Table of Contents

Plain-Language Summaries

Editorial

All Quality Metrics Are Wrong; Some Quality Metrics Could Become Useful

Background: This editorial builds on a study by Brulin and Teoh, released ahead of the March/April 2025 issue of Annals of Family Medicine, which found that performance-based reimbursement is associated with lower perceived quality of care by increasing illegitimate tasks and moral distress for primary care physicians. Despite past evaluations showing mediocre results, pay-for-performance quality metrics have proliferated, supported by multiple levels of government.

Editorial Stance: Quality metrics and pay-for-performance initiatives are far more expensive than many patients, clinicians, or administrators realize, prompting a reevaluation of the pay-for-quality approach in primary care. The authors call for more rigorous review—through cluster randomized controlled trials—both before and after implementation, and for prompt de-implementation of metrics with little impact or that detract from care. They recommend refocusing incentives on targets that are impactful, time limited, low cost, and physician controlled. Otherwise, pay-for-performance risks continuing to add administrative burdens and unrecognized costs that further degrade the value of primary care.

Why It Matters: The article’s title—“All Quality Metrics Are Wrong; Some Quality Metrics Could Become Useful”—highlights that while no single metric is perfect, some can support better care if applied thoughtfully and tested in real-world settings. Overall, the authors advocate aligning pay-for-performance with realistic clinician workflows and meaningful outcomes, rather than relying on a one-size-fits-all model that can distort clinical priorities and patient care.

All Quality Metrics Are Wrong; Some Quality Metrics Could Become Useful

Michael E. Johansen, MD, MS, et al 

Grant Family Medicine, OhioHealth, Columbus, Ohio

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Original Research 

Performance-Based Reimbursement Linked to Increased Administrative Burden, Moral Distress, and Lower Perceived Care Quality

Background and Goal: Performance based reimbursement (PBR) is a payment system in which clinics receive compensation based on the quality and outcomes of care they deliver, rather than the volume of services provided. Although designed to improve efficiency and effectiveness, the growth of PBR systems has been linked to increased administrative work for physicians. This study examined how PBR affects doctors' perceived ability to provide quality care at both the individual and organizational levels. Researchers explored whether illegitimate tasks (tasks that fall beyond the scope of an employee's primary responsibilities and professional role or tasks that are not anticipated for a particular position)  and moral distress—feelings of stress or guilt due to forced unethical decisions—played a role in these outcomes.

Study Approach: Researchers conducted a longitudinal study using a three-wave survey of primary care physicians. Data were drawn from the Longitudinal Occupational Health Survey in Health Care Sweden. The first wave, conducted from March to May 2021, involved a survey sent to a nationally representative sample of physicians (N = 6,699). Respondents rated the impact of the PBR system on a scale ranging from very negative to very positive. The second wave, conducted from March to May 2022, measured illegitimate tasks using the Bern Illegitimate Tasks Scale. Moral distress was assessed using an instrument originally developed for Norwegian physicians and later translated into Swedish. The third wave, conducted from October to December 2023, evaluated perceived quality of care at both the individual and organizational levels using the English National Health Staff Survey.

 Main Results: A total of 433 primary care physicians responded to the survey at all three time points. Overall, 70.2% of respondents reported that PBR negatively impacted their work (58.9% negative, 12.3% very negative).

Quality of Individual Care

• PBR was associated with increased illegitimate work tasks, which in turn was linked to greater moral distress.

• Both illegitimate work tasks and moral distress were associated with lower perceived individual quality of care.

Quality of Organizational Care

• PBR was associated with an increase in illegitimate work tasks, which was linked to lower perceived organizational quality of care.

• Moral distress did not have a significant association with perceived organizational quality of care.

Why It Matters: The identification of illegitimate tasks and moral distress as factors associated with perceived care quality suggests that reducing tasks that are seen as irrelevant could support physician well-being and health care delivery. Given these findings, policymakers should consider how health care systems, including PBR structures, impact the workforce’s well-being and ability to provide care. 

