Friday Apr 19, 2013

They're Your Comments; Make Them Count

Since AAFP News Now opened its stories to member comments in 2010, we've heard from you more than 3,000 times. Through the comments field, Academy leaders and staff have been able to answer numerous member questions, clarify issues and provide additional information from our in-house experts.

We've also been able to correct broken links and other errors that members have brought to our attention.

Since we launched the AAFP Leader Voices Blog in 2011, family physicians have been able to communicate directly with Academy Board members, who have answered questions related to advocacy, education and clinical issues.

Academy staff and leaders also have responded to member questions and comments on Facebook.

Overall, it's a system that has worked pretty well, and the discourse, although sometimes spirited, has been overwhelmingly professional in nature.

But, on occasion, comments can get out of hand. Although we have had many interesting, helpful dialogues between members, members and leaders, and members and staff through comment fields, we also have had a few members resort to personal attacks.

 

And, there have been a few instances of inappropriate language.

Disagreement is fine. We created the comment fields to encourage and improve communication, but let's remember that we all share a common goal of delivering the best care for patients that we possibly can and steer away from anything that gets in the way of that goal.

It's also worth keeping in mind that our news stories, blogs and social media content are open to the public and anyone -- patients, other health care professionals and members of the media -- can and do read that content.

The issues we discuss in these venues are important to the health of our nation and deserve level-headed discourse. Negative, hostile comments have a polarizing effect. Researchers published findings earlier this year that showed that readers who were exposed to antagonizing comments were more likely to dig in their heels on an issue than commenters who read the same story or blog without the accompanying name-calling.

In other words, readers faced with an online fight aren't open to new ideas or the other side of a discussion. Ugly arguments actually reinforce readers' preconceived ideas -- right or wrong -- on a given topic.

Name-calling can disrupt constructive dialogues, and that's not what we want. We family physicians need to be able to discuss important topics, including payment issues, health care reform and gun laws, with the understanding -- indeed, the expectation -- that our diverse, 100,000-plus members won't all agree. Some topics are divisive, but we can't afford to allow them to divide us.

We're here. We're listening. We want to hear from you. And we hope you'll continue the conversation with your colleagues. How will you make your comments count?

Glen Stream, M.D., M.B.I.is the Board Chair of the AAFP.

Monday Dec 31, 2012

Technology Brings New Meaning to Being There for Patient

As families gather and celebrate the holidays, I am reminded how things change and yet stay the same. We look forward to folks coming home, but travel is getting harder. Sometimes, we need to reach out through texting, tweeting, Skype, FaceTime, Facebook and other virtual methods. They may not seem as intimate, but they allow distant connections to be maintained and even grow.

Family medicine is all about nurturing relationships. How we care for our patients is also being affected by social media technologies. I recently experienced a powerful example of how modern technology let me be there during a difficult time for one of my families, although I actually was far away.

Serving on the AAFP Board of Directors takes me away from home and my practice frequently to attend meetings. A few weeks ago, I was sitting in the Academy's boardroom in Leawood, Kan., when one of my residents back home in Tennessee texted me a question from the emergency room about a patient. My resident did not know I was away, and she asked if I was available. I texted back to say "no" … and "yes" and would do what I could remotely. Due to the Health Insurance Portability and Accountability Act (HIPAA), I asked only for my patient's initials. Because of my relationship with my patients, with just that information, I knew exactly who the resident meant, and suspected I knew the problem.

The 91-year-old woman with altered mental status who was the subject of the resident's text has been my patient for about seven years. I first met this dynamic, independent, well-educated former teacher when she started to slow down. Sadly, her cognitive function was doing the same. I diagnosed her dementia while she still understood the devastating losses ahead of her. I worked with her four children, who all live in different states, to help everyone cope with the huge changes. We communicated by phone, e-mail, home visits and appointments over the years. As her disease progressed beyond what they could do at home, I coordinated care as she moved into an assisted living facility one month ago.

Just before I left for Kansas City, her daughter had e-mailed about one of her meds at the facility, and I had noted a discrepancy that I addressed. But now my resident was seeing her for confusion. With that information only, we quickly went through the possibilities, including a stroke, infection and trauma, but I suspected that the medication might still be wrong. Ultimately, that was indeed the problem. That text conversation allowed me to direct my patient's care quickly and efficiently through my resident, saving time and unnecessary investigations.

