Last week, the USUHS FMIG hosted a lunch with the student clerkship coordinators from most of the military's family medicine residency training sites. The coordinators were in town for a clerkship planning retreat held by LtCol Jessica Servey and the USUHS Department of Family Medicine, and were enthusiastic about meeting with the students.
I find it really inspirational to hear what is happening at each of our training sites. For instance, Madigan AMC at Fort Lewis is bringing an endoscopy fellowship on line for Army family physicians, Nellis AFB is continuing to grow the military's newest family medicine residency program, and our Navy colleagues continue to prepare physicians for garrison and operational billets alike.
Even more inspirational are the students coming up the ranks and ready to stand in the gap. During the meet, we discussed the "ecology" of healthcare in the United States. If you look at a map of the US, you'll notice that the majority of counties in the US interior (i.e. non-coastal, non-urban areas) are designated as a Primary Care Health Professional Shortage Area. If you remove family physicians from the mix, close to 70% of the US falls into this category. [See the article at http://fmignet.aafp.org/online/fmig/index/family-medicine/questions-about-fm.html for details]
Health reform is underway, but for some, it perhaps will not, or cannot, come soon enough. There simply are not enough primary care physicians in the right places. Whether we have a shortage of physicians is debatable. What is not debatable is the fact that we do not have the right geographic distribution of current physicians. Family physicians tend to be more likely to serve in interior and rural areas that have a hard time recruiting health professionals. Fortunately, I think that our students are increasingly drawn to what we have to offer—procedurally competent, operational-savvy, professionals able to serve in the acute, chronic, urgent, emergent and trauma settings—and I think we’ll all be the better off for their service.
Monday, November 22, 2010
Friday, November 12, 2010
Spanish Catholic Charities Guest Blog
Hello! Three to four times a month, students accompany CAPT Mark Stephens to local free clinics. Below is a write-up by 2LT Bryan Malave of his recent experiences:
"The moment I walked into the clinic, I was greeted by smiles and continued on to Dr. Stephens' patient room. He was draining a subungual hematoma and enthusiastically asked me to put gloves on and learn the process. I did so and finished up the procedure as he explained to me how he had prepped the patient first with anesthetic and discussed with the patient how she had sustained the injury. The patient got the finger slammed in a door four days ago and was in great pain. Dr. Stephens informed the patient of how to care for the finger and we called in our next patient who suffered from a chronic cough causing her pain and terrible discomfort.
"The 15 day cough prevented her from sleeping well and was really interfering with her life. Dr. Stephens examined her and diagnosed her with pneumonia. She had a fever, achy muscles, dry mouth, and had been sweating more than usual. He allowed me to listen to her breathing, which sounded normal but caused her discomfort to take in deep breaths, and he explained how he came up with his diagnosis.
"We then had a lady come in for cataracts in her left eye. The right eye was operated on last year and she needed the referral to get the other operated on as well. Dr. Stephens used this as an opportunity for me to learn technique in using the ophthalmoscope for the first time. The patient was complaining of dusty vision and did in fact have cataracts.
"After this patient left, I asked Dr. Stephens how he handled older Hispanic patients loyalty to "old school" remedies and often [in] opposition to modern medicine. The question stemmed from a comment the previous patient made regarding that she was not getting the flu shot because she didn't get the flu and even if she did, she would kill it with lemon juice. As a Hispanic, her comments remind me of things my own family members do and say. A shot of honey, lemon, and rum will "cut" a variety of ailments in the opinion of an elderly Puerto Rican. When I've tried to tell my grandmother otherwise, I usually just settle for her taking her doctor prescribed medication as well as the homemade concoctions. Dr. Stephens interestingly said he encourages home remedies as long as they are not unhealthy.
"Our last patient was an 8 year old boy's school physical. The child was in good health and was cleared to play sports. An important topic was discussed after the family left regarding how the mother could not read English. As a community support worker with at risk and victimized children in the Hispanic community, I dealt with this problem daily. The schools sent all the important paperwork like grades, conference letters, field day forms, etc. in English to homes where no one read it. An 8 year old is then responsible for educating his parents on how his or her education is going. Specifically with this patient who loved playing soccer, Dr. Stephens made the point that if the child had not told the mother what the form was and the mother not come to the clinic, the boy would have been ineligible to play soccer at his school. Who knows what the consequences in the long run of keeping a healthy child who loves playing sports from doing so, all because of a form that was never explained or translated."
This last part really spoke to me--equality of opportunity is frequently cited as being a bedrock of American liberty, but an example like this shows some of the many roadblocks some must face just to get to the starting line.
"The moment I walked into the clinic, I was greeted by smiles and continued on to Dr. Stephens' patient room. He was draining a subungual hematoma and enthusiastically asked me to put gloves on and learn the process. I did so and finished up the procedure as he explained to me how he had prepped the patient first with anesthetic and discussed with the patient how she had sustained the injury. The patient got the finger slammed in a door four days ago and was in great pain. Dr. Stephens informed the patient of how to care for the finger and we called in our next patient who suffered from a chronic cough causing her pain and terrible discomfort.
