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This month on the blog, we're highlighting primary care exemplars. Virginia Tilden is a champion of interprofessional education and team-based care. She represents the values we need in the next generation of primary care delivery. Today, we run a post by Dr. Tilden from our archives.

By Virginia P. Tilden, Ph.D., R.N.

It’s been a long time since I was a baccalaureate nursing student at Georgetown University in Washington, D.C., but my memory is sharp about this fact: nothing in our curriculum taught us to work as an interprofessional team.  In 1967, the year I graduated, nursing was a rigid, rule-based discipline driven as much by hospital policy and faculty dogma as by scientific evidenceAnd, just like medicine, it was siloed by its own knowledge, traditions, and truths.  Even back then it struck me as odd that we nursing students and fellow medical students cared for the same patients when barely a word passed between us. Further, our faculty seemed unaware of each other, as though the two professions operated in parallel universes with almost private and separate languages about the very same patients for whom we jointly cared.

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Posted by Sonya Collins on Apr 23, 2015 11:54 AM EDT
Though they live in a city whose medical community prides itself on innovation, these three young docs felt they were getting no more exposure to primary care innovation than their colleagues in any other city. So they decided to create a primary care innovation elective. 

By Norris Kamo, M.D. (top left); Leah Marcotte, M.D.; and Richard Waters, M.D.

How is it that so many medical students who express an interest in primary care careers before starting residency decide to subspecialize by the time they finish an internal medicine residency?   How many family medicine residents get exposed to diverse models of primary care during their training?  Talking to residents in all of the Seattle family medicine and internal medicine residency programs, we realized that family medicine and internal medicine residents in Seattle weren’t that different from residents elsewhere in the country, even in a city that prides itself on emphasizing primary care, with some of the most innovative primary care practice models in the country. Residents in Seattle programs get almost no exposure to primary care innovation outside of their own institutions.  With a national conversation ongoing about how to enhance prevention and patient-centeredness at the primary care level, exposure to innovation is essential for new physicians.  We wanted to create an opportunity for residents to learn and experience primary care innovation firsthand.

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Posted by Sonya Collins on Apr 21, 2015 12:22 PM EDT
Stuart Pollack is a primary care internist and medical director of Brigham and Women's Advanced Primary Care Associates. The clinic, an innovative patient-centered medical home model, opened in 2011 as a demonstration project to test a team-based approach in primary care. Dr. Pollack is a primary care leader who we believe demonstrates the characteristics needed in future primary care leaders. Our director of media and communications, Jenette Restivo, asked Dr. Pollack some questions about his work. Here’s what he said.

JR: Dr. Pollack, you say that the primary goal of the clinic was always the quadruple aim – higher quality, greater satisfaction, lower cost, and provider sustainability. Secondarily, the goal was learning to teach trainees to deliver care in a team-based environment, serving as a learning lab for the Brigham and its vast primary care network.  Can you explain why it was so important to adopt a team-based approach at Advanced Primary Care Associates?


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Posted by Sonya Collins on Apr 16, 2015 10:48 AM EDT
Today on the blog, Duke Family Medicine Residency's program director gives us a look behind the scenes at this year's interview process and shares her excitement about the incoming crop of residents (spoiler: two of them are from PCP!).

By Viviana Martinez-Bianchi, M.D.

It was that time of the year. Match Day was approaching, and some nights I would lie awake, wondering who our new interns would be.
 
I would think of the outstanding young men and women we interviewed this recruiting season for the Duke Family Medicine Residency Program and the amazing conversations that often felt rushed in a 30-minute interview, feeling that I had just met a peer, a soul mate, a passionate advocate, someone with an extremely intelligent mind. I would think of the wealth of information they shared, their willingness, their passion and what steps they had taken in their lives to be sitting in front me, a program director in a family medicine residency program in an academic medical center.

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Posted by Sonya Collins on Apr 14, 2015 12:22 PM EDT
State and federal regulations aim to measure and improve the value and quality of health care. But this primary care doctor says they're measuring the wrong things. 

By Andy Lazris, M.D.

When I was a resident at University of Virginia, my wisest mentors gave me one piece of advice that far exceeded all the scientific and statistical jargon that others expected me to swallow. Consider this: When patients walk into your room and sit down, shut up and look into their eyes. When they are done talking, have a conversation. The key word is conversation. The visit should not include a lecture or statistics that diminish the complex needs and wants of the person sitting in front of us. Primary care doctors who care for the elderly and chronically ill confront a plethora of medical problems in virtually every patient who walks through our doors. To solve them all is not possible and may not be what the patient wants. As my mentor told me, unless you address the patients’ concerns, they will hear nothing else that spews from your mouth.

