Annals Journal Club Selection:

Jul/Aug 2008

The Annals Journal Club is designed to encourage a learning community of those seeking to improve health care and health through enhanced primary care. Additional information is available on the Journal Club home page.

The Annals of Family Medicine encourages readers to develop the learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club, and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for: Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care, and then acting on those discussions.¹

Article for Discussion

Glazner C. Dinosaurs, hospital ecosystems, and the future of family medicine. Ann Fam Med.2008;6(4):368-369.

Discussion Tips

This article is a bit of a departure for a journal club, since it is an essay. The topic is compelling and relevant (at least for family physicians in the United States, Canada, and the few other countries where general practitioners see patients in the hospital). How does one evaluate the credibility of an essay, for which there is no explicit method, only the reflections of the author? The questions below provide a start, but we encourage journal clubs to share their suggestions for criteria on how to evaluate essays, and to share the results of their discussion as well. Please post your comments at http://www.annfammed.org/cgi/eletter-submit/6/4/368.

Discussion Questions

What questions are addressed by the article? Why do they matter?
What is the main thesis of the essay?
How compellingly does the author convey her personal experience on this topic?
How credibly is the author�s personal argument bolstered by other information?
What biases are apparent?
Do you agree that "the voluntary disappearance of the family physician from the community hospital adversely affects not only the health of the patient but the health and well-being of family medicine?"
If you are in training, how does this argument fit with your goals for eventual practice?
How do the author�s reflections contrast with or match your own experience as a clinician? Do you feel you can be a patient advocate without having a hospital practice?
The author contends that hospital practice is possible if we "make the work of the family physician financially and emotionally sustainable." In your opinion, how could this sustainability be achieved?
What are the implications of hospital practice issues for patients, family physicians, workforce planning, and the health care system?
What questions does this essay generate for research, reflection, education, or policy?

Reference

Stange KC, Miller WL, McLellan LA, et al. Annals journal club: It�s time to get RADICAL. Ann Fam Med. 2006;4:196-197. Available at: http://annfammed.org/cgi/content/full/4/3/196.

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