Jeff Susman, MD

“Damn, my cell phone says no service.”

Leaving the reach of the electronic grid is getting harder, and when we do, many of us suffer an instant panic attack. You may remember those quaint days, pre-Microsoft and Sprint, when you went on vacation and gave nary a thought to work—no laptop, no cell phone, no communication unless a true emergency. But now I schlep all the accoutrements of the plugged-in age with me, lest I miss a single electron of significance. God forbid I delay the notice of the steam plant shutdown, a helpful e-mail offering a unique investment opportunity, or a way to improve my sex life. Even our camp (that’s Down East for summer home in Maine) provides reliable phone service and Internet and our cruise ship to Antarctica boasted satellite service. Our lives have become one Sisyphean attempt to better communicate by always being accessible.

So hiking with my oldest son in the Great North Woods of New Hampshire provided a welcome respite from information overload, despite our initial signs of withdrawal. A daily routine of boiling water, eating sensibly, and exercising regularly (not to mention the beautiful final days of summer) provided a cleansing antidote to 24/7 electronic addiction. Listening to loons, raptors, and crickets replaced the constant cell phone cacophony and e-mail chatter. Indeed, not only did we actually have time to focus and truly listen to one another, but it was nice to validate Twain’s sentiment, “When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in 7 years.”

So mark my vote for a day of voluntary cellular celibacy and e-mail escape. Call it “quiet time.” And just maybe we can remember what it is like to have a single, focused conversation and not multitask—a chance to live in the moment and not be “a thousand miles away.”

I invite you to turn off, tune out, and drop out—deliver yourself from the white noise of your daily life. Give yourself the gift of stillness.

“Damn, my cell phone says no service.”

Leaving the reach of the electronic grid is getting harder, and when we do, many of us suffer an instant panic attack. You may remember those quaint days, pre-Microsoft and Sprint, when you went on vacation and gave nary a thought to work—no laptop, no cell phone, no communication unless a true emergency. But now I schlep all the accoutrements of the plugged-in age with me, lest I miss a single electron of significance. God forbid I delay the notice of the steam plant shutdown, a helpful e-mail offering a unique investment opportunity, or a way to improve my sex life. Even our camp (that’s Down East for summer home in Maine) provides reliable phone service and Internet and our cruise ship to Antarctica boasted satellite service. Our lives have become one Sisyphean attempt to better communicate by always being accessible.

So hiking with my oldest son in the Great North Woods of New Hampshire provided a welcome respite from information overload, despite our initial signs of withdrawal. A daily routine of boiling water, eating sensibly, and exercising regularly (not to mention the beautiful final days of summer) provided a cleansing antidote to 24/7 electronic addiction. Listening to loons, raptors, and crickets replaced the constant cell phone cacophony and e-mail chatter. Indeed, not only did we actually have time to focus and truly listen to one another, but it was nice to validate Twain’s sentiment, “When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in 7 years.”

So mark my vote for a day of voluntary cellular celibacy and e-mail escape. Call it “quiet time.” And just maybe we can remember what it is like to have a single, focused conversation and not multitask—a chance to live in the moment and not be “a thousand miles away.”

I invite you to turn off, tune out, and drop out—deliver yourself from the white noise of your daily life. Give yourself the gift of stillness.

“Damn, my cell phone says no service.”

Leaving the reach of the electronic grid is getting harder, and when we do, many of us suffer an instant panic attack. You may remember those quaint days, pre-Microsoft and Sprint, when you went on vacation and gave nary a thought to work—no laptop, no cell phone, no communication unless a true emergency. But now I schlep all the accoutrements of the plugged-in age with me, lest I miss a single electron of significance. God forbid I delay the notice of the steam plant shutdown, a helpful e-mail offering a unique investment opportunity, or a way to improve my sex life. Even our camp (that’s Down East for summer home in Maine) provides reliable phone service and Internet and our cruise ship to Antarctica boasted satellite service. Our lives have become one Sisyphean attempt to better communicate by always being accessible.

So hiking with my oldest son in the Great North Woods of New Hampshire provided a welcome respite from information overload, despite our initial signs of withdrawal. A daily routine of boiling water, eating sensibly, and exercising regularly (not to mention the beautiful final days of summer) provided a cleansing antidote to 24/7 electronic addiction. Listening to loons, raptors, and crickets replaced the constant cell phone cacophony and e-mail chatter. Indeed, not only did we actually have time to focus and truly listen to one another, but it was nice to validate Twain’s sentiment, “When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in 7 years.”

So mark my vote for a day of voluntary cellular celibacy and e-mail escape. Call it “quiet time.” And just maybe we can remember what it is like to have a single, focused conversation and not multitask—a chance to live in the moment and not be “a thousand miles away.”

I invite you to turn off, tune out, and drop out—deliver yourself from the white noise of your daily life. Give yourself the gift of stillness.

Hey doc, I hear you’re trying to kill me with that diabetes drug you got me on.”

So began my conversation with MJ, an overweight man with type 2 diabetes who, despite counseling, resolutely smokes a pack of cigarettes a day.

Perhaps you’ve had a similar encounter with a patient of yours who’s taking rosiglitazone (Avandia). As I write this, the news is awash with reports of the FDA Panel that voted 20-3 that rosiglitazone may increase the chances of a heart attack and 22-1 to keep the drug on the market. Small solace to the 7 million MJs worldwide who see some irony in remaining on a drug that has caused a “virtual public health emergency.”¹

So where do we go from here?

Discussing the matter with patients is not easy, given that the facts are not black and white. Taken together, the data from the original meta-analysis by Nissen,² the analysis of the RECORD trial,³ and GlaxoSmithKline’s own analysis⁴ do not conclusively demonstrate either cardiovascular risk or benefit from rosiglitazone or provide a robust comparison to a full range of alternative therapies. While most experts believe (as do I) that it is unlikely that rosiglitazone reduces cardiac events in patients with diabetes, what we actually advise individual patients remains more challenging. Consider:

1. The magnitude of increased risk and variation of risk for classes of patients is largely unknown. With rosiglitazone’s association with congestive heart failure (see the RECORD study), it would seem prudent to steer away from peroxisome-proliferator-activated receptor (PPAR) agonists in patients with existing heart failure, or those who are at high risk.
2. The unintended consequences of switching from rosiglitazone to another agent, including factors such as new side effects, nonadherence, or relative worsening of glycemic control may obviate any increased risk in cardiovascular events.
3. The timing of risk is uncertain. A more robust time to event analysis is not possible given the data that’s available in the public domain. Thus, we do not know if cardiovascular risk is increased early, after a certain time, or if it escalates over time.
4. There is an alternative. Another PPAR, pioglitazone (Actos), may reduce macrovascular complications. However, the most robust trial—the PROspective pioglitAzone Clinical Trial In macroVascular Events (PROACTIVE)⁵—has been criticized for its methodology.

With all of this in mind, I’m going to counsel patients on the risks and benefits of ongoing rosiglitazone use and lean towards switching to another alternative.

I’m also going to advocate for change. I believe we need to:

• develop a robust drug surveillance system. And what better way to uncover drug side effects than equipping every family physician with electronic health records? I say ditch that new bomber, cut industry subsidies, and give us a system for capturing patient level data throughout our healthcare system.
• stop approving drugs based on surrogate outcomes such as glycemic control and require patient-oriented outcomes such as cardiovascular events or all cause mortality before giving new drugs the green light. The Journal of Family Practice has been a leader in emphasizing patient-oriented outcomes—isn’t it time the FDA did the same?
• require all pharmaceutical companies to publish patient level data from their trials, including all results (eg, side effects) from preliminary trials. It is clear that at least one other PPAR agonist in development was abandoned because of its association with cardiovascular events. Thus, it should be no surprise that such information might emerge during post-marketing surveillance.
• stop demonizing pharmaceutical companies and condemning the FDA, while ignoring the lamentable state of healthcare in the US.

