December 30, 2010

By Randi Sokol, MD, MPH

As a resident who loves developing relationships with my patients, I (almost always!) violate my 15 minute time limit with each of them. It’s not just my social nature that’s at fault: Realistically, all of a patient’s health care needs cannot be addressed adequately in one 15 minute session. And even with unlimited time, the office setting has its limitations in truly improving patient outcomes:


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December 22, 2010

By Patrick Lee, MD, DTM&H

These days, my colleagues and I hear two recurring conversations among medical students and residents. In one conversation, trainees who recognize the critical role of better primary care lament the sacrifices in salary, professional opportunities, and prestige that often accompany a primary care career. In the other conversation, students interested in global health are dissatisfied with the pressure to specialize when the most pressing health challenges include inequity and under-performing health systems. Remarkably, it is often the same students in both conversations.
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December 15, 2010

By David Margolius

In the Department of Public Health (DPH) clinics in San Francisco, CA, demand for doctor’s appointments far outweighs supply. This has been especially dramatic in clinics that have switched to “open access” scheduling, an innovation that allows patients to schedule same-day or next-day appointments. Open access is meant to eliminate long waits for appointments, but the reality is that often, dozens of patients call for a limited number of appointments. Fifteen minutes into each day, receptionists have to tell patients that there are no more appointments available. more...

December 8, 2010

By Michelle Hauser

What if patients left the doctor’s office with a recipe for a flavorful stir-fry and a few new friends in addition to the usual prescription? As a culinary instructor turned medical student, I’m pretty excited about the idea.

This summer, Dr. Helen Delichatsios, an MGH primary care physician, and I attended a conference about shared medical appointments (SMAs), in which patients with similar medical conditions see a doctor as a group. Dr. Delichatsios and I had met because of our mutual interests in nutrition, cooking, and helping people make healthy lifestyle changes. We have taught cooking alongside nutrition together for the past few years. At the conference, we were struck by the idea of creating a modified version of the SMA for patients with hypertension, diabetes, high cholesterol, and weight issues that would pair a healthy cooking class with nutritional education. more...

November 22, 2010

By Karl Singer, MD

Nothing says family practice like four generations of patients. During my 38 years as a doctor in Exeter, NH, I have cared for at least three four-generation families. A few weeks ago, when I saw members of two of these families on the same day, I was reminded of how much I learned from each generation and how much they meant to me. more...

November 14, 2010

By Stephen R. Smith, MD

A 28-year-old woman with acute low back pain came in to see me last week. She was in a lot of pain but had no “red flags” that might indicate that this was anything more than an acute back strain. She had no past history of back problems, fever, or neurological deficits. Yet, she and her husband were insisting that I order an MRI. more...

November 5, 2010

On Wednesday night, Dean of Harvard Medical School Jeffrey Flier hosted a reception to celebrate the new $30 million Center for Primary Care announced last week. It was a classy affair with hundreds in attendance. We heard from the likes of Harvard President Drew Faust, global health guru Paul Farmer, and our ownAndrew Morris-Singer and David Gellis. What a great tribute to an important cause! more...

October 28, 2010

By Kathleen Wakeham and David Tian

During the first two years of medical school, students often hear conflicting messages about primary care. On one hand, we learn that health systems built on a solid foundation of primary care deliver more effective and equitable care. However, we are just as likely to be discouraged from entering primary care, hearing that primary care providers are underpaid and overworked. The dissonance between these two messages highlights the need for medical students to take an active role on our campuses to correct misconceptions about primary care and to demonstrate exciting possibilities in primary care practice. Through our work with Primary Care Progress, students at Harvard Medical School (HMS) have learned that building coalitions with residents and attending physicians is an especially effective way to achieve these goals. more...