AMA Wire® http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page Tue, 27 Sep 2016 19:42:00 GMT Self-regulation key to the future of health care tech http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_self-regulation-key-future-of-health-care-tech Tue, 27 Sep 2016 19:42:00 GMT <p> There are tools that work and there are tools that do not, but it’s important for the health care industry to decide what is required of these technologies for the future. And that means patients, physicians and developers working together. AMA Chief Executive Officer James L. Madara, MD, sat down with Matthew Holt of Health 2.0 at the annual conference yesterday to discuss the future of health care technology.</p> <p> On center-stage during the first day of the Health 2.0 conference in Santa Clara, Calif., Matthew Holt, co-chairman of Health 2.0, asked Dr. Madara about his past comments on digital health tools and what needs to be done so that they work in clinical practice to enhance patient care.</p> <p> <strong>Holt: </strong>The first thing that you said was that we have a bunch of remarkable tools already, which doctors are using … often there is at least dispute about the clinical efficacy of some of those tools.</p> <p> Is it fair to say that you’re saying that stuff is all well and good or do you have any doubts, issues or problems with those?<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/8/0f35f112-0389-421b-a89e-2335fb4645de.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/8/0f35f112-0389-421b-a89e-2335fb4645de.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>Dr. Madara:</strong> There are issues with all of these things, Matthew. The issue that I was trying to raise, by the way thank you for noticing, [is] that in the ‘do you love us, do you hate us’ … there is love in it. Let me give you an example of love and an example of hate. The love is that <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-demand-of-digital-tools-yet-remain-optimistic" target="_self">physicians want to engage digital health</a>, [our survey demonstrates that]. And the reason they want to engage digital health is for better outcomes for patients and better work flows. We have developed digital solutions—<a href="https://www.stepsforward.org/" rel="nofollow" target="_blank">STEPS Forward™</a> for physicians’ offices to engage patients, helping physicians plan so that when the patient comes in it will be a collaboration.</p> <p> We’re working with [Omada Health and Intermountain Health to fight prediabetes]. So we’re engaging digital broadly and we love that. What we love about it, take Omada as an example, there are many others, [Omada is] evidence-based, validated, it is actionable, it improves patient care, there are outcomes measures. Having said that let me tell you what we don’t like.</p> <p> Digital health is rapidly emerging. This conference is wonderful because it stretches the thinking as conferences should, but it also has a little sense of woebegone, everyone is above normal, there are no problems, but there are a few problems and I’d like to name some of them.</p> <p> Instant blood pressure … was one of the best-selling, highest downloaded apps from the app store in 2014-2015. In the digital health literature, your magazines, it was criticized as not being accurate. JAMA did a scientific study … that showed that if you took everyone with hypertension and you did readings with this app, 80 percent of the hypertensives would be called normotensive. Hypertension is the number one killer in the United States.</p> <p> What one has to recognize is that health care is not a normal market. You put a leaky faucet out there, the market is efficient, people stop buying it, no harm no foul except for a minor investment. In health care it’s different. If something doesn’t work there is potential patient harm.</p> <p> <strong>Holt: </strong>The usability of the average EMR tends to be that pretty much all the clients say they want to go back to the 1990s. When you say digital health … do you regard it as all the same?</p> <p> <strong>Dr. Madara:</strong> No one wants to go back to paper. In the late 80s when I was a faculty member at Harvard we were always thinking about this solution and it would be wonderful when x-rays wouldn’t be in someone’s trunk, you could read each other’s notes, it could all be organized with the push of a button.</p> <p> A recent [time-motion] study that we did with Dartmouth … showed that <a href="http://www.ama-assn.org/ama/ama-wire/post/clicks-keyboards-stealing-face-time-patients" target="_self">50 percent of a physician’s time now during the day is spent on data entry</a> and only a third on interacting with patients. And patients feel that, and also complain about that.</p> <p> That 50 percent, it does not give the meaning to the career that the other 30 percent does and it leads to burnout.</p> <p> <strong>Holt: </strong>I agree. No one’s debating that. The patient community sites … the patient self-education sites, a lot of things, which let’s be fair, back in the olden days the AMA was saying don’t trust the website, trust your doctor, but I have one issue or frustration with that. Most of those were founded because somebody had a problem, sought a technological solution, because the health care system and solutions weren’t giving them what they need.</p> <p> A lot of this patient-activated and consumer health movement, a lot of it’s a scam, you’ve got the guys selling digital snake oil, that’s still around, we’re not rid of that completely, but nonetheless you’ve got to realize there’s a real pain there and that a solution is needed.</p> <p> <strong>Dr. Madara:</strong> There are two points I’d like to make around that, Matthew. The first is you’re absolutely right, and not only patients but physicians haven’t been involved as deeply as they should be in solutions. I think if the patient community and the physician community would have been more involved in EHR rollout, we would have a different product.</p> <p> And that’s why we have <a href="https://health2047.com/" rel="nofollow" target="_blank">Health2047</a>, our work with <a href="http://matterchicago.com/" rel="nofollow" target="_blank">MATTER</a> and these kinds of things. I think perhaps the more important point of the entire conversation is why raise a siren now with this intentionally used term—snake oil? And the reason is that I think we’re in a period of criticality for [digital health]. And the criticality is that there’s no regulatory framework.</p> <p> Does anyone think that you’ll get to the future that was outlined here … without regulation? So you have two choices: You can self-regulate or let the government do it.</p> <p> We work really well with government regulatory agencies. These are friends of ours, but let me tell you, they tend to be heavy-handed, they overreach, they’re not nuanced, and it’s one-size-fits-all.</p> <p> If a community shows a responsibility to self-regulate, you can have a different story. We’ve done that in many areas [including the joint commission for hospital accreditation and a liaison committee for medical school certification, among many others].</p> <p> We convened some stakeholders around this topic [and developed principles which we would have liked to announce at this meeting] but it’s not quite developed yet. The initial idea would be to establish some principles that the field … and then move that forward step by step to get to some self-regulating body that an agency under Health and Human Services (HHS) will say, yes, I will deem that authority.</p> <p> Because what we have now, from the FDA point of view, are pretty loose criteria. An example of that is if you have a [digital health tool] and it’s to treat obesity, it probably goes to the FDA because it’s treating a disease. If you have a [tool] that’s for weight-loss, you’re home free.</p> <p> So I think the most important thing is how you move through this period of criticality to get a self-regulatory framework that feels good to the industry and allows it to flourish and not have the noise and lost opportunities.</p> <p> <strong>Holt: </strong>I think we all agree that that’s true; we need to figure out how to get to that place. We also have to work together… How are we going to get this done?</p> <p> <strong>Dr. Madara:</strong> Our preliminary group … included physicians, patient-oriented domains, everything.… Now we’re getting another broader group that will have to get together … to establish principles that will or will not be accepted by the community and agreed upon and then keep working that. Because ultimately, I’ve got to tell you, if these things are as important to health transformation as we think that they are, there is not only going to be regulation but there will be a certification of some kind. That can be nuanced, flexible, it can be adaptive to the industry or it can be central-federal that usually doesn’t have the characteristics that I’ve just described.</p> <p> <strong>Holt: </strong>How do we all get involved in that process?</p> <p> <strong>Dr. Madara:</strong> Let us roll this out. There will be companies that are represented here I’m sure, as well as large companies that are stakeholders in this ecosystem, and patients … I mean this is really all about the patients. </p> <p style="text-align:right;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;"><em style="color:rgb(26, 20, 20);font-family:Gotham, "font-size:13px;text-align:-webkit-right;">By AMA staff writer</em><span style="color:rgb(26, 20, 20);"> </span><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" style="color:rgb(0, 102, 204);cursor:pointer;word-wrap:break-word;overflow:hidden;font-family:Gotham, "font-size:13px;text-align:-webkit-right;" target="_blank"><em>Troy Parks</em></a></span></span></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:211a6485-903f-49ad-93d0-af4435064479 Overcoming gender obstacles in medicine http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_overcoming-gender-obstacles-medicine Tue, 27 Sep 2016 19:40:00 GMT <p> A lack of women in leadership positions, a gender pay gap, stereotypes and self-confidence all play a role in gender inequality in medicine. At the inaugural Women in Medicine Symposium, Vineet Arora, MD, detailed these issues and discussed how women could be more empowered in the medical field.</p> <p> Dr. Arora has spent most of her career in academic medicine and is currently assistant dean for Scholarship and Discovery at the University of Chicago. Because there is good data, she said, academic medicine is a great lens to track women in medicine. The data and results of many studies prove there are specific obstacles that women face, and now the focus needs to be on finding the solutions.