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Collaborative Family Healthcare Assoc Mtg

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The annual meeting of the Collaborative Family Healthcare Association begins today in Denver. I've only learned of this group a few months ago. According to their website, here is how they describe the organization: 

CFHA promotes a comprehensive and cost-effective model of healthcare delivery that integrates mind and body, individual and family, patients, providers, and communities. 

I have the honor of being The Moderator for the opening session tonight. First for this meeting, they will be having presentations in the style called "Pecha Kucha" in which an big idea is presented only with 20 slides at 20 seconds per slide.  You can read more here, but here are the titles of the presentations

  • Sowing and Harvesting the Literature of Collaborative Family Healthcare
  • Righting Wrongs and Reforming Rights
  • Health in Hope: Finding the Soul of Primary Care
  • When We Look Away: Primary Care and Serious Mental Illness
  • Clinician as Patient: The Gift of Illness
  • Cold Spotting: Linking Primary Care and Public Health to Create Communities of Solution

The meeting is also taking its first steps in social media. You can follow the meeting via the #CFHA13 hashtag on twitter. There has been a social media team put together to try to interview attendees following sessions, and there is even a tweet up scheduled tonight following the opening session.  Finally, in a fun way, I recorded the videos below to share my journey to the meeting. Maybe I'll be done more of this during the meeting as well...

 

AAFP Global Health Workshop

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The Family Medicine Global Health Workshop is going on over the next couple of days in Baltimore. This meeting is organized by our friends at the American Academy of Family Physicians.

According to their website, you'll learn the following at the meeting: 

  • How to get started in global health
  • Strengthen your capacity to contribute to global health programs
  • Prepare to serve as family medicine consultants and organize and conduct global health consultation
  • Broaden your clinical knowledge about diseases rarely encountered in your home country
  • Evaluate the practical management of chronic diseases in resource-contrainted settings
  • Strengthen preparation of students, residents, and physicians for global health field work
  • Promote family medicine faculty development

You can also follow the meeting using the #AAFPGlobal hashtag on twitter. I imagine that AAFP will also group tweets for your review later as well. What follows below are some initial tweets from day one... 

Family Medicine Words To Live By

These are selected tweets from the 2013 Congress of Delegates of the American Academy of Family Physicians. See other accumulated tweets from the meeting on the AAFP Storify link.

Social Media at 2013 #AAFPCOD

Monday was the first full day at the Congress of Delegates of the American Academy of Family Physicians (AAFP) in San Diego. For those unfamiliar, this is the annual meeting of the organization where health policy is debated and organizational statements are made.

One of the cool things about a blog is that you can look back at previous years to see what I have written in the past. Just two years ago, I wrote a blog post called "AAFP Embraces Social Media." It was in May 2011 at the NCSC meeting where AAFP leadership really jumped on the social media bandwagon. It was at 2011 #AAFPCOD when, for the first time ever, portions of the Congress would have a live video stream for all to see.

Just a year ago, I wrote an essay called "Social Media and #AAFPCOD." In this essay, I wrote this: "Through the 3 days of the Congress of Delegates meeting in Philadelphia, those on twitter were able to get 3.7 million impressions on the internet. Now, I know that other meetings do a lot better. But, given that social media was not even on the AAFP radar just 2 years ago, this is a huge accomplishment." 

Fast forward to this year, 2013, and as of Monday afternoon, there were already  2.1 million impressions from more #AAFPCOD tweeters than I have seen in past years. Again, this year, selected sessions of the meeting will have live internet video streaming. Unlike previous years, the AAFP organization is utilizing multiple social media platforms like twitter, storify, instagram, and ustream. Collected tweets from Monday's sessions are in the storify at the bottom of this post.

I'm very excited that the American Academy of Family Physicians and the Family Medicine Revolution (#FMRevolution) are continuing to increase their use of digital communication and social media to spread the message of Family Medicine Healthcare Policy Advocacy. The challenge will always be to continue this high social media use following the meeting, but each year, my optimism continues to grow. As I have said on multiple occasions in the past, if We, as Family Physicians, cannot be advocates for ourselves, who will? 

2013 #AAFPCOD Begins Today

Out in San Diego tonight, the 2013 Congress of Delegates begins for the American Academy of Family Physicians. Unfortunately, I will not be in attendance because of scheduling challenges with work. 

The good thing is that it will seem like I'm there because of social media, specifically twitter, and the hashtag #AAFPCOD. Shout out to all my friends who are there, and I hope that they will keep us updated. 

Did want to give out a shout out to our pal Dr. Glen Stream who mentioned me in the video above right before he became AAFP President. It was also with Dr. Stream that the twitter handle @aafpprez was started. Our pal Dr. Reid Blackwelder who will be taking over the @aafpprez twitter feed this week. 

If you're like me, and cannot attend the Congress of Delegates in person, don't worry, AAFP is live video streaming parts of the proceedings this year again at this link. Thanks to AAFP for using digital communication like video streaming and social media to get the message out about Family Medicine and #FMRevolution!