During our Scientific Assembly in October, the Academy asked, "What is your best moment as a family physician?" Nearly 300 family physicians responded with tales of delivering babies, helping patients make important changes and offering hope to those who needed it.

My story is a different kind of feel-good moment, but it points out how relationships and technology can grow together. The impact we make in people's lives is profound. We need to be there for our patients and families even when we can't be there physically. My knowledge of my patient's situation and willingness to use e-mails, texts and calls made a difference for her and her family, from the beginning of her disease through this latest ER crisis.

So, what is your best moment as a family physician?

And what will you do in the New Year to make a difference for your patients?

Reid Blackwelder, M.D., is President-elect of the AAFP.

Thursday Nov 22, 2012

Thankful for Family and Family Medicine

Holiday greetings from Indianapolis. This year, I was fortunate enough to get away for a few days to spend time with my brother, Mark; sister-in-law, Charla; and their kids in their home. On this Thanksgiving, I'm grateful for the chance to play a little football and catch up with my nieces and nephews, reconnecting with relatives who live more than 1,000 miles and two time zones away. (Plus, Charla's table would make Martha Stewart jealous.)

I hope you also are able to be with those you care about and who care about you. Today, my sense of family includes all of the Cains around the table and around the world. It also reaches out to my extended family of family medicine. In many ways, my family isn't just defined by those who share similar DNA; it extends to all those I care about, including my clinic staff, patients and Academy family.

I've been practicing full-scope family medicine at AF Williams Family Medicine Center in Denver for more than a decade. Although my patients often thank me for helping them, I am grateful for the gift they give me: the privilege to be part of their lives.

I'm also thankful for another kind of family back home in Colorado -- my students and residents. Just as it is rewarding to watch my nieces and nephews grow into wonderful young men and women, it's incredibly satisfying to watch bright, talented medical students grow to become bright, talented residents and for those residents to mature into bright, talented young doctors. Thanks to all of my fellow educators around the country who are helping train the next generation of family physicians.

We also can get a sense of family when we spend time with a group of people who share our values. I got that feeling last month in Philadelphia at the AAFP Scientific Assembly. It was a bit overwhelming to see more than 4,000 family physicians gathered there for the same reason -- for healthier patients and practices.

We don't always agree on everything, but our Academy continues to grow as we work together to advance our vision of achieving optimal health for everyone. Our membership is nearing 106,000, up from 100,300 a year ago. As that number grows, our voice and our influence grow with it. More and more, people are recognizing the value of family medicine. Congress, federal agencies and others routinely seek our input on important issues, including payment and physician workforce issues.

Despite the many challenges facing family medicine, student interest in our specialty continues to grow. Our student membership increased to 20,600 this year, up from 17,100 a year ago. Thanks to the Family Medicine Interest Groups for getting the word out on campuses around the country. The number of FMIGs has increased by more than a dozen in the past few years with more than 140 groups active at our nation's medical schools. Those students are off to a good start because helping people is what being a family physician is about.

Have a great holiday, and thanks for all you do for the health of our patients, families and communities every day.

Tell us what you are thankful for, and help promote the specialty of family medicine by participating in this month's social media campaign.

Jeff Cain, M.D., is President of the AAFP.

Monday Oct 15, 2012

Countdown to Zero

I enjoy countdown calendars, and it's easy to set one up. After all, there's an app for that.

For me, it usually is a countdown to a vacation trip or some other special event. I used a countdown to the 2010 AAFP Congress of Delegates election where I was fortunate to be chosen the Academy's President-elect. 

On the day I was installed as AAFP President last year, I started a countdown to the end of my term. Due to the timing of our annual meetings, I looked forward to 13 months as president -- 399 days. When I spoke of the countdown, however, some misunderstood and thought I was looking forward to being done.

I don't use countdowns to track the time remaining in something I want to put behind me. My intent was to be reminded of the time I had left to make an impact, to advance the goals of family physicians and the AAFP and to enjoy the experience. Looking forward, 399 days seemed like a long time. Now looking back, the countdown to zero went quickly. As the days counted down, my respect and appreciation for the AAFP and its members grew significantly.