Performance-Based Reimbursement, Illegitimate Tasks, Moral Distress, and Quality Care in Primary Care: A Mediation Model of Longitudinal Data

Emma Brulin, RD, PhD

Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden 

Kevin Teoh, PhD 

Birkbeck Business School, Birkbeck, University of London, London, United Kingdom

Visual Abstract: 

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Original Research

Family-Based Lifestyle Intervention Lowers Obesity and Heart Disease Risk

Background and Goal:Obesity management often focuses on individual-level approaches, such as calorie restriction, lifestyle modifications, medication, and surgery. Family-based interventions often target the entire family environment to promote healthier behaviors. However, the effectiveness of such strategies in low- and middle-income countries remains largely unexplored. The PROgramme of Lifestyle Intervention in Families for Cardiovascular risk reduction (PROLIFIC) Study, conducted in India, aimed to assess whether a family-based approach to lifestyle interventions could improve weight management and obesity-related health outcomes among individuals with a family history of premature coronary heart disease​.

Study Approach: In this cluster randomized controlled trial in India, families were randomly assigned to a family-based intervention group or a usual care group. The intervention group received structured lifestyle counseling from nonphysician health workers, who provided regular home visits, goal-setting, 

Main Results:In total, 1,671 participants (1,111 women) from 750 families participated. After adjusting for family clustering and socio-economic factors, intervention participants experienced, on average, these improvements compared to the usual care group after two years:

• 2.61 kg greater reduction in weight (P < .001)

• 1.06 kg/m² greater reduction in BMI (P < .001)

• 4.17 cm greater reduction in waist circumference (P < .001)

Why It Matters:The findings from this study demonstrate that a family-based approach to lifestyle interventions can significantly improve weight management and cardiovascular health among high-risk individuals. The reductions in weight, BMI, and waist circumference suggest that these interventions could have a substantial public health impact in preventing future diabetes and other noncommunicable disease conditions.                     

Family-Based Interventions to Promote Weight Management in Adults: Results From a Cluster Randomized Controlled Trial in India

Jeemon Panniyammakal, PhD, et al 

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India 

Visual Abstract: 

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Original Research    

Innovative Strategies in Primary Care Clinics Improve Regular Follow-Up for Chronic Patients

Background and Goal: Regular follow-up visits are critical for managing chronic conditions, yet some primary care clinics achieve higher visit regularity than others. While teamwork and collaboration among clinic staff are thought to influence follow-ups, little research has examined these dynamics. This study aimed to identify specific strategies used by high-performing clinics to promote consistent follow-up visits for adults with chronic conditions​.

Study Approach:This qualitative study used semi-structured interviews with 15 primary care physicians, 12 nurses, 15 administrative staff, and 4 pharmacists from 12 clinics—half with high temporal regularity (patients attending follow-ups consistently) and half with low temporal regularity. Researchers analyzed how teamwork, workflows, and communication influenced patient follow-ups, identifying strategies that helped high–temporal regularity clinics maintain regular chronic care visits​.

Main Results:Clinics with high temporal regularity shared key teamwork strategies that distinguished them from low–temporal regularity clinics:                

• Close working relationships with less hierarchical, and more flat, structures within the staff where every team member is part of the decision-making process 

• Staff members described a clear system to ensure follow-up for “no show” patients, beginning with administrative staff reaching out to patients and ending with recruiting the help of patients’ family members 

•  Additional innovative strategies, including routine staff meetings, adaptive workflows, assisting patients with bureaucracy, informal communication channels, and consulting social workers    

Why It Matters:This study highlights how team-based strategies—including structured follow-up systems, proactive patient outreach, and interdisciplinary collaboration—can improve regular follow-up for patients with chronic conditions. These findings may inform educational and clinical programs on how staff relationships can support patient engagement, particularly for those who are harder to reach.    

