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Only a quarter of American medical schools offer the 25 hours of nutrition training recommended by the National Academy of Sciences, NPR news reported yesterday. Yet, what we eat is the most important factor in preventing early death and chronic disease. Today on the blog, we'll see what some med students at Baylor College of Medicine did to get the nutrition training they needed.

By Amy Cobb, M.D. 

When I saw that Mr. Jones was in for yet another exacerbation of his chronic congestive heart failure, I felt utterly exasperated. I approached his bedside to find out what had gone wrong in the few weeks since his last hospitalization when I saw them. They were unmistakable and all too familiar. Red, freshly polished, and clownishly big, two shoes were peeking out from underneath the bedside curtain. Sniff, sniff. If the shoes hadn’t given him away, the smell would have. I gathered whatever patience and calm I could muster and pulled back the curtain. To no surprise (but to much dismay), Ronald McDonald was sitting there by my 47 year-old obese, hypertensive, diabetic patient, serving him an over-sized Big Mac and fries.

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Posted by Sonya Collins on Jul 2, 2015 9:12 AM EDT
We're excited to be planning our fourth annual Gregg Stracks Leadership Summit. Today on the blog, you'll meet Krisda, one of our summit coaches. He wrote this post after he attended the summit for the first time in 2013. This year he will return for the second time as a coach. Hope to see you at the summit!

By Krisda Chaiyachati, M.D.

I had been back on US soil after a six-week rotation in South Africa for barely a week before attending the 2013 Gregg Stracks Leadership Summit in Boston. The night before, my wife Barbara asked, “Remind me why you’re going to this?” I glossed over a few catch phrases about primary care and leadership, but she surely could tell I wasn’t convinced. more...
Posted by Sonya Collins on Jun 30, 2015 10:32 AM EDT
Saturday, June 27, is National HIV Testing Day. Today on the blog, we revisit a post from our archives about the current state of HIV care in the U.S. As HIV is no longer an acute crisis and instead a lifelong chronic disease, care needs for HIV+ people have changed. Here, the writer discusses the need for ongoing primary care for aging HIV+ people.

By Andrew Hart, M.P.H.

My interest in HIV is both personal and professional. I am a member of a community that continues to be the hardest hit by the epidemic: gay men. Some of my friends are HIV+ and while the shock and sadness is perhaps less than when the epidemic was nothing short of a nightmare through the 1980s and early 1990s, the struggles they must confront are many and complicated, and will only increase as they age with the disease. Professionally, I’m interested in HIV because I am trained in public health and pursuing my PhD in social policy with an emphasis on health services research and health policy.
 
Mainly because of the success of combination antiretroviral therapy (cART), Americans think all is well with HIV. But that simply isn’t true. HIV has become a disease of the impoverished, so it’s easier to hide. What’s more, those aging with HIV are mostly forgotten – in part because of the “all is well assumption” but also because the elderly in general are mostly forgotten in our culture. By 2015, 50 percent of people diagnosed with HIV or AIDS will be 50 years old or older. The life expectancy of people living with HIV is approaching that of the general population.

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Posted by Sonya Collins on Jun 25, 2015 12:31 PM EDT
At its inception, the direct-pay, retail clinic was an innovative model that expanded access to primary care and made payment a direct transaction between patient and provider. But has it continued to be an alternative to the traditional model? Today on the blog, the founders of Minute Clinic look back on the model they designed more than 15 years ago and discuss the future of retail clinics. 

By Rick Krieger and Doug Smith, M.D.

Retail health clinics, by definition, are when the consumer pays the provider directly at point of sale. It was a model created to compete for the co-pay, the patient’s money, by providing a better care experience.   
 
The original QuickMedx/Minute Clinic model that we created in 1999 was a flat fee $35 for each visit; paid when care was received, and no insurance claim was submitted. This model lowered the cost of care significantly by avoiding the insurance billing. It was a retail sale in the truest sense and a major disruptor as patients came to us knowing exactly what the cost of care was. It was also profitable. 

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Posted by Sonya Collins on Jun 23, 2015 11:22 AM EDT
It's Men's Health Week, a time to raise awareness of preventable health problems and encourage early detection and treatment of disease among men and boys. The first stop for prevention is your primary care provider. As you'll read here, going to urgent care to see a new provider whenever you have a problem is not the same as having a primary care provider who knows you.

By Katharine Treadway, M.D.

Last week, a patient I have known for several years called my office and spoke to my nurse. She said that while she was driving, her vision had gone blank for one second and then she was fine. My schedule was already overbooked. Almost all of the slots were filled with patients with the usual array of multiple chronic medical problems for follow-up and management of what were, for the most part, stable conditions. Thus my nurse sent her to urgent care, a unit set up so that patients can see a health care provider quickly for acute medical problems rather than go to the emergency room. The necessity for such a system has developed gradually as the burden of prevention, chronic care, documentation, and paperwork has eroded the flexibility of many internists to squeeze in the extra patient with an acute problem. The result, paradoxically, is that I see my patients when they are well or stable, and urgent care sees them when they are sick -- the reverse of what should happen. The cost of such a system can be significant, as this story illustrates.

