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- Page navigation anchor for Re: Hope for Family MedicineRe: Hope for Family MedicineShow More
Family Medicine in the real world has and continues being seen as quick fix limited knowledge; urgent care type of medicine business. Recently I have a discussion with a satellite company that approach me to do nuclear stress test. The organizer of this organization specify that family physician can not oversee the nuclear stress test procedure and the company can not be paid unless an internist or a cardiologist do so....
Competing Interests: None declared. - Page navigation anchor for What a Beautiful PieceWhat a Beautiful PieceShow More
I've been wanting to read this piece since it came out over a month ago. And now, during the last days of a vacation I'm finally finding the time. Should we laugh or cry at our busyness? I prefer the former, even when it's through gritted teeth.
What I loved about this piece was the acknowledgment of our struggle as family physicians--to finance what we do, take appropriate time with our patients, get the me...
Competing Interests: None declared. - Page navigation anchor for Hope for Family MedicineHope for Family MedicineShow More
I do agree that family medicine is in crisis. On the other hand, I believe our future has never been brighter. Because of the unprecedented demand of our services today and in the coming years, family doctors are desperately needed.
I realized five years ago that I had to become more efficient to respond to this growing demand and to survive financially. I embarked on a course to teach my nurses to take...
Competing Interests: None declared. - Page navigation anchor for GratitudeGratitudeShow More
It has been gratifying and a little intimidating to read the many wonderful comments on our Reflections essay. Marly McMillen provides an excellent summary of the National Demonstration Project. TransforMED was no less responsive to change than were the participating practices; without its help and support, the Self-Directed Retreat could not have been so successful. Elizabeth Stewart was more than a guest at the retrea...
Competing Interests: None declared. - Page navigation anchor for Response to Bonita TomsResponse to Bonita TomsShow More
Dear Bonita,
Thank you for your thoughtful, well-spoken response to "Changes Horses Midstream." I thoroughly agree with you: it is the relationships in family medicine- between providers and patients and among the team members - that can help turn a patient's nightmare into a positive transition. So much of what consumes the time and energy of the team is not a face-to- face encounter and, therefore, cannot be rei...
Competing Interests: None declared. - Page navigation anchor for The NDP Journey: A TransforMED PerspectiveThe NDP Journey: A TransforMED PerspectiveShow More
TransforMED’s National Demonstration Project (NDP) has been referred to as a “learning lab,” reflecting the desire for continual learning and sharing throughout the project. We were aware (and reminded) early on that this NDP was too many years late in coming and we felt the burden of this in the planning stages. We knew that waiting over two years for publishable research would be too late, so the project was designed to...
Competing Interests: None declared. - Page navigation anchor for Reaching for the revolutionReaching for the revolutionShow More
As a physician in another of the self-directed practices, I can also attest to the “renewed sense of optimism and commitment,” as described by Drs. Loxterkamp and Kazal, which emerged from our group retreat last year. Sharing frustrations and victories together with a diverse group of motivated practices was just the therapy that my practice needed to move into the next phase of change. Although I feel that the practice “...
Competing Interests: None declared. - Page navigation anchor for Family Medicine specialty, nursing point of viewFamily Medicine specialty, nursing point of viewShow More
I am a RN in one of the self directed practices and have been nursing in the specialty of family medicine for more than 25 years. I cannot tell you how many times I have explained to patients that family medicine is not the equivalent of the earlier day "general practitioners", that it is it's OWN specialty. Family medicine has never gotten the respect it deserves and is most often completely misunderstood.
No...
Competing Interests: None declared. - Page navigation anchor for Why the Journey?Why the Journey?Show More
Principles not taught in medical school when I attended. It takes money to run a medical practice. Someone has to pay for medical services provided. Primary Care Medicine is the foundation of a country's health care system. A society's health is better if its primary healthcare system is adequate.
Medicare and health insurance companies do not acknowledge these principles. The AAFP is to be applauded for its wil...
Competing Interests: None declared. - Page navigation anchor for Embracing the journey of a family physicianEmbracing the journey of a family physicianShow More
As a family physician member of one of the self-directed groups of the NDP, what I appreciate most about this article and this project is the renewed emphasis of physicians' taking charge of their practice to fit with their ideals. Too often we look to someone else to solve our challenges in family medicine and I'm excited to see more attention focused on how we can create the ultimate practice environment for our patie...
Competing Interests: None declared. - Page navigation anchor for From Knowing to Believing: Two Groups, One JourneyFrom Knowing to Believing: Two Groups, One JourneyShow More
As a member of the National Demonstration Project Evaluation Team, it was a privilege to attend the self-directed retreat described in the insightful and stimulating commentary by Drs. Loxterkamp and Kazal. Organized and facilitated by the physicians themselves, this retreat was primarily about sharing and reflection in a discussion-based rather than didactic format. In today’s world of tightly structured CME conferences,...
Competing Interests: None declared. - Page navigation anchor for Prescription For ChangePrescription For ChangeShow More
No matter the outcome of each project set forth by the participants at the retreat written about by Loxterkamp and Kazal- I think they are on track with their prescription for change. The ten pearls they outline in the table are very thoughtful and comprehensive. Communication, full staff support, a sense of joy along the way and at the finish line, and accounting for costs are essential. I will use this list for my ne...
Competing Interests: None declared. - Page navigation anchor for Patient Centered Medical HomesPatient Centered Medical HomesShow More
I am a physician in a faciltated practice in the NDP. I have spent much time trying to get my mind around what the TransforMed model is and how we can improve ourselves using it as a guide. I am unable to digest all of my thoughts into a brief comment, but I am drawn to reflect that the concept of the Patient Centered Medical Home excites me just as it seems to rankle the authors. Our "transformation" will not be comp...
Competing Interests: None declared. - Page navigation anchor for Healing PracticesHealing PracticesShow More
Dr. Loxterkamp and Dr. Kazal have provided a thoughtful and thought provoking critique of the TransforMed project from their unique position as both insiders and outsiders in the NDP. The acronym TransforMed was chosen to suggest that practices who implement the recommendations of the Future of Family Medicine report will experience transformation, yet as the authors point out, a more useful view is that of a tool bo...
Competing Interests: None declared. - Page navigation anchor for Healing occurs within relationshipsHealing occurs within relationshipsShow More
Don Berwick’s commentary in JAMA this week, “The Science of improvement,” offers specific advice to “accelerate the improvement of systems of care and practice:” 1) embrace wider methodologies of analysis, 2) reconsider thresholds in evidence, 3) rethink trust and bias, and 4) encourage civil and respectful dialogue between academicians and practitioners. Berwick points out that the search for truth in complex systems...
Competing Interests: None declared. - Page navigation anchor for Where is This Trail Ride Headed?Where is This Trail Ride Headed?Show More
As the director of a self directed TransforMed practice, I have sometimes succumbed to discouragement with the NDP process. I do not doubt that primary care must be overhauled to survive, and I commend the founders of the National Demonstration Project for the courage and determination they have shown in initiating transformation.
Doctors Loxtercamp and Kazal framed the issues well and posed poignant questions...
Competing Interests: None declared. - Page navigation anchor for Family RoomFamily RoomShow More
Well written article, I share concern about the "Advanced Medical Home" and whether there is room for the Family. Family Centered care should be the Center Piece of Family Medicine. Providers of care must recognize and act as though the family is the extension of care beyond the office or the hospital. Family Care is not a luxury, it is fundamental to high quality cost effective care.
Competing interests: None decla...
Competing Interests: None declared.