Teamwork Among Primary Care Staff to Achieve Regular Follow-Up of Chronic Patients

Maram Khazen, PhD, et al                

Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel            

Department of Health Systems Management, the Max Stern Yezreel Valley College, Jezreel Valley, Israel 

Visual Abstract:

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Original Research

When Patients Prefer Their Own Doctor: Balancing Continuity and Timely Access

Background and Goal:Although team-based care models, which involve multiple health care professionals working together, can improve access and efficiency, they may also affect continuity of care, which is linked to better health outcomes and stronger patient-physician relationships. This study focuses on how primary care patients balance the trade-off between continuity of care and access to timely appointments. It examines whether patients prefer to wait longer to see their own primary care physician (PCP) or if they are willing to see another clinician for faster care.

Study Approach: Researchers analyzed data from the 2022 Patient Well-Being Survey, a cross-sectional online survey of adult primary care patients in Michigan. Patients were presented with scenarios in the survey for different visit types—annual checkups, chronic and mental health follow-ups, new symptoms, and urgent concerns—and asked to choose among three options: see only their PCP, prefer their PCP but willing to see another clinician, or see the first available clinician. The survey included the Person-Centered Primary Care Measure and the What Matters Index to assess patient-centered care and health-related quality of life. 

Results: 2,319 questionnaires were included in the analysis. 

• Over one-half of patients preferred their PCP for annual checkups (52.6%), chronic condition follow-up (54.6%), and mental health follow-ups (56.8%).

• Patients were willing to wait 3-4 weeks to see their PCP for sensitive exams (68.2%), new mental health concerns (58.9%), and new concerns about chronic conditions (61.1%).

• Only 7.2% of patients were willing to wait for their PCP for urgent concerns—most preferred the soonest available clinician​.

Why It Matters:As urgent care use rises and health systems prioritize rapid access over continuity, this study suggests these shifts may not align with patient preferences. Most patients prefer to wait 3-4 weeks to see their PCP for certain visits, emphasizing trust and continuity over convenience. Expanding direct scheduling and patient portals could enhance autonomy and transparency around PCP availability, improving patient satisfaction and continuity of care.                     

Convenience or Continuity: When Are Patients Willing to Wait to See Their Own Doctor?

Gregory Shumer, MD, MHSA, et al                    

University of Michigan, Michigan Medicine, Ann Arbor, Michigan 

Visual Abstract: 

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Original Research

Many Patients With Chlamydia and Gonorrhea Do Not Receive CDC-Recommended Treatment in Primary Care 

Background and Goal:Chlamydia and gonorrhea are the most common bacterial sexually transmitted infections (STIs) in the United States. Prompt treatment following a confirmed diagnosis is essential to prevent complications and reduce transmission. The Centers for Disease Control and Prevention (CDC) provides treatment guidelines, but adherence in primary care settings remains a concern. This study aimed to quantify the overall treatment rate for chlamydia and gonorrhea and identify factors associated with treatment delays and disparities. 

Study Approach:Researchers analyzed electronic health record data from the PRIME registry, which includes information from over 2,000 primary care clinicians across the United States. The study included patients diagnosed with chlamydia or gonorrhea between 2018 and 2022 and assessed whether they received appropriate antibiotic treatment within 30 days of diagnosis.

Main Results:6,678 cases of chlamydia and 2,206 cases of gonorrhea confirmed by a positive test were identified.

• 75.3% of chlamydia cases and 69.6% of gonorrhea cases were treated within 30 days.

• More than 80% of treated patients received antibiotics within 7 days of diagnosis.

• However, only 14% of chlamydia cases were treated with the recommended doxycycline and only 38.7% of gonorrhea cases were treated with the recommended ceftriaxone.

• Women, young adults (ages 10-29), and suburban residents were more likely to receive treatment.

• Time to treatment of chlamydia was longer for patients aged 50-59 years and for non-Hispanic Black patients.

Why It Matters:Many patients with chlamydia and gonorrhea in primary care settings do not receive the recommended treatment. This gap in care may contribute to ongoing STI transmission and adverse health outcomes, particularly among marginalized populations. Incentives may be needed to promote adherence to clinical practice guidelines and ensure timely, appropriate treatment. More efficient and standardized management approaches could help improve the quality of care and address health inequities.