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Posted by Sonya Collins on Jun 18, 2015 11:44 AM EDT
This summer marks the kickoff of our second annual Hotspotting Mini-Grant Project. Read all about it today on the blog.

By Sonya Collins

Tuesday, June 16, 2015 – For the second year, the Camden Coalition of Healthcare Providers (CCHP), Primary Care Progress (PCP), and the Association of American Medical Colleges (AAMC) are collaborating on the Hotspotting Mini-Grant Project. The initiative gives interdisciplinary teams of health professions students an unparalleled hands-on opportunity to learn and practice an innovative model of health care coordination called hotspotting. Here, program partners weigh in on why hotspotting is important and the new elements participants can expect this year.
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Posted by Sonya Collins on Jun 16, 2015 11:03 AM EDT
In this month's issue of The New England Journal of Medicine, James Macinko and Matthew Harris discuss the lessons our health care system could learn from Brazil's team- and community-based primary care program known as the Family Health Strategy. One of our PCP community members shared her firsthand experience with this innovative model here on the blog back in 2013. Here's what she said. 

By Michelle Jose-Kampfner, M.D.

Rio de Janeiro: Beautiful beaches, majestic mountains, sequined-clad samba dancers, and innovative primary care delivery. You probably didn’t expect that last one. Neither did I! But it was indeed what I found. 

In 1988, the Brazilian constitution declared that health care is a human right, to be provided by the government, and to that end it created a single-payer health system. In practice, however, many middle and upper class Brazilians choose to purchase private health insurance or receive it from their employer, so the government provides health care largely to those in Brazil’s lower socioeconomic strata. In the 1990s, recognizing the increasing burden of chronic disease, the government created a national primary care policy, the Estratégia Saúde da Família, or Family Health Strategy (FHS). During a gap year from medical school, I went to Rio de Janeiro on a Fulbright Fellowship to study this policy, both the macro aspects and the day-to-day experience of providing patient care under the policy. To that end, I worked as an intern at the Ministry of Health in Rio de Janeiro, and as part of a health care team at one of the FHS Clinics.  more...
Posted by Sonya Collins on Jun 11, 2015 10:53 AM EDT
Today we run a favorite from our archives. On an ER rotation -- which she thought should have been the most exciting rotation of all --  this med student knew more than ever that she wanted to form long-term relationships with patients through the practice of primary care.

By Jennifer Stella, M.D.

As a third-year med student, I was doing an ER shift when the call came through our dispatch: 56-year-old man, status epilepticus, being flown in from Yosemite, 10 minutes out. I watched the residents snap into a semi-ordered chaos. Ten crucial minutes. Prepping the trauma bay. Anticipating acute management, who was going to do it, half-tying the yellow paper gowns. Anyone who had looked tired didn’t anymore.

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Posted by Sonya Collins on Jun 9, 2015 10:30 AM EDT
If it weren't for the great role models, teachers and mentors he had, this rising family medicine intern might not have gone into primary care at all. Here he encourages other primary care doctors to do their part to grow the workforce by becoming mentors and role models to students. 

By Cleveland Piggott, M.D.

Dr. Quinn, Medicine Woman, was my first physician role model when I was a kid. She had full scope of practice in the Wild West, and what kid doesn’t like a good Western? But it wasn’t until later in high school that I started considering a career in medicine. A great biology teacher sparked my love for science. That, coupled with my passion for helping others, made medicine seem like a good fit.  

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Posted by Sonya Collins on Jun 4, 2015 10:31 AM EDT
We're thrilled to announce our fourth annual Gregg Stracks Leadership Summit, which will be held in Cambridge, Massachusetts, August 28 - 30. Want to know what the summit's all about? Stay tuned for new posts about our leadership summit in the coming weeks. Till then, here's a wrap-up of last year's summit. 

By Sonya Collins

For nearly a decade, transformation and reform have been dominant themes in health care. Primary Care Progress (PCP) wants to prepare the next generation of primary care providers to help lead that transformation. As part of that mission, the grassroots organization hosted its third annual Gregg Stracks Leadership Summit this September at the Microsoft New England Research and Development (NERD) Center in Cambridge, MA. The summit brought together 67 PCP chapter leaders and six faculty advisors from four health care professions and 22 institutions around the country. 

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Posted by Sonya Collins on Jun 2, 2015 11:10 AM EDT
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Most Recent Comments

Interesting article, Mara! I absolutely agree that the best way to treat a patient is to focus on patient-engagemen...
Such an inspirational post, Sonya! I feel so good after reading this post!
Thank you for sharing!
Thank you for sharing this. Many medical students I know struggle with the family vs. internal medicine (vs. med-pe...
What a compliment to be included in your piece, Dr. Nace. We agree that training as part of a care team is essential for...

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