</p> <p> <strong>The gender gap</strong></p> <p> A study from 2016 looked at data through the Freedom of Information Act from state institutions controlling for factors like age, years of experience, specialty, scientific authorship, number of Medicare patients and more. The absolute difference between salaries of men and women was $50,000, and after the controls were taken into account it was still $18,000.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/11/8c52d569-6a48-47a6-8ba5-74cf81cd7d62.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/11/8c52d569-6a48-47a6-8ba5-74cf81cd7d62.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> “When I went to medical school in 1998, at Washington University in St. Louis, I was part of a medical class that for the first time had more women than men,” Dr. Arora said. The number of women entering medical school is increasing.</p> <p> Looking at data from the Association of American Medical Colleges, 46 percent of applicants to medical school and 47 percent of matriculates are women, one in five full professors are women and only 16 percent are deans.</p> <p> “I don’t think we can say we just have poor representation because there are fewer women,” she said. “38 percent of faculty in academic health centers are now women, but only 13 percent of those women are full professors,” but as they move on in their careers, there is a clear separation in leadership roles.</p> <p> Assistant dean, she said, is usually a job in medical education. Citing a stereotype, Dr. Arora said, “When you think about teachers you think teachers are women … but the path to become a department chair or division chief is usually through research and it’s usually through clinical leadership …”</p> <p> When you look at the data even closer, she said, “you’ll see there are some nuances there. We’re making some gains in some areas, but it may be because those areas are associated with gender stereotypes for teaching, and not making gains in other areas.”</p> <p> <strong>Stereotype threats</strong></p> <p> “I remember being a resident … and Janet Bickle, who is a well-known luminary in the field, a PhD scientist who studies women in medicine, had come to give grand rounds at the University of Chicago,” Dr. Arora said. “She presented a lot of the same data … and somebody raised their hand in the back and said maybe women don’t want to lead.”</p> <p> “You may have heard this too in your career at some point and maybe not about you,” she said. “Maybe you were in a meeting and you were debating the merit of somebody else and then someone else says ‘Oh they have small kids at home, they probably don’t want this position,’ and you just looked them over.”</p> <p> It might be that you even think that about yourself, Dr. Arora said. “At some point in your career, maybe you thought, ‘I’m probably not the right fit for this job because it’s kind of a man’s job.’”</p> <p> “That’s what we call stereotype threat,” she said. Stereotype threat is when you start believing the stereotype that women cannot do everything a men can do.</p> <p> Dr. Arora talked about one study where women and men were asked to take a math test under two conditions. In one condition, the participants were told it was a high stakes exam, and both genders did well. But in the stereotype threat condition, the participants were told they were about to take a test that exposes gender differences in math. Under that condition, women’s performance dropped and men’s performance rose.</p> <p> <strong>Impostor syndrome</strong></p> <p> Many women do become leaders, but they often face what is called “impostor syndrome,” Dr. Arora said. “Impostor syndrome is experiencing feelings of inadequacy because you do not feel skilled to do your job. This is known to affect women way more than it affects men.”</p> <p> For example, “I go to grand rounds every Tuesday at noon to hear the latest speaker and I often look to see who asks questions at the end,” she said. “Occasionally I have a question. But I have to formulate it in my head and think did the speaker actually address that already? Because I don’t want to ask a question and they say it was on slide three, but by that time somebody has already raised their hand and asks the same question that I was thinking.”</p> <p> “So what was I thinking?” she asked. “I had impostor syndrome. I was thinking that what I know is a microcosm of what everyone else knows, but really it’s that there may be people who know more than me in one field but I know quite a lot about my field …  and a way to overcome this is that we just accept this.”</p> <p> “How do you get rid of stereotype threat and impostor syndrome?” she asked. “A lot of it is about empowering women at early stages in their career and telling them that they can do it … but who is going to do that mid-career?”</p> <p> And that’s where we need to empower each other, Dr. Arora said. “We need to stop thinking that we live in a man’s world. Because in the frame of you can do everything a man can do, the reference group is the man."</p> <p> “The first person that must believe you can do it is yourself,” she said. “And you must believe you can do it and not view being a woman as a hindrance. If we frame context that being a woman is a hindrance, we’re never going to get anywhere.”</p> <p> To learn more about solutions to gender inequality in medicine, read Dr. Arora’s article, “<a href="http://archinte.jamanetwork.com/article.aspx?articleid=2532784" rel="nofollow" target="_blank">It’s time for equal pay for equal work for physicians—paging Dr. Ledbetter</a>,” published in JAMA Internal Medicine earlier this month.</p> <p style="text-align:right;"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:02dfb4b5-1ac4-4617-82ff-41168eb3bbc3 Obesity rates fall in 4 states, but overall rates remain high http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_obesity-rates-fall-4-states-but-overall-rates-remain-high Tue, 27 Sep 2016 00:00:00 GMT <p> Adult obesity rates decreased in four states, according to a new annual study. But with obesity increasing nationwide, there’s still a lot of work to be done so that millions of Americans aren’t at an increased risk of diabetes and heart disease.</p> <p> <strong>A few signs of change<strong><strong><a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/14/12709abb-211f-409e-aece-adea9fed7446.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/14/12709abb-211f-409e-aece-adea9fed7446.Full.jpg?1" style="margin:15px;float:right;height:1324px;width:200px;" /></a></strong></strong></strong></p> <p> There’s a glimmer of good news on the adult obesity front this year: Minnesota, Montana, New York and Ohio saw rates decline between 2014 and 2015, according to the newly release study, <a href="http://healthyamericans.org/reports/stateofobesity2016/" rel="nofollow" target="_blank"><em>The State of Obesity: Better Policies for a Healthier America</em></a>.</p> <p> With the exception of a decline in Washington, D.C., in 2010, this is the first time in the past decade that any state has seen a decrease in its adult obesity numbers, according to the report by the Trust for America’s Health and the Robert Wood Johnson Foundation.</p> <p> But the report says work to lower obesity rates is far from over, and notes that its findings are “an urgent call to action.”</p> <p> <strong>Obesity rates still high</strong></p> <p> Adults in Kentucky and Kansas saw obesity rates rise between 2014 and 2015, the study showed. And, although other states saw rates remain stable, adult obesity rates remain above 30 percent in half the nation’s states.</p> <p> In 2015, Louisiana had the highest adult obesity rate, at 36.2 percent; Colorado ranked the lowest with a 20.2 percent obesity rate, authors found.</p> <p> Keep in mind, though, that in 1991 every state’s obesity rate was below 20 percent.</p> <p> “These new data suggest that we are making some progress, but there’s more yet to do,” said Richard Hamburg, interim president and CEO of Trust for America’s Health. “Across the country, we need to fully adopt the high-impact strategies recommended by numerous experts. Improving nutrition and increasing activity in early childhood, making health choices easier in people’s daily lives and targeting the startling inequities are all key approaches we need to ramp up.”</p> <p> More detailed policy recommendations are outlined in <a href="http://healthyamericans.org/reports/stateofobesity2016/" rel="nofollow" target="_blank"><em>The State of Obesity</em> </a>report.</p> <p> <strong>Location, heritage and education matter</strong></p> <p> Minorities, those who live in the South, those with lower incomes and those who did not graduate high school are more likely to be obese, according to the report.</p> <p> Among the study’s findings on where people live:</p> <ul> <li> Nine of the 11 states with the highest obesity rates are in the South</li> <li> 22 of the 25 states with the highest obesity rates are in the South and Midwest</li> <li> 10 of the 12 states with the highest rates of diabetes are in the South</li> </ul> <p> When broken down by ethnicity, the study found obesity rates are:</p> <ul> <li> 48.4 percent among blacks</li> <li> 42.6 percent among Latinos</li> <li> 36.4 percent among whites</li> <li> 12.6 percent among Asian-Americans</li> </ul> <p> And here is how education and income impacts rates:</p> <ul> <li> Nearly 33 percent of adults who did not graduate high school were obese compared with 21.5 percent of college or technical college graduates</li> <li> More than 33 percent of adults who earn less than $15,000 annually are obese; 24.6 percent who earned at least $50,000 annually were obese</li> </ul> <p> For more interactive graphs, charts and obesity rates visit <a href="http://stateofobesity.org/" rel="nofollow" target="_blank">stateofobesity.org</a></p> <p> <strong>Physician resources to combat diabetes, obesity</strong></p> <p> The AMA’s online resource <a href="http://www.ama-assn.org/sub/prevent-diabetes-stat/" target="_self">Prevent Diabetes STAT</a> provides physicians with information and tools to help patients prevent diabetes.