My health center, Alvernon Family Medicine, in the heart of Midtown Tucson is surrounded by vibrant communities from around the world. Our physicians, nurse practitioners, residents, nurses and staff pride ourselves as the medical home for a diverse patient population, with as many as a quarter of our patient visits made by individuals and families who came to this country as refugees from war-torn regions of Africa, the Middle East, and South Asia. While we struggle with visits prolonged by translator phones and managing the health needs in resource-challenged communities, we know we provide great care to many who refer more from their community to us day after day.
As I listen to the vitriol from the highest levels of our government — painting refugees as dangerous and taking advantage of us — my patients I’ve cared for over the last two years prove the opposite. They’ve reminded me of how lucky I am to be an American, our role in ensuring human rights for families that have fled their homes for a second chance at life, and how they keep America great.
In the fall of 2004, my last year of medical school, I spent nearly 3 months in South Asia.
India, the country where my parents were born and raised and where nearly all my relatives still live, had historically been a regular destination for me. The fall of 2004 was an opportunity to visit my grandparents, uncles and aunts, and cousins, experience Diwali and a host of other festivals in India for the first time, explore the city of Mumbai independently, and travel through historic cities of Sri Lanka and Tamil Nadu state in Southern India.
Demon King Raven Effigy during Navratri
Roaming the Streets of Surat
New Years Pooja to Books
Ganesh Festival, Mumbai
The technical reason I was in India, however, was to complete two month-long elective rotations as part of my medical education. I spent a month in Surat (Gujarat State’s second city, a few hours north of Mumbai) at a private pediatrics hospital seeing burgeoning services for the rising middle class, with some additional time at an aunt’s homeopathic clinic. I also spent a month at KEM Hospital in Mumbai, a government hospital for Mumbai’s indigent population.
*** Primary Care Physicians vs. Nurse Practitioners ***
It’s the marquis turf battle that’s sexy and exciting for journalists, politicians, and healthcare groups. State-by-state changes have been giving nurse practitioners (NPs) more and more (sometimes less) ability to practice more medicine with less supervision.
In many states and federally, expansion of NP scope of practice has, by the viewpoint of many physicians and physician groups, become the Pandora’s Box that will reshape primary care for the worse, challenge the future of the profession of primary care physicians, increase healthcare costs, and cause great harm to patients and communities. Full legal independent scope to practice medicine is the line in the sand that most states yet have not crossed, requiring NPs to have a “collaborative agreement” with a physician who “supervises” their care of patients.
Computers are getting smarter, better, and more personable, there’s no doubt about it. Will there ever come a time, however, when computers get so good at human interaction that even the highest-skilled in the work force — primary care physicians (PCPs) — go the way of the travel agent?
I began wondering this a few months ago after listening to Dr. Martin Kohn, a physician who works at IBM Research and works on integrating the Watson supercomputer (of Jeopardy! fame) in healthcare. He spoke about computer technology changes, their history, and their integration with healthcare.
Could computers be the biggest disruptors of healthcare delivery (and my career as primary care physician)? Here are five reason why, one day, primary care physicians could possibly be replaced by computer…
Last week I gave testimony to the Oak Park Village Board in support of a youth bicycle helmet ordinance (passed 5-2!). It was pure policy work for population-based health safety outcomes. Using my voice as a primary care physician (who just happens to bike to work regularly) was instrumental to the broader public health arguments made.
The “integration” of the two realms, primary care and public health, came up regularly throughout my year on the Board of Directors for the AAFP (American Academy of Family Physicians), especially through my Commission liaison role on the Health of the Public and Science.
I learned something new: public health and primary care aren’t integrated, and a number of groups are working to bridge the two.
People say that doctors make the most difficult patients. They’re wrong. My parents make the most difficult patients.
My parents are great case studies for the challenges of primary care and prevention. Years upon years of my attempts reinforcing health education have seen more failures than successes. What can we do to win the primary care and public health battle of prevention? Continue reading →
No meeting, no forum, no report has left me so fearful for the future of my profession than being a patient.
“Practice transformation,” or how practices can transform into patient-centered medical homes (PCMH), is all the rage. One of the four pillars is “patient-centered care” and emphasizes metrics like same-day appointment availability. (Click for more info on PCMH)
As more and more practices move towards PCMH certification, can primary care physicians make all these changes yet still run their practices like dinosaurs, ripe for extinction? Will we be replaced by the smaller, warm-blooded mammals of walk-in pharmacy clinics and Advanced Nurse Practitioners?
Previously, I would have said, “We will not only survive, we’ll thrive!” Now I’m not too sure. Continue reading →