Isn’t it time Congress, the FDA, Pharma, our major insurers, big business, and yes—family physicians—unite to foster a health system built on equity, evidence, effectiveness, and efficiency?

Hey doc, I hear you’re trying to kill me with that diabetes drug you got me on.”

So began my conversation with MJ, an overweight man with type 2 diabetes who, despite counseling, resolutely smokes a pack of cigarettes a day.

Perhaps you’ve had a similar encounter with a patient of yours who’s taking rosiglitazone (Avandia). As I write this, the news is awash with reports of the FDA Panel that voted 20-3 that rosiglitazone may increase the chances of a heart attack and 22-1 to keep the drug on the market. Small solace to the 7 million MJs worldwide who see some irony in remaining on a drug that has caused a “virtual public health emergency.”¹

So where do we go from here?

Discussing the matter with patients is not easy, given that the facts are not black and white. Taken together, the data from the original meta-analysis by Nissen,² the analysis of the RECORD trial,³ and GlaxoSmithKline’s own analysis⁴ do not conclusively demonstrate either cardiovascular risk or benefit from rosiglitazone or provide a robust comparison to a full range of alternative therapies. While most experts believe (as do I) that it is unlikely that rosiglitazone reduces cardiac events in patients with diabetes, what we actually advise individual patients remains more challenging. Consider:

1. The magnitude of increased risk and variation of risk for classes of patients is largely unknown. With rosiglitazone’s association with congestive heart failure (see the RECORD study), it would seem prudent to steer away from peroxisome-proliferator-activated receptor (PPAR) agonists in patients with existing heart failure, or those who are at high risk.
2. The unintended consequences of switching from rosiglitazone to another agent, including factors such as new side effects, nonadherence, or relative worsening of glycemic control may obviate any increased risk in cardiovascular events.
3. The timing of risk is uncertain. A more robust time to event analysis is not possible given the data that’s available in the public domain. Thus, we do not know if cardiovascular risk is increased early, after a certain time, or if it escalates over time.
4. There is an alternative. Another PPAR, pioglitazone (Actos), may reduce macrovascular complications. However, the most robust trial—the PROspective pioglitAzone Clinical Trial In macroVascular Events (PROACTIVE)⁵—has been criticized for its methodology.

With all of this in mind, I’m going to counsel patients on the risks and benefits of ongoing rosiglitazone use and lean towards switching to another alternative.

I’m also going to advocate for change. I believe we need to:

• develop a robust drug surveillance system. And what better way to uncover drug side effects than equipping every family physician with electronic health records? I say ditch that new bomber, cut industry subsidies, and give us a system for capturing patient level data throughout our healthcare system.
• stop approving drugs based on surrogate outcomes such as glycemic control and require patient-oriented outcomes such as cardiovascular events or all cause mortality before giving new drugs the green light. The Journal of Family Practice has been a leader in emphasizing patient-oriented outcomes—isn’t it time the FDA did the same?
• require all pharmaceutical companies to publish patient level data from their trials, including all results (eg, side effects) from preliminary trials. It is clear that at least one other PPAR agonist in development was abandoned because of its association with cardiovascular events. Thus, it should be no surprise that such information might emerge during post-marketing surveillance.
• stop demonizing pharmaceutical companies and condemning the FDA, while ignoring the lamentable state of healthcare in the US.

Isn’t it time Congress, the FDA, Pharma, our major insurers, big business, and yes—family physicians—unite to foster a health system built on equity, evidence, effectiveness, and efficiency?

Hey doc, I hear you’re trying to kill me with that diabetes drug you got me on.”

So began my conversation with MJ, an overweight man with type 2 diabetes who, despite counseling, resolutely smokes a pack of cigarettes a day.

Perhaps you’ve had a similar encounter with a patient of yours who’s taking rosiglitazone (Avandia). As I write this, the news is awash with reports of the FDA Panel that voted 20-3 that rosiglitazone may increase the chances of a heart attack and 22-1 to keep the drug on the market. Small solace to the 7 million MJs worldwide who see some irony in remaining on a drug that has caused a “virtual public health emergency.”¹

So where do we go from here?

Discussing the matter with patients is not easy, given that the facts are not black and white. Taken together, the data from the original meta-analysis by Nissen,² the analysis of the RECORD trial,³ and GlaxoSmithKline’s own analysis⁴ do not conclusively demonstrate either cardiovascular risk or benefit from rosiglitazone or provide a robust comparison to a full range of alternative therapies. While most experts believe (as do I) that it is unlikely that rosiglitazone reduces cardiac events in patients with diabetes, what we actually advise individual patients remains more challenging. Consider:

1. The magnitude of increased risk and variation of risk for classes of patients is largely unknown. With rosiglitazone’s association with congestive heart failure (see the RECORD study), it would seem prudent to steer away from peroxisome-proliferator-activated receptor (PPAR) agonists in patients with existing heart failure, or those who are at high risk.
2. The unintended consequences of switching from rosiglitazone to another agent, including factors such as new side effects, nonadherence, or relative worsening of glycemic control may obviate any increased risk in cardiovascular events.
3. The timing of risk is uncertain. A more robust time to event analysis is not possible given the data that’s available in the public domain. Thus, we do not know if cardiovascular risk is increased early, after a certain time, or if it escalates over time.
4. There is an alternative. Another PPAR, pioglitazone (Actos), may reduce macrovascular complications. However, the most robust trial—the PROspective pioglitAzone Clinical Trial In macroVascular Events (PROACTIVE)⁵—has been criticized for its methodology.

With all of this in mind, I’m going to counsel patients on the risks and benefits of ongoing rosiglitazone use and lean towards switching to another alternative.

I’m also going to advocate for change. I believe we need to:

• develop a robust drug surveillance system. And what better way to uncover drug side effects than equipping every family physician with electronic health records? I say ditch that new bomber, cut industry subsidies, and give us a system for capturing patient level data throughout our healthcare system.
• stop approving drugs based on surrogate outcomes such as glycemic control and require patient-oriented outcomes such as cardiovascular events or all cause mortality before giving new drugs the green light. The Journal of Family Practice has been a leader in emphasizing patient-oriented outcomes—isn’t it time the FDA did the same?
• require all pharmaceutical companies to publish patient level data from their trials, including all results (eg, side effects) from preliminary trials. It is clear that at least one other PPAR agonist in development was abandoned because of its association with cardiovascular events. Thus, it should be no surprise that such information might emerge during post-marketing surveillance.
• stop demonizing pharmaceutical companies and condemning the FDA, while ignoring the lamentable state of healthcare in the US.

Isn’t it time Congress, the FDA, Pharma, our major insurers, big business, and yes—family physicians—unite to foster a health system built on equity, evidence, effectiveness, and efficiency?

The woods welcome me with a chorus of birdsong and a murmur of crickets as I make my way up the forest road. The sun is just chasing the shadows from the trees as I turn down the unmarked drive. These shadows bear the bantering voices of men shuffling to greet the day. “Hey, Doc—park right over there by the van.” I’ve arrived at the Mount Airy Forest Shelter for the Homeless.