The Presidents' Gatekeepers

I don't know what it is, but even as a young kid, I've been fascinated with politics (but not being a politician). I've been watching a new TV show from the Discovery show called "The Presidents' Gatekeepers" talking about the job of White House Chief of Staff. 

Up to this point, there have been two episodes. Not only has it's been a cool review of history, but a great first person account by those who were advising the President. We have a lot to learn from history. I have always told myself that before looking ahead, you have to look back to the past. There are still lessons that we can learn...

Antibiotic Overuse: Why We Don't Care

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This week in the news, another report was released by the Centers For Disease Control saying that antibiotic overuse is creating "so-called superbugs." In this USA Today article (from which the graphic above was taken), it states that superbugs "cause at least 2 million infections and 23,000 deaths each year."

You know who is causing the problem, right? It's doctors like me. Depending on the report you read, I am the one who is giving antibiotics out like candy. Now, if you have the courage to dig deeper, Antibiotic Overuse is just a symptom of our broken health care system, unrealistic high expectations from society, and paralyzed government bureaucracy. Consider these factors:

  • Where's the Tort Reform? In the United States, it is our right to sue anyone we want to at any time and for any reason. Many people yell at hospitals for using too powerful antibiotics and this is the cause of resistance. "Antibiotic Stewardship Programs" are being put forth to limit hospital antibiotic use. Will this really work? If I have a patient pass away from an infection, and the attorney asks me why I didn't use X antibiotic and I say it's because of the "Antibiotic Stewardship Program," of course I will be labelled as someone who is looking more out for the hospital and not for the patient. My career will be over. Why risk that? I'm gonna prescribe that antibiotic. Don't blame me. Fix the legal system, and then talk to me.

  • Where is Choosing Wisely? The Choosing Wisely campaign is designed to educate and make physicians order less "unnecessary" tests. It's no secret that I'm skeptical about this (read this post). I challenge the campaign to add appropriate use of antibiotics to their recommendations. Will they? Let's see.

  • Yes, I get paid when you're sick. The broken payment system has been written about many times, and illustrated in movies like Escape Fire. I would rather be paid for high quality care, and not high volume of patients coming through my door. Many docs believe coming in for an office visit is quid pro quo for then giving an antibiotic. Or, in more awkward fashion, see the next item...
  • I paid a $30 co-pay and didn't get an antibiotic? For the foreseeable future, there will be the expectation of antibiotic since, "I had to pay such a high copay to see you." Or, "next time, I'll take my business elsewhere." Or, "it doesn't matter what you do, I'll get my antibiotic here or at the urgent care." Which leads to the next item...

  • Where's that rating sheet? Many patients know that patient satisfaction surveys factor into physician payment schemes. It has been written about many times that "The Customer Is Always Right" is maybe good business, but sometimes bad medicine. Check out the KevinMD site for multiple essays on this including this one,  this one, this one. and this one.

  • You're not making me get a flu shot. I already ranted in a previous post, so, I won't do that here. The unintended consequence of not immunizing is more and more use of antibiotics and antiviral meds - which, of course, will lead to more resistance. Just imagine how much Antibiotic Resistance could be slowed down if everyone received their recommended immunizations. Mind blowing, isn't it?

  • Animals also get antibiotics. I only learned about this a few years ago. But, this is an easy fix, right? Here's a quote from the USA Today article, "In 2012, the FDA asked food producers to stop putting antibiotics in animal feed to promote growth, but the guidelines do not have the force of law." So, animals and humans will continue to get their antibiotics.

When it comes down to it, the medical issue of Antibiotic Resistance is like the political issues of trying to solve Mass Shootings, Government Spending, and Immigration. We all know what the problems are. But, there is no real emotional or political will to actually solve the problem. So, we will continue to have mass shootings, we will continue to raise the debt limit, we will continue to allow illegal/undocumented people in this country, and, oh yeah, we will continue to have Antibiotic Resistance. Go ahead. Tell me where I'm wrong here...

Addendum: For clarification, I did hear back from the ABIM Foundation this afternoon on a number of fronts. In addition to their comment below, which I appreciate, they also had the following tweets. Thank you for your response, and I ask the readers of this essay to also note their input.

Why Immunizations Matter

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One of the reasons I love social media is that it keeps me up to date on breaking news stories. Here are two stories that came through my social media channels in just a few hours tonight. Both of these have to do with immunizations, which, of course, is a Healthcare and Social Media hot topic, especially among pediatricians.

"U.S. Measles Cases in 2013 May Be The Most In 17 Years ," was posted on CNN earlier today (photo credit from this article). In case you're not familiar, measles is a highly contagious respiratory disease caused by a virus. According to the Centers of Disease Control, there have been 159 cases from January 1 through August 24. If this keeps up, this will be a record year of cases. According to this article...

Nearly two-thirds of the reported cases happened in three outbreaks in communities where many people don't vaccinate their children for religious or philosophical reasons.

Some parents have been hesitant on childhood immunizations for many years, but the controversy was ramped up in 1998, when a study was released stating that the measles vaccine was linked to autism. The press and many celebrities got on board to tell people to avoid vaccines.