</p> <p> And for more information on how physicians are helping patients prevent diabetes and fight obesity:</p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-patients-active-approach-diabetes-fight-online" target="_self">Physicians, patients take active approach to diabetes fight online</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/5-nutrition-misconceptions-sabotage-patient-health" target="_self">Five Nutrition Facts misconceptions that sabotage patient health</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/inside-look-physicians-success-story-prediabetic-patient" target="_self">Inside look: A physician's success story as a prediabetic patient</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-obesity-medicine-shadowing-dr-lazarus" target="_self">What's it like to be in obesity medicine: Shadowing Dr. Lazarus</a></li> </ul> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:3b9cf26d-084d-48df-a7cb-212a145d2beb Test your readiness with this month’s USMLE Step 1 stumper http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_test-readiness-this-months-usmle-step-1-stumper Mon, 26 Sep 2016 23:00:00 GMT <p> The United States Medical Licensing Examination® (USMLE®) Step 1 exam is often the first major test of a medical student’s knowledge, and some of its questions are missed by all but a select few highly prepared test takers. Check out this month’s question that Kaplan Medical says stumps most students, and view an expert video explanation of the answer.</p> <p> Welcome to this month’s installment of the <em>AMA Wire</em>® series, Tutor talk: Tips from Kaplan Medical on the most missed USMLE test prep questions from Kaplan’s Qbank: Step 1. Each month, <em>AMA Wire® </em>reveals questions many physicians-in-training miss on the USMLE and provides helpful analysis of correct answers, along with videos featuring tips on how to advance test-taking strategies. See <a href="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" target="_self">all posts in this series</a>.</p> <p> Think you have what it takes to rise above your peers? Test your USMLE knowledge below.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong></p> <p> Gastrin, acetylcholine and histamine all regulate gastric acid secretion from parietal cells under normal conditions. Administration of atropine will most likely cause which of the following changes in the ability of gastrin, acetylcholine and histamine to stimulate acid secretion?</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/11/c6adb520-d18b-493a-ab35-dfe2c9da708a.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/11/c6adb520-d18b-493a-ab35-dfe2c9da708a.Large.jpg?1" style="margin:15px;float:left;" /></a></p> <p>  </p> <p>  </p> <p>  </p> <p>  </p> <p>  </p> <p>  </p> <p>  </p> <p>  </p> <p>  </p> <p> <object data="http://www.youtube.com/v/Q36wAgonnE8" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/Q36wAgonnE8" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/Q36wAgonnE8" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowFullScreen" value="true" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object></p> <p>  </p> <p> <strong>The correct answer is C.</strong></p> <p> <strong>Kaplan says, here’s why: </strong></p> <p> Parietal cells express at least five different receptors types that control acid secretion—three excitatory, two inhibitory. All five receptors signal their occupancy via G-proteins. The three excitatory receptors bind acetylcholine (ACh), gastrin and histamine.</p> <ul> <li> The ACh receptor is an M<sub>3</sub> AChR that activates in response to ACh released from vagal nerve endings. It couples intracellularly via G<sub>q</sub> to the IP<sub>3</sub> signaling pathway. The AChR facilitates reflex acid secretion in response to the sight and smell of food (a vagovagal reflex).</li> <li> Gastrin binds to a cholecystokinin B (CCK<sub>B</sub>) receptor that also couples intracellularly via G<sub>q</sub> to the IP<sub>3</sub> signaling pathway. Gastrin is released from G cells located in the gastric mucosa. They release gastrin in response to luminal peptides and amino acids whose appearance indicates that a meal has begun. G-cells are also regulated by the vagus nerve, but the nerve terminals signal via a peptide neurotransmitter (gastrin releasing peptide; GRP) rather than the usual ACh.</li> <li> Histamine binds to an H<sub>2</sub> receptor that couples via G<sub>s</sub> to the cAMP intracellular signaling pathway. Histamine originates from enterochromaffin-like (ECL) cells, which are neuroendocrine cells located in the gastric mucosa. ECL cells secrete histamine when stimulated either by the autonomic nervous system or by gastrin. <ul style="list-style-type:circle;"> <li> ECL cells are innervated by the vagus nerve. They are activated via ACh release and an M<sub>3</sub> AChR.</li> <li> ECL cells also express CCK<sub>B</sub> receptors, which allows them to respond to gastrin when G cells are activate.</li> </ul> </li> </ul> <p> Histamine is the primary stimulus for gastric acid secretion. Even though ACh and gastrin are secretagogues also, their effects are entirely secondary to histamine. Thus, mice models lacking H<sub>2</sub> receptors are unable to secrete acid, even when the vagus nerve and G-cells are active and releasing ACh and gastrin, respectively. The importance of the histamine pathway is also reflected in the efficacy of H<sub>2</sub> blockers (e.g. cimetidine, ranitidine) in controlling acid secretion in patients with peptic ulcers and gastroesophageal reflux disease. Note that H<sub>2</sub> blockers, unlike knock-out studies, cannot inhibit the histamine pathway by 100%. Any residual H<sub>2</sub> receptor signaling is subsequently potentiated by the ACh and gastrin pathways, which is why proton pump inhibitors (e.g. omeprazole) have replaced H<sub>2</sub> blockers as the drugs of choice in controlling gastric acid production.</p> <p> Under normal circumstances, all three secretagogues are released during a meal and all three receptor types are active and their effects on acid secretion are multiplicative; their combined actions are greater than might be expected from the sum of their individual actions. This phenomenon is known as “potentiation”, and reflects the power of G-protein signaling pathways to interact with and amplify sensory signals.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/1/18048798-6a4f-48e6-919f-89b438eef10f.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/1/18048798-6a4f-48e6-919f-89b438eef10f.Large.png?1" style="margin:15px;float:left;" /></a></p> <p>  </p> <p>  </p> <p>  </p> <p>  </p> <p>  </p> <p>  </p> <p>  </p> <p>  </p> <p> Atropine is an M-type AChR (mAChR) antagonist. Referring to the pathways above, it would be expected to block the parietal cell mAChR and the mAChR on ECL cells. The ability of ACh to stimulate acid secretion is, thus, clearly reduced.</p> <p> Because gastrin and histamine act through different receptor types that are not blocked by atropine, their ability to stimulate acid secretion might be expected to be resistant to mAChR blockade. In practice, however, the phenomenon of potentiation means that the loss of the ACh-mediated signal decreases the potency of both gastrin and histamine, so all three secretagogues have decreased efficacy when atropine is applied (choice C).</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:21fe8f3d-0ad8-4046-b33b-d7d288035875 Physicians demand more of digital tools, yet remain optimistic http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-demand-of-digital-tools-yet-remain-optimistic Mon, 26 Sep 2016 10:00:00 GMT <p> Physician enthusiasm about digital health innovation requires a few “must haves” to turn that enthusiasm into adoption of digital tools in clinical practice. A new AMA survey shows that physician optimism toward digital health products is present across all ages, but the tools must be beneficial to clinical practice and not a burden. One way to make sure the tools are effective in practice is to get physicians involved in their development.</p> <p> The AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/digital-health.page" target="_self">digital health survey</a> asked 1,300 physicians about their motivations and requirements for integrating digital health tools in their practices. Conducted by Kantar TNS, one of the world’s largest research agencies, the survey asked physicians to answer questions regarding telemedicine and telehealth, mobile health, wearable, remote monitoring, mobile applications and many others.</p> <p> <strong>Patient care among top concerns</strong></p> <p> The top three characteristics that attract physicians to digital health tools are that they improve work efficiency, increase patient safety and improve diagnostic ability. All three relate directly to patient care. If a tool does not make the work day run more efficiently, that affects patient care—and physicians strive every day to make sure their processes and tools work for patients above all else.</p> <p> With 85 percent of physicians surveyed saying that digital health solutions are advantageous to patient care, it is clear that the medical community sees the potential of these tools.</p> <p> But physicians need tools that fit within current systems and look to technology experts to meet those needs—tools that don’t <a href="http://www.ama-assn.org/ama/ama-wire/post/clicks-keyboards-stealing-face-time-patients" target="_self">take away time spent face-to-face with patients</a>. When asked what requirements must be met by digital health tools of the future, three themes emerged:</p> <ul> <li> Tools should be easy to use and as effective as current methods of patient care—if not more effective</li> <li> Liability coverage, data privacy and work flow integration are essential</li> <li> Physicians should be paid for time spent using the tools</li> </ul> <p> If tools meet the requirements physicians have set forth, physicians anticipate rapid adoption and minimal disruption to their practice, the survey found. Nearly half of all physicians surveyed, regardless of age, stated high enthusiasm for new digital solutions.</p> <p> When asked how much of an advantage digital health solutions provide to a physician’s ability to care for patients, 87 percent of primary care physicians said there was definite or some advantage and 83 percent of specialists agreed.</p> <p> A prime example of a tool that has the potential to transform clinical practice is the electronic health record (EHR). Physicians have adopted EHR technologies at a rapid rate and recognize the promise of EHRs, but that promise has not been met. A <a href="http://www.rand.org/content/dam/rand/pubs/research_reports/RR400/RR439/RAND_RR439.pdf" rel="nofollow" target="_self">study</a> by the AMA and the RAND Corporation found that <a href="http://www.ama-assn.org/ama/ama-wire/post/framework-evaluates-top-20-ehrs-dont-quite-measure-up" target="_self">EHRs are one of the top sources of physician dissatisfaction</a>. Yet, it also found that among the 30 participating practices, 28 were using an EHR at the time of the study.</p> <p> <strong>Getting physicians involved in development</strong></p> <p> Developers agree that physician involvement is critical to making sure digital health tools enhance care and have the longevity to improve patient health outcomes. Several recent AMA efforts focus on helping physicians take on a greater role in leading changes that will move technological innovations forward.