One nurse gathers information in a shelter building, while another works with me in the van. She knows the routine well: forms and paperwork, pills and shots, making referrals for what is possible, counseling acceptance for what is not. It could be any suburban practice—hypertension, diabetes, headaches, and back pain—but for a few details: the fellow who looks like an accountant, save for the distant look in his eyes and the voices in his head; the man who is HIV-positive and hasn’t had care for well over a year. One patient is trying to cadge some Vicodin (“Yeah, I didn’t think you would give me any”), another needs treatment for a penile discharge (what’s the revised recommendation?), still a third wants some Cialis. Slyly, I ask why. He quickly informs me that he gets “off the hill” now, as he begins making the transition from the shelter to life “outside.” But what about the cost of Cialis? He is more cagey in answering this question. “A little of this, a little of that,” he replies.

While their stories are unique, the endings are remarkably similar: After abusing alcohol/crack/meth, and exhausting the patience of family/friends/acquaintances, there was nowhere to turn but the streets. For some, “up on the hill” is a refuge from the temptations of the city below, an escape from the noise of the crowded shelters, another last chance to shake the specters of the past. A place to contemplate the tatters of their lives and slowly resolve to put those pieces back together. The clipping on the van’s bulletin board—a yellowing photo and story about a shelter worker who was herself homeless—is a testament that some actually succeed. As the morning draws to a close, I ask the nurse how many of the patients complete rehabilitation. She guesses 30% or 40%. Most will slip somewhere. But still, there is a chance.

I still don’t know how I feel about my experiences with the homeless—embarrassed that we can’t do better? Guilty that I can return to a comfortable home? Displeased I don’t do more? It is difficult to summon a simple answer.

Today, as I return home from weekend chores, I see a slightly disheveled man at the end of the exit ramp. His crude sign reads: “Homeless. Please help. God Bless.” Sure, I could spare a few bucks. Or maybe you could help dig my new patch of garden? Hey, I know a place where you can get 3 meals a day and free medical care. My reverie dissolves at the sound of a horn proclaiming the green light. I rush forward to hurry about the rest of my day and I don’t look back.

The woods welcome me with a chorus of birdsong and a murmur of crickets as I make my way up the forest road. The sun is just chasing the shadows from the trees as I turn down the unmarked drive. These shadows bear the bantering voices of men shuffling to greet the day. “Hey, Doc—park right over there by the van.” I’ve arrived at the Mount Airy Forest Shelter for the Homeless.

One nurse gathers information in a shelter building, while another works with me in the van. She knows the routine well: forms and paperwork, pills and shots, making referrals for what is possible, counseling acceptance for what is not. It could be any suburban practice—hypertension, diabetes, headaches, and back pain—but for a few details: the fellow who looks like an accountant, save for the distant look in his eyes and the voices in his head; the man who is HIV-positive and hasn’t had care for well over a year. One patient is trying to cadge some Vicodin (“Yeah, I didn’t think you would give me any”), another needs treatment for a penile discharge (what’s the revised recommendation?), still a third wants some Cialis. Slyly, I ask why. He quickly informs me that he gets “off the hill” now, as he begins making the transition from the shelter to life “outside.” But what about the cost of Cialis? He is more cagey in answering this question. “A little of this, a little of that,” he replies.

While their stories are unique, the endings are remarkably similar: After abusing alcohol/crack/meth, and exhausting the patience of family/friends/acquaintances, there was nowhere to turn but the streets. For some, “up on the hill” is a refuge from the temptations of the city below, an escape from the noise of the crowded shelters, another last chance to shake the specters of the past. A place to contemplate the tatters of their lives and slowly resolve to put those pieces back together. The clipping on the van’s bulletin board—a yellowing photo and story about a shelter worker who was herself homeless—is a testament that some actually succeed. As the morning draws to a close, I ask the nurse how many of the patients complete rehabilitation. She guesses 30% or 40%. Most will slip somewhere. But still, there is a chance.

I still don’t know how I feel about my experiences with the homeless—embarrassed that we can’t do better? Guilty that I can return to a comfortable home? Displeased I don’t do more? It is difficult to summon a simple answer.

Today, as I return home from weekend chores, I see a slightly disheveled man at the end of the exit ramp. His crude sign reads: “Homeless. Please help. God Bless.” Sure, I could spare a few bucks. Or maybe you could help dig my new patch of garden? Hey, I know a place where you can get 3 meals a day and free medical care. My reverie dissolves at the sound of a horn proclaiming the green light. I rush forward to hurry about the rest of my day and I don’t look back.

The woods welcome me with a chorus of birdsong and a murmur of crickets as I make my way up the forest road. The sun is just chasing the shadows from the trees as I turn down the unmarked drive. These shadows bear the bantering voices of men shuffling to greet the day. “Hey, Doc—park right over there by the van.” I’ve arrived at the Mount Airy Forest Shelter for the Homeless.

One nurse gathers information in a shelter building, while another works with me in the van. She knows the routine well: forms and paperwork, pills and shots, making referrals for what is possible, counseling acceptance for what is not. It could be any suburban practice—hypertension, diabetes, headaches, and back pain—but for a few details: the fellow who looks like an accountant, save for the distant look in his eyes and the voices in his head; the man who is HIV-positive and hasn’t had care for well over a year. One patient is trying to cadge some Vicodin (“Yeah, I didn’t think you would give me any”), another needs treatment for a penile discharge (what’s the revised recommendation?), still a third wants some Cialis. Slyly, I ask why. He quickly informs me that he gets “off the hill” now, as he begins making the transition from the shelter to life “outside.” But what about the cost of Cialis? He is more cagey in answering this question. “A little of this, a little of that,” he replies.

While their stories are unique, the endings are remarkably similar: After abusing alcohol/crack/meth, and exhausting the patience of family/friends/acquaintances, there was nowhere to turn but the streets. For some, “up on the hill” is a refuge from the temptations of the city below, an escape from the noise of the crowded shelters, another last chance to shake the specters of the past. A place to contemplate the tatters of their lives and slowly resolve to put those pieces back together. The clipping on the van’s bulletin board—a yellowing photo and story about a shelter worker who was herself homeless—is a testament that some actually succeed. As the morning draws to a close, I ask the nurse how many of the patients complete rehabilitation. She guesses 30% or 40%. Most will slip somewhere. But still, there is a chance.

I still don’t know how I feel about my experiences with the homeless—embarrassed that we can’t do better? Guilty that I can return to a comfortable home? Displeased I don’t do more? It is difficult to summon a simple answer.

Today, as I return home from weekend chores, I see a slightly disheveled man at the end of the exit ramp. His crude sign reads: “Homeless. Please help. God Bless.” Sure, I could spare a few bucks. Or maybe you could help dig my new patch of garden? Hey, I know a place where you can get 3 meals a day and free medical care. My reverie dissolves at the sound of a horn proclaiming the green light. I rush forward to hurry about the rest of my day and I don’t look back.

My EHR and I are beginning a long-term relationship and already I wonder if the honeymoon is over. To be fair, this is not the first rocky relationship I’ve had with an EHR. In a past life, I persevered during a lengthy EHR implementation, only to leave before the marriage was consummated. The second time around, the system we were implementing became a casualty of changing financial support and residency affiliation.

This time, I’m going the distance. Our academic, multispecialty group practice is in the midst of implementing a system that we believe will meet our needs.

The system is a far cry from what was being offered over a decade ago. We now have ready access to basic problem lists, allergies, and immunizations; better templates; and remote access to information. The system also affords us the ability to effectively communicate across a large group in many locations.

But the EHR is a demanding mistress. First, she requires you to change workflows: from the check-in process, to answering phone messages, to engaging learners effectively in care. Chaos ensues as newly trained staffers try to master the new screens. The quick message that I scribbled in response to a refill request now becomes an elaborate dance.

The time commitment for training, retraining, and updating is not insignificant. Add this to the need for periodic upgrades (let alone the upfront cost), and the personnel and software costs really begin to add up.