When I was in residency in the early 2000s, it was very difficult for me to convince parents to give their kids not only the MMR vaccine, but any vaccines. This controversial research paper was partially retracted in 2004 and labelled totally inaccurate (meaning the study lied) in 2010. But, by then, the damage was done. To this day, many parents still refuse immunizations for their children. 

Fast forward to today's report. Twitter was lighting up today with medical professionals and the general public upset with people who do not vaccinate their children. 1998 was pre-social media the way that we know it today. The mainstream media, celebrities, and vaccine opponents went unchecked and the lies perpetuated. These days, you see tweets below to spread the correct information...

 

The second story I'll quickly mention is "Whooping Cough Reaches Epidemic Level In Texas," from Reuters. According to the article, the number of whooping cough (aka Pertussis) could hit a 50-year high. Pertussis is a highly contagious bacterial disease that can last weeks, especially with severe coughing fits. Pertussis can be prevented with vaccination. The piece does not go into why state officials believe cases are increased. Some on social media have stated that this epidemic was also caused by vaccine refusal.

I believe both of these infection stories underscore the importance of childhood immunizations. Even as I write this blog post, I'm receiving e-mail messages and direct messages on social media saying things like, "Well, if there were only safe immunizations, then I could get my children vaccinated." Really? That's what you have to say for yourself?

Whether it be childhood immunizations, adult immunizations, flu shots, statin medications, or whatever - until the fear of the disease, illness, or death - until this can overcome the unrealistic expectation of zero side effects, tragedies like preventable illness and preventable mortality will continue... 

E-Cigarettes: Good for adults, Bad for kids

Are electronic cigarettes, e-cigarettes, good or bad? There have been two huge stories in the past week, which may be seen as conflicting and confusing. First, the good news. Last week, the research journal "The Lancet" showed that Electronic Cigarettes are effective in helping adults stop smoking. How effective? About as effective as the nicotine patch. Of course, more research is needed in this area, but this is a positive step, right?

Now, the bad news. Also last week, a study from the Centers for Disease Control showed that E-Cigarette Use More Than Doubled among US Middle School and High School Students. I recommend you check out leading pediatrician social media journalists Dr. Wendy Sue Swanson and Dr. Claire McCarthy on their great essays on the topic. (BTW, where are the Family Physician social media leaders on this topic? We care for kids, too, right? Get out there on social media and tell people about it!)

But, what's the problem? Kids cannot purchase real cigarettes. So, that means they cannot purchase e-cigarettes, right? WRONG! My home state of Ohio currently allows minors to purchase e-cigs, at least for now, according to this Dayton Daily News article. That's gotta change. Currently ONLY about a dozen states prohibit minors from purchasing.

In the video above, the news report from last weekend outlines the dangers of e-cigarette use, especially in children. Many editorials have been written, including this one from Newsday, asking states and the federal government to increase regulation to prohibit minors from purchasing e-cigarettes, just like prohibiting purchase of "real" cigarettes.

Don't misunderstand. I don't want to ban all e-cigarettes. I have a lot of stories from patients and stories from friends saying how much e-cigarettes have helped them cut back and/or eliminate the use of real cigarettes. The initial data from The Lancet study is hopeful, and reinforces the anecdotal stories that I have from patients and from friends.

My issue is preventing children from access to electronic cigarettes. There is a window of opportunity (legally) for tobacco companies to expose children to the nicotine experience. And, I think that the health community, as well as the general public, have to educate ourselves on this subject, and get our lawmakers to do the right thing...

My Experience at 9/11 Memorial

September 11, 2001 was a significant day in my life. And, even without social media (as we know it at the time), I felt connected somehow to the events in New York City. I saw the people walking across the Queensboro Bridge trying to get home. At the beginning of last week's podcast, I shared what happened to me on 9/11/01. Back in 2008, I wrote this blog post about it, and even sparked a video response below from our pal Crzegrl.

As I mentioned in a previous post, I was in New York City last week with my family. The one place I was both most anxious about and most looking forward to was the National September 11 Memorial at the World Trade Center site. 

As you approach the entrance to the memorial, you cannot help but look up and see Freedom Tower, or as they refer to it now, One World Trade Center. It's an eerie feeling I had when entering the site. The first thing you notice is the many security check points that you have to go through before entering the memorial plaza. The second thing you notice is that even with all these people around you, the silence is deafening.

As you enter the memorial plaza, the South Memorial Pool is in front of you. I've seen it on television, but you do not have a gauge of the size of the pool until you physically walk around it. In addition, the sound of the waterfalls of the pool is so loud, that it drowns out the city noises and the people talking around the pool. As you look up from the pool, you see Freedom Tower, and the emotion overcomes you. 

As I walked around the rest of the memorial plaza, I saw young children being talked to by their parents and grandparents about what happened here. In addition, on some of the names, I saw one flower placed in the letters of the name. This made me think of all the families affected. I shared my experience in real time on twitter. My tweets are at the bottom of this post. 

In the video above, you see and hear the segment from last week's podcast where I share my experience at the National September 11 Memorial. You can check out the entire audio podcast in the player above, and you can download the episode here. Never Forget the events that happened on September 11, 2001....