Jeff Susman, MD

As I sit down to write this editorial in mid-December, I look forward to the coming decade and consider this an apt time to review the events of 2009 and the columns I’ve written.

My December editorial expressing my disappointment with the new partnership between the AAFP and The Coca-Cola Company moved many of you to write. As you will remember, this plan is part of the Academy’s Consumer Alliance program. Recently, the Academy’s board reaffirmed that this venture is “consistent with the mission, vision, and values of the AAFP.” I strongly disagree and, judging from my mail, many of you do, too.

What of some of my other editorial topics?

Last January, I wrote about the Robert Wood Johnson Aligning Forces for Quality initiative in Cincinnati, a pilot measurement program that nearly 250 physicians have participated in thus far. To date, about 14% of patients with diabetes—the focus of the program—have achieved “perfect control.” While these results are sobering, they are consistent with other communities’ efforts and help motivate us to improve care.

In April, I wrote about the limitations of the medical home. Since then, the concept has continued to grow in a positive direction. The AAFP recently asked the NCQA, the organization most widely used to assess practices’ readiness to be medical homes, to revise its assessment criteria to better incorporate measures of continuity and comprehensive patient care.

On more than 1 occasion, my 2009 editorials dealt with health care reform. After my initial elation at watching the House pass a reform package and glimpsing the possibility of an end to SGR (sustained growth rate), I’ve been disappointed to see the prospects for substantial health reform and the demise of SGR grow increasingly dim.

Finally, I wrote about my mother, and as I write she has been transferred to a long-term acute care facility; we are hoping for a gradual recovery. Thanks to all of you who asked me about her—and indeed, to all of you who take the time to comment on anything I write. Much of the joy of sharing my perspective each month comes from receiving your e-mails, phone calls, letters—and even an occasional tweet.

I look forward to the year ahead with great excitement and hope, and wish all of you a Happy New Year.

As I sit down to write this editorial in mid-December, I look forward to the coming decade and consider this an apt time to review the events of 2009 and the columns I’ve written.

My December editorial expressing my disappointment with the new partnership between the AAFP and The Coca-Cola Company moved many of you to write. As you will remember, this plan is part of the Academy’s Consumer Alliance program. Recently, the Academy’s board reaffirmed that this venture is “consistent with the mission, vision, and values of the AAFP.” I strongly disagree and, judging from my mail, many of you do, too.

What of some of my other editorial topics?

Last January, I wrote about the Robert Wood Johnson Aligning Forces for Quality initiative in Cincinnati, a pilot measurement program that nearly 250 physicians have participated in thus far. To date, about 14% of patients with diabetes—the focus of the program—have achieved “perfect control.” While these results are sobering, they are consistent with other communities’ efforts and help motivate us to improve care.

In April, I wrote about the limitations of the medical home. Since then, the concept has continued to grow in a positive direction. The AAFP recently asked the NCQA, the organization most widely used to assess practices’ readiness to be medical homes, to revise its assessment criteria to better incorporate measures of continuity and comprehensive patient care.

On more than 1 occasion, my 2009 editorials dealt with health care reform. After my initial elation at watching the House pass a reform package and glimpsing the possibility of an end to SGR (sustained growth rate), I’ve been disappointed to see the prospects for substantial health reform and the demise of SGR grow increasingly dim.

Finally, I wrote about my mother, and as I write she has been transferred to a long-term acute care facility; we are hoping for a gradual recovery. Thanks to all of you who asked me about her—and indeed, to all of you who take the time to comment on anything I write. Much of the joy of sharing my perspective each month comes from receiving your e-mails, phone calls, letters—and even an occasional tweet.

I look forward to the year ahead with great excitement and hope, and wish all of you a Happy New Year.

As I sit down to write this editorial in mid-December, I look forward to the coming decade and consider this an apt time to review the events of 2009 and the columns I’ve written.

My December editorial expressing my disappointment with the new partnership between the AAFP and The Coca-Cola Company moved many of you to write. As you will remember, this plan is part of the Academy’s Consumer Alliance program. Recently, the Academy’s board reaffirmed that this venture is “consistent with the mission, vision, and values of the AAFP.” I strongly disagree and, judging from my mail, many of you do, too.

What of some of my other editorial topics?

Last January, I wrote about the Robert Wood Johnson Aligning Forces for Quality initiative in Cincinnati, a pilot measurement program that nearly 250 physicians have participated in thus far. To date, about 14% of patients with diabetes—the focus of the program—have achieved “perfect control.” While these results are sobering, they are consistent with other communities’ efforts and help motivate us to improve care.

In April, I wrote about the limitations of the medical home. Since then, the concept has continued to grow in a positive direction. The AAFP recently asked the NCQA, the organization most widely used to assess practices’ readiness to be medical homes, to revise its assessment criteria to better incorporate measures of continuity and comprehensive patient care.

On more than 1 occasion, my 2009 editorials dealt with health care reform. After my initial elation at watching the House pass a reform package and glimpsing the possibility of an end to SGR (sustained growth rate), I’ve been disappointed to see the prospects for substantial health reform and the demise of SGR grow increasingly dim.

Finally, I wrote about my mother, and as I write she has been transferred to a long-term acute care facility; we are hoping for a gradual recovery. Thanks to all of you who asked me about her—and indeed, to all of you who take the time to comment on anything I write. Much of the joy of sharing my perspective each month comes from receiving your e-mails, phone calls, letters—and even an occasional tweet.

I look forward to the year ahead with great excitement and hope, and wish all of you a Happy New Year.

I was so “proud” when the American Academy of Family Physicians (AAFP) announced that The Coca-Cola Company was the first partner in its Consumer Alliance program. In its press release, AAFP President Lori Heim, MD, describes the program as “a way of working with interested companies to develop educational materials to help consumers make informed decisions so they can include the products they love in a balanced diet and healthy lifestyle.” The content is to be posted on familydoctor.org and “will address sugar-free alternatives to help patients make better choices,” the press release states.

In fact, I can’t begin to express my excitement about working with a corporation whose most visible product is linked to the epidemic of obesity and tooth decay. Yet the relationship makes perfect sense in light of the AAFP’s work with Pepsico and McDonald’s to help support its Americans in Motion campaign. Indeed, the Academy has long been an innovator in patient education through familydoctor.org. The resource, Family doctor: Your essential guide to health and wellbeing, for example, is replete with helpful ads (including a spread featuring VasoRect Ultra next to an article on erectile dysfunction). Such judgment is hard to question.

“We’ve made a conscious effort to diversify our sources of revenue,” Heim notes. “This is the first of what we hope will be many Consumer Alliance agreements. We’re looking across a broad spectrum.”

The possibilities are endless! I eagerly await a deal with Phillip Morris to educate people about smoking, a partnership with Seagram’s to discourage alcohol misuse, and an alliance with Colt’s Manufacturing to combat gun violence.