</p> <p> Physicians are willing to move health care technology into the future and are getting more involved each day. If you want to get involved, sign up for an invitation to the AMA Physician Innovation Network, which connects entrepreneurs to practicing physicians to consult on new ideas and technologies. The AMA offered a sneak peek of the Physician Innovation Network at Health 2.0 2016 and it will be live in October. The future of health IT is one that involves collaboration between developers and physicians and both sides have shown they are more than willing to work together to improve patient health and care delivery.</p> <p> Some physicians are taking matters into their own hands. Frank Opelka, MD, a physician in Louisiana, is leading a statewide effort to <a href="http://www.ama-assn.org/ama/ama-wire/post/medicine-needs-cloud" target="_self">create a larger cloud architecture where EHRs are the access point</a> to using data for quality improvement and clinical support. Lawrence Kosinski, a gastroenterologist in Illinois, founded SonarMD, which he uses to <a href="http://www.ama-assn.org/ama/ama-wire/post/tracking-patients-between-visits-new-care-model" target="_self">track patients between visits</a>.</p> <p> At <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-silicon-valley-common" target="_self">Health2047</a>, a San Francisco-based health care innovation company, strategy, design and venture opportunities are developed in partnership with physicians, leading companies and entrepreneurs.</p> <p> In an expanded partnership with <a href="http://www.ama-assn.org/ama/ama-wire/post/three-teams-tapped-create-healthier-nation" target="_self">MATTER</a>, Chicago’s health care technology incubator, physicians and entrepreneurs collaborate on the development of new technologies, services and products in a simulated health care environment. This enables them to make sure that the number-one requirement of physicians—that the technologies work in practice—is met.</p> <p> Though Health2047 and MATTER bring practicing physicians and entrepreneurs together, medical students also are tackling clinical problems by developing technological solutions at <a href="http://idealabsincubator.org/" rel="nofollow" target="_self">IDEA Labs</a>, a student-run biotechnology incubator that helps the next generation of physicians and young entrepreneurs address unmet needs in health care delivery.</p> <p> Physicians also play a key advisory role in the <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-making-ehrs-interoperable" target="_self">SMART project</a>, created to ensure EHR systems work better for physicians and patients through the development of a flexible information infrastructure that allows for free, open-development of “plug and play” apps to increase interoperability. AMA Board Member Jesse Ehrenfeld, MD, sits on the advisory board for the SMART project.</p> <p> Dr. Ehrenfeld has also taken the initiative at Vanderbilt University by creating a team focused on better use of technology that was already at physicians’ fingertips. Their solutions bring <a href="http://www.ama-assn.org/ama/ama-wire/post/overcoming-barriers-physicians-use-ehrs-innovative-ways" target="_self">actionable information from the EHR to clinical faculty</a> to help them better track patients’ progress and prepare for the next day’s patients.   </p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:eeab9434-c5c2-47ef-9fa7-dca0272b72ee Rethinking how race contributes to a patient’s health http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_rethinking-race-contributes-patients-health Mon, 26 Sep 2016 04:30:00 GMT <p> Physicians have been trained to think about race as a demographic factor that may influence a patient’s health, but understanding how race influences health is evolving. One medical school is attempting to expand the way future physicians think about race in the exam room.</p> <p> Jennifer Tsai and Bryan Leyva, medical students at Warren Alpert Medical School of Brown University, shared how students at their school succeeded in changing how race is addressed in their curriculum in a presentation titled, “Moving past diversity toward decolonization: Bringing critical race theory to the Warren Alpert Medical School of Brown University.”</p> <p> The talk was held during the AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education</a> Consortium student-led meeting on health equity and community-based learning at the University of California, Davis, School of Medicine in early August. The Warren Alpert Medical School of Brown University is a member of the consortium, but this work on race theory is not a part of their consortium project.</p> <p> <strong>What is race?</strong></p> <p> Race is socially and politically constructed, Tsai told those gathered at the meeting. Racial categories on the U.S. Census have changed every decade since 1790, showing just how vulnerable they are to the current political climate, she said.</p> <p> “Race becomes a poor surrogate for family history,” she said. For example, a physician could say, “‘You’re from Africa, so you have a higher rate of this disease.’ …. But Africa is a whole continent.”</p> <p> With that in mind, Brown medical students went through lecture slides at their medical school to find examples of how race is used as a biological factor. They found that of the 102 slides that mentioned race, 96 percent of them suggested a biological risk. Just 4 percent of the slides acknowledged social determinants of disease disparities among people of different races.</p> <p> Tsai said the results were “surprising.” The students’ findings were published in <a href="http://journals.lww.com/academicmedicine/Fulltext/2016/07000/Race_Matters__Examining_and_Rethinking_Race.14.aspx" target="_blank" rel="nofollow"><em>Academic Medicine</em></a>.</p> <p> In addition, she said, “A school-wide survey of 180 students showed 90 percent of students supported curriculum reform on race and when it came to race and about 80 percent felt inadequately prepared to use and talk about race in the clinic.”</p> <p> <strong>What did Brown do with the findings?</strong></p> <p> Medical students in December 2014 sent a letter detailing their concerns on teaching race as biology. From there, a task force of students and administrators worked to implement changes.</p> <p> For example, the medical school designated an elective for first year medical students. The 10-session class includes lectures, discussions and case studies. Students address topics such as the health of minorities, race and segregation, Leyva said.</p> <p> The program encourages developing a healthy skepticism of research. For example, students looked at a study that found there was no genetic difference among racial groups, yet the study’s abstract said there were differences.</p> <p> Students in the class also address how racism is prevalent in structures in society. They talk about the historical structural and political forces that created problems and then propose solutions, Leyva said.</p> <p> The students talk about restrictive covenants that prohibited African-Americans and other racial and ethnic minorities from buying homes in certain neighborhoods—and redlining—where insurance companies and banks decided which communities would receive money for insurance and loans and which would not.</p> <p> “Segregation… did not happen on its own,” Leyva said. “It is intentional, driven at the local, state and federal level, and it has an impact on people’s lives today.”</p> <p> Tsai said students also discuss the idea of medical authority and how it has been used through history when discussing race and health.</p> <p> <strong>How the discussions are making a difference</strong></p> <p> Leyva said surveys and focus groups have shown that students appreciate the discussions and new ways of thinking. Students also said they have a better understanding of bias and institutional racism, as well as have the skills to talk about race and racism in clinical and non-clinical contexts.</p> <p> Tsai asked those gathered how medical school leaders can hold themselves accountable, noting that they need to think about things such as admissions, research dollars and community interaction “so we can be committed to and practice equity in ways that critical race theory works.”</p> <p> Other topics discussed at the recent Accelerating Change in Medical Education consortium meeting included:</p> <ul> <li> How <a href="http://www.ama-assn.org/ama/ama-wire/post/death-zip-code-address-matters-genetics" target="_self">zip code impacts patients' health</a> more than genetics</li> <li> Learning to<a href="http://www.ama-assn.org/ama/ama-wire/post/treating-community-patient" target="_self"> treat the community as your patient</a></li> <li> What it means to <a href="http://www.ama-assn.org/ama/ama-wire/post/working-upstream-achieve-quadruple-aim" target="_self">work upstream to achieve the quadruple aim</a></li> </ul> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:276e61ae-093a-4cb1-b813-c97cb6d33e20 How physician input is changing MOC http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physician-input-changing-moc Fri, 23 Sep 2016 01:00:00 GMT <p> With Maintenance of Certification (MOC) in its second decade, many changes are underway. Through conversations between physicians and the American Board of Medical Specialties (ABMS), these changes are intended to make the MOC process, including the Part III examination, more relevant to clinical practice and less burdensome. </p> <p> In recent years, the AMA’s Council on Medical Education (Council) has developed a constructive working relationship with the ABMS on these issues. Council work has been effective in contributing to moving the Boards to consider alternatives to high-stakes testing and other changes in MOC to make it more relevant for physicians.</p> <p> An <a href="http://journals.lww.com/academicmedicine/Abstract/publishahead/The_ABMS_MOC_Part_III_Examination___Value,.98450.aspx" target="_blank" rel="nofollow">article</a> that describes a conference discussion between the Council and ABMS details the changes that are currently underway and what could be coming in the future through conversations between the two organizations.</p> <p> “The AMA has been very helpful in bringing the voice of the physicians to the Boards Community,” said Mira Irons, MD, senior vice president for academic affairs at the ABMS, “and to help us understand the greatest concerns that physicians have regarding MOC.”</p> <p> “The Council has created an opportunity for the Boards Community to maintain a dialogue with relevant groups of the AMA.” Dr. Irons said. “This is a way to learn about what each organization is doing and, more importantly, the context in which these innovations are being created.”