palliative care and advance directives, and American Family Physician has a collection of journal articles related to end-of-life care that include content for patients as well as physicians. These tools can help your practice and your patients with end-of-life discussions.
Often, family members are put in situations that require them to make decisions on behalf of their loved ones. Sometimes they disagree on how these decisions should be made or carried out. Difficult conversations can often be managed skillfully by family doctors who have developed trust and intimate knowledge of those they care for. Being able to give people a wide array of options is an honor. Putting the needs of those we serve above our own is an even higher honor.
Helping Mrs. Gold through this process was deeply inspiring for me. In the closing paragraphs of Mr. Gold's funeral service program, she quoted an anonymous poem: "So I gave to you life's greatest gift, the gift of letting go."
It's worth noting that a growing number of dying patients will soon have the ability to control their fate, allowing them to experience a far different process than my patient in Maryland. A new law in California that goes into effect June 9 will allow qualified patients the ability to self-administer a prescribed medication to aid in the dying process. For many, this would be preferred to the common hospital scenario of prolonged suffering, often alone.
The California AFP has responded with a set of resources that includes a series of four podcasts (each less than 10 minutes) on end-of-life conversations, an American Board of Family Medicine Part IV (Performance in Practice) Maintenance of Certification Module, a guide to weaving palliative care into your practice and additional information on the new California law (which is similar to laws already in place in Washington and Oregon).
Richard Bruno, M.D., M.P.H., is the resident member of the AAFP Board of Directors.
Seeing the Diseases Vaccines Prevent Illustrates Importance of Immunizations
Editor's Note: In recognition of National Infant Immunization Week, the AAFP is participating in a blog relay to discuss the critical role vaccines play in protecting children, families and communities against vaccine-preventable diseases. You can follow the conversation on social media using #NIIW.
It was a hot, humid day in Cap-Haitien. I was a premed student serving as both an extra pair of hands and as a medical interpreter during my first medical mission trip to Haiti.
The magic of being in the country of my roots enveloped my senses. A deep sense of pride swelled within me as I heard the ocean in the distance, smelled the spices that I had grown up eating and marveled at the intense beauty of the terrain. However, that pride was repeatedly flattened by grief from the immense poverty that surrounded me. Even though it has been more than 10 years since that trip, the images of so many people in need of the type of care I had taken for granted continue to drive me today.
I remember seeing a teenager stiff from tetanus and unable to swallow. His mother held him and pleaded for help.
I held an infant, feverish with pneumonia, who improved after my group paid for penicillin, IV fluids and oxygen.
We forget that American children used to routinely die from diseases that now can be prevented by vaccines. However, this is not the reality in many countries.
Today marks the beginning of National Infant Immunization Week which highlights the importance of protecting infants from vaccine-preventable diseases and celebrates the achievements of immunization programs across the country.
As a family doctor, one of the most important roles I play in my patients' lives is preventing disease and improving health. Every day I discuss the role of vaccines in health maintenance with my patients as a means to protect them and at-risk populations.
Thankfully, we are in an era where terrible diseases like polio, Haemophilus influenzae type B and measles are no longer commonplace in our country. However, in California (where I live), there are many parents who still choose not to vaccinate their children despite overwhelming evidence that demonstrates the safety and effectiveness of immunizations. As a result, we have witnessed the devastating effects of disease outbreaks.
Family physicians and other primary care stakeholders in my state have had to work hard mitigating a measles outbreak and the dangerous rise of pertussis, or whooping cough, in recent years.
The importance of vaccination resonates with me, personally, as a mother of three. When I returned to work after the birth of my youngest child, I had to consider exposing my child to potential antigens brought home from work. I was concerned that the decisions of others could affect the health of my own newborn.
I changed my practice and became more proactive in educating parents about vaccinations. Some parents entrusted their children to my counsel. For others, I decided that I may not be the right physician for them. Although I was torn between caring for patients and doing no harm, I knew I could not withhold vaccinations from a child who lacks the ability to make an informed decision. I also knew that not vaccinating families put others in our community at risk. With that said, I have gladly welcomed families who may have questions about immunizations or decide to use a catch-up schedule.
In California, we have adopted a law that emphasizes an individual's obligation to protect others. Specifically, it eliminates religious and personal belief exemptions for vaccines. This is an important step because the benefits of immunizations are not confined to the individual. Vaccination -- or lack of it -- can affect others unknowingly. Consider the newborn, too young to get vaccinated, or the immunocompromised person undergoing chemotherapy.
In a world that is so interconnected, we must be diligent to protect those at most risk, our children. Giving children the recommended immunizations by age 2 is the best way to protect them from more than a dozen serious -- but preventable -- diseases.
The CDC is right to trumpet the role immunizations have played in reducing the burden of illness in our society. Primary care physicians can add our voice by posting information in our waiting rooms and exam rooms. The CDC also has resources to help physicians get the word out by working with local media, using social media and more. We all can do our part.
It is easy to forget our past and to ignore the fact that the threat of preventable disease is palpable in other countries. For me, I remember those days on the mission field and the children whose fates were sealed without the option of prevention that too many among the privileged are rejecting.
Marie-Elizabeth Ramas, M.D., is the new physician member of the AAFP Board of Directors.
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