I agree that the AAFP should look for new revenue sources, but is this the type of relationship that makes its members proud? Obviously, consumers choose products—some of which may adversely affect their health—on the basis of many factors. But developing consumer product partnerships in the arena of patient education poses an inherent conflict of interest and falls prey to subliminal influence, unconscious reciprocity, or—at a minimum—the appearance of endorsement.

To rely on The Coca-Cola Company to “enable consumers to make informed decisions about what they drink based on individual need,” as Rhona Applebaum, MD, Coca-Cola’s VP and chief scientific and regulatory officer, suggests, is like letting the fox guard the hen house. As a professional organization, the AAFP should promote the highest ethical standards. We owe our patients such unfettered relationships. The AAFP should exercise its opt-out clause with The Coca-Cola Company.

All things do not go better with Coke.

I was so “proud” when the American Academy of Family Physicians (AAFP) announced that The Coca-Cola Company was the first partner in its Consumer Alliance program. In its press release, AAFP President Lori Heim, MD, describes the program as “a way of working with interested companies to develop educational materials to help consumers make informed decisions so they can include the products they love in a balanced diet and healthy lifestyle.” The content is to be posted on familydoctor.org and “will address sugar-free alternatives to help patients make better choices,” the press release states.

In fact, I can’t begin to express my excitement about working with a corporation whose most visible product is linked to the epidemic of obesity and tooth decay. Yet the relationship makes perfect sense in light of the AAFP’s work with Pepsico and McDonald’s to help support its Americans in Motion campaign. Indeed, the Academy has long been an innovator in patient education through familydoctor.org. The resource, Family doctor: Your essential guide to health and wellbeing, for example, is replete with helpful ads (including a spread featuring VasoRect Ultra next to an article on erectile dysfunction). Such judgment is hard to question.

“We’ve made a conscious effort to diversify our sources of revenue,” Heim notes. “This is the first of what we hope will be many Consumer Alliance agreements. We’re looking across a broad spectrum.”

The possibilities are endless! I eagerly await a deal with Phillip Morris to educate people about smoking, a partnership with Seagram’s to discourage alcohol misuse, and an alliance with Colt’s Manufacturing to combat gun violence.

I agree that the AAFP should look for new revenue sources, but is this the type of relationship that makes its members proud? Obviously, consumers choose products—some of which may adversely affect their health—on the basis of many factors. But developing consumer product partnerships in the arena of patient education poses an inherent conflict of interest and falls prey to subliminal influence, unconscious reciprocity, or—at a minimum—the appearance of endorsement.

To rely on The Coca-Cola Company to “enable consumers to make informed decisions about what they drink based on individual need,” as Rhona Applebaum, MD, Coca-Cola’s VP and chief scientific and regulatory officer, suggests, is like letting the fox guard the hen house. As a professional organization, the AAFP should promote the highest ethical standards. We owe our patients such unfettered relationships. The AAFP should exercise its opt-out clause with The Coca-Cola Company.

All things do not go better with Coke.

I was so “proud” when the American Academy of Family Physicians (AAFP) announced that The Coca-Cola Company was the first partner in its Consumer Alliance program. In its press release, AAFP President Lori Heim, MD, describes the program as “a way of working with interested companies to develop educational materials to help consumers make informed decisions so they can include the products they love in a balanced diet and healthy lifestyle.” The content is to be posted on familydoctor.org and “will address sugar-free alternatives to help patients make better choices,” the press release states.

In fact, I can’t begin to express my excitement about working with a corporation whose most visible product is linked to the epidemic of obesity and tooth decay. Yet the relationship makes perfect sense in light of the AAFP’s work with Pepsico and McDonald’s to help support its Americans in Motion campaign. Indeed, the Academy has long been an innovator in patient education through familydoctor.org. The resource, Family doctor: Your essential guide to health and wellbeing, for example, is replete with helpful ads (including a spread featuring VasoRect Ultra next to an article on erectile dysfunction). Such judgment is hard to question.

“We’ve made a conscious effort to diversify our sources of revenue,” Heim notes. “This is the first of what we hope will be many Consumer Alliance agreements. We’re looking across a broad spectrum.”

The possibilities are endless! I eagerly await a deal with Phillip Morris to educate people about smoking, a partnership with Seagram’s to discourage alcohol misuse, and an alliance with Colt’s Manufacturing to combat gun violence.

I agree that the AAFP should look for new revenue sources, but is this the type of relationship that makes its members proud? Obviously, consumers choose products—some of which may adversely affect their health—on the basis of many factors. But developing consumer product partnerships in the arena of patient education poses an inherent conflict of interest and falls prey to subliminal influence, unconscious reciprocity, or—at a minimum—the appearance of endorsement.

To rely on The Coca-Cola Company to “enable consumers to make informed decisions about what they drink based on individual need,” as Rhona Applebaum, MD, Coca-Cola’s VP and chief scientific and regulatory officer, suggests, is like letting the fox guard the hen house. As a professional organization, the AAFP should promote the highest ethical standards. We owe our patients such unfettered relationships. The AAFP should exercise its opt-out clause with The Coca-Cola Company.

All things do not go better with Coke.

Flu season is upon us. But every time I hear that simple question or a request for the latest H1N1 update, I am dismayed that we don’t have a robust system for distributing vaccines.

Our university hospital debated mandating flu vaccination for health care professionals—a sensible approach, given that we care for some of Cincinnati’s sickest and most complicated patients. There was just one hitch: We don’t have an adequate supply of vaccine. Sure, we ordered enough, but like many health systems and providers, we received only about half of what we need (the result of a production problem, we were told). We suggested that our CEO call Kroger, a Cincinnati-based food chain, to see if we could share its supply of flu vaccine.

Accessing H1N1 vaccine involves a Byzantine process that we have yet to figure out. Call the Health Department? See if CVS has it? Acquire a secret decoder ring?

How hard is it to distribute a commodity to the places with the greatest need? Pretty difficult, it would seem. The initial distribution of antivirals ran afoul because no one thought about storage requirements. And, for some unexplained reason, major store chains like Kroger, Walgreens, and CVS all received sufficient quantities; health systems and doctors’ offices did not.

State health departments are supposed to solve such problems, but many offer little help—promoting parallel immunization clinics, in some cases, rather than redirecting immunization supplies to patient-centered medical homes. Inadequate reimbursement, multiple registries, and complex guidelines make matters worse.

Here is my simple solution:

• Offer manufacturers incentives to produce an adequate supply of vaccine.
• Centralize distribution, and supply vaccine to health care facilities and providers first—before retailers.
• Require that every insurer cover CDC-recommended vaccination at 10% above cost.
• Integrate vaccination registries into the major electronic health record systemS, and assure transfer of immunization information from every outside point of care to the primary care medical home.

My final suggestion? Recommend that everyone be vaccinated. Maybe next year I’ll be able to tell my patients, “Of course, you can have that flu shot today!”

Flu season is upon us. But every time I hear that simple question or a request for the latest H1N1 update, I am dismayed that we don’t have a robust system for distributing vaccines.