But my real gripe is that our EHR doesn’t “put out.” I can’t find all my patients who have diabetes and an A_1C greater than 7 or those with asthma who have frequent visits and are not on controller agents. The assistance we gain in billing and compliance is rudimentary compared to the fantastic system we’d used in our paper charts. Indeed, the ability to really use decision support of any form is archaic unless we buy more costly upgrades.

We have a terrific community-wide electronic flow of medical information through HealthBridge, but my EHR won’t sully her reputation with such imported data. Summaries of records look like a monkey produced them.

Now I know many of you will write and tell me your EHR prepares your coffee and humbly awaits your every command. But why shouldn’t every EHR support routine medical functions out of the box? Why do I have to argue with vendors, fellow group members, CFOs and who knows—probably the housekeeping service—to have a product that really supports the future of family medicine?

I have promised my EHR that I will talk to her nicely. If only she could show me some love in return.

My EHR and I are beginning a long-term relationship and already I wonder if the honeymoon is over. To be fair, this is not the first rocky relationship I’ve had with an EHR. In a past life, I persevered during a lengthy EHR implementation, only to leave before the marriage was consummated. The second time around, the system we were implementing became a casualty of changing financial support and residency affiliation.

This time, I’m going the distance. Our academic, multispecialty group practice is in the midst of implementing a system that we believe will meet our needs.

The system is a far cry from what was being offered over a decade ago. We now have ready access to basic problem lists, allergies, and immunizations; better templates; and remote access to information. The system also affords us the ability to effectively communicate across a large group in many locations.

But the EHR is a demanding mistress. First, she requires you to change workflows: from the check-in process, to answering phone messages, to engaging learners effectively in care. Chaos ensues as newly trained staffers try to master the new screens. The quick message that I scribbled in response to a refill request now becomes an elaborate dance.

The time commitment for training, retraining, and updating is not insignificant. Add this to the need for periodic upgrades (let alone the upfront cost), and the personnel and software costs really begin to add up.

But my real gripe is that our EHR doesn’t “put out.” I can’t find all my patients who have diabetes and an A_1C greater than 7 or those with asthma who have frequent visits and are not on controller agents. The assistance we gain in billing and compliance is rudimentary compared to the fantastic system we’d used in our paper charts. Indeed, the ability to really use decision support of any form is archaic unless we buy more costly upgrades.

We have a terrific community-wide electronic flow of medical information through HealthBridge, but my EHR won’t sully her reputation with such imported data. Summaries of records look like a monkey produced them.

Now I know many of you will write and tell me your EHR prepares your coffee and humbly awaits your every command. But why shouldn’t every EHR support routine medical functions out of the box? Why do I have to argue with vendors, fellow group members, CFOs and who knows—probably the housekeeping service—to have a product that really supports the future of family medicine?

I have promised my EHR that I will talk to her nicely. If only she could show me some love in return.

My EHR and I are beginning a long-term relationship and already I wonder if the honeymoon is over. To be fair, this is not the first rocky relationship I’ve had with an EHR. In a past life, I persevered during a lengthy EHR implementation, only to leave before the marriage was consummated. The second time around, the system we were implementing became a casualty of changing financial support and residency affiliation.

This time, I’m going the distance. Our academic, multispecialty group practice is in the midst of implementing a system that we believe will meet our needs.

The system is a far cry from what was being offered over a decade ago. We now have ready access to basic problem lists, allergies, and immunizations; better templates; and remote access to information. The system also affords us the ability to effectively communicate across a large group in many locations.

But the EHR is a demanding mistress. First, she requires you to change workflows: from the check-in process, to answering phone messages, to engaging learners effectively in care. Chaos ensues as newly trained staffers try to master the new screens. The quick message that I scribbled in response to a refill request now becomes an elaborate dance.

The time commitment for training, retraining, and updating is not insignificant. Add this to the need for periodic upgrades (let alone the upfront cost), and the personnel and software costs really begin to add up.

But my real gripe is that our EHR doesn’t “put out.” I can’t find all my patients who have diabetes and an A_1C greater than 7 or those with asthma who have frequent visits and are not on controller agents. The assistance we gain in billing and compliance is rudimentary compared to the fantastic system we’d used in our paper charts. Indeed, the ability to really use decision support of any form is archaic unless we buy more costly upgrades.

We have a terrific community-wide electronic flow of medical information through HealthBridge, but my EHR won’t sully her reputation with such imported data. Summaries of records look like a monkey produced them.

Now I know many of you will write and tell me your EHR prepares your coffee and humbly awaits your every command. But why shouldn’t every EHR support routine medical functions out of the box? Why do I have to argue with vendors, fellow group members, CFOs and who knows—probably the housekeeping service—to have a product that really supports the future of family medicine?

I have promised my EHR that I will talk to her nicely. If only she could show me some love in return.

My car was broken into and my Vicodin was stolen. “I lost my medicine; that’s why my drug test was negative.” “I have tried everything, and Oxy-Contin is the only medicine that helps.”

You’ve probably heard the same stories. They’re as far-fetched and transparent as the drop-in patient arriving at 5:15 pm on a Friday who is visiting from out of town and needs some of those Percocets to last him through the weekend.

We publish a number of articles in this journal about how to manage chronic pain, administer drug contracts, and work with the drug-seeking patient. But in the end, it’s not the science of half-lives and potencies that’s the challenge, it’s the patients themselves. Where do you set the boundaries? Do you give a person a second chance? Do you even bother with their forlorn stories in the first place?

And forlorn stories they usually are. The patient with chronic back pain who watched as his son was gunned down in cold blood; the college student whose family has more money than sense, more addictions than money; the housewife whose chronic headaches are a product of years of abuse. Who knows if their tales are fact or fiction?

I review the chart of my next patient and see a note from one of my partners. “Refused refill of Soma, Klonopin, and hydrocodone. Strongly suspect diversion.” Yes, I suppose that could well be the case. I’m roused from my reverie by one of the medical assistants. “Looks like your druggies are here in force today.”

Of course, there is no easy answer or ready explanation for our response. For me, it goes back to a lesson I learned during my residency. Mr A was nonadherent, often belligerent, and hospitalized urgently on a regular basis for multisystem failure and dialysis, largely due to his noncompliance. Dr M was the only person who would take care of this trying individual. When we asked with a mix of cynicism and awe, “Why do you put up with this GOMER?” Dr M patiently explained: “Because everyone deserves a doctor. Do you think Mr A wants to live like this? Sure he’s frustrating, but if I don’t care for him, who will?”

I snap back to the present and listen as my patient describes his experiences in school, his anxieties, and his challenges. I refill his prescriptions—another month of Soma, Klonopin, and hydrocodone—ask him to stop by the lab for his drug screen, and take a moment to chat with the medical student who’s working with me today.

“Dr Susman, why do you put up with him?”

The answer is easy. “Everyone deserves a family physician.”

And it sounds right to me.

My car was broken into and my Vicodin was stolen. “I lost my medicine; that’s why my drug test was negative.” “I have tried everything, and Oxy-Contin is the only medicine that helps.”

You’ve probably heard the same stories. They’re as far-fetched and transparent as the drop-in patient arriving at 5:15 pm on a Friday who is visiting from out of town and needs some of those Percocets to last him through the weekend.

We publish a number of articles in this journal about how to manage chronic pain, administer drug contracts, and work with the drug-seeking patient. But in the end, it’s not the science of half-lives and potencies that’s the challenge, it’s the patients themselves. Where do you set the boundaries? Do you give a person a second chance? Do you even bother with their forlorn stories in the first place?