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Posted by Sonya Collins on Apr 9, 2015 10:26 AM EDT
This medical student had always heard of patient-centered care but it wasn't until she joined this innovative group that she saw it in action.

By Mara Gordon

When I showed up to my first Stress In Pregnancy: Improving Results with Interactive Technology (SPIRIT) meeting last summer, I wasn’t sure what to expect. SPIRIT is a participatory research group, meaning that patients, providers and clinic administrators all work together on projects. Based in the Helen O. Dickens Center for Women’s Health at the University of Pennsylvania, SPIRIT got started to help address disparities in mental health services for pregnant women from underserved communities. Depression in pregnancy is a sticky subject, and many women feel afraid to ask for help. So why not involve them in the process? 

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Posted by Sonya Collins on Apr 7, 2015 7:19 AM EDT

Rx: The Quiet Revolution premieres on PBS tonight at 9pm ET. PCP is a proud supporter of this documentary that showcases innovation and teamwork in primary care. Today the editor of Progress Notes talks about the screening last month in Atlanta.

By Sonya Collins

Last month, I attended a screening of clips from Rx: The Quiet Revolution. In a small theater at Fernbank Museum of Natural History, we watched about four clips from the film and got some commentary from David Grubin, the film’s director, in between clips. But I want to talk about the conversation that took place after the screening.

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Posted by Sonya Collins on Apr 2, 2015 10:38 AM EDT
Rx: The Quiet Revolution premieres on PBS this Thursday, April 2, at 9pm ET. PCP is a proud supporter of this documentary that showcases innovation and teamwork in primary care. Today on the blog, we have a Q&A with our director of media and communications, Jenette Restivo, and the film's director, David Grubin.

JR: Why did you want to make a film about primary care? 
 
DG: My father was a general practitioner, and I learned from him that primary care is where the action is.  There’s plenty of excitement for a filmmaker in the emergency room, or in the operating theater, but that’s not where the challenges to our health care system are.  Fifty percent of Americans have a chronic illness.  One in four have two or more chronic illnesses.  And 75 cents of every health care dollar is for treating chronic illness.  If the film could show the innovations in primary care practice, it could make a real contribution.

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Posted by Sonya Collins on Mar 31, 2015 12:34 PM EDT
Today on Progress Notes, a podiatrist encourages primary care practitioners not to forget their patients' feet in routine exams.

By Lori Weisenfeld, DPM

When I was a resident, I saw a middle-aged man, “Charles,” who came into the hospital after playing a round and a half of golf. When I looked at his right foot, he had an ulcer in the shape of a golf tee. He had played the entire day with a golf tee in his shoe and only noticed when he found drainage on his sock. The story sticks in my mind because he was the first person I ever had to tell that he might have to have his foot amputated. It turned out that he had been diagnosed with diabetes, but he never complained about his feet so nobody ever checked them. He never complained because he had neuropathy, so he never felt anything.

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Posted by Sonya Collins on Mar 26, 2015 10:50 AM EDT
In the final day of our Match Day 2015 series, "Matching to Lead," we will hear from three of our PCP fellows about their match application experience. Here's Devorah Donnell, our training and engagement fellow.

By Devorah Donnell

“I have no idea how I’ll choose an age group because I love them all.” I can’t count how many times I said that during my first and second years of medical school, but I do remember the first time I saw the three generations of care that are possible in family medicine while at my family medicine continuity clinic. I remember the grandmother was there for her visit, accompanied by her daughter and grandson, who were also my preceptor’s patients. I realized early in medical school that family medicine is my best fit. I love caring for children, teenagers, adults and seniors, with continuity and comprehensive care and the extra bonus of also being able to do procedures. Though family medicine residencies meet the same core requirements, programs around the country are very different — so how do you choose? 

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Posted by Sonya Collins on Mar 24, 2015 2:25 PM EDT
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Most Recent Comments

Wow, I had no idea that it was so hard for a general physician to enter back into medical practice after being out of it....
Thanks for sharing, Mara. I totally agree that patient input makes everything more powerful! It's great to see how t...
I like your point about good primary care physicians having the ability to converse with people, and enjoying getti...
I'm so glad you shared your experience, David. We've been watching your team take on this tremendous task with such e...
Thanks for sharing this piece. How wonderful that you were able to build such a close relationship with your patient...

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