Our university hospital debated mandating flu vaccination for health care professionals—a sensible approach, given that we care for some of Cincinnati’s sickest and most complicated patients. There was just one hitch: We don’t have an adequate supply of vaccine. Sure, we ordered enough, but like many health systems and providers, we received only about half of what we need (the result of a production problem, we were told). We suggested that our CEO call Kroger, a Cincinnati-based food chain, to see if we could share its supply of flu vaccine.

Accessing H1N1 vaccine involves a Byzantine process that we have yet to figure out. Call the Health Department? See if CVS has it? Acquire a secret decoder ring?

How hard is it to distribute a commodity to the places with the greatest need? Pretty difficult, it would seem. The initial distribution of antivirals ran afoul because no one thought about storage requirements. And, for some unexplained reason, major store chains like Kroger, Walgreens, and CVS all received sufficient quantities; health systems and doctors’ offices did not.

State health departments are supposed to solve such problems, but many offer little help—promoting parallel immunization clinics, in some cases, rather than redirecting immunization supplies to patient-centered medical homes. Inadequate reimbursement, multiple registries, and complex guidelines make matters worse.

Here is my simple solution:

• Offer manufacturers incentives to produce an adequate supply of vaccine.
• Centralize distribution, and supply vaccine to health care facilities and providers first—before retailers.
• Require that every insurer cover CDC-recommended vaccination at 10% above cost.
• Integrate vaccination registries into the major electronic health record systemS, and assure transfer of immunization information from every outside point of care to the primary care medical home.

My final suggestion? Recommend that everyone be vaccinated. Maybe next year I’ll be able to tell my patients, “Of course, you can have that flu shot today!”

Flu season is upon us. But every time I hear that simple question or a request for the latest H1N1 update, I am dismayed that we don’t have a robust system for distributing vaccines.

Our university hospital debated mandating flu vaccination for health care professionals—a sensible approach, given that we care for some of Cincinnati’s sickest and most complicated patients. There was just one hitch: We don’t have an adequate supply of vaccine. Sure, we ordered enough, but like many health systems and providers, we received only about half of what we need (the result of a production problem, we were told). We suggested that our CEO call Kroger, a Cincinnati-based food chain, to see if we could share its supply of flu vaccine.

Accessing H1N1 vaccine involves a Byzantine process that we have yet to figure out. Call the Health Department? See if CVS has it? Acquire a secret decoder ring?

How hard is it to distribute a commodity to the places with the greatest need? Pretty difficult, it would seem. The initial distribution of antivirals ran afoul because no one thought about storage requirements. And, for some unexplained reason, major store chains like Kroger, Walgreens, and CVS all received sufficient quantities; health systems and doctors’ offices did not.

State health departments are supposed to solve such problems, but many offer little help—promoting parallel immunization clinics, in some cases, rather than redirecting immunization supplies to patient-centered medical homes. Inadequate reimbursement, multiple registries, and complex guidelines make matters worse.

Here is my simple solution:

• Offer manufacturers incentives to produce an adequate supply of vaccine.
• Centralize distribution, and supply vaccine to health care facilities and providers first—before retailers.
• Require that every insurer cover CDC-recommended vaccination at 10% above cost.
• Integrate vaccination registries into the major electronic health record systemS, and assure transfer of immunization information from every outside point of care to the primary care medical home.

My final suggestion? Recommend that everyone be vaccinated. Maybe next year I’ll be able to tell my patients, “Of course, you can have that flu shot today!”

In Victorian times, people embraced elaborate death rituals, including mourning clothes, covered mirrors, stopped clocks—even coffin bells lest one was buried alive. Today, we have euphemisms for death: passing, kicking the bucket, departing this world for a better place. As physicians, we avoid death assiduously, even though we face our patients’ mortality on a regular basis. I worry about this disconnect.

My own awakening to death began with the loss of our son, Michael, to sepsis shortly after his birth. This was followed by the death of twins, Sarah and Elizabeth, who were born quite prematurely. Before these events, death was an abstraction, seemingly confined to those with the misfortune to be stricken by a rare disease and to elderly grandparents after a long and productive life.

More recently, I’ve had my perspective broadened further, by 3 individuals—a patient, a friend, and a colleague—all diagnosed with advanced colon cancer. The first of these, my patient, greets me regularly with the same question: “Did you get your colonoscopy yet?” I sheepishly acknowledge that it remains on my to-do list, crowded out by “higher priorities.” I meditate on this choice—I don’t think it is driven by fear of the procedure or concern about finding cancer, or anything more than the complexity of scheduling a test that will undoubtedly require the loss of a couple of days in the endless struggle to balance family, work, and self. Or could it be something more?

The second, a good friend of the family, lives in the shadow of death daily, yet she smiles and enjoys what days she has. Surgery, conventional chemotherapy, clinical trials—her options have diminished as her cancer gained the upper hand. We’d promised to share a special bottle of wine with her and her husband. Just a few days ago, she ventured that we should get together without delay.

Finally, my colleague writes on her blog about dividing perennials, amid a report on survival statistics and the nuances of tumor markers. I bought a book she mentioned, Who Dies? by Stephen and Ondrea Levine. Borrowing from Native American, Zen, Chinese, and Indian traditions, the authors explore “conscious dying.” They write, “…wholeness is not seen as the duration one has lived but rather the fullness with which one enters each complete moment.” I find myself wondering: When does death begin? Is death an end or a process?

While I remain a crusader for life, I am gradually facing the futility of this fight and recognizing the need to focus on both living and dying deliberately, aware and unafraid. The lesson I take from these experiences is the importance of talking to patients about end-of-life decisions on an ongoing basis so we can help them to live well and die well.

In Victorian times, people embraced elaborate death rituals, including mourning clothes, covered mirrors, stopped clocks—even coffin bells lest one was buried alive. Today, we have euphemisms for death: passing, kicking the bucket, departing this world for a better place. As physicians, we avoid death assiduously, even though we face our patients’ mortality on a regular basis. I worry about this disconnect.

My own awakening to death began with the loss of our son, Michael, to sepsis shortly after his birth. This was followed by the death of twins, Sarah and Elizabeth, who were born quite prematurely. Before these events, death was an abstraction, seemingly confined to those with the misfortune to be stricken by a rare disease and to elderly grandparents after a long and productive life.

More recently, I’ve had my perspective broadened further, by 3 individuals—a patient, a friend, and a colleague—all diagnosed with advanced colon cancer. The first of these, my patient, greets me regularly with the same question: “Did you get your colonoscopy yet?” I sheepishly acknowledge that it remains on my to-do list, crowded out by “higher priorities.” I meditate on this choice—I don’t think it is driven by fear of the procedure or concern about finding cancer, or anything more than the complexity of scheduling a test that will undoubtedly require the loss of a couple of days in the endless struggle to balance family, work, and self. Or could it be something more?