And forlorn stories they usually are. The patient with chronic back pain who watched as his son was gunned down in cold blood; the college student whose family has more money than sense, more addictions than money; the housewife whose chronic headaches are a product of years of abuse. Who knows if their tales are fact or fiction?

I review the chart of my next patient and see a note from one of my partners. “Refused refill of Soma, Klonopin, and hydrocodone. Strongly suspect diversion.” Yes, I suppose that could well be the case. I’m roused from my reverie by one of the medical assistants. “Looks like your druggies are here in force today.”

Of course, there is no easy answer or ready explanation for our response. For me, it goes back to a lesson I learned during my residency. Mr A was nonadherent, often belligerent, and hospitalized urgently on a regular basis for multisystem failure and dialysis, largely due to his noncompliance. Dr M was the only person who would take care of this trying individual. When we asked with a mix of cynicism and awe, “Why do you put up with this GOMER?” Dr M patiently explained: “Because everyone deserves a doctor. Do you think Mr A wants to live like this? Sure he’s frustrating, but if I don’t care for him, who will?”

I snap back to the present and listen as my patient describes his experiences in school, his anxieties, and his challenges. I refill his prescriptions—another month of Soma, Klonopin, and hydrocodone—ask him to stop by the lab for his drug screen, and take a moment to chat with the medical student who’s working with me today.

“Dr Susman, why do you put up with him?”

The answer is easy. “Everyone deserves a family physician.”

And it sounds right to me.

My car was broken into and my Vicodin was stolen. “I lost my medicine; that’s why my drug test was negative.” “I have tried everything, and Oxy-Contin is the only medicine that helps.”

You’ve probably heard the same stories. They’re as far-fetched and transparent as the drop-in patient arriving at 5:15 pm on a Friday who is visiting from out of town and needs some of those Percocets to last him through the weekend.

We publish a number of articles in this journal about how to manage chronic pain, administer drug contracts, and work with the drug-seeking patient. But in the end, it’s not the science of half-lives and potencies that’s the challenge, it’s the patients themselves. Where do you set the boundaries? Do you give a person a second chance? Do you even bother with their forlorn stories in the first place?

And forlorn stories they usually are. The patient with chronic back pain who watched as his son was gunned down in cold blood; the college student whose family has more money than sense, more addictions than money; the housewife whose chronic headaches are a product of years of abuse. Who knows if their tales are fact or fiction?

I review the chart of my next patient and see a note from one of my partners. “Refused refill of Soma, Klonopin, and hydrocodone. Strongly suspect diversion.” Yes, I suppose that could well be the case. I’m roused from my reverie by one of the medical assistants. “Looks like your druggies are here in force today.”

Of course, there is no easy answer or ready explanation for our response. For me, it goes back to a lesson I learned during my residency. Mr A was nonadherent, often belligerent, and hospitalized urgently on a regular basis for multisystem failure and dialysis, largely due to his noncompliance. Dr M was the only person who would take care of this trying individual. When we asked with a mix of cynicism and awe, “Why do you put up with this GOMER?” Dr M patiently explained: “Because everyone deserves a doctor. Do you think Mr A wants to live like this? Sure he’s frustrating, but if I don’t care for him, who will?”

I snap back to the present and listen as my patient describes his experiences in school, his anxieties, and his challenges. I refill his prescriptions—another month of Soma, Klonopin, and hydrocodone—ask him to stop by the lab for his drug screen, and take a moment to chat with the medical student who’s working with me today.

“Dr Susman, why do you put up with him?”

The answer is easy. “Everyone deserves a family physician.”

And it sounds right to me.

I am 50 years old. I am plagued by a persistent pain in my back. I sleep sporadically. I don’t eat as well as I should and don’t exercise as I might. And yet, I expect to be skiing with abandon in the Vail bowls on Friday.

I am the future of Family Medicine.

With all the talk of the New Model, TransforMed, and technologies that will revolutionize practice, I invite you to consider the other side—our patients.

With the impending Blitz of the Boomers, middle age and geriatrics are being blurred. I am not talking about the 90-year-old elder in the nursing home, but the 72-year-old who recounted her cross-country skiing travails to me. FPs have opportunities to rethink the agenda of care, ministering to those who are unwilling to age gracefully on the porch. Maybe I’m envisioning a new specialty: Sports Geriatrics?

When we do deign to age, we Boomers will demand care beyond the confines of today’s practices and institutions, beyond the stereotypical limits of the past. We’ll demand more than end-of-life or hospice care. We’ll demand care that extends independence and function.

I wonder if we remain blind to meeting the needs of today’s patients. Why do we make busy executives visit our crowded offices? Why is the office even the locus of care—efficient for us, but not so for patients. The Burger King mentality of getting things our way will surely extend to medicine. Are we up to the challenge?

Do you look at Consumer Reports before making a major purchase? We need to rethink accountability in healthcare. Ever try to compare outcomes of your local surgeons? If your practice is like mine, we are fortunate to get the phone calls answered, let alone assess the progress of our patients with diabetes. How can we expect to really change behaviors of our patients and be responsive to unpredictable upheavals in our system without such skills? Rather than worrying about drive-through clinics and the expanding roles of nurse practitioners, I wager our time is better spent improving our own practices and knowing our outcomes.

Finally, I believe many of us are indeed committed to the notion of community—a place that is nurturing and nurtured. Yet I see a wide discrepancy between our values and actions. How many physicians focus beyond the patients who show up at their doors? How many practices really know their community needs, based on data? Can we meaningfully address the “epidemic of obesity,” the needs of the homeless, or the challenges of teen pregnancy by sitting in our offices? Can our communities sustain us as we age if we fail to participate in them?

Are we ready to be the future of Family Medicine?

I am 50 years old. I am plagued by a persistent pain in my back. I sleep sporadically. I don’t eat as well as I should and don’t exercise as I might. And yet, I expect to be skiing with abandon in the Vail bowls on Friday.

I am the future of Family Medicine.

With all the talk of the New Model, TransforMed, and technologies that will revolutionize practice, I invite you to consider the other side—our patients.

With the impending Blitz of the Boomers, middle age and geriatrics are being blurred. I am not talking about the 90-year-old elder in the nursing home, but the 72-year-old who recounted her cross-country skiing travails to me. FPs have opportunities to rethink the agenda of care, ministering to those who are unwilling to age gracefully on the porch. Maybe I’m envisioning a new specialty: Sports Geriatrics?

When we do deign to age, we Boomers will demand care beyond the confines of today’s practices and institutions, beyond the stereotypical limits of the past. We’ll demand more than end-of-life or hospice care. We’ll demand care that extends independence and function.

I wonder if we remain blind to meeting the needs of today’s patients. Why do we make busy executives visit our crowded offices? Why is the office even the locus of care—efficient for us, but not so for patients. The Burger King mentality of getting things our way will surely extend to medicine. Are we up to the challenge?

Do you look at Consumer Reports before making a major purchase? We need to rethink accountability in healthcare. Ever try to compare outcomes of your local surgeons? If your practice is like mine, we are fortunate to get the phone calls answered, let alone assess the progress of our patients with diabetes. How can we expect to really change behaviors of our patients and be responsive to unpredictable upheavals in our system without such skills? Rather than worrying about drive-through clinics and the expanding roles of nurse practitioners, I wager our time is better spent improving our own practices and knowing our outcomes.

Finally, I believe many of us are indeed committed to the notion of community—a place that is nurturing and nurtured. Yet I see a wide discrepancy between our values and actions. How many physicians focus beyond the patients who show up at their doors? How many practices really know their community needs, based on data? Can we meaningfully address the “epidemic of obesity,” the needs of the homeless, or the challenges of teen pregnancy by sitting in our offices? Can our communities sustain us as we age if we fail to participate in them?