As AAFP President, I've had the opportunity to work even more directly with members of our AAFP staff, represent our Academy in the public and private sectors, be our public media voice, and interact with our members and chapters across the country. The president gets a lot of the recognition and credit, but it is often others who do the heavy lifting.

I've had the privilege to be invited to chapter meetings to speak on advocacy, provide an update on AAFP activities, and install new chapter leaders. I always put my best efforts into these meetings, but no matter how hard I worked, I always got more from these meetings than I could contribute. I'm continually impressed and educated by the energy, innovation and dedication of my fellow family physicians.

Private sector advocacy is critical to our members, and this year, I had the opportunity to meet with leaders from the major national health plans. Discussions centered on better payment for family physicians, reducing administrative burden and supporting the PCMH with necessary payment reform. These meetings were very productive because of the ongoing relationships built by AAFP staff and the tremendous knowledge base of our staff.

Governmental advocacy is a high priority for our Academy, representing our interests in both the legislative and executive branches of the federal government. This past year, I've had the opportunity to meet with leaders in the House and Senate, and executive branch leaders in HHS, CMS, the Office of the National Coordinator for Health Information Technology (ONC), and the White House. The highlight was the opportunity to testify in July for the Senate Finance Committee regarding physician payment reform.  Without the hard work and skill of our government relations staff, these meetings would have not been successful or, in some cases, even possible.

The AAFP President is the public and media voice for our Academy. I've given more media interviews than I can count and been quoted in numerous trade and mainstream media sources. Press conferences at the National Press Club regarding Patient-Centered Outcomes Research Institute (PCORI) and Choosing Wisely were an opportunity to have a family medicine voice in these important initiatives. The highlight was being on the "PBS News Hour" discussing the Choosing Wisely campaign. Again, I could not have done these things without media training and other resources provided by our expert public relations staff.

A particular focus for me has been improved member communication, particularly utilizing social media, including this blog. I've strived to let you know what I've been doing on your behalf through the blog, Twitter, and Facebook. My thanks to all of you who have followed and provided your valuable input. This is yet another effort that would not have been successful without our dedicated staff.

As I count down the last few days to zero in my term, I'm grateful for this opportunity to serve as AAFP President. In my President-elect campaign speech I said, "for family medicine and our Academy, the future is so bright … I gotta wear shades." Now, more than ever, I'm convinced that is true.

Glen Stream, M.D., M.B.I., is President of the AAFP.

Monday Jul 02, 2012

Physician, Google Thyself: Know What's Being Said About You Online

How often do you run a Google search for your own name? Do you actually know what the public -- and potential patients or employers -- are reading about you?

For doctors, it's no longer a question of if you have a presence online. Physician rating websites, where anyone can offer a review of your services, have been around for years. Now product review giant Consumer Reports is partnering with the Robert Wood Johnson Foundation's Aligning Forces for Quality Initiative to offer online information about quality and satisfaction with primary care doctors. The project already has published ratings for roughly 500 primary care physicians in Massachusetts and plans to expand to Minnesota and Wisconsin.

With increasing demands for transparency and quality reporting from payers, expect initiatives like this to become more common. Fortunately, as physicians we are not at the mercy of every disgruntled patient's whim. There are ways we can protect our personal reputations and promote our businesses even in the Internet's untamed wilderness.

The first, most important step is to generate positive content. You will have an online presence, whether you contribute content or not. If you don't define your online identity, somebody else will define it for you.

Creating your own positive online presence can take many forms. The easiest way is to participate in social media sites like Facebook, Twitter, and LinkedIn. You don't have to use these platforms every day, but it doesn't take long to create your profile and populate your page with information about your credentials, achievements and interests.

If you sign into AAFP Connection (click on "Make Your Connections" and log in with your AAFP member ID) you can access guides the Academy has developed for Facebook and Twitter as well as a best practices guide for social media in general. (Those documents were developed for AAFP staff who use social media on behalf of the Academy, but the information could benefit members, too.)

If you don't want to share personal information in social media, try posting seasonally-appropriate links to patient information from FamilyDoctor.org or another trusted site. One note: Always make sure your social media passwords are secure.