</p> <p> <strong>Physicians detail issues with current MOC approach</strong></p> <p> One challenge to the current approach to MOC examinations is that practice patterns evolve over the years. Examination measurement standards require a thorough and explicit definition of the content of the domain, yet physicians have expressed concern that the material included on the exam is broader than what typically presents in most physician practices.</p> <p> AMA members have raised a number of important issues about the exam; for example, that it needs to be more personalized to practice and it needs to be more about clinical judgment and patient management skill. And the experience needs to be more convenient and easier to integrate into their busy practices.</p> <p> As a result, the Boards are piloting a number of changes specifically to address these issues:</p> <ul> <li> <strong>Modularizing the exam</strong> to make it more relevant</li> <li> <strong>Incorporating audio and video</strong> to simulate real-life decision-making</li> <li> <strong>Redesigning questions</strong> to move from recall to clinical judgment and decision making</li> <li> <strong>Incorporating remote proctoring</strong> that moves the experience from testing centers to the home or office environment</li> <li> <strong>Moving to more frequent, low-stakes testing</strong> in place of the single high-stakes exam</li> <li> <strong>Providing more feedback</strong> to make the experience more formative and helpful to continuing professional development</li> </ul> <p> <strong>Alternatives to the current MOC Part III examination</strong></p> <p> In response to both physician input and emerging views on how to increase the relevance and benefit of the Part III exam, several ABMS member boards are piloting alternative formats consistent with the Standards for the ABMS Program for MOC. The Standards offer flexibility to individual boards for implementation, and some of the boards have been taking advantage of that flexibility with major innovations in content and delivery.</p> <p> <strong>The ABA’s MOCA Minute</strong><sup>®</sup></p> <p> After analyzing feedback from board-certified anesthesiologists and the availability of information technology, the American Board of Anesthesiology (ABA) explored ways to enhance the Maintenance of Certification Anesthesiology Program<sup>®</sup> (MOCA<sup>®</sup>) through a program redesign called <a href="http://www.theaba.org/MOCA/About-MOCA-2-0" target="_blank" rel="nofollow">MOCA 2.0<sup>®</sup>.</a> MOCA 2.0 is intended to promote continuous lifelong learning, increase the relevance of MOCA to practices, integrate Parts II, III and IV of MOC and include continuous longitudinal (low-stakes) assessment.</p> <p> The result of the ABA’s exploration and discussions is the implementation of <a href="http://www.theaba.org/MOCA/MOCA-Minute" target="_blank" rel="nofollow">MOCA Minute<sup>®</sup></a>, an online longitudinal assessment tool. Introduced as an expanded pilot in January to replace the cognitive high-stakes exam taken every 10 years, physicians who are enrolled in MOCA 2.0 answer 120 MOCA Minute questions annually.</p> <p> The questions include core information essential for anesthesiologists as well as topics that are reflective of an anesthesiologist’s areas of subspecialization. Once a physician accesses a question, she or he has one minute to answer. As soon as the question is answered, the physician is shown a feedback page that includes the correct answer, a critique explaining the answer with references and a one-sentence summary of the material. The critiques from previous questions are available at any time to reinforce learning.</p> <p> Initial analysis of the pilot showed that participation was associated with positive diplomate feedback and improved performance on the MOCA examination. Additional analyses are underway.</p> <p> Watch <em>AMA Wire®</em> for more examples of how medical boards are changing the MOC process.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f39ca154-a348-47a8-a76e-bf0a0364b9dc Redesigning the Gas Lounge: How residents changed their space http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_redesigning-gas-lounge-residents-changed-their-space Thu, 22 Sep 2016 01:00:00 GMT <p> Anesthesiology residents at Stanford used to spend their few precious moments of relaxation in a lounge that looked like a dirty apartment. With a low-budget, resident-led plan, they found the funds and redesigned the anesthesiology lounge—known as the “Gas Lounge”—into a space that is clean, calm and where they would actually want to eat and sleep.</p> <table align="right" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/11/45d54fdc-d345-41fd-9bb5-9470fc6ee7c1.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/11/45d54fdc-d345-41fd-9bb5-9470fc6ee7c1.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <em><span style="font-size:10px;">The Gas Lounge "before"</span></em></td> </tr> </tbody> </table> <p> Physicians spend a large portion of their lives at work and most of the time they get to actually relax is in the on-call room. Adam Was, MD, a fifth-year resident in the combined pediatrics and anesthesia program at Stanford, spoke this week to physicians at the <a href="http://www.ama-assn.org/ama/ama-wire/post/building-emotional-intelligence-medical-trainees" target="_self">International Conference on Physician Health™</a> in Boston about how he and his fellow residents redesigned their own on-call room.</p> <p> The changes to the Gas Lounge came about through the <a href="http://med.stanford.edu/prime.html" rel="nofollow" target="_blank">Peer Support and Resiliency in Medicine Program</a> (PRIME) at Stanford, which was built in 2010 around Jon Kabat-Zinn’s <a href="http://www.ama-assn.org/ama/ama-wire/post/being-attendance-medicine-meditation-merge" target="_self">mindfulness-based stress reduction work</a> and is intended to create a new culture that fosters interdependence, concern for others, self-care and emotional literacy. The program holds resident wellness retreats, regular wellness sessions led by faculty and wellness education sessions.</p> <p> Then, in 2014, the addition of a scholarship for resident-driven wellness initiatives opened the door for residents in the program to make meaningful changes that affect their daily lives.</p> <p> “It was really wonderful because they had these funds and made them available and invited residents to put together whatever ideas they could come up with that they thought might help resident wellness,” Dr. Was said. And the residents lead the programs.</p> <p> <strong>Residents decide what goes into their home away from home</strong></p> <table align="right" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/8/bd7ed4cd-9bce-4e29-b87e-4dfd59f88c17.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/8/bd7ed4cd-9bce-4e29-b87e-4dfd59f88c17.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <em><span style="font-size:10px;">The Gas Lounge "after"</span></em></td> </tr> </tbody> </table> <p> Dr. Was initiated a project to improve the Gas Lounge. It was feasible, could easily be implemented and was cost-effective. “We really wanted to empower the beneficiaries of the scholarship,” he said, “let the residents choose what they wanted, lead the selection of that and be a guide and a means to an end for them.”</p> <p> The group surveyed the 79 anesthesia residents regarding their current use and satisfaction with the lounge. They asked for ideas for improvements as well as their permission to make those improvements “to make sure that they were on board and didn’t feel like we were changing the existing structure … and that we weren’t forcing any changes on people,” Dr. Was said.</p> <p> In the initial survey, the residents suggested a total of 33 potential improvements ranging from couches, coffee tables and lighting to hot tubs and massage therapists—the latter of which were not quite feasible.</p> <p> “We asked what kept them from using it more often,” Dr. Was said. “People said they use it pretty frequently … but in terms of limitations a good portion of people said it’s just too small, or it’s dirty, or they often forget their key.”</p> <p> They also asked residents if they would use the lounge more often if these improvements were made and whether they felt these interventions would improve their well-being. Fifty-nine percent said it would improve their well-being—and so the group budgeted and began purchasing items and redesigning the Gas Lounge.</p> <p> <strong>Revealing the Gas Lounge makeover</strong></p> <p> The selected improvements included a new couch, monthly cleaning, badge-entry rather than key-entry, snacks, phone chargers, new lighting and pillows and blankets among several others. Once the room was completely cleaned from top to bottom, they placed all of the new items in the room.</p> <table align="left" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/9/38f1535a-283b-4ca3-b9c2-99f2af78b5d0.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/9/38f1535a-283b-4ca3-b9c2-99f2af78b5d0.Large.jpg?1" /></a></td> <td>   </td> </tr> <tr> <td> <span style="font-size:10px;"><em>Anesthesiology residents in the Gas Lounge</em></span></td> <td>   </td> </tr> </tbody> </table> <p> Dr. Was said that some of the things they found under the old couch were not for repeating to an audience. “Suffice to say, I didn’t know that oranges could turn black,” he said. “And I don’t know how long that takes.”</p> <p> In a post-intervention survey, residents were asked how often they used the Gas Lounge. Before the interventions, only about 20 percent of residents said they used it daily. After the interventions, almost 70 percent of residents said they used it daily.</p> <p> One resident wrote in the survey, “I go to the Gas Lounge nearly every day for lunch because I know I can sit down with the people I love (my co-residents) and get a half hour of socializing and humor. It is also my home-base for those long call evenings, and essential for naps while on cardiac call.”</p> <p> Another resident said, “The Gas Lounge is my home. If we didn’t have it I’d be an orphaned child … I love the new changes.”</p> <p>  </p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:fc8a48c6-cf39-46f3-bb7a-09383b881013 New tool identifies short-term volunteer and paid opportunities http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-tool-identifies-short-term-volunteer-paid-opportunities Thu, 22 Sep 2016 01:00:00 GMT <p> A new interactive tool provides physicians interested in volunteering or working outside of their normal practice settings with short-term opportunities in the field of medicine. The <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-opportunities-portal.page" target="_self">Physician Opportunities Portal</a>, launched today by the AMA, enables physicians to quickly and easily identify opportunities to add stability and longevity to their careers and increase joy in practice by giving back.