"The 15 day cough prevented her from sleeping well and was really interfering with her life. Dr. Stephens examined her and diagnosed her with pneumonia. She had a fever, achy muscles, dry mouth, and had been sweating more than usual. He allowed me to listen to her breathing, which sounded normal but caused her discomfort to take in deep breaths, and he explained how he came up with his diagnosis.
"We then had a lady come in for cataracts in her left eye. The right eye was operated on last year and she needed the referral to get the other operated on as well. Dr. Stephens used this as an opportunity for me to learn technique in using the ophthalmoscope for the first time. The patient was complaining of dusty vision and did in fact have cataracts.
"After this patient left, I asked Dr. Stephens how he handled older Hispanic patients loyalty to "old school" remedies and often [in] opposition to modern medicine. The question stemmed from a comment the previous patient made regarding that she was not getting the flu shot because she didn't get the flu and even if she did, she would kill it with lemon juice. As a Hispanic, her comments remind me of things my own family members do and say. A shot of honey, lemon, and rum will "cut" a variety of ailments in the opinion of an elderly Puerto Rican. When I've tried to tell my grandmother otherwise, I usually just settle for her taking her doctor prescribed medication as well as the homemade concoctions. Dr. Stephens interestingly said he encourages home remedies as long as they are not unhealthy.
"Our last patient was an 8 year old boy's school physical. The child was in good health and was cleared to play sports. An important topic was discussed after the family left regarding how the mother could not read English. As a community support worker with at risk and victimized children in the Hispanic community, I dealt with this problem daily. The schools sent all the important paperwork like grades, conference letters, field day forms, etc. in English to homes where no one read it. An 8 year old is then responsible for educating his parents on how his or her education is going. Specifically with this patient who loved playing soccer, Dr. Stephens made the point that if the child had not told the mother what the form was and the mother not come to the clinic, the boy would have been ineligible to play soccer at his school. Who knows what the consequences in the long run of keeping a healthy child who loves playing sports from doing so, all because of a form that was never explained or translated."
This last part really spoke to me--equality of opportunity is frequently cited as being a bedrock of American liberty, but an example like this shows some of the many roadblocks some must face just to get to the starting line.
Tuesday, November 9, 2010
Listening to Gladwell, spending time in Richmond
I turn around and wonder where the weekend went...
This weekend was the Association of American Medical Colleges' Annual Meeting in Washington D.C. The world of medical school academics is pretty new to me, so it really was a great opportunity to attend--it's just, wow--a lot of information to receive and process in a very short time (and on a beautiful weekend, too--very hard to stay focused when the sun is shining and the leaves are changing).
One of the highlights was Malcolm Gladwell speaking on Sunday. As the author of Outliers, he is one of my favorites for pop psychology, and his address did not disappoint. He weaved the story of Civil War General "Fighting Joe" Hooker with the story of the now defunct Bear Stearns firm to craft an allegory of how it is not those that are incompetent that wreak the world-changing calamaties that befall us--it is those we presume to be experts in their field that generate the most damage. An interesting thought, and one that he felt had parallels in medicine and possibly medical reform. (As an aside, Joe Hooker lost the battle of Chancellorsville, VA despite superior numbers, and the Bear Stearns executive blamed everyone but himself for the firm's failure--no tears for him, I'm sure he is living well)
Before seeing Gladwell, I ran into a prior teacher from FSU--Dr. Hurt! She was my first medical instructor and is still a vital part of the now four year medical school.
Today, as a break from the conference, I got to work with some swell Army medical recruiters at a military/health day fair at VCU in Richmond. SSG Pursell and gang are a good group, and did a nice job informing, instead of selling, students. VCU has a strong biomedical engineering program, and we talked to some very intelligent students--here's hoping some of them go Army! We're always looking for good colleagues.
This weekend was the Association of American Medical Colleges' Annual Meeting in Washington D.C. The world of medical school academics is pretty new to me, so it really was a great opportunity to attend--it's just, wow--a lot of information to receive and process in a very short time (and on a beautiful weekend, too--very hard to stay focused when the sun is shining and the leaves are changing).
One of the highlights was Malcolm Gladwell speaking on Sunday. As the author of Outliers, he is one of my favorites for pop psychology, and his address did not disappoint. He weaved the story of Civil War General "Fighting Joe" Hooker with the story of the now defunct Bear Stearns firm to craft an allegory of how it is not those that are incompetent that wreak the world-changing calamaties that befall us--it is those we presume to be experts in their field that generate the most damage. An interesting thought, and one that he felt had parallels in medicine and possibly medical reform. (As an aside, Joe Hooker lost the battle of Chancellorsville, VA despite superior numbers, and the Bear Stearns executive blamed everyone but himself for the firm's failure--no tears for him, I'm sure he is living well)
Before seeing Gladwell, I ran into a prior teacher from FSU--Dr. Hurt! She was my first medical instructor and is still a vital part of the now four year medical school.