Treatment of Chlamydia and Gonorrhea in Primary Care and Its Patient-Level Variation: An American Family Cohort Study

Shiying Hao, PhD, et al

Center for Population Health Sciences, School of Medicine, Stanford University, Stanford, California 

An accompanying episode of the Annals of Family Medicine Podcast, featuring study authors Shiying Hao, PhD, and Neil Kamdar, MA, will be available here beginning 9am EDT March 25.

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Original Research

Long-Term Inhaled Corticosteroid Use for Chronic Obstructive Pulmonary Disease Linked to Increased Risk of Type 2 Diabetes, Pneumonia, Fractures, Cataracts, and Osteoporosis

Background and Goal: Inhaled corticosteroids (ICS) are commonly prescribed for chronic obstructive pulmonary disease (COPD), but they are not recommended as first-line treatment unless patients have asthma/COPD overlap or frequent exacerbations. Despite this, ICS is often overprescribed, potentially exposing patients to unnecessary risks. This study examined whether long-term ICS use (more than two years) increases the risk of serious health conditions compared to short-term use.

Study Approach:Researchers analyzed electronic health records from over 20 million patients, focusing on individuals aged 45 and older with a COPD diagnosis. They created two groups: a prevalent cohort (patients diagnosed with COPD at any time) and an inception cohort (patients newly diagnosed with COPD). Using propensity score matching, they compared long-term ICS users (more than two years) to those with short-term use (less than 4 months). Researchers examined the risk of developing both a composite outcome (any of five major conditions) and individual health outcomes for over 500,000 people, including 318,385 individuals in the prevalent cohort and 209,062 in the inception cohort.

Main Results: 

Overall Risk (Composite Outcome)

• Compared to those using ICS for a short time, long-term ICS users were more than twice as likely to develop at least one of the following conditions:

• Type 2 diabetes

• Cataracts

• Pneumonia

• Osteoporosis

• Nontraumatic fractures

• People on long-term ICS were nearly three times as likely to have repeated cases of pneumonia (HR = 2.85–2.88).

• Fractures were also more likely to happen again (HR = 1.57–1.77).

• Facilitators of shared decision making included:

• Empathetic, clear, and honest communication from clinicians

• Encouraging patient participation by allowing time and space for questions and discussion

• Cultural and language alignment between clinicians and patients, improving trust

• Incorporating family in decision making, as many patients sought input from relatives outside of the clinical visit

• Mistrust of clinicians and the health care system, often due to past discrimination and prejudice

• Language and cultural barriers that limited meaningful communication

• Clinician time constraints, reducing opportunities for shared decision making

• Implicit bias and stereotyping, leading patients to feel dismissed or unheard

• Use of most antibiotics significantly decreased after the first lockdown and remained lower for at least 12 months compared to expected levels.

• Amoxicillin (−27.5% at 3 months; −55.5% at 12 months)

• Amoxicillin-clavulanic acid (−10.9% at 3 months; −24.9% at 12 months)

• Cefepime (−22% at 3 months; −8.3% at 12 months)

• Fosfomycin (−10.4% at 3 months; −8.6% at 12 months)

• 99.4% of individuals receiving Heplisav-B reached protective antibody levels.

• 92.7% of individuals receiving a standard booster reached protective levels.

• The 6.7% higher response rate with Heplisav-B was statistically significant (95% CI, 1.9%-14.5%; P = .003).

• All seven individuals who remained below protective levels after one booster eventually reached immunity after receiving additional vaccinations.

Recurrent Cases

Some conditions were also analyzed for recurrent cases (meaning patients who developed them more than once):

• People on long-term ICS were nearly three times as likely to have repeated cases of pneumonia (HR = 2.85–2.88).

• Fractures were also more likely to happen again (HR = 1.57–1.77).

Individual Outcomes

Each individual condition—diabetes, cataracts, pneumonia, osteoporosis, and fractures—was also more common in long-term ICS users before being combined into the composite outcome.

Why It Matters: Many patients with COPD are prescribed ICS even when not medically necessary, exposing them to serious long-term risks. Clinicians should carefully evaluate whether ICS is appropriate before initiating long-term therapy. Ensuring ICS use aligns with current guidelines can help reduce unnecessary harm.