</p> <p> The Portal features many opportunities, including:</p> <ul> <li> Consulting</li> <li> Legal expert</li> <li> Locum tenens</li> <li> Emergency and safety</li> <li> Health and wellness</li> <li> AMA opportunities</li> </ul> <p> Users may search by location, start date and even time of day. The Portal also features opportunities in areas that are not health care focused, such as advocacy, education and recreation.</p> <p> <strong>Created from physician feedback</strong></p> <p> The Physician Opportunities Portal grew out of an initiative in which the AMA reached out to physicians across the country to start a dialogue about the realities of practicing medicine in today’s world and how the AMA can better serve them. Feedback indicated physicians in small practices are highly stressed by administrative burdens and government regulations. Many have very little time and multiple pressing priorities, so they are seeking quick, short-term opportunities to create additional revenue streams to help stabilize their practices.</p> <p> The AMA also received feedback from retired physicians indicating they are interested in staying connected to medicine and may continue to work in the field of medicine.</p> <p> <strong>Additional tools supporting physicians</strong></p> <p> The Portal is the latest product developed by the AMA to help physicians plan their careers and manage their finances.</p> <p> The AMA also recently launched the <a href="http://www.ama-assn.org/ama/pub/advocacy/state-advocacy-arc/health-workforce-mapper.page#free-tool" target="_self">Health Workforce Mapper</a> to help practices identify high-priority areas for workforce expansion. It illustrates the geographic distribution of the health care workforce and enables users to filter physician and non-physician health care professionals by specialty and employment setting at the state, county and metropolitan levels.</p> <p> The latest version of the mapper incorporates every specialty and subspecialty in the <a href="http://www.ama-assn.org/ama/pub/about-ama/physician-data-resources/physician-masterfile.page" target="_self">AMA Physician Masterfile</a> and the <a href="https://npiregistry.cms.hhs.gov/" rel="nofollow" target="_blank">CMS National Provider Identifier database</a>, including non-physician specialties. It also includes resident physicians.</p> <p> Meanwhile, the <a href="http://www.jamacareercenter.com/" rel="nofollow" target="_self"><em>JAMA</em> Career Center</a> aggregates career opportunities, news and information relevant to the full spectrum of medical practice. Job postings are available from nearly every specialty, practice setting and region in the United States. Opportunities can range from remote rural and underserved urban areas to thriving neighborhoods in towns and major metropolitan centers.</p> <p> The <em>JAMA </em>Career Center also presents select international physician employment and volunteer opportunities and offers a <a href="http://www.jamacareercenter.com/volunteer_opportunities.cfm" rel="nofollow" target="_self">list of organizations looking for volunteers</a>, which includes the areas each organization serves and the specialties needed.</p> <p> <strong>Physician feedback an important factor</strong></p> <p> The Physician Opportunities Portal is a free tool, and all users may view available volunteer opportunities. With a free online AMA account, users can also save searches and receive timely alerts. AMA members may save searches, receive alerts and access paid opportunities.</p> <p> Your feedback can help ensure the tool is providing the resources you need. If you have opinions of the Physician Opportunities Portal, the AMA would like to <a href="mailto:physicianopportuntiesportal@ama-assn.org" rel="nofollow">hear from you</a>.</p> <p align="right"> <em>By AMA staff writer Tim Smith</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1c27ca10-686a-40b9-97e7-42b8d7caa2ba New analyses support blocking pending insurance mergers http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-analyses-support-blocking-pending-insurance-mergers Wed, 21 Sep 2016 10:00:00 GMT <p> Two analyses released today demonstrate further that the proposed Anthem-Cigna and Aetna-Humana health insurance mergers would exceed federal antitrust guidelines designed to preserve competition and jeopardize patient access to affordable coverage and care.</p> <p> The analyses are based on data from the 15<sup>th</sup> edition of <em>Competition in Insurance: A Comprehensive Study of U.S. Markets,</em> published today by the AMA, which continues to find the majority of commercial health insurance markets in the United States are highly concentrated.</p> <p> High market concentration can lead to enhanced market power by health insurers on physicians and patients, wherein payments to physicians are lower than those resulting in a competitive market and premiums charged to patients are higher with no added benefits.</p> <p> <strong>The most complete picture of competition in health insurance<strong><strong><a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/7/549d8bb2-0f80-4aa9-b722-ea5f06f68a17.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/7/549d8bb2-0f80-4aa9-b722-ea5f06f68a17.Full.jpg?1" style="float:right;margin:15px;width:300px;height:627px;" /></a></strong></strong></strong></p> <p> Using 2014 data from captured from commercial enrollment in fully and self-insured plans, <em>Competition in Insurance</em> presents the two largest insurers’ commercial market shares and the market concentrations for 388 metropolitan statistical areas (MSAs), the 50 states and the District of Columbia.</p> <p> “This is the most complete picture available of competition in health insurance markets,” the report said.</p> <p> In terms of market concentration, it shows:</p> <ul> <li> <strong>Seventy-one percent</strong> of the combined health maintenance organization (HMO), preferred provider organization (PPO), point-of-service (POS) and health exchange (EXCH) markets are highly concentrated.</li> <li> <strong>Ninety-three percent</strong> of HMO markets are highly concentrated.</li> <li> <strong>Eighty-seven percent</strong> of PPO markets are highly concentrated.</li> <li> <strong>One hundred percent</strong> of POS markets are highly concentrated.</li> <li> <strong>Ninety-five percent</strong> of exchanges are highly concentrated.</li> </ul> <p> In terms of market shares, it found:</p> <ul> <li> <strong>In 40 percent of the MSAs,</strong> one insurer had a combined HMO+PPO+POS+EXCH market share of 50 percent or greater.</li> <li> <strong>In 64 percent of the MSAs,</strong> one insurer had an HMO market share of 50 percent or greater.</li> <li> <strong>In 59 percent of the MSAs,</strong> one insurer had a PPO market share of 50 percent or greater.</li> <li> <strong>In 86 percent of the MSAs,</strong> one insurer had a POS market share of 50 percent or greater.</li> <li> <strong>In 75 percent of the MSAs,</strong> one insurer had an exchange market share of 50 percent or greater.</li> </ul> <p> <strong>Pending mergers would cause harm across numerous markets</strong></p> <p> In 2015, Anthem announced its intent to acquire Cigna, and Aetna announced plans to acquire Humana. All are among the five largest commercial health insurers in the country.</p> <p> The motivation for <em>Competition in Insurance</em> has been to help identify markets where mergers would cause competitive harm. The analyses of those mergers using data from this year’s report calculated the changes in market concentration that would result from the mergers and then classified markets based on how anticompetitive the mergers would be.</p> <p> They found:</p> <ul> <li> <strong>The <a href="https://download.ama-assn.org/resources/doc/washington/anthem-cigna-analysis.pdf" target="_self">Anthem-Cigna merger</a> would diminish competition in 121 metropolitan areas located in all of the 14 states where Anthem is licensed to provide commercial coverage,</strong> including California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin.</li> <li> <strong>The <a href="https://download.ama-assn.org/resources/doc/washington/aetna-humana-analysis.pdf" target="_self">Aetna-Humana merger</a> would diminish competition in 57 metropolitan areas in 15 states,</strong> including Arizona, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Ohio, Tennessee, Texas, Utah, West Virginia and Wisconsin.</li> </ul> <p> “The AMA analyses show that the Anthem-Cigna and Aetna-Humana mergers would significantly compromise market competition in the health insurance industry and threaten health care access, quality and affordability,” said AMA President Andrew W. Gurman, M.D. “With existing competition in health insurance markets already at alarmingly low levels, federal and state antitrust officials have powerful reasons to block harmful mergers and foster a more competitive marketplace that will operate in patients' best interests."</p> <p> The AMA and state medical societies have worked behind the scenes in opposition to the two mergers.  The AMA has encouraged the Department of Justice (DOJ) and a number of state attorneys general to oppose both on antitrust grounds.</p> <p> The AMA believes more can be done in states where state regulators have not yet taken a strong stance against the mergers, and it will work to expand the bi-partisan group of state attorneys general that has already joined the DOJ to block the massive deals.</p> <p> <em>Competition in Insurance: A Comprehensive Study of U.S. Markets</em> is free to AMA members. It is also available to non-members. To order a copy, visit the <a href="https://commerce.ama-assn.org/store/catalog/subCategoryDetail.jsp?category_id=cat1150037&navAction=push" target="_self">AMA store</a> or call (800) 621-8335 and mention OP number 427116.</p> <p align="right"> <em>By AMA staff writer Tim Smith</em></p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7be28f9c-afa9-4116-b88d-a4eb9971f60b When good work is acknowledged, we aspire to work harder http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_good-work-acknowledged-aspire-work-harder Tue, 20 Sep 2016 18:30:00 GMT <p> <em>An AMA Viewpoints post by AMA President Andrew W. Gurman, MD</em></p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/9/da866b19-dd9b-43ae-992c-821f3477e458.