Today, as a break from the conference, I got to work with some swell Army medical recruiters at a military/health day fair at VCU in Richmond. SSG Pursell and gang are a good group, and did a nice job informing, instead of selling, students. VCU has a strong biomedical engineering program, and we talked to some very intelligent students--here's hoping some of them go Army! We're always looking for good colleagues.
Saturday, November 6, 2010
Wilderness Hiking with the FMIG
Great day today!
With friends from Georgetown and USUHS, several family physicians (including one who is also an ER doc), and families, a group of us went hiking at Great Falls National Park, Maryland, on the Billy Goat Trail. We had some really fantastic hiking weather (see the photos), a great time on the trail, and some yummy comestables thanks to the planning of my wife and our FMIG President, Angel.
We also had an opportunity to talk a little about wilderness medicine (pressure is the key to bleeding, no matter what the setting), and about dealing with hemorrhage requiring massive transfusions (blood products--early and often--and in a 1:1:1 ratio of PRBC to FFP to Platelets). We also had the opportunity to talk about the evidence for the use of fresh whole blood as a supplement or possible replacement for component therapy (retrospective studies indicate a potentially lower mortality, risk of transmission of viral illnesses notwithstanding.
I love spending time with students--this upcoming generation of physicians strikes me as very altruistic and service oriented. With young blood like this, I think the future is in very good hands indeed!
With friends from Georgetown and USUHS, several family physicians (including one who is also an ER doc), and families, a group of us went hiking at Great Falls National Park, Maryland, on the Billy Goat Trail. We had some really fantastic hiking weather (see the photos), a great time on the trail, and some yummy comestables thanks to the planning of my wife and our FMIG President, Angel.
We also had an opportunity to talk a little about wilderness medicine (pressure is the key to bleeding, no matter what the setting), and about dealing with hemorrhage requiring massive transfusions (blood products--early and often--and in a 1:1:1 ratio of PRBC to FFP to Platelets). We also had the opportunity to talk about the evidence for the use of fresh whole blood as a supplement or possible replacement for component therapy (retrospective studies indicate a potentially lower mortality, risk of transmission of viral illnesses notwithstanding.
I love spending time with students--this upcoming generation of physicians strikes me as very altruistic and service oriented. With young blood like this, I think the future is in very good hands indeed!
Tuesday, November 2, 2010
Election Day!
It was cool this morning, a frost advisory was in effect, my car required a little time to warm-up, but I remember thinking that I was glad to be alive, and proud that I had voted.
When I was deployed, it was an off year. No elections, just the prospect of holidays a world apart from my most loved ones. I sometimes wish that it had been an election year. The prospect of casting my vote, the fundamental act of citizenship, while wearing my nation's cloth (even if my nation's fashion sense is sometimes suspect--I mean, really? Digital ACUs?), is something sublime.
Happily, I am not currently deployed, but I'm still voting. In my clinics, I have the privelege of being an advocate for my patients. In the military, I have the honor of being an advocate for soldier health. And, in my country, I have the proud duty of being an advocate for my nation.
Happy election day!
When I was deployed, it was an off year. No elections, just the prospect of holidays a world apart from my most loved ones. I sometimes wish that it had been an election year. The prospect of casting my vote, the fundamental act of citizenship, while wearing my nation's cloth (even if my nation's fashion sense is sometimes suspect--I mean, really? Digital ACUs?), is something sublime.
Happily, I am not currently deployed, but I'm still voting. In my clinics, I have the privelege of being an advocate for my patients. In the military, I have the honor of being an advocate for soldier health. And, in my country, I have the proud duty of being an advocate for my nation.
Happy election day!
Sunday, October 31, 2010
Halloween and the approaching holidays
In 2007, Halloween was simply another holiday that I had to spend away from my family. I had missed Halloween 2006 due to a last minute Advanced Trauma Life Support Class prior to deployment, and was bound to miss subsequent Halloweens due to conferences, Temporary Duty (military speak for "business trip"), and the like.
This Halloween I was home, having just returned from a Family Medicine conference in Pennsylvania. I accompanied my Harry Potter while wearing my Flash costume, and my Link (from "Legend of Zelda") took off with some tweens from down the street. After a walk of the neighborhood, one beer, and countless pieces of candy later, we're done for another year.
I would like to thank all of those soldiers, sailors, airmen, marines, civilians, coalition members, and local national security forces for doing the good work that allows me to spend this time with my family. I know my time to the same will come again quite soon, but for now, I just want to say thank-you for your service adn your sacrifice.
This Halloween I was home, having just returned from a Family Medicine conference in Pennsylvania. I accompanied my Harry Potter while wearing my Flash costume, and my Link (from "Legend of Zelda") took off with some tweens from down the street. After a walk of the neighborhood, one beer, and countless pieces of candy later, we're done for another year.
I would like to thank all of those soldiers, sailors, airmen, marines, civilians, coalition members, and local national security forces for doing the good work that allows me to spend this time with my family. I know my time to the same will come again quite soon, but for now, I just want to say thank-you for your service adn your sacrifice.
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