The second, a good friend of the family, lives in the shadow of death daily, yet she smiles and enjoys what days she has. Surgery, conventional chemotherapy, clinical trials—her options have diminished as her cancer gained the upper hand. We’d promised to share a special bottle of wine with her and her husband. Just a few days ago, she ventured that we should get together without delay.

Finally, my colleague writes on her blog about dividing perennials, amid a report on survival statistics and the nuances of tumor markers. I bought a book she mentioned, Who Dies? by Stephen and Ondrea Levine. Borrowing from Native American, Zen, Chinese, and Indian traditions, the authors explore “conscious dying.” They write, “…wholeness is not seen as the duration one has lived but rather the fullness with which one enters each complete moment.” I find myself wondering: When does death begin? Is death an end or a process?

While I remain a crusader for life, I am gradually facing the futility of this fight and recognizing the need to focus on both living and dying deliberately, aware and unafraid. The lesson I take from these experiences is the importance of talking to patients about end-of-life decisions on an ongoing basis so we can help them to live well and die well.

In Victorian times, people embraced elaborate death rituals, including mourning clothes, covered mirrors, stopped clocks—even coffin bells lest one was buried alive. Today, we have euphemisms for death: passing, kicking the bucket, departing this world for a better place. As physicians, we avoid death assiduously, even though we face our patients’ mortality on a regular basis. I worry about this disconnect.

My own awakening to death began with the loss of our son, Michael, to sepsis shortly after his birth. This was followed by the death of twins, Sarah and Elizabeth, who were born quite prematurely. Before these events, death was an abstraction, seemingly confined to those with the misfortune to be stricken by a rare disease and to elderly grandparents after a long and productive life.

More recently, I’ve had my perspective broadened further, by 3 individuals—a patient, a friend, and a colleague—all diagnosed with advanced colon cancer. The first of these, my patient, greets me regularly with the same question: “Did you get your colonoscopy yet?” I sheepishly acknowledge that it remains on my to-do list, crowded out by “higher priorities.” I meditate on this choice—I don’t think it is driven by fear of the procedure or concern about finding cancer, or anything more than the complexity of scheduling a test that will undoubtedly require the loss of a couple of days in the endless struggle to balance family, work, and self. Or could it be something more?

The second, a good friend of the family, lives in the shadow of death daily, yet she smiles and enjoys what days she has. Surgery, conventional chemotherapy, clinical trials—her options have diminished as her cancer gained the upper hand. We’d promised to share a special bottle of wine with her and her husband. Just a few days ago, she ventured that we should get together without delay.

Finally, my colleague writes on her blog about dividing perennials, amid a report on survival statistics and the nuances of tumor markers. I bought a book she mentioned, Who Dies? by Stephen and Ondrea Levine. Borrowing from Native American, Zen, Chinese, and Indian traditions, the authors explore “conscious dying.” They write, “…wholeness is not seen as the duration one has lived but rather the fullness with which one enters each complete moment.” I find myself wondering: When does death begin? Is death an end or a process?

While I remain a crusader for life, I am gradually facing the futility of this fight and recognizing the need to focus on both living and dying deliberately, aware and unafraid. The lesson I take from these experiences is the importance of talking to patients about end-of-life decisions on an ongoing basis so we can help them to live well and die well.

Every July brings a new crop of residents. And every year, they adapt to the demands of critically ill patients and to the plethora of arcane electronic health record systems—but they are utterly confounded by our coding and billing system.

Overheard recently:

“What’s the difference between a brief HPI and an extended HPI?”

“You mean I have to count these elements on every patient? You’ve got to be kidding!”

I can think of no more egregious waste in our current health care system than the legions of coders, consultants, and procedures in place to assure that we bill correctly and remain “compliant.” And don’t get me started on the arbitrary and political nature of assigning Relative Value Units, determining the geographic practice cost index, and figuring out the sustainable growth rate.

You couldn’t dream up a more dysfunctional and counterproductive system if you tried.

Rather than paying for outcomes or setting a clearly defined price for a particular service, we perpetuate a system that reduces physicians to piece workers and bookkeepers. Even after claims are submitted, our judgment and integrity are repeatedly questioned: Was that really a level 4? Did that patient really need that service? Was complex decision making really required?

Proposals to augment our fees with a capitated medical home payment or pay for performance may be a step in the right direction (if implemented well). Better yet, pay me $100 per visit or $79 a month for the typical patient, and eliminate E&M coding. When physicians report spending 3 hours each week—the equivalent of more than 3 weeks a year—on administrative work for health plans (substantially more time than is devoted to quality improvement), it is time to simplify.¹ Sure, some physicians will game the system, but they’ll be the same small minority who already do.

The solution is straightforward: Eliminate the legions of coding and compliance consultants. Create transparency. Provide enhanced pay for medical homes or key outcomes. And, above all, declare evaluation and management codes dead.

Every July brings a new crop of residents. And every year, they adapt to the demands of critically ill patients and to the plethora of arcane electronic health record systems—but they are utterly confounded by our coding and billing system.

Overheard recently:

“What’s the difference between a brief HPI and an extended HPI?”

“You mean I have to count these elements on every patient? You’ve got to be kidding!”

I can think of no more egregious waste in our current health care system than the legions of coders, consultants, and procedures in place to assure that we bill correctly and remain “compliant.” And don’t get me started on the arbitrary and political nature of assigning Relative Value Units, determining the geographic practice cost index, and figuring out the sustainable growth rate.

You couldn’t dream up a more dysfunctional and counterproductive system if you tried.

Rather than paying for outcomes or setting a clearly defined price for a particular service, we perpetuate a system that reduces physicians to piece workers and bookkeepers. Even after claims are submitted, our judgment and integrity are repeatedly questioned: Was that really a level 4? Did that patient really need that service? Was complex decision making really required?

Proposals to augment our fees with a capitated medical home payment or pay for performance may be a step in the right direction (if implemented well). Better yet, pay me $100 per visit or $79 a month for the typical patient, and eliminate E&M coding. When physicians report spending 3 hours each week—the equivalent of more than 3 weeks a year—on administrative work for health plans (substantially more time than is devoted to quality improvement), it is time to simplify.¹ Sure, some physicians will game the system, but they’ll be the same small minority who already do.

The solution is straightforward: Eliminate the legions of coding and compliance consultants. Create transparency. Provide enhanced pay for medical homes or key outcomes. And, above all, declare evaluation and management codes dead.

Every July brings a new crop of residents. And every year, they adapt to the demands of critically ill patients and to the plethora of arcane electronic health record systems—but they are utterly confounded by our coding and billing system.

Overheard recently:

“What’s the difference between a brief HPI and an extended HPI?”

“You mean I have to count these elements on every patient? You’ve got to be kidding!”

I can think of no more egregious waste in our current health care system than the legions of coders, consultants, and procedures in place to assure that we bill correctly and remain “compliant.” And don’t get me started on the arbitrary and political nature of assigning Relative Value Units, determining the geographic practice cost index, and figuring out the sustainable growth rate.