Most family physicians are already involved in a variety of charitable and community organizations, and you can generate positive mentions by making sure your name shows up on the websites of the groups you are involved with. The more times your identity appears with search-engine-friendly content that you control, the less power any negative reviews will wield.

If you have a little more time, do some writing. Volunteer to contribute to the blog of an organization you care about, or if you're really motivated, start a blog for your own practice and update it regularly. Do you work for a large hospital or health system? Chances are it has a website that is always hungry for new and interesting content; why not offer to write an article about one of your own passions or to be the subject of a human-interest feature story?

Second, make a good-faith attempt to correct anything you find online that is incorrect. If a blog or a news organization reports false information, most of the time, a simple note or phone call will correct it. Always be polite and cheerfully persistent with media organizations because being confrontational will only invite more negative coverage. If a friend or acquaintance has published an unflattering or potentially damaging photo of you, politely ask for it to be removed. (And those pictures you have from your own bachelor party? They should probably not go up on your Facebook wall.) If you want to know more about professionalism and social media, check out the AMA's guidance on the issue.

Of course, some online content is nothing but opinion, and you have little recourse there. Still, even patient-review websites will sometimes allow you to control your profile: take advantage of this opportunity, again, to advertise factual information about your achievements, awards and the like.

Finally, and this is really important, everything you say online is public. Don't use your Facebook or Twitter account to post derogatory or inflammatory content. There is always a lot of kerfuffle about the latest changes to Facebook privacy policies and so on, but really, none of it matters. Everything you put on the Internet is just as public as if you shouted it in the town square. You cannot control who hears, who records or who repeats what you say, and don't ever let a privacy policy give you the false assurance that you can.

For better or for worse, today's Internet is chock-full of unregulated content, and some of it is about you. It is worth your time to make sure that the image the world sees online is the one you wish to project.

Robyn Liu, M.D., M.P.H., of Portland, Ore., is the new physician member of the AAFP Board of Directors.

Monday May 14, 2012

AAFP.org Coming Soon to a Mobile Device Near You

When it comes to interacting with for-profit companies, consumers expect to be able to do just about anything -- banking, downloading music, paying bills, shopping or even making dinner reservations -- via their mobile device.

Although most nonprofit companies aren't quite as advanced in mobile technology, the AAFP is working on making it possible for us to engage with the Academy on our smartphones or tablet computers as easily as when we buy something on Amazon.com. That means we won't have to be in front of a desktop or laptop computer to

  •  find and report CME;
  • engage with our peers on AAFP Connection;
  • register for AAFP events;
  • access Academy resources;
  • read AAFP news and journals; and
  • view and make purchase from the Academy's catalog.

The upgrade also will allow us to, ahem, pay dues anytime, anywhere.

With more than 20,000 web pages to optimize for mobile devices, however, it likely won't happen overnight. The website also will be redesigned during this process, and the goal is for both projects to be completed by June 2013.

I realize that's a little more than a year from now, but I wanted to let you know the Academy is working on this because communication is critical in a member organization. When this work is completed, we will all be able to communicate with each other and the AAFP even better.

Glen Stream, M.D., M.B.I., is president of the AAFP.

Wednesday Apr 25, 2012

Uniformed Services President Stays Connected During Deployment

I had never met Col. Michael Place, M.D., when I recently installed him as the Uniformed Services AFP president. Technically, I still haven't.

I attended the USAFP annual meeting March 18-23 in Las Vegas, but Mike couldn't make it -- at least not in person. Thanks to the Internet and Skype, the roughly 600 USAFP members in attendance did get to see their chapter president take his oath, as you can see in the photo below. (I'm the tiny figure in the bottom left corner.)

While we were in a comfortable hotel on the Las Vegas strip, Mike -- commander of a U.S. Army combat support hospital and medical task force -- was more than 7,000 miles away in a tent in Afghanistan.

I've installed 16 chapter presidents during my years on the AAFP Board of Directors, and I've heard some pretty good speeches. But nothing compares to that inspiring day.

During the ceremony, there was a laptop with a webcam on the podium so I could see Mike, and he could see me. Chapter members watched him on a big screen. As we finished the installation, I turned the laptop/webcam to the crowd so Mike could see the people clapping and cheering for him.

It was a tremendous sight. Mike was beaming.

