By Aaron Stupple, M.D.

As the current social media revolution is being compared to the advent of the printing press, Stupple explores whether health behavior apps could have the impact on public health that clean water, sewer systems and antibiotics have. 

Despite an increasingly advanced understanding of disease, roughly half of all deaths in the US are preventable, according to a 2004 JAMA article. And medical and public health efforts to change individual behavior and lifestyle choice have been of little help, the article said.

If patients would make different choices, there’s no telling what rewards could be reaped—environmentally, politically, economically. It is easy to be glib about behavior change; just because we can describe half of all deaths by a simple phrase doesn’t mean the solution is simple.  However, revolutions do happen. The greatest boon to public health came with the advent of public water and sewer systems early last century, followed shortly by the advent of antibiotics. A combination of public choices and medical innovations spurred dramatic shifts in life expectancy and quality. Could the same kind of revolution in behavior and lifestyle happen today?
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By John Luo & Jeffrey P. Guenette

Program at Brown inspires med students to see physicians not just as clinicians but as innovators, poising them to drive future improvements in care delivery.  

Technologies in the field of medicine have grown exponentially in the past few decades.  Stemmed by a growth in our knowledge of disease pathology, incentives from governmental granting agencies for translational research, and rapidly advancing technical and engineering capabilities, the role of the physician as innovator has never been more important.  Physicians have played a significant role in the creation of a wide variety of medical tools from drug therapies to electronic health records.  It is estimated that over 20% of all patented medical devices were invented by physicians. And, perhaps surprisingly, roughly 60% of physician-inventors are at private practices versus in academic settings, according to a Duke study. 
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By David Rebedew

Before starting medical school, this Wisconsin student traveled from town-to-town to shadow every doctor in every specialty he could find.  Looking for the specialty he'd one day like to practice, he discovered where he'd like to practice, too.

While I was only in my third year of medical school, I delivered a baby and the placenta in a hospital in rural Whitehall, Wisconsin, while the attending watched in the background.  That same year, I helped deliver triplets and subsequently repaired the c-section incisions.  This is unheard of among my classmates doing rotations in Madison, but on rotations in rural towns with populations sometimes under 2,000, I was the only student, so when there was an incredible surgery or an especially interesting case, I was one of the first people to know about it.   
 
I didn’t always know I wanted to practice medicine in a rural area. I had tried to determine what specialty I wanted to pursue before medical school. I shadowed ER physicians, internists, anesthesiologists, neurologists, and family practitioners in various cities around Wisconsin with populations ranging from 1,000 to 50,000 people. Although my original intent was to figure out what I wanted to do “when I grew up,” I also found out where: rural Wisconsin. 
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By Rajasree Pai, M.D.

This young doctor reflects on the primary care residency that allowed her to build the types of relationships with patients that attract students to primary care in the first place.  Residencies that  accurately represent primary care are the "need of the hour" for training and maintaining primary care docs, she says.

During my second year of residency, I made house visits with the veteran’s clinic staff as part of my geriatric rotation. I met many veterans and their families. Examining a patient in his own environment was a novel experience for me, through which I built relationships that I might not have in a more traditional internal medicine residency program. I never would have met Mr. M nor would I have gotten this real life experience with a private doctor in outpatient primary care. But as a resident in the University of Connecticut’s Primary Care Internal Medicine program, I spent a part of my second and third years working with private physicians in the outpatient setting.
 
The Primary Care Internal Medicine program at UConn aims to address the current trend of medical students and residents opting to sub-specialize rather than practice primary care.  Health care workers and policymakers who have looked into the reasons for the trend have proposed, among other strategies, improving physician-patient relationships developed in primary care residencies.  Uconn’s program strives to do exactly that. 
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By William Rawlings, M.D.

Rural doc gives illiterate patient the tools to make art. Patient gives doctor hope in hard times.

The practice of primary care is never easy, especially in lesser towns and rural communities across the land where small physician groups and the few remaining solo practitioners guard the front lines against illness and medical misfortune. But for those of us who prefer the countryside to urban sprawl and traffic congestion, a practice far from the city lights is nothing short of the best lifestyle possible.

I am now winding down my medical career, having reached my thirty-five year milestone a few months ago.  It’s been a good run, and when I’m asked if I would change things given the opportunity, my answer is a resounding “No!”  Both professionally and financially, the rewards reaped in my small Georgia town have been more than adequate.  I am happily drifting into my second part-time career as a writer all the richer for the experience and insight gained from my years of medical practice. 

Every now and then someone asks what has been most meaningful to me over the years.  Did I enjoy my patients?  Did I achieve whatever goals I might have set for myself?  Did I have fun?  To these questions, the answers are affirmative, but among the many convoluted tales in my mixed bag of memories, one stands out:  My friendship with J. B. Murry.
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By Gena Cooper, M.D.

Wisconsin Academy for Rural Medicine allowed this young doc, then a medical student, to find culturally competent solutions to health and safety concerns that would be suited to the unique lifestyle of Wisconsin's Amish.

In my third year of medical school, I provided care to a young Amish family in rural Wisconsin, who had recently had their first child.  Amish people use horse and buggy for transportation, and their beliefs exclude the use of modern safety equipment for children, such as car seats, so small children are generally held in their mothers' arms.

A local Amish child had recently been thrown from a buggy in an accident and crushed by the horse.  The new Amish parents who had come to me for care were terrified that this could happen to their child, but they were also concerned about adhering to their beliefs.  I worked with the mother to find a number of different restraint devices that would be acceptable in their culture, such as a fabric sling. At their next visit, the family was delighted to tell me that their elders approved one of the devices we had researched.  It was a privilege to work with this family to find a solution for a major public health issue that would not compromise their beliefs.  
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By Kunmi Sobowale

Sobowale envisions a day when technology like Siri for iPhone 4S can be used to address the early signs of depression.  Here he discusses the potential for primary care doctors to leverage mobile technology to play a key role in improving mental health care.  

In the summer of 2011, I traveled to Hong Kong to investigate the cultural adaptation of primary care-based intervention to prevent depression. Thousands of miles away from home, I heard a familiar discussion among a group of Hong Kong primary care physicians—how to effectively deliver mental health care with limited resources? Though known as a modern financial hub, Hong Kong has only 300 psychiatrists for over 7 million people or roughly 4 psychiatrists per 100,000 people. By comparison, Japan, has 9 psychiatrists per 100,000 people and the U.S has 14 psychiatrists per 100,000 people, according to the Lancet.
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By Paula Porter
Paired with a PA student during a rotation in a primary care clinic, this med student learned the value of all the members of the care team and deep respect for her PA colleagues.

The first time I presented a patient to Ty, I was nervous. I couldn’t remember Mrs. L’s complete past medical history, and I definitely added the vitals at the wrong point of the patient summary. But rather than demeaning me, Ty helped me through it- he pointed out things I did well and helped me understand how to mentally organize a patient presentation. Then he presented to our preceptor, Dr. T, in a perfect example of a concise yet thorough presentation.

It was only my fourth day in clinic during my first year of medical school, and Ty was my new hero. No, he wasn’t a medical resident or senior medical student. He was a second-year Physician Assistant student who I had been paired with for a new pilot project at the University of Utah School of Medicine.
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