You couldn’t dream up a more dysfunctional and counterproductive system if you tried.

Rather than paying for outcomes or setting a clearly defined price for a particular service, we perpetuate a system that reduces physicians to piece workers and bookkeepers. Even after claims are submitted, our judgment and integrity are repeatedly questioned: Was that really a level 4? Did that patient really need that service? Was complex decision making really required?

Proposals to augment our fees with a capitated medical home payment or pay for performance may be a step in the right direction (if implemented well). Better yet, pay me $100 per visit or $79 a month for the typical patient, and eliminate E&M coding. When physicians report spending 3 hours each week—the equivalent of more than 3 weeks a year—on administrative work for health plans (substantially more time than is devoted to quality improvement), it is time to simplify.¹ Sure, some physicians will game the system, but they’ll be the same small minority who already do.

The solution is straightforward: Eliminate the legions of coding and compliance consultants. Create transparency. Provide enhanced pay for medical homes or key outcomes. And, above all, declare evaluation and management codes dead.

Her home is much as I remembered: immaculately clean, expensive art, and way too hot. She sits in her chair, a wisp of the woman she once was and more frail than I remembered. After a warm greeting, she raises her robe to show me her right leg and allows me to gently remove her slipper.

The foot is even more mottled, more black at the tips of the toes than blue. It hurts all the time, and the OxyContin does little to help. The foot is cool; the pulses imperceptible.

We discuss the recommendations of her local vascular surgeon—a rather heroic effort to perform a complicated bypass at the local medical school. Unfortunately, she missed the appointment for her urgent vascular evaluation: The office had called in the morning for a noon appointment, and without a ready means of transportation she’d arrived late, in the wrong office. (Her closest son lives over an hour away, and pleas for her to move closer are flatly rejected.) A new appointment is scheduled for the following Tuesday, the only time the doctor sees new patients.

She relays this story with a resigned weariness, complaining about the caretaker who took her to the wrong place. “I wish I could just die,” she concludes.

“Maybe you should go to the emergency room,” I venture. She mumbles something unintelligible. “I’m sorry, I didn’t hear you,” I say. But I do hear the fear in her voice, and I hear the pain and anguish. I want to protect her, to make it better. I love this old woman. Of course, I have my reasons. She is my mother.

As my mother awaits her visit with the vascular surgeon and a likely confrontation with a callous scalpel, I read—once again—about health care reform. Even with a “public option” and a trillion dollars of new investment, will my mother, and countless elders like her, ever be able to navigate our complicated health care system? Will elderly people who yearn for dignity and independence ever get the support required to safely remain in their own homes, secure in the knowledge that they can get the preventive and palliative care they need?

I wish I could reassure her. Instead I say, “Tuesday, Mom, Tuesday,” and leave with the echo of the fear in her voice ringing in my ears.

Her home is much as I remembered: immaculately clean, expensive art, and way too hot. She sits in her chair, a wisp of the woman she once was and more frail than I remembered. After a warm greeting, she raises her robe to show me her right leg and allows me to gently remove her slipper.

The foot is even more mottled, more black at the tips of the toes than blue. It hurts all the time, and the OxyContin does little to help. The foot is cool; the pulses imperceptible.

We discuss the recommendations of her local vascular surgeon—a rather heroic effort to perform a complicated bypass at the local medical school. Unfortunately, she missed the appointment for her urgent vascular evaluation: The office had called in the morning for a noon appointment, and without a ready means of transportation she’d arrived late, in the wrong office. (Her closest son lives over an hour away, and pleas for her to move closer are flatly rejected.) A new appointment is scheduled for the following Tuesday, the only time the doctor sees new patients.

She relays this story with a resigned weariness, complaining about the caretaker who took her to the wrong place. “I wish I could just die,” she concludes.

“Maybe you should go to the emergency room,” I venture. She mumbles something unintelligible. “I’m sorry, I didn’t hear you,” I say. But I do hear the fear in her voice, and I hear the pain and anguish. I want to protect her, to make it better. I love this old woman. Of course, I have my reasons. She is my mother.

As my mother awaits her visit with the vascular surgeon and a likely confrontation with a callous scalpel, I read—once again—about health care reform. Even with a “public option” and a trillion dollars of new investment, will my mother, and countless elders like her, ever be able to navigate our complicated health care system? Will elderly people who yearn for dignity and independence ever get the support required to safely remain in their own homes, secure in the knowledge that they can get the preventive and palliative care they need?

I wish I could reassure her. Instead I say, “Tuesday, Mom, Tuesday,” and leave with the echo of the fear in her voice ringing in my ears.

Her home is much as I remembered: immaculately clean, expensive art, and way too hot. She sits in her chair, a wisp of the woman she once was and more frail than I remembered. After a warm greeting, she raises her robe to show me her right leg and allows me to gently remove her slipper.

The foot is even more mottled, more black at the tips of the toes than blue. It hurts all the time, and the OxyContin does little to help. The foot is cool; the pulses imperceptible.

We discuss the recommendations of her local vascular surgeon—a rather heroic effort to perform a complicated bypass at the local medical school. Unfortunately, she missed the appointment for her urgent vascular evaluation: The office had called in the morning for a noon appointment, and without a ready means of transportation she’d arrived late, in the wrong office. (Her closest son lives over an hour away, and pleas for her to move closer are flatly rejected.) A new appointment is scheduled for the following Tuesday, the only time the doctor sees new patients.

She relays this story with a resigned weariness, complaining about the caretaker who took her to the wrong place. “I wish I could just die,” she concludes.

“Maybe you should go to the emergency room,” I venture. She mumbles something unintelligible. “I’m sorry, I didn’t hear you,” I say. But I do hear the fear in her voice, and I hear the pain and anguish. I want to protect her, to make it better. I love this old woman. Of course, I have my reasons. She is my mother.

As my mother awaits her visit with the vascular surgeon and a likely confrontation with a callous scalpel, I read—once again—about health care reform. Even with a “public option” and a trillion dollars of new investment, will my mother, and countless elders like her, ever be able to navigate our complicated health care system? Will elderly people who yearn for dignity and independence ever get the support required to safely remain in their own homes, secure in the knowledge that they can get the preventive and palliative care they need?

I wish I could reassure her. Instead I say, “Tuesday, Mom, Tuesday,” and leave with the echo of the fear in her voice ringing in my ears.

President Obama’s Council of Economic Advisers (CEA) released The Economic Case for Health Care Reform on June 2. The report, which is a masterful summary of the sad and unsustainable state of US health care, overlooks the key linchpin in the journey ahead: family physicians.

First, some highlights of the report:

• Health expenditures are expected to be 18% of gross domestic product in 2009.
• Slowing the annual growth rate of health care costs by 1.5 percentage points would increase GDP by more than 2% in 2020, and by nearly 8% in 2030.
• Bringing down health care costs would increase the income of a typical family of 4 by $2600 in 2020, and by $10,000 in 2030 (in 2009 dollars).
• Extending health insurance coverage to the uninsured would increase net economic well-being by roughly $100 billion a year.