Are we ready to be the future of Family Medicine?

I am 50 years old. I am plagued by a persistent pain in my back. I sleep sporadically. I don’t eat as well as I should and don’t exercise as I might. And yet, I expect to be skiing with abandon in the Vail bowls on Friday.

I am the future of Family Medicine.

With all the talk of the New Model, TransforMed, and technologies that will revolutionize practice, I invite you to consider the other side—our patients.

With the impending Blitz of the Boomers, middle age and geriatrics are being blurred. I am not talking about the 90-year-old elder in the nursing home, but the 72-year-old who recounted her cross-country skiing travails to me. FPs have opportunities to rethink the agenda of care, ministering to those who are unwilling to age gracefully on the porch. Maybe I’m envisioning a new specialty: Sports Geriatrics?

When we do deign to age, we Boomers will demand care beyond the confines of today’s practices and institutions, beyond the stereotypical limits of the past. We’ll demand more than end-of-life or hospice care. We’ll demand care that extends independence and function.

I wonder if we remain blind to meeting the needs of today’s patients. Why do we make busy executives visit our crowded offices? Why is the office even the locus of care—efficient for us, but not so for patients. The Burger King mentality of getting things our way will surely extend to medicine. Are we up to the challenge?

Do you look at Consumer Reports before making a major purchase? We need to rethink accountability in healthcare. Ever try to compare outcomes of your local surgeons? If your practice is like mine, we are fortunate to get the phone calls answered, let alone assess the progress of our patients with diabetes. How can we expect to really change behaviors of our patients and be responsive to unpredictable upheavals in our system without such skills? Rather than worrying about drive-through clinics and the expanding roles of nurse practitioners, I wager our time is better spent improving our own practices and knowing our outcomes.

Finally, I believe many of us are indeed committed to the notion of community—a place that is nurturing and nurtured. Yet I see a wide discrepancy between our values and actions. How many physicians focus beyond the patients who show up at their doors? How many practices really know their community needs, based on data? Can we meaningfully address the “epidemic of obesity,” the needs of the homeless, or the challenges of teen pregnancy by sitting in our offices? Can our communities sustain us as we age if we fail to participate in them?

Are we ready to be the future of Family Medicine?

The next patients were in their late teens, dressed entirely in black, and punctuated by an array of silver studs and chains. What skin showed was festooned with tattoos, the significance of which I could only guess—a simple “Mom” was not among them. While ostensibly here for an upper respiratory issue, it soon became clear that STDs were on their mind. A previous boyfriend had called, and it sounded like Chlamydia or GC was likely.

A dozen half-formed connections permeated my thinking: Gothic, Columbine, raves, plain ol’ weird. My mind drifted back to a study proposed for a practice-based research network: were tattoos or piercings a marker for risky behaviors? Did such patients have a higher risk of hepatitis or HIV? What was with all these body modifications anyway?

An article in this issue of the Journal of Family Practice offers interesting insights into these questions (“Piercing among adolescents: Body art as risk marker,”). While the population studied is from Switzerland, I suspect many of the report’s findings are transferable to the US. And though concerns about STDs and drug use are not entirely misplaced, we need to remain mindful that our mental profiling can quickly slip into prejudice.

For as I talked to this couple, I was surprised to hear their articulate discussion of college plans, predictable problems with parents, the desire to travel and see more of the world, and a curiosity and naïveté belied by their appearance. They claimed neither to drink nor to use drugs, though they readily acknowledged the availability of recreational substances. They believed in long-term relationships and monogamy. In short, these kids could have easily been poster children for well-adjusted teens, if you saw beyond their body art.

And while I really struggled to be comfortable with the piercings and tattoos on all those body parts (that has got to hurt!), I was once again reminded how privileged we are to enter the lives of our patients, and that appearances are only skin-deep.

The next patients were in their late teens, dressed entirely in black, and punctuated by an array of silver studs and chains. What skin showed was festooned with tattoos, the significance of which I could only guess—a simple “Mom” was not among them. While ostensibly here for an upper respiratory issue, it soon became clear that STDs were on their mind. A previous boyfriend had called, and it sounded like Chlamydia or GC was likely.

A dozen half-formed connections permeated my thinking: Gothic, Columbine, raves, plain ol’ weird. My mind drifted back to a study proposed for a practice-based research network: were tattoos or piercings a marker for risky behaviors? Did such patients have a higher risk of hepatitis or HIV? What was with all these body modifications anyway?

An article in this issue of the Journal of Family Practice offers interesting insights into these questions (“Piercing among adolescents: Body art as risk marker,”). While the population studied is from Switzerland, I suspect many of the report’s findings are transferable to the US. And though concerns about STDs and drug use are not entirely misplaced, we need to remain mindful that our mental profiling can quickly slip into prejudice.

For as I talked to this couple, I was surprised to hear their articulate discussion of college plans, predictable problems with parents, the desire to travel and see more of the world, and a curiosity and naïveté belied by their appearance. They claimed neither to drink nor to use drugs, though they readily acknowledged the availability of recreational substances. They believed in long-term relationships and monogamy. In short, these kids could have easily been poster children for well-adjusted teens, if you saw beyond their body art.

And while I really struggled to be comfortable with the piercings and tattoos on all those body parts (that has got to hurt!), I was once again reminded how privileged we are to enter the lives of our patients, and that appearances are only skin-deep.

The next patients were in their late teens, dressed entirely in black, and punctuated by an array of silver studs and chains. What skin showed was festooned with tattoos, the significance of which I could only guess—a simple “Mom” was not among them. While ostensibly here for an upper respiratory issue, it soon became clear that STDs were on their mind. A previous boyfriend had called, and it sounded like Chlamydia or GC was likely.

A dozen half-formed connections permeated my thinking: Gothic, Columbine, raves, plain ol’ weird. My mind drifted back to a study proposed for a practice-based research network: were tattoos or piercings a marker for risky behaviors? Did such patients have a higher risk of hepatitis or HIV? What was with all these body modifications anyway?

An article in this issue of the Journal of Family Practice offers interesting insights into these questions (“Piercing among adolescents: Body art as risk marker,”). While the population studied is from Switzerland, I suspect many of the report’s findings are transferable to the US. And though concerns about STDs and drug use are not entirely misplaced, we need to remain mindful that our mental profiling can quickly slip into prejudice.

For as I talked to this couple, I was surprised to hear their articulate discussion of college plans, predictable problems with parents, the desire to travel and see more of the world, and a curiosity and naïveté belied by their appearance. They claimed neither to drink nor to use drugs, though they readily acknowledged the availability of recreational substances. They believed in long-term relationships and monogamy. In short, these kids could have easily been poster children for well-adjusted teens, if you saw beyond their body art.

And while I really struggled to be comfortable with the piercings and tattoos on all those body parts (that has got to hurt!), I was once again reminded how privileged we are to enter the lives of our patients, and that appearances are only skin-deep.

You say goodbye to your children as they prepare to go out for the evening:

“Don’t forget to smoke a couple of joints before driving in the snow tonight.”

“Grandma, Grandpa, it was great seeing you for the Holidays. To make sure you safely make it home, let’s share a few cocktails before you hit the road.”

“Hi, honey. I should be home in 15 minutes if this traffic doesn’t kill me.”

I suspect few of us would suggest our children or grandparents drive while impaired. But I bet a lot more you have had a cellular conversation while navigating the rush hour. And most of us take solace that our kids carry a cell phone in case of emergency.

