Thursday, March 20, 2014

This I believe

I believe that Family Medicine is the solution to American health care.

I believe that family doctors give high quality, cost efficient care. Counties with the right proportion of primary care* to specialty care have populations who live longer and health care that costs less. Too many specialists and not enough family physicians = unnecessarily expensive care and shorter life expectancy.

I believe that family doctors provide something intangible to our patients and our communities as well. We value relationships with our patients and our communities. We tailor the care we give to our patients’ values and preferences as much as possible. We care for every age at every stage, and we provide continuity of care to individuals and generations.

I believe that Family Medicine has an image problem that is largely our own fault.  The average American does not know what a “family doctor” is. Many family physicians are fatigued from wading through our fragmented health care system, and too few of us feel we have the time and/or the skills to share who we are and what we do with the public.  

I believe that Family Medicine is under attack. The RUC devalues what we do, largely because Family Medicine is underrepresented on the RUC (only 1 family physician out of 31 physicians on the committee). My office receives more payment for snipping off a skin tag than for a thirty-minute patient visit working with a patient on his/her diabetes, hypertension, and heart failure, along with the the social challenges that often co-exist with the medical issues. 

I believe that Family Medicine will overcome these challenges. I have seen the future of our specialty in the applicants to our residency program and the students who attend our specialty meetings. They are intelligent, dedicated, and optimistic. They believe in what Family Medicine can do and are not shy about sharing it. They are taking over social media with their stories. They are our future, and the future is bright.

Family Medicine is the solution to American health care.  This I believe.

*In 2014, with fewer and fewer general internists and pediatricians, primary care in the US = Family Medicine.

Friday, February 14, 2014

Thank you

I had a pretty grueling office session yesterday - one of those days where you're sending someone to the hospital and calling another consultant on the phone and bouncing among three rooms at once and, well, you know...a typical family medicine day.

I was 45 minutes late seeing my last patient.  I was a little surprised that she was still on the schedule; we had actually resolved her issue over the phone the week prior, and I told her then to feel free to cancel this appointment.  As I knocked on the door, I wondered if something new had happened and why she was willing to wait so long to see me.

She started the visit by reviewing what we had talked about last week, and we both made sure that we were still on the same page.  After that, there was an awkward pause.

Me: What else can I do for you today?
Patient: Nothing.
Me (confused look on face): came in today to make sure there was nothing else to do?  Do you have any questions?
Patient: No.  I just wanted to say thank you.

A seemingly mundane task from our end can have a big impact on a patient's life. We don't expect our patients to routinely give anything back to us, maybe because we worry that our gift of service could then make our patients feel obligated to give back.

But, needless to say, I was overcome with appreciation at this selfless act.  It was an incredible gesture that said more about this patient's character than my own, yet still reminded me why I'm a family doctor.

I don't expect it all the time, but, every now and then, a "thank you" is awfully nice to hear.

Friday, January 17, 2014

Easy on the eyes

I'm reading less of JAMA these days.  They recently changed the font they use in some sections of the journal, and it's not easy on my eyes.

There are two basic types of font: serif and sans serif.  "Serif" is Latin for "tail," and "sans" is Latin for "without."

Sans serif ("without tails") fonts include Arial, Helvetica, and Verdana.
Note: no little tails hanging off the edges of these letters.

Serif (with "tails") fonts include Times New Roman, Georgia, and Courier.
Note: the little dashes or squiggles on the tops of the w, along with the extra lines on the N and the T.
(Here's Arial's w, N, and T for comparison.)

Sans serif fonts are easier to read far away; your brain doesn't have to work as hard to make out the letters without those tails.  When I teach presentation skills workshops, one of the points I focus on is that projected material should always be in sans serif font.  (Try observing what happens to your interest and fatigue level during the next PowerPoint presentation you see with serif font.)

Interestingly, computer screens seem to be just far enough away that most people prefer a sans serif font. Look at the fonts on your favorite web sites, and, chances are, they will be sans serif.

Those tails, though, theoretically make reading close-up easier and less fatiguing on the eyes.  (Try observing what happens to your interest and fatigue level while reading the next printed material you come across in a sans serif font.)  I must admit that most of the studies done regarding readability disagree with me regarding serif fonts for reading, but my personal experience has shown a definite preference for serif fonts on printed materials.  JAMA is the only journal of the Top 10 impact factor medical journals, by my cursory review, to use sans serif font for some of its articles, so perhaps others share my bias toward serif fonts for close-up readability.

Not only did JAMA change several of its printed sections to a sans serif font last year, but they also dramatically reduced their font size throughout the whole journal.  I know that journals are trying to cut costs and stay relevant in an increasingly online world, but I am much less likely to read print material with eye-taxing font styles and sizes.  I actually prefer reading paper to the glare of a computer or tablet LCD screen, and I hope that print journals will find a way to continue delivering at least some content in a reader-friendly manner.

Take some time to observe fonts, both on big screens and close-up.  Which seem most comfortable to you?