How do we realize such staggering savings? According to the CEA, the following changes are imperative:

• Slow cost growth. (At a meeting with the President on May 11, key stakeholders—insurers and pharma among them—pledged to “bend the health care cost curve” by 1.5 percentage points per year.)
• Reorient the financial incentives of providers to value rather than volume.
• Conduct comparative effectiveness research.
• Expand performance measurement and feedback.
• Reduce fragmentation, particularly in administrative services.
• Target fraud and abuse aggressively.
• Engage patients in decision making.
• Expand coverage by establishing an insurance exchange and increasing the availability and affordability of health insurance.

But these changes—and savings—can be achieved only if we have a robust, and valued, primary care workforce. The administration may need to encourage medical students to enter family practice through payment reform, provide incentives for establishing patient-centered medical homes and delivering evidence-based care, or reconfigure reimbursement for graduate medical education. Whatever steps it takes, one thing is certain: Without more family physicians, this plan is doomed.

President Obama, are you listening?

President Obama’s Council of Economic Advisers (CEA) released The Economic Case for Health Care Reform on June 2. The report, which is a masterful summary of the sad and unsustainable state of US health care, overlooks the key linchpin in the journey ahead: family physicians.

First, some highlights of the report:

• Health expenditures are expected to be 18% of gross domestic product in 2009.
• Slowing the annual growth rate of health care costs by 1.5 percentage points would increase GDP by more than 2% in 2020, and by nearly 8% in 2030.
• Bringing down health care costs would increase the income of a typical family of 4 by $2600 in 2020, and by $10,000 in 2030 (in 2009 dollars).
• Extending health insurance coverage to the uninsured would increase net economic well-being by roughly $100 billion a year.

How do we realize such staggering savings? According to the CEA, the following changes are imperative:

• Slow cost growth. (At a meeting with the President on May 11, key stakeholders—insurers and pharma among them—pledged to “bend the health care cost curve” by 1.5 percentage points per year.)
• Reorient the financial incentives of providers to value rather than volume.
• Conduct comparative effectiveness research.
• Expand performance measurement and feedback.
• Reduce fragmentation, particularly in administrative services.
• Target fraud and abuse aggressively.
• Engage patients in decision making.
• Expand coverage by establishing an insurance exchange and increasing the availability and affordability of health insurance.

But these changes—and savings—can be achieved only if we have a robust, and valued, primary care workforce. The administration may need to encourage medical students to enter family practice through payment reform, provide incentives for establishing patient-centered medical homes and delivering evidence-based care, or reconfigure reimbursement for graduate medical education. Whatever steps it takes, one thing is certain: Without more family physicians, this plan is doomed.

President Obama, are you listening?

President Obama’s Council of Economic Advisers (CEA) released The Economic Case for Health Care Reform on June 2. The report, which is a masterful summary of the sad and unsustainable state of US health care, overlooks the key linchpin in the journey ahead: family physicians.

First, some highlights of the report:

• Health expenditures are expected to be 18% of gross domestic product in 2009.
• Slowing the annual growth rate of health care costs by 1.5 percentage points would increase GDP by more than 2% in 2020, and by nearly 8% in 2030.
• Bringing down health care costs would increase the income of a typical family of 4 by $2600 in 2020, and by $10,000 in 2030 (in 2009 dollars).
• Extending health insurance coverage to the uninsured would increase net economic well-being by roughly $100 billion a year.

How do we realize such staggering savings? According to the CEA, the following changes are imperative:

• Slow cost growth. (At a meeting with the President on May 11, key stakeholders—insurers and pharma among them—pledged to “bend the health care cost curve” by 1.5 percentage points per year.)
• Reorient the financial incentives of providers to value rather than volume.
• Conduct comparative effectiveness research.
• Expand performance measurement and feedback.
• Reduce fragmentation, particularly in administrative services.
• Target fraud and abuse aggressively.
• Engage patients in decision making.
• Expand coverage by establishing an insurance exchange and increasing the availability and affordability of health insurance.

But these changes—and savings—can be achieved only if we have a robust, and valued, primary care workforce. The administration may need to encourage medical students to enter family practice through payment reform, provide incentives for establishing patient-centered medical homes and delivering evidence-based care, or reconfigure reimbursement for graduate medical education. Whatever steps it takes, one thing is certain: Without more family physicians, this plan is doomed.

President Obama, are you listening?

Mrs. B makes her entrance in a peacock-inspired dress and a hat so flashy it would make Carmen Miranda envious. Decidedly middle-aged with a figure that’s distinctly Rubenesque, my patient makes no bones about her weight: “I’m fat, doctor, and I like my body the way it is.”

We begin with a bit of banter about her latest flamboyant outfit, her husband—a ne’er-do-well to whom she has been married for at least 40 years—and the dwindling value of our retirement plans. Then we go through her current problems: knee pain secondary to osteoarthritis, blood sugar and blood pressure that remain over 200, fatigue, and stress precipitated by her niece, who’s pregnant at 15.

“You know, I think you would really feel better if you lost just a few pounds,” I venture.

“Doctor, I’ve been fat since I was born, and there’s no turning back now,” she retorts.

Mrs. B has made it clear that she’s through with the litany of unsuccessful diets, failed exercise programs, and ineffective weight-loss medications, and she’s not about to have bariatric surgery. If there were a stage of change before precontemplation, Mrs. B would be its exemplar.

I find it hard to disagree.

While I would be the first to admit to the ravages of obesity and our growing national epidemic, I am not convinced that we have effective interventions to offer the majority of our overweight patients. I would venture that many patients would gain more self-acceptance and a greater sense of well-being if we acknowledged that there is little high-quality evidence that diet, exercise, and counseling lead to long-term weight control. Promoting a positive body image and managing other risk factors, I suspect, would be a better approach.

Still, as I add another antihypertensive and increase my patient’s dosage of Lantus, I negotiate yet another exercise plan. We part with encouraging words. Mrs. B promises to take her medications as prescribed and watch her diet during family gatherings; I challenge her to wear a “church hat” on her next visit. Unabashedly flirting now, Mrs. B flashes me a big smile. “You know I’d do anything for you, doc.”

Smiling back, I wave good-bye and turn to my next patient.

Mrs. B makes her entrance in a peacock-inspired dress and a hat so flashy it would make Carmen Miranda envious. Decidedly middle-aged with a figure that’s distinctly Rubenesque, my patient makes no bones about her weight: “I’m fat, doctor, and I like my body the way it is.”

We begin with a bit of banter about her latest flamboyant outfit, her husband—a ne’er-do-well to whom she has been married for at least 40 years—and the dwindling value of our retirement plans. Then we go through her current problems: knee pain secondary to osteoarthritis, blood sugar and blood pressure that remain over 200, fatigue, and stress precipitated by her niece, who’s pregnant at 15.