Adverse Outcomes Associated With Inhaled Corticosteroid Use in Individuals With Chronic Obstructive Pulmonary Disease

Wilson D. Pace, MD, et al

DARTNet Institute, Aurora, Colorado

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Original Research 

Designing a Tool to Drive Conversations About Cognitive Health in Primary Care 

Background and Goal: Conversations about cognitive impairment are not happening as often as they should in primary care, despite the growing aging population and the importance of early discussions. Existing tools for cognitive impairment focus primarily on clinical diagnosis but do not support whole-person, values-based discussions that address patients’ personal fears, goals, and social needs. The goal of this study was to develop and test the “About Me” Care Card, a tool designed to promote dialog between patients, caregivers, families, and clinicians on care related to dementia, cognitive impairment, and aging. 

Study Approach: Researchers conducted a feasibility study using a community and user-centered design approach to develop and test the “About Me” Care Card. The tool was developed based on shared decision-making principles. An environmental scan identified gaps in existing cognitive care tools, and a global steering committee made up of health care professionals, patient advocacy groups, caregivers/family members, and individuals with dementia provided feedback. Testing occurred in two phases across twelve clinical sites (care teams). In phase 1, the initial prototype was tested and feedback led to design refinements. In phase 2, a revised version was tested. Data collection included postuse surveys, clinician and patient feedback, and steering committee discussions.

Main Results Fourteen clinicians consisting of 7 clinician types across 7 institutions piloted the card during in-person visits or by telephone. Observations showed that the card (1) allowed time to elicit what matters most to patients, (2) created space for personalized care conversations, (3) opened an examination of social care needs, and (4) moderated emotional relationships between families and individuals. Findings from 44 completed postuse surveys showed that most patients found the card beneficial, with 65% recommending it for those over age 65. It encouraged meaningful conversations, as 59% valued sharing what mattered most with their provider, and 43% felt it helped facilitate these discussions. However, while 41% found it easy to use, some patients with advanced cognitive challenges required assistance. Additionally, only 32% felt it helped in creating a concrete plan to address their priorities.

Why It Matters: Findings from this study suggest that integrating tools like the “About Me” Care Card into primary care workflows could help clinicians identify patient concerns earlier, ultimately improving care planning and cognitive health management. 

Feasibility and Acceptability of the “About Me” Care Card as a Tool for Engaging Older Adults in Conversations About Cognitive Impairment

Stuart W. Grande, PhD, MPA, et al

University of Minnesota School of Public Health, Minneapolis, Minnesota 

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Original Research

Improving Shared Decision Making for Racially and Ethnically Diverse Patients in Primary Care 

Background and Goal: Shared decision making is an important part of patient-centered care, helping clinicians and patients make health care decisions together. However, racial and ethnic minority patients often face barriers to quality shared decision making, contributing to disparities in health care access and outcomes. This study reviewed existing research to identify barriers and facilitators that influence shared decision making for diverse patient populations in primary care settings.

Study Approach: Researchers conducted a scoping review of 39 studies that examined shared decision making among racially and ethnically diverse adults in U.S. and Canadian primary care settings. They used thematic analysis to identify key factors affecting shared decision making before, during, and after clinical visits.

Main Results:

• Facilitators of shared decision making included:

• Empathetic, clear, and honest communication from clinicians

• Encouraging patient participation by allowing time and space for questions and discussion

• Cultural and language alignment between clinicians and patients, improving trust

• Incorporating family in decision making, as many patients sought input from relatives outside of the clinical visit

• Mistrust of clinicians and the health care system, often due to past discrimination and prejudice

• Language and cultural barriers that limited meaningful communication

• Clinician time constraints, reducing opportunities for shared decision making

• Implicit bias and stereotyping, leading patients to feel dismissed or unheard

• Use of most antibiotics significantly decreased after the first lockdown and remained lower for at least 12 months compared to expected levels.