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/9/da866b19-dd9b-43ae-992c-821f3477e458.Large.jpg?1" style="width:100px;height:150px;margin:15px;float:left;" /></a></p> <p> In a time of unprecedented change in medicine, the AMA has evolved to become a more nimble, responsive and forward-thinking organization that better prepares physicians for the unique challenges of a rapidly evolving health care system, according to an independent study being released this week. Such change is seldom quick or easy, and far too often we fail to pause and reflect on just how far this organization has come.</p> <p> The international public affairs and communications firm, APCO Worldwide, this week ranked the AMA first in its annual <a href="http://trademarks.apcoworldwide.com/" rel="nofollow" target="_blank">TradeMarks survey</a> of the 50 most effective professional and trade organizations in the U.S., not just in the health care sector but across all industries. In fact, the AMA finished first or second overall in 14 of the 15 leadership characteristics identified by APCO, including advocacy work in Washington D.C., coalition building and partnerships, local impact and effective communications with members, stakeholders and the media.</p> <p> This is a remarkable achievement that is a credit to the vision established by the AMA’s Board of Trustees, its senior management, the AMA employees that advance that vision, but also the tens of thousands of physicians across the country who support the AMA and champion the causes that move our profession forward.</p> <p> As president of the AMA, I am proud of my colleagues and their tireless work to advance our strategic initiatives to improve health outcomes for patients, professional satisfaction for physicians and create the medical schools of the future.  </p> <p> <strong>No one on the sidelines</strong></p> <p> At my inauguration in June, I spoke about the power in advocating for our profession and leaving a legacy in medicine that we all could be proud of. And I asked my fellow physicians to get off the sidelines and get involved in these efforts, either through the AMA or their state and specialty societies. Take a stand on the issues that are important to you, your practice and your patients.</p> <p> Our message is simple: Your opinion matters. Your involvement matters. </p> <p> Anyone who practices medicine today understands the frustrations that are, unfortunately, driving too many of our most experienced and accomplished colleagues from the profession. We’re frustrated by the pace of our jobs, by unnecessary regulations that steal time from our patients, and by <a href="http://www.ama-assn.org/ama/ama-wire/post/clicks-keyboards-stealing-face-time-patients">EHRs that are inefficient</a>, difficult to use and don’t advance the quality of care we are trying to provide. We’re frustrated when we feel unsupported by administrators, and by complicated new payment models that seem to have no connection to the real-world demands of our jobs.</p> <p> The APCO survey is important because it independently validates the efforts of the AMA and physicians like you who lend your time and your voice to make a difference for all of us who practice medicine. You have done so by speaking out against the fatally-flawed Medicare Sustainable Growth Rate and we achieved repeal last year. You’ve also done so by participating in our <a href="https://physiciansgrassrootsnetwork.org/" rel="nofollow">Break the Red Tape</a> campaign to fight back against burdensome regulations.</p> <p> Another fight that physicians have taken on is to help our patients gain access to treatment for substance use disorders and lifesaving medications that prevent overdose. The opioid epidemic is affecting communities across the country no matter their size or location. Our <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page">task force</a> has worked tirelessly to ensure access to naloxone, improve prescription drug monitoring programs and increase their use; and have continued to emphasize that substance use disorder is a brain disease, not a moral failing.</p> <p> Other physicians have lent their expertise to tech innovators as they design and develop the tools that will one day transform health care, or helped our nation’s efforts to reduce chronic disease and opioid abuse and addiction. Some have simply chosen to become members.</p> <p> For all of you who are already participating in these efforts, I thank you. For those who have not yet joined our ranks, I hope the APCO survey will cause you to look anew at our efforts, and to consider adding your voice to ours.</p> <p> Let’s use the power of our collective voice to create a health care system that works for patients and physicians by removing the obstacles that contribute to so much dissatisfaction and dysfunction. Help us spread the word. Help us bring more of our colleagues to the table.</p> <p> Never forget that we physicians are the custodians of a marvelous profession and a noble tradition of healing and ethics. Health care as we know it will not survive unless physicians make professional advocacy a part of our commitment to the profession; a part of our mission.</p> <p> Let this be the year we capitalize on this momentum by working collaboratively to create a future that supports thriving physicians, expands quality care and strengthens the health of our nation for our patients.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9458c746-a439-4ce2-8dbf-504beaeaeb02 Building emotional intelligence in medical trainees http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_building-emotional-intelligence-medical-trainees Mon, 19 Sep 2016 23:00:00 GMT <p> Medical schools around the world are working to help students develop resilience to not only make them better physicians but also healthier individuals. At Cardiff University in the United Kingdom, they are accomplishing this with a new program that focuses on building emotional intelligence.</p> <p> At the <a href="http://www.ama-assn.org/ama/ama-wire/post/being-attendance-medicine-meditation-merge" target="_self">International Conference on Physician Health™</a> in Boston, Debbie Cohen, MD, OBE, an occupation health physician and director of student support at the Centre for Psychosocial and Disability Research at Cardiff University in the United Kingdom, explained the theory behind Cardiff’s emotional intelligence development program and how it works.</p> <p> “We have to provide structures to both manage and support our learners,” Dr. Cohen said. “That is becoming a priority. And within that … we have to have both systems to provide the health and well-being for our learners.”</p> <p> “What an opportunity to think about how we might change those structures,” she said. “It’s a challenge, because what we’re talking about is changing behavior.”</p> <p> Dr. Cohen outlines two ways of thinking:</p> <p> You can either teach people by telling them what to do and give them interventions like put your personal things aside, get enough sleep and make sure you get enough exercise, she said. “Or, you can try and bring about change, and that’s about guiding them…. Guide them to understand more about their emotions to enable better use of their own inherent skills and learn when and how to use skills and strategies to support well-being.”</p> <p> Making valuable change takes time, importance and practice, Dr. Cohen said. “It’s what you do every day and how you do it.”</p> <p> <strong>How does resilience fit into the equation?</strong></p> <p> “Emotional intelligence is about how you perceive your emotions,” she said. “It’s how you integrate them into what’s going on and how you manage it. What are the impacts?”</p> <p> In order to accomplish emotional intelligence four things need to happen, Dr. Cohen said. You need to accurately perceive emotions, integrate them with cognition, understand the emotional causes and consequences and manage those emotions for personal adjustment.</p> <p> “We have to be careful about this,” she said. “Because if you want to build emotional intelligence you have to talk about cognitive empathy, and that’s different than sympathy.”</p> <p> Cognitive empathy, she said, is about understanding your patient’s experiences while keeping a certain affective distance. While sympathy involves sharing in the patient’s suffering.</p> <p> “The problem that we see is if you have too much sympathy maybe that’s when we wind up in emotional exhaustion,” she said. “We shift the way we’re functioning from empathy to sympathy and that’s what drains us.”</p> <p> At Cardiff, Dr. Cohen and her colleagues are implementing a new method of training future physicians where they guide them to understand both their personal values and their professional values. The problem, she said, is when those personal values conflict with those professional values.</p> <p> <strong>What they’re doing at Cardiff</strong></p> <p> To build emotional intelligence and help trainees develop strategies, they use a series of guided observation and reflection tasks over a period of time. Tasks that ask students and doctors to spend five minutes every day completing a task that trains them to become aware of how they communicate and what the effect of their communication is on the other person, while they are actually communicating.</p> <p> Then they are asked to write a reflective piece on their experiences and share it online.</p> <p> Third-year medical students have a 10 week block of self-observation and reflection where they complete workshops and observation tasks. The first workshop teaches them how to do self-observations, communicate well and to understand their personal values while listening and communicating will colleagues and patients. The tasks include:</p> <ul> <li> <strong>Listening to others.</strong> In this task students are asked to reflect on their own pattern of listening and then answer the question, how do your personal and professional values influence your actions?</li> <li> <strong>Discussing and asking questions.</strong> Students are asked to investigate, do you try to really listen to find out what their ideas are or are you more concerned about getting the other person to listen to your opinions and ideas? Or do you do a bit of both depending on the situation?</li> <li> <strong>Understanding and managing emotions.</strong> Students are asked to discover what irritates, frustrates or annoys them and when those emotions occur. They are also asked what happens to the other person and your communication when you are experiencing those emotions?</li> </ul> <p> In the second workshop, the students investigate what they have found out about themselves and their emotions while listening and communicating with their colleagues and patients in the first workshop, including what comes next. Three major themes emerged from their qualitative responses:</p> <ul> <li> Recognizing negativity and its destructive influence on work morale and taking steps to turn it around to the positive.