“You know, I think you would really feel better if you lost just a few pounds,” I venture.

“Doctor, I’ve been fat since I was born, and there’s no turning back now,” she retorts.

Mrs. B has made it clear that she’s through with the litany of unsuccessful diets, failed exercise programs, and ineffective weight-loss medications, and she’s not about to have bariatric surgery. If there were a stage of change before precontemplation, Mrs. B would be its exemplar.

I find it hard to disagree.

While I would be the first to admit to the ravages of obesity and our growing national epidemic, I am not convinced that we have effective interventions to offer the majority of our overweight patients. I would venture that many patients would gain more self-acceptance and a greater sense of well-being if we acknowledged that there is little high-quality evidence that diet, exercise, and counseling lead to long-term weight control. Promoting a positive body image and managing other risk factors, I suspect, would be a better approach.

Still, as I add another antihypertensive and increase my patient’s dosage of Lantus, I negotiate yet another exercise plan. We part with encouraging words. Mrs. B promises to take her medications as prescribed and watch her diet during family gatherings; I challenge her to wear a “church hat” on her next visit. Unabashedly flirting now, Mrs. B flashes me a big smile. “You know I’d do anything for you, doc.”

Smiling back, I wave good-bye and turn to my next patient.

Mrs. B makes her entrance in a peacock-inspired dress and a hat so flashy it would make Carmen Miranda envious. Decidedly middle-aged with a figure that’s distinctly Rubenesque, my patient makes no bones about her weight: “I’m fat, doctor, and I like my body the way it is.”

We begin with a bit of banter about her latest flamboyant outfit, her husband—a ne’er-do-well to whom she has been married for at least 40 years—and the dwindling value of our retirement plans. Then we go through her current problems: knee pain secondary to osteoarthritis, blood sugar and blood pressure that remain over 200, fatigue, and stress precipitated by her niece, who’s pregnant at 15.

“You know, I think you would really feel better if you lost just a few pounds,” I venture.

“Doctor, I’ve been fat since I was born, and there’s no turning back now,” she retorts.

Mrs. B has made it clear that she’s through with the litany of unsuccessful diets, failed exercise programs, and ineffective weight-loss medications, and she’s not about to have bariatric surgery. If there were a stage of change before precontemplation, Mrs. B would be its exemplar.

I find it hard to disagree.

While I would be the first to admit to the ravages of obesity and our growing national epidemic, I am not convinced that we have effective interventions to offer the majority of our overweight patients. I would venture that many patients would gain more self-acceptance and a greater sense of well-being if we acknowledged that there is little high-quality evidence that diet, exercise, and counseling lead to long-term weight control. Promoting a positive body image and managing other risk factors, I suspect, would be a better approach.

Still, as I add another antihypertensive and increase my patient’s dosage of Lantus, I negotiate yet another exercise plan. We part with encouraging words. Mrs. B promises to take her medications as prescribed and watch her diet during family gatherings; I challenge her to wear a “church hat” on her next visit. Unabashedly flirting now, Mrs. B flashes me a big smile. “You know I’d do anything for you, doc.”

Smiling back, I wave good-bye and turn to my next patient.

Picture your home: your front door, your favorite place to read, your bedroom, your patio. Now imagine your home in the midst of a slum, bounded on every side by ramshackle buildings, deafening noise, and mountains of debris.

Could this be the future of the patient-centered medical home? Are we becoming too myopic, in effect developing a highly functioning island in a sea of dysfunction? To avoid that fate, we need to look beyond our office walls at the larger environment in which we practice.

What will it take to create patient-centered medical communities? Here are some thoughts that come to mind:

Specialty care. Like it or not, many primary care patients will continue to get specialty care—when it’s appropriate and, at times, when it’s not. What standards for 2-way communication and care planning do we expect? How do we rationally choose specialty services based on outcomes and specialists based on competence and efficiency? What should we do if our patients prefer to “live” in other houses—with the cardiologist, the nurse practitioner, or maybe even the naturopath?

Patient handoffs. What standards do we expect for handoffs to other homes, including temporary ones such as hospitals, nursing homes, or hospices? Electronic communication will help, but we still must ensure that every member of the health care team has the just-in-time information that’s crucial to decision making.

How can we collaborate with clinicians in settings such as emergency departments and urgent care clinics? How can we align incentives?

Public health. What kind of coordination do we need with the mental health/behavioral health and social services communities, and other public health partners? Is it realistic to expect family physicians to be the arbiters for all such services? How can we reform the payment and carve-out structure to make mental health services available in our practices—and what services should we routinely refer patients to other practitioners for?

Finally, how do we judge the success of the medical home—on the basis of our services alone, or on the integration of our services with others in the community?

Without thought to the development of communities where all care is accessible, coordinated, patient-centered, and efficient, I fear, we’ll build fine medical homes in an old, blighted neighborhood where no one’s expectations are met.

Picture your home: your front door, your favorite place to read, your bedroom, your patio. Now imagine your home in the midst of a slum, bounded on every side by ramshackle buildings, deafening noise, and mountains of debris.

Could this be the future of the patient-centered medical home? Are we becoming too myopic, in effect developing a highly functioning island in a sea of dysfunction? To avoid that fate, we need to look beyond our office walls at the larger environment in which we practice.

What will it take to create patient-centered medical communities? Here are some thoughts that come to mind:

Specialty care. Like it or not, many primary care patients will continue to get specialty care—when it’s appropriate and, at times, when it’s not. What standards for 2-way communication and care planning do we expect? How do we rationally choose specialty services based on outcomes and specialists based on competence and efficiency? What should we do if our patients prefer to “live” in other houses—with the cardiologist, the nurse practitioner, or maybe even the naturopath?

Patient handoffs. What standards do we expect for handoffs to other homes, including temporary ones such as hospitals, nursing homes, or hospices? Electronic communication will help, but we still must ensure that every member of the health care team has the just-in-time information that’s crucial to decision making.

How can we collaborate with clinicians in settings such as emergency departments and urgent care clinics? How can we align incentives?

Public health. What kind of coordination do we need with the mental health/behavioral health and social services communities, and other public health partners? Is it realistic to expect family physicians to be the arbiters for all such services? How can we reform the payment and carve-out structure to make mental health services available in our practices—and what services should we routinely refer patients to other practitioners for?

Finally, how do we judge the success of the medical home—on the basis of our services alone, or on the integration of our services with others in the community?

Without thought to the development of communities where all care is accessible, coordinated, patient-centered, and efficient, I fear, we’ll build fine medical homes in an old, blighted neighborhood where no one’s expectations are met.

Picture your home: your front door, your favorite place to read, your bedroom, your patio. Now imagine your home in the midst of a slum, bounded on every side by ramshackle buildings, deafening noise, and mountains of debris.

Could this be the future of the patient-centered medical home? Are we becoming too myopic, in effect developing a highly functioning island in a sea of dysfunction? To avoid that fate, we need to look beyond our office walls at the larger environment in which we practice.