• Amoxicillin (−27.5% at 3 months; −55.5% at 12 months)

• Amoxicillin-clavulanic acid (−10.9% at 3 months; −24.9% at 12 months)

• Cefepime (−22% at 3 months; −8.3% at 12 months)

• Fosfomycin (−10.4% at 3 months; −8.6% at 12 months)

• 99.4% of individuals receiving Heplisav-B reached protective antibody levels.

• 92.7% of individuals receiving a standard booster reached protective levels.

• The 6.7% higher response rate with Heplisav-B was statistically significant (95% CI, 1.9%-14.5%; P = .003).

• All seven individuals who remained below protective levels after one booster eventually reached immunity after receiving additional vaccinations.

• Mistrust of clinicians and the health care system, often due to past discrimination and prejudice

• Language and cultural barriers that limited meaningful communication

• Clinician time constraints, reducing opportunities for shared decision making

• Implicit bias and stereotyping, leading patients to feel dismissed or unheard

Why It Matters: Many barriers to shared decision making are modifiable. Primary care teams and health systems can improve shared decision making for diverse populations by strengthening cultural language and cultural competence, addressing discrimination, ensuring adequate time for shared decision-making discussions, and incorporating family input when appropriate. These efforts can promote equitable patient-centered care.

Shared Decision Making Among Racially and/or Ethnically Diverse Populations in Primary Care: A Scoping Review of Barriers and Facilitators

Yohualli Anaya, MD, MPH, et al

Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin

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Research Brief

The General Public Vastly Overestimates Primary Care Spending in the U.S. by More Than Tenfold, Study Finds

Background and Goal: Despite its foundational importance to health outcomes, primary care in the United States accounts for only 4.7% of total health care expenditures. This study, based on an online survey of 1,135 adults demographically representative of the U.S. population, aimed to measure public perceptions of primary care spending.

Key Insights: Respondents estimated that primary care addresses 58.7% of U.S. health care needs. However, participants believed that 51.8% of overall health care spending goes to primary care—more than 10 times the documented share of 4.7%.

Why It Matters: Chronic underinvestment in primary care has resulted in workforce shortages, physician burnout, reduced access, and suboptimal care. Access to high-quality primary care has been associated with better population health and more equitable outcomes. The substantial overestimation of primary care spending by the public highlights the need for increased patient and public engagement and education to rally additional state and national support for policy changes that affirm the essential role of primary care in the health care system.

The General Public Vastly Overestimates Primary Care Spending in the United States

Melissa Ma, BS, et al

School of Medicine, University of California, San Francisco, San Francisco, California

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Research Brief

 Significant and Prolonged Decline in Ambulatory Antibiotic Use in France During COVID-19

Background and Goal: Before the COVID-19 pandemic, France had one of the highest antibiotic consumption rates in Europe. The pandemic and lockdown measures affected health care access and prescribing patterns, leading to significant changes in outpatient (ambulatory) antibiotic use. This study examined how systemic antibiotic use in France changed from 2020 to 2022 compared to expected trends.

Study Approach: Researchers used nationwide health insurance data covering 67 million people to track monthly antibiotic prescriptions from January 2010 to March 2022. They applied interrupted time-series analysis to measure changes in antibiotic use following the first national lockdown on March 17, 2020, while adjusting for seasonal trends and pre-existing usage patterns.

Main Results:

• Use of most antibiotics significantly decreased after the first lockdown and remained lower for at least 12 months compared to expected levels.

• Amoxicillin (−27.5% at 3 months; −55.5% at 12 months)

• Amoxicillin-clavulanic acid (−10.9% at 3 months; −24.9% at 12 months)

• Cefepime (−22% at 3 months; −8.3% at 12 months)

• Fosfomycin (−10.4% at 3 months; −8.6% at 12 months)

• 99.4% of individuals receiving Heplisav-B reached protective antibody levels.

• 92.7% of individuals receiving a standard booster reached protective levels.

• The 6.7% higher response rate with Heplisav-B was statistically significant (95% CI, 1.9%-14.5%; P = .003).

• All seven individuals who remained below protective levels after one booster eventually reached immunity after receiving additional vaccinations.

