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I am heading to Denver to help my friend John Meigs run for President-Elect of the American Academy of Family Physicians. John is an impressive gentleman and has been active in  trying to bring healthcare to all Alabamians. As he so eloquently states:

The premise of family medicine is centered in the value that an ongoing continuous relationship with a trusted family physician brings to an individual and his or her community.  The promise of family medicine is patient centered care that recognizes the value of the individual as well as the benefits to the larger community of true primary care with effective preventive care and chronic disease management.  This makes us the specialty with the potential to reach the underserved and hopefully make a difference in overcoming the barriers and social determinants of health that affect way too many people in a country as prosperous as ours.  The payoff is the triple aim we talk about of better care of higher quality leading to better health.

He will be an outstanding leader for our organization and will help to further our efforts to bring high end primary care to the American public..

John and the Academy by the numbers

120,900 – the number of physicians and students represented by our academy

4891 – the number of people in the town of Brent, Alabama, where John is from and still lives.

2778  – the number of people in Centreville, Alabama, where John practices.

160 – the number of days John is going to have to give up to the cause if he wins

33 – the number of years John has been in practice

26 – the number of years John has been involved with organized medicine

25 – the number of beds at Bibb County Hospital, where John practices

3 – the number of candidates for president-elect

1 – Last quote

At the heart of primary care is the idea that patients should have an ongoing relationship with a family physician they know and trust. I have that kind of relationship with my patients because I’ve lived here most of my life, and I’ve practiced medicine here for more than 30 years.

If you are a delegate, please consider voting for John. Thank you for your support!

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My wife has taken to describing the minor tragedies that occur in our life as our “first world problems.” This stems from a meme being used in popular culture about the petty concerns of those of us living in the richest areas of the richest countries in the world. You can post your own (I guess as sort of a soul cleansing confessional) at this website. The best example of a first world problem on it currently is

My iPad 3 doesn’t warm my lap as much as my MacBook Pro.

You get the picture.

The cab driver taking me to the airport in Kansas City somehow knew that I was in town  for the National Conference of Family Medicine Residents and Medical Students. Perhaps it was the fact that I caught the cab in front of the convention center where the conference was being held. Perhaps it was the name tag I still had on. Anyway, somehow he knew and wanted to talk to me, the physician.

“So, you here for the convention?” he said in good but accented English

“Yes, I have been trying to recruit young doctors to come and work in Alabama.”

“I am trying to get into pharmacy school in Louisville,” he said

“Oh,” I said, not wanting to hear his personal essay so trying exude only polite interest.

“Yes,” he said, “this is my weekend job. I am a pharmacy tech working for an insurance company. We do mail-order prescriptions for Medicare patients.”

We had a discussion about health economics, insurance companies, and the general state of the world. I offered my opinion when asked whether Congress could  fix the cost problem that we gave our seniors a blank check in Medicare and I did not see, 40 years later, anyone with the intestinal fortitude to tell seniors (who vote) that the rent was coming due. We both acknowledged that the Affordable Care Act offered some opportunities but not enough.

He said “I see it first hand. I get requests to fill drugs and when we review them there are 2 or 3 that are in the same class (such as simvistatin and Lipitor) we try to get the docs to make changes and they accuse us of trying to micromanage their patients.”

I said the average Medicare beneficiary has between five and seven doctors and have on average 7.1 prescriptions. No one doctor has a complete drug list for most of these people and many of the meds are duplicated. We agreed that there was a lot of waste and likely Congress didn’t care much. No one wants ask seniors to pay out-of-pocket to double up on their chance at better living through chemistry when they’ve been getting it for “free” for the last eight years. That would be an example of a first world problem.

He then asked me if Alabama was rural and I said parts of it were very rural. He said his country was rural as well and he asked me if folks in Alabama had trouble getting to adequate health care. I admitted that some did and that was what I was working on as part of my job.

“That is good,” he said. “I come from a rural area. In my country, there is not adequate health care because of corruption. My sister, she was pregnant and went to the dispensary. They said they could not help her and she would have to go into the city. We put her in the bed of [he pointed to a pick-up truck] one of those and we drive her on the bumpy road for 2 hours. When we get to the city, she was dead. This is not an unusual story in my country. I come to America to study but cannot go back because, my countrymen, they do not care. So I will be a pharmacist in America.”

I had to admit that though we had care delivery problems, death during transportation via flat bed for a routine pregnancy complication was not common, even in the Alabama blackbelt.

An object with a large mass moving at high-speed (such as a Navy ship) requires a lot of effort to turn as shown here. Health care consumes almost 20% of the economy, has a lot of momentum, and changing the direction is going to take a lot of energy. The Affordable Care Act includes several provisions that will move healthcare, discussed here.  Many practices are experimenting with changes in care delivery and mechanisms of payment, documented by the Patient Centered Primary Care Collaborative here. The American Academy of Family Medicine has posted resources on practice change for established practices and residency training sites here. We are graduating 16000 physicians every year, though, that may not be exposed to any of this. The AAMC has identified 12 medical schools (out of approximately 120) who are trying to expose students to different types of care delivery, discussed here, but we are not trying to influence medical students in an organized fashion.  Because of the 8 to 12 years needed from admission to practice, turning this ship will require new educational materials, new faculty skilled in different types of care delivery, and new methods of educating physicians-to-be.

The American Academy of Family Physic ians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association have put together a list of educational skills that they feel should be adopted by medical schools and used to teach American physicians-to-be, found here. Th reason for this, as identified by Perry Pugno of the AAFP is

“Training for PCMH practice has been embraced by the graduate medical education community, but at the medical school level, the response has been less — hence, the development of these principles to guide development at the medical school level of training,” said Pugno.

The reason these were developed is to help turn the health care ship around

It’s important for medical schools to recognize the need to invest in the future to provide these educational opportunities, Pugno said.

“We know that the current model of health care isn’t financially sustainable,” said Pugno. “We need at least some medical schools and their academic medical centers to show leadership and make some difficult choices — and change how they do business. In the short term, it will cost, but the dividends will come in the future.”

Maybe not “All Engines Reverse” but perhaps moving off “All Ahead Full.”

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