What will it take to create patient-centered medical communities? Here are some thoughts that come to mind:

Specialty care. Like it or not, many primary care patients will continue to get specialty care—when it’s appropriate and, at times, when it’s not. What standards for 2-way communication and care planning do we expect? How do we rationally choose specialty services based on outcomes and specialists based on competence and efficiency? What should we do if our patients prefer to “live” in other houses—with the cardiologist, the nurse practitioner, or maybe even the naturopath?

Patient handoffs. What standards do we expect for handoffs to other homes, including temporary ones such as hospitals, nursing homes, or hospices? Electronic communication will help, but we still must ensure that every member of the health care team has the just-in-time information that’s crucial to decision making.

How can we collaborate with clinicians in settings such as emergency departments and urgent care clinics? How can we align incentives?

Public health. What kind of coordination do we need with the mental health/behavioral health and social services communities, and other public health partners? Is it realistic to expect family physicians to be the arbiters for all such services? How can we reform the payment and carve-out structure to make mental health services available in our practices—and what services should we routinely refer patients to other practitioners for?

Finally, how do we judge the success of the medical home—on the basis of our services alone, or on the integration of our services with others in the community?

Without thought to the development of communities where all care is accessible, coordinated, patient-centered, and efficient, I fear, we’ll build fine medical homes in an old, blighted neighborhood where no one’s expectations are met.

Dinner at our house is not a pretty affair, what with an ever-changing constellation of family, friends, and felines; a cacophony of conversations; and a telltale tapping in the background. Kids on cell phones, PDAs, and who-knows-what other devices are busy accessing instant messages, bidding on eBay, and exchanging e-mail messages with their pals a continent away. It’s enough to make anyone feel like a Luddite.

The feeling remains as I sit down at my computer in February to write this editorial, which will be printed in a few weeks, make its way through the mail system, and finally land in your mail box in early March.

So when, at the journal, we sit down to discuss the future of publishing, I hold myself suspect. I hate Blackboard (an online learning system) with a passion. I can’t understand why anyone would want a Second Life (a 3-D virtual world); managing my first life is complicated enough. And who needs a wiki, when “old-fashioned” electronic drafts circulated via e-mail will do?

But looking around my dinner table, I am convinced that we’re in the midst of a communications evolution—no, make that a revolution.

That’s where you come in.

As many of you know, JFP has recently begun posting audiocasts, which are available at www.jfponline.com and accompany every issue. We’ve also set up a Facebook page and are exploring blogs and Twitter. But asking a middle-aged, decidedly low-tech family physician like me what technology can best meet your needs is like asking the Iceman about the future of refrigeration.

That’s why I’m asking you to answer 3 questions:

1. What new communication technologies do you use regularly?
2. What new communication technologies would you like to try, provided the content was compelling?
3. Would you like to see more JFP audiocasts, and would you read a JFP blog, check us out on Facebook, or follow us on Twitter?

I look forward to your comments and suggestions. You can e-mail me at jfp@fammed.uc.edu, or post a comment to this article. In the meantime, I’ve got to make a telephone call—on my landline.

P.S. Confused about the meaning of wikis, blogs, Blackboard, or Twitter? You’ll find definitions at www.wikipedia.org.

Dinner at our house is not a pretty affair, what with an ever-changing constellation of family, friends, and felines; a cacophony of conversations; and a telltale tapping in the background. Kids on cell phones, PDAs, and who-knows-what other devices are busy accessing instant messages, bidding on eBay, and exchanging e-mail messages with their pals a continent away. It’s enough to make anyone feel like a Luddite.

The feeling remains as I sit down at my computer in February to write this editorial, which will be printed in a few weeks, make its way through the mail system, and finally land in your mail box in early March.

So when, at the journal, we sit down to discuss the future of publishing, I hold myself suspect. I hate Blackboard (an online learning system) with a passion. I can’t understand why anyone would want a Second Life (a 3-D virtual world); managing my first life is complicated enough. And who needs a wiki, when “old-fashioned” electronic drafts circulated via e-mail will do?

But looking around my dinner table, I am convinced that we’re in the midst of a communications evolution—no, make that a revolution.

That’s where you come in.

As many of you know, JFP has recently begun posting audiocasts, which are available at www.jfponline.com and accompany every issue. We’ve also set up a Facebook page and are exploring blogs and Twitter. But asking a middle-aged, decidedly low-tech family physician like me what technology can best meet your needs is like asking the Iceman about the future of refrigeration.

That’s why I’m asking you to answer 3 questions:

1. What new communication technologies do you use regularly?
2. What new communication technologies would you like to try, provided the content was compelling?
3. Would you like to see more JFP audiocasts, and would you read a JFP blog, check us out on Facebook, or follow us on Twitter?

I look forward to your comments and suggestions. You can e-mail me at jfp@fammed.uc.edu, or post a comment to this article. In the meantime, I’ve got to make a telephone call—on my landline.

P.S. Confused about the meaning of wikis, blogs, Blackboard, or Twitter? You’ll find definitions at www.wikipedia.org.

Dinner at our house is not a pretty affair, what with an ever-changing constellation of family, friends, and felines; a cacophony of conversations; and a telltale tapping in the background. Kids on cell phones, PDAs, and who-knows-what other devices are busy accessing instant messages, bidding on eBay, and exchanging e-mail messages with their pals a continent away. It’s enough to make anyone feel like a Luddite.

The feeling remains as I sit down at my computer in February to write this editorial, which will be printed in a few weeks, make its way through the mail system, and finally land in your mail box in early March.

So when, at the journal, we sit down to discuss the future of publishing, I hold myself suspect. I hate Blackboard (an online learning system) with a passion. I can’t understand why anyone would want a Second Life (a 3-D virtual world); managing my first life is complicated enough. And who needs a wiki, when “old-fashioned” electronic drafts circulated via e-mail will do?

But looking around my dinner table, I am convinced that we’re in the midst of a communications evolution—no, make that a revolution.

That’s where you come in.

As many of you know, JFP has recently begun posting audiocasts, which are available at www.jfponline.com and accompany every issue. We’ve also set up a Facebook page and are exploring blogs and Twitter. But asking a middle-aged, decidedly low-tech family physician like me what technology can best meet your needs is like asking the Iceman about the future of refrigeration.

That’s why I’m asking you to answer 3 questions:

1. What new communication technologies do you use regularly?
2. What new communication technologies would you like to try, provided the content was compelling?
3. Would you like to see more JFP audiocasts, and would you read a JFP blog, check us out on Facebook, or follow us on Twitter?

I look forward to your comments and suggestions. You can e-mail me at jfp@fammed.uc.edu, or post a comment to this article. In the meantime, I’ve got to make a telephone call—on my landline.

P.S. Confused about the meaning of wikis, blogs, Blackboard, or Twitter? You’ll find definitions at www.wikipedia.org.