But did you know that according to a recent study, “the impairments associated with using a cell phone while driving can be as profound as those associated with drinking and driving”?¹

It’s time we recognize this important public health hazard. A recent review concluded that cellular phone users had a four-fold risk of a “property-damage-only crash,” and this risk was increased regardless of age, gender, or use of a hands-free phone.² Moreover, while bans on cellphone use have an initial salutary effect, there is a rapid decline in compliance without regular enforcement and publicity.³

It’s certainly odd to see a well-groomed and seemingly sane businessman gesticulating wildly on a downtown street. It’s bad enough that you can’t even go into the airport restroom or a fine restaurant without the constant cacophony of cellular conversation. But amusement turns to horror as a car full of teens, radio blaring, weaves through traffic or a bleary-eyed commuter blithely converses while applying her makeup and juggling her latte.

While I don’t have the ultimate solution to cellular commotion, we should be counseling our patients about this public health hazard. Driven to distraction could mean a detour to death.

You say goodbye to your children as they prepare to go out for the evening:

“Don’t forget to smoke a couple of joints before driving in the snow tonight.”

“Grandma, Grandpa, it was great seeing you for the Holidays. To make sure you safely make it home, let’s share a few cocktails before you hit the road.”

“Hi, honey. I should be home in 15 minutes if this traffic doesn’t kill me.”

I suspect few of us would suggest our children or grandparents drive while impaired. But I bet a lot more you have had a cellular conversation while navigating the rush hour. And most of us take solace that our kids carry a cell phone in case of emergency.

But did you know that according to a recent study, “the impairments associated with using a cell phone while driving can be as profound as those associated with drinking and driving”?¹

It’s time we recognize this important public health hazard. A recent review concluded that cellular phone users had a four-fold risk of a “property-damage-only crash,” and this risk was increased regardless of age, gender, or use of a hands-free phone.² Moreover, while bans on cellphone use have an initial salutary effect, there is a rapid decline in compliance without regular enforcement and publicity.³

It’s certainly odd to see a well-groomed and seemingly sane businessman gesticulating wildly on a downtown street. It’s bad enough that you can’t even go into the airport restroom or a fine restaurant without the constant cacophony of cellular conversation. But amusement turns to horror as a car full of teens, radio blaring, weaves through traffic or a bleary-eyed commuter blithely converses while applying her makeup and juggling her latte.

While I don’t have the ultimate solution to cellular commotion, we should be counseling our patients about this public health hazard. Driven to distraction could mean a detour to death.

You say goodbye to your children as they prepare to go out for the evening:

“Don’t forget to smoke a couple of joints before driving in the snow tonight.”

“Grandma, Grandpa, it was great seeing you for the Holidays. To make sure you safely make it home, let’s share a few cocktails before you hit the road.”

“Hi, honey. I should be home in 15 minutes if this traffic doesn’t kill me.”

I suspect few of us would suggest our children or grandparents drive while impaired. But I bet a lot more you have had a cellular conversation while navigating the rush hour. And most of us take solace that our kids carry a cell phone in case of emergency.

But did you know that according to a recent study, “the impairments associated with using a cell phone while driving can be as profound as those associated with drinking and driving”?¹

It’s time we recognize this important public health hazard. A recent review concluded that cellular phone users had a four-fold risk of a “property-damage-only crash,” and this risk was increased regardless of age, gender, or use of a hands-free phone.² Moreover, while bans on cellphone use have an initial salutary effect, there is a rapid decline in compliance without regular enforcement and publicity.³

It’s certainly odd to see a well-groomed and seemingly sane businessman gesticulating wildly on a downtown street. It’s bad enough that you can’t even go into the airport restroom or a fine restaurant without the constant cacophony of cellular conversation. But amusement turns to horror as a car full of teens, radio blaring, weaves through traffic or a bleary-eyed commuter blithely converses while applying her makeup and juggling her latte.

While I don’t have the ultimate solution to cellular commotion, we should be counseling our patients about this public health hazard. Driven to distraction could mean a detour to death.

I just returned from the AAFP Annual Scientific Assembly and Congress of Delegates, in Washington, DC. Between a rally at the Capitol and a night at the Smithsonian, I was renewed by the energy and enthusiasm of colleagues, new and old.

Quality, the Chronic Care Model, and P4P

Many of the “non-clinical” talks focused on improving the quality of care we deliver. Using performance improvement techniques, and elements of the Chronic Care Model (www.ihi.org/IHI/Topics/ChronicConditions/AllConditions/Changes), there is recognition that we have a responsibility to foster practice enhancement. Whether the ABFM, Performance in Practice Modules, the AAFP Metric program, local P4P plans, or the national dialogue about consumer directed care, quality is finally making a main stage appearance. This past week I also listened to leaders from CMS, private insurers, and large consumer groups at the National Quality Forum meeting—it is time you begin experimenting with practice improvement efforts, while the stakes are low. Don’t be left out!

Pharma and medicine

I participated in a seminar on the relationship between pharma and medicine, a timely discussion given resolutions to the (AAFP) Congress to limit the role of proprietary entities within the Academy. Should the AAFP stop accepting financial support for CME (and would members be willing to pay the substantially increased fees)? What restrictions should be placed on scientists at the NIH? How do you resolve conflicts of interest effectively? Clearly, this debate has moved to the public eye and I foresee further scrutiny of these interactions.

Dissemination of technology

The number of firms marketing health care technology has skyrocketed. For the first time I have the sense we aren’t talking about how to implement the electronic health record, but when. Whether a system for patients to self-complete a review of systems or a telephone repository for laboratory results, I was impressed by how more systems are leveraging technology in a robust and consumer friendly manner. Now, if they could only figure out how to seamlessly integrate quality improvement measures into their software.

The future of family medicine remains bright, and you can be a part by preparing for quality improvement and the impact of information technology today! But remember…

The light at the end of the tunnel may be a train!

I just returned from the AAFP Annual Scientific Assembly and Congress of Delegates, in Washington, DC. Between a rally at the Capitol and a night at the Smithsonian, I was renewed by the energy and enthusiasm of colleagues, new and old.

Quality, the Chronic Care Model, and P4P

Many of the “non-clinical” talks focused on improving the quality of care we deliver. Using performance improvement techniques, and elements of the Chronic Care Model (www.ihi.org/IHI/Topics/ChronicConditions/AllConditions/Changes), there is recognition that we have a responsibility to foster practice enhancement. Whether the ABFM, Performance in Practice Modules, the AAFP Metric program, local P4P plans, or the national dialogue about consumer directed care, quality is finally making a main stage appearance. This past week I also listened to leaders from CMS, private insurers, and large consumer groups at the National Quality Forum meeting—it is time you begin experimenting with practice improvement efforts, while the stakes are low. Don’t be left out!

Pharma and medicine

I participated in a seminar on the relationship between pharma and medicine, a timely discussion given resolutions to the (AAFP) Congress to limit the role of proprietary entities within the Academy. Should the AAFP stop accepting financial support for CME (and would members be willing to pay the substantially increased fees)? What restrictions should be placed on scientists at the NIH? How do you resolve conflicts of interest effectively? Clearly, this debate has moved to the public eye and I foresee further scrutiny of these interactions.

Dissemination of technology

The number of firms marketing health care technology has skyrocketed. For the first time I have the sense we aren’t talking about how to implement the electronic health record, but when. Whether a system for patients to self-complete a review of systems or a telephone repository for laboratory results, I was impressed by how more systems are leveraging technology in a robust and consumer friendly manner. Now, if they could only figure out how to seamlessly integrate quality improvement measures into their software.

The future of family medicine remains bright, and you can be a part by preparing for quality improvement and the impact of information technology today! But remember…

The light at the end of the tunnel may be a train!