There is a high level of collegiality at most chapter meetings as old friends reconnect, possibly for the only time all year. For most chapters, members are scattered across an entire state. For this chapter, they are scattered across the globe even in the best of circumstances.

Mike has been in Afghanistan for more than five months. Given the time difference and bandwidth limitations, most of his correspondence is by e-mail. He will get plenty of help from his vice president during his deployment, just as he covered for a previous president during a deployment. Mike thought it was important that he be formally sworn in as president, even though he is overseas, because deployments are a real possibility for nearly all of the chapter's members. It was important to him and the chapter to recognize and celebrate the important role that family physicians play in the Uniformed Services during a time of conflict. 

USAFP members serve in small unit aid stations and in a variety of leadership positions up to and including command of a deployed hospital. They prevent illness and injury in addition to treating those who are injured, ill or wounded in combat. Mike is proud -- and rightly so -- to be one of them.

I have great respect and admiration for these men and women and the work they do, and I felt blessed to be with them.

You can read more about the USAFP in AAFP News Now's latest chapter spotlight story.

Glen Stream, M.D., M.B.I., of Spokane, Wash., is president of the AAFP.

Thursday Apr 19, 2012

I'm Still Listening; So What Do You Have to Say?

Last fall the AAFP launched three new tools to help Academy leaders better communicate with members: the AAFP Leader Voices blog, the AAFP President Facebook page and the AAFPPrez Twitter account.

The idea was simple:

  • Use Facebook and Twitter to communicate what the Academy is doing on your behalf -- including real-time updates of our lobbying efforts in Washington and meetings with large health plans -- and to respond to your comments or questions.
  • Use the blog to communicate more detailed information about those activities and, again, to respond to your comments or questions.

So how are we doing?

A little more than half way through my term, I have tweeted 194 times in 221 days from 11 states; Washington, D.C.; and Canada from meetings with legislators, CMS, the AMA, AAFP chapters and others.

One of my goals was to reach 1,000 Twitter followers. With about 180 days to go, we're half way there. I may not make it, but the AAFPPrez account will transition to President-elect Jeff Cain, M.D., when he takes office in October. I hope the numbers of those following the three new social media platforms will continue to grow under successive presidents. The connections we make and the feedback we receive from you can help make us more nimble in responding to issues.

(By the way, Dr. Cain recently joined the twitterverse, and you can start getting to know him by following @JeffreyCainMD.)

The AAFP President Facebook page has had 111 posts and 64 comments in seven months. I read all your comments and do my best to respond in a timely manner. The same is true for the AAFP Leader Voices blog. The last four blog entries have received a total of 30 comments, including a lively discussion about scope of practice and the future of family medicine training.

In the past few months, the blog has expanded to include input from other Board members, and you will be hearing from more of us in the coming weeks. The Board is a diverse group of family physicians with representation from students, residents, new physicians, solo doctors, large practice physicians, urban and rural doctors, and academic physicians from all parts of the country.

Some of us are brand new to social media. When my term started, Skype wasn't even on my radar, but I now have used the technology to conduct a video conference call with our Family Medicine Interest Group coordinators  and more recently to install the president of the Uniformed Services AFP (more on that in my next blog) who is serving the U.S. Army in Afghanistan.

I also had the privilege of recently appearing on the Family Medicine Rocks podcast  with Mike Sevilla, M.D., for a discussion about the AMA/Specialty Society Relative Value Scale Update Committee (RUC) and the AAFP's Primary Care Valuation Task Force. That one-hour interview provided listeners with a more intimate, detailed discussion than what I could provide in my own message to members That podcast drew more live listeners and downloads than any in the five-year history of Mike's show, which demonstrates there is a strong social media community in family medicine, and it's continuing to grow.

Mike, who I've dubbed the king of family medicine social media, will be the presenter in a session about social media during the Annual Leadership Forum  May 3-5 in Kansas City, Mo. I've learned a lot in the past seven months, but I'm ready to learn more.

How are you using social media to connect to your patients and colleagues?

Glen Stream, M.D., M.B.I., of Spokane, Wash., is president of the AAFP.

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Editor's Note: In addition to the AAFP Leader Voices blog and the AAFP President Facebook and Twitter accounts, you can connect with the Academy through many other social media accounts.

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