Why It Matters: The pandemic significantly reduced antibiotic use, particularly for those with indications for the treatment of respiratory and urinary tract infections, which may indicate that some antibiotics were overprescribed before COVID-19. The findings from this study emphasize the need for continued antimicrobial stewardship efforts and clear public health messaging during health crises.

Changes in the Ambulatory Use of Antibiotics in France Due to the COVID-19 Pandemic in 2020- 2022: A Nationwide Time-Series Analysis

Nicolas Rousselot, MD, MSc, et al

Department of General Practice, University of Bordeaux, Bordeaux, France

Inserm U1219, Bordeaux Population Health Research Center, Bordeaux, France 

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• 99.4% of individuals receiving Heplisav-B reached protective antibody levels.

• 92.7% of individuals receiving a standard booster reached protective levels.

• The 6.7% higher response rate with Heplisav-B was statistically significant (95% CI, 1.9%-14.5%; P = .003).

• All seven individuals who remained below protective levels after one booster eventually reached immunity after receiving additional vaccinations.

Heplisav-B vs Standard Hepatitis B Vaccine Booster for Health Care Workers 

Alan L. Williams, MD, MPH

Department of Family Medicine, Uniformed Services University, Bethesda, Maryland

Raquelle S. Newman, MD

Spangdahlem Air Base, 54529 Spangdahlem, AE, Germany 

Visual Abstract: 

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Essay

When Physician Self-Disclosure Helps Patients Overcome Stigma in Mental Health Care

Background: Physician self-disclosure is frequently employed intentionally to establish rapport, cultivate trust, convey empathy, or strengthen the credibility of clinical recommendations. Self-disclosure of mental health issues is very personal and is considered to be outside the scope of the patient-physician relationship. In this essay, a primary care physician shares a personal experience of disclosing their own mental health history to help a patient struggling with anxiety and depression.

Key Argument: Thoughtful, strategic self-disclosure can strengthen the physician-patient relationship and help patients feel less alone in their struggles. The author reflects on a case where sharing their own experience with anxiety and antidepressant use helped a longtime patient overcome resistance to treatment. While research on self-disclosure in medicine presents both benefits and risks, the author argues that carefully chosen personal disclosures—when used with clear boundaries—can be a valuable tool in primary care.

Why It Matters: Physicians' willingness to share their own experiences—within appropriate boundaries—can help break down the isolation that patients often feel, reassuring them that they are not alone in their journey toward healing. Thoughtful, authentic connections between physicians and patients can strengthen trust and ultimately support both mental and physical well-being.

Let’s Dare to Be Vulnerable: Crossing the Self-Disclosure Rubicon

Ohad Avny, MD

Clalit Health Services, Department of Family Medicine, Hebrew University, Jerusalem, Israel

Aya Alon

Department of Counseling and Human Development, Haifa University, Haifa, Israel

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Essay

Balancing Grief and Bureaucracy: A Call for Compassion in Post-Mortem Authorship

Background: When an academic researcher passes away before their work is published, their colleagues may face difficult legal and ethical challenges in maintaining their authorship. Many journals require a deceased author’s estate or trust to sign copyright and disclosure forms, placing a burden on grieving families. There is little clear guidance on handling post-mortem authorship, forcing corresponding authors to navigate these policies alone.

Key Argument: The requirement for a deceased author’s family to sign publishing forms is both emotionally distressing and impractical. Instead, journals should allow a corresponding author or supervisor to sign on the deceased’s behalf. This approach would respect the author’s contributions while sparing families from unnecessary hardship.

Why It Matters: Grief and bureaucracy should not collide in academic publishing. More thoughtful policies could help preserve the legacy of deceased authors while reducing stress for colleagues handling post-mortem authorship.                     

When the Death of a Colleague Meets Academic Publishing: A Call for Compassion 

Catherine G. Derington, PharmD, MS

Intermountain Healthcare Department of Population Health Sciences, University of Utah Spencer Fox-Eccles School of Medicine, Salt Lake City, Utah