I just returned from the AAFP Annual Scientific Assembly and Congress of Delegates, in Washington, DC. Between a rally at the Capitol and a night at the Smithsonian, I was renewed by the energy and enthusiasm of colleagues, new and old.

Quality, the Chronic Care Model, and P4P

Many of the “non-clinical” talks focused on improving the quality of care we deliver. Using performance improvement techniques, and elements of the Chronic Care Model (www.ihi.org/IHI/Topics/ChronicConditions/AllConditions/Changes), there is recognition that we have a responsibility to foster practice enhancement. Whether the ABFM, Performance in Practice Modules, the AAFP Metric program, local P4P plans, or the national dialogue about consumer directed care, quality is finally making a main stage appearance. This past week I also listened to leaders from CMS, private insurers, and large consumer groups at the National Quality Forum meeting—it is time you begin experimenting with practice improvement efforts, while the stakes are low. Don’t be left out!

Pharma and medicine

I participated in a seminar on the relationship between pharma and medicine, a timely discussion given resolutions to the (AAFP) Congress to limit the role of proprietary entities within the Academy. Should the AAFP stop accepting financial support for CME (and would members be willing to pay the substantially increased fees)? What restrictions should be placed on scientists at the NIH? How do you resolve conflicts of interest effectively? Clearly, this debate has moved to the public eye and I foresee further scrutiny of these interactions.

Dissemination of technology

The number of firms marketing health care technology has skyrocketed. For the first time I have the sense we aren’t talking about how to implement the electronic health record, but when. Whether a system for patients to self-complete a review of systems or a telephone repository for laboratory results, I was impressed by how more systems are leveraging technology in a robust and consumer friendly manner. Now, if they could only figure out how to seamlessly integrate quality improvement measures into their software.

The future of family medicine remains bright, and you can be a part by preparing for quality improvement and the impact of information technology today! But remember…

The light at the end of the tunnel may be a train!

Every once in a while, our department’s hospitalist suffers me helping out on our inpatient service. And amidst the intricacies of inferior vena cava filters and community-acquired MRSA, I get to reflect on the health of our hospitals. Without further fanfare, here are my current top ten gripes:

1. I wish they would get rid of the ads, billboards, and marketing. Do you really pick your “heart hospital” on the basis of a catchy jingle or being in the top 100 in Mad magazine’s survey of area health care facilities? Maybe if the gruel that was served was edible (go to number 10).
2. No rooms or amenities for families. I really feel sorry for patients from out of town.
3. Patients are scattered throughout the facility, and places never meant to house inpatients are being used for “overflow.” And we haven’t even hit influenza season. The gift shop will be pressed into service next.
4. Patients get discharged too early (we had one patient allegedly discharged directly from a local ICU before being admitted). And discharge planning is still haphazard and rehabilitation guidelines too restrictive. I guess you just can’t charge enough for social services and physical therapy.
5. Want the records from a primary clinician’s office—tough luck. Critical information barriers remain the rule, not the exception.
6. Despite the promise of informatics, it’s almost impossible to get health care information at the bedside—I either traipse out to the computer or pray that the latest wireless “solution” doesn’t decimate my PDA.
7. Have you ever tried to get anything done on a weekend, let alone a long holiday weekend?
8. You ever ask a nurse about a patient and get a blank stare? Nurses no longer have time for patients; they are too busy slaving on their documentation.
9. Why should patients and family pay for the privilege of parking? Don’t they get enough revenue from those $10 aspirin?
10. Does anyone actually eat hospital food? The phrase is an oxymoron.

While I am sure there are more innovative hospitals, and solutions to these issues, I doubt my experience is unique. Guess I’ll saunter down to the doctor’s lounge and indulge in a cup of coffee and a sweet roll: despite the increasing competition, changing health system networks, and focus on patient safety, “Plus ça change, plus c’est la même chose.”

Every once in a while, our department’s hospitalist suffers me helping out on our inpatient service. And amidst the intricacies of inferior vena cava filters and community-acquired MRSA, I get to reflect on the health of our hospitals. Without further fanfare, here are my current top ten gripes:

1. I wish they would get rid of the ads, billboards, and marketing. Do you really pick your “heart hospital” on the basis of a catchy jingle or being in the top 100 in Mad magazine’s survey of area health care facilities? Maybe if the gruel that was served was edible (go to number 10).
2. No rooms or amenities for families. I really feel sorry for patients from out of town.
3. Patients are scattered throughout the facility, and places never meant to house inpatients are being used for “overflow.” And we haven’t even hit influenza season. The gift shop will be pressed into service next.
4. Patients get discharged too early (we had one patient allegedly discharged directly from a local ICU before being admitted). And discharge planning is still haphazard and rehabilitation guidelines too restrictive. I guess you just can’t charge enough for social services and physical therapy.
5. Want the records from a primary clinician’s office—tough luck. Critical information barriers remain the rule, not the exception.
6. Despite the promise of informatics, it’s almost impossible to get health care information at the bedside—I either traipse out to the computer or pray that the latest wireless “solution” doesn’t decimate my PDA.
7. Have you ever tried to get anything done on a weekend, let alone a long holiday weekend?
8. You ever ask a nurse about a patient and get a blank stare? Nurses no longer have time for patients; they are too busy slaving on their documentation.
9. Why should patients and family pay for the privilege of parking? Don’t they get enough revenue from those $10 aspirin?
10. Does anyone actually eat hospital food? The phrase is an oxymoron.

While I am sure there are more innovative hospitals, and solutions to these issues, I doubt my experience is unique. Guess I’ll saunter down to the doctor’s lounge and indulge in a cup of coffee and a sweet roll: despite the increasing competition, changing health system networks, and focus on patient safety, “Plus ça change, plus c’est la même chose.”

Every once in a while, our department’s hospitalist suffers me helping out on our inpatient service. And amidst the intricacies of inferior vena cava filters and community-acquired MRSA, I get to reflect on the health of our hospitals. Without further fanfare, here are my current top ten gripes:

1. I wish they would get rid of the ads, billboards, and marketing. Do you really pick your “heart hospital” on the basis of a catchy jingle or being in the top 100 in Mad magazine’s survey of area health care facilities? Maybe if the gruel that was served was edible (go to number 10).
2. No rooms or amenities for families. I really feel sorry for patients from out of town.
3. Patients are scattered throughout the facility, and places never meant to house inpatients are being used for “overflow.” And we haven’t even hit influenza season. The gift shop will be pressed into service next.
4. Patients get discharged too early (we had one patient allegedly discharged directly from a local ICU before being admitted). And discharge planning is still haphazard and rehabilitation guidelines too restrictive. I guess you just can’t charge enough for social services and physical therapy.
5. Want the records from a primary clinician’s office—tough luck. Critical information barriers remain the rule, not the exception.
6. Despite the promise of informatics, it’s almost impossible to get health care information at the bedside—I either traipse out to the computer or pray that the latest wireless “solution” doesn’t decimate my PDA.
7. Have you ever tried to get anything done on a weekend, let alone a long holiday weekend?
8. You ever ask a nurse about a patient and get a blank stare? Nurses no longer have time for patients; they are too busy slaving on their documentation.
9. Why should patients and family pay for the privilege of parking? Don’t they get enough revenue from those $10 aspirin?
10. Does anyone actually eat hospital food? The phrase is an oxymoron.

While I am sure there are more innovative hospitals, and solutions to these issues, I doubt my experience is unique. Guess I’ll saunter down to the doctor’s lounge and indulge in a cup of coffee and a sweet roll: despite the increasing competition, changing health system networks, and focus on patient safety, “Plus ça change, plus c’est la même chose.”