</li> <li> Recognizing insecurity, tiredness and vulnerability and acknowledging it rather than ignoring and fearing it as they had before, and taking steps to take care of themselves.</li> <li> Getting perspective on what goes on around them—not reacting automatically, but rather taking a step back and acting from awareness.</li> </ul> <p> Dr. Cohen shared one student’s response: “I have noticed over the last few weeks that my feelings of anger and irritation have greatly reduced … I find that I have a lot more patience for both patients and colleagues. I feel I am more empathetic to others [and] I try to see it from their perspective before evoking a reaction. … If I am in a situation which has evoked these emotions [anger and irritation] the way I handle them and deal with them has also changed for the better.”</p> <p> This program has been in the pilot phase for three months and Cardiff is rolling it out on a larger scale this week.</p> <p align="right"> By AMA staff writer <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0d4ee8c5-7f6f-4924-a25b-7a7ea5c8ea88 Michigan students launch peer-reviewed medical journal http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_michigan-students-launch-peer-reviewed-medical-journal Mon, 19 Sep 2016 23:00:00 GMT <p> A University of Michigan Medical School student, Sagar Deshpande, noticed a trend emerging in the student experience. He heard colleagues repeatedly voicing frustration at having spent time on methodologically sound research without getting their work published because their results were not what principal investigators had expected. So he had an idea: Why not start a medical journal run by students, for students’ own research?</p> <p> Deshpande shared the idea with a fellow student, Spencer Lewis, and in 2014 the two approached a faculty member, Mike Englesbe, MD, in the Department of Surgery.</p> <p> “I immediately appreciated how well it fit into a lot of the broader goals we’re trying to achieve with our new medical school curriculum, including fostering leadership and autonomy in students,” Dr. Englesbe said. University of Michigan is one of 32 member schools in the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education Consortium</a>. “One of the keys was that early on we got aggressive buy-in from higher-level folks in the institution, especially my boss, who said, ‘Whatever it costs, we can cover it.’”</p> <p> <strong>Making better scientists<strong><a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/2/39f26dab-44c6-44f5-92e1-bbbd907485b3.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/2/39f26dab-44c6-44f5-92e1-bbbd907485b3.Large.jpg?1" style="float:right;margin:15px;" /></a></strong></strong></p> <p> Dr. Englesbe realized the journal could also provide opportunities for students to learn how to write, edit and talk like scientists. Previously, there were few specific opportunities for this kind of learning in medical school. Most of it came later, on the job, with no formal structure.</p> <p> He contacted a colleague in the medical school, Jasna Markovac, PhD, who had years of experience in journal publishing and runs the Learning Design and Publishing group within Health Information Technology and Services. Together, Drs. Engelsbe and Markovac created a new course for fourth-year medical students, Medical Editing and Writing, which included significant hands-on journal work.</p> <p> “The journal in some ways would be the ‘lab’ part of the course,” Dr. Markovac said. “It’s all about how to express yourself, what makes a good paper, how to do peer review, the whole end-to-end workflow.”</p> <p> They needed a publisher too, so Dr. Markovac looked across campus to Michigan Publishing Services, a unit of the University library, which had published various journals on behalf of learned societies but hadn’t done much journal publishing with the medical school.</p> <p> Meanwhile, Dr. Englesbe recruited a fourth-year medical student, Shannon Cramm, to serve as the journal’s first editor-in-chief.  She then assembled a team of about 30 student editors and reviewers.</p> <p> “Having been on the research side but never on the publication side, the logistics of how one actually publishes a journal were very unfamiliar to me and to the rest of our editorial staff,” Cramm said. “So establishing that relationship [with Dr. Markovac and the library] was essential to our success.”</p> <p> <strong>Putting it all together</strong></p> <p> Students were empowered to run every aspect of the journal and make all decisions.</p> <p> “The most important thing in a new idea like this is to keep your ear to the ground,” Cramm said. “Over the course of the year, we found shifts in what was needed. Eventually, we learned that some students wanted to be able to publish their parts of larger projects as the first author, to get experience writing manuscripts and working with reviewers and review teams.”</p> <p> Dr. Markovac’s staff and the publishing services staff from the library provided guidance and kept students from being tripped up by things they wouldn’t necessarily know.</p> <p> For example, in reviewing a draft layout of the first issue of the journal, Dr. Markovac noticed that the attribution of authors in the table of contents was irregular, not something she had ever seen.</p> <p> “I was thinking, ‘Hmm, now this is a teachable moment,’” she said. “‘Let’s teach them exactly how papers are called out in tables of contents and what the differences are between medical and nonmedical journals.’ For example, readers expect medical journals will be eight-and-a-half by 11 inches when formatted and printed, whereas humanities journals can be much smaller. Students don’t empirically know that, but if they’re going to run a journal, they need to know all of those things.”</p> <p> <strong>Delivering more than a publication</strong></p> <p> The first issue of the <em><a href="http://www.michjmed.org/" rel="nofollow" target="_blank">Michigan Journal of Medicine</a></em> (<em>MJM</em>) was published in May. It was the culmination of a full school year’s work and was the editorial team’s final product.</p> <p> “I heard over and over from student reviewers and editors what a unique experience this was,” Cramm said. “It has definitely made me a better scientist, better at critically analyzing literature and a better scientific writer. It has only furthered my passion for academics and for research.</p> <p> “Working with a journal as a medical student isn’t just for people who are interested in academics. There’s a lot of benefit to honing your critical analysis skills, to honing your writing skills, to honing your [reading] skills, no matter which practice setting you choose.”</p> <p> Drs. Engelsbe and Markovac’s hope is that this curriculum will become a full four-year experience. Part of their charge is to transform students—to empower them to think beyond taking care of one patient at a time. For some students, medical writing and editing would be a significant focus in their careers, but for most it would be a small but important part of what they do as they learn how to be successful, impactful physicians.</p> <p> As they look to the journal’s second year, Drs. Engelsbe and Markovac are encouraging the new editorial team to try to publish two issues. The new editorial team and the infrastructure are in place—the submission system and production workflow are set up through the library, and there is institutional memory—so whether they will depends simply on how many manuscripts they can get.</p> <p> “The danger in starting student journals in general is that when the students graduate, the journal ceases to exist because there’s no one to take it over who has the same enthusiasm,” Dr. Markovac said. “The advantage of this is that it is now part of the curriculum, and we have other people in addition to the students who are involved who are very dedicated. So we’re seeing a long shelf life here.”</p> <p> The experience has also been helpful to the library’s publishing services staff who weren’t previously very familiar with medical publishing, and it has furthered one of the university’s priority initiatives: cross-campus collaboration.</p> <p> “The nice thing about the <em>MJM</em> story is that people who are not intimately involved with journal publishing or the curriculum can actually understand what we are doing and can appreciate it,” Dr. Markovac says. “That’s been the attraction across campus. It’s a good story that’s easy to tell.”</p> <p> <strong>For more on the Accelerating Change in Medical Education Consortium: </strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/treating-community-patient" target="_self">Treating the community as your patient</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/working-upstream-achieve-quadruple-aim" target="_self">Working upstream to achieve the quadruple aim</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physician-wellness-global-collaboration">Physician wellness: A global collaboration</a></li> </ul> <p align="right"> <em>By AMA staff writer Tim Smith</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f262a263-9795-458c-b663-5da2bc0ede0d Five ways to recognize patient cues, understand needs http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_five-ways-recognize-patient-cues-understand-needs Mon, 19 Sep 2016 04:00:00 GMT <p> When physicians show true empathy while listening to their patients in the exam room, patients and their families are often more satisfied and more open to adopting their advice—and it builds a much stronger patient-physician relationship. Though it seems simple, empathetic listening requires understanding how to recognize the cues that patients offer.</p> <p> Practicing empathy can save time and help physicians navigate difficult situations that arise in practice. It can also forge deeper connections with patients that lead to greater professional satisfaction and joy in work for physicians.</p> <p> <strong>Listening with empathy, recognizing cues</strong></p> <p> Highly charged situations may arise in practice and those are the ideal times to use empathetic listening. A new <a href="https://www.stepsforward.org/modules/empathetic-listening" rel="nofollow">module</a> from the AMA’s <a href="https://www.stepsforward.org/" rel="nofollow">STEPS Forward™</a> collection of practice improvement strategies can help you become a better listener and get to the heart of your patients’ needs.</p> <p> Once you have decided that connecting with empathy is the best way to approach the patient, follow these steps to improve that skill:</p> <ul> <li> <strong>Honor the first “golden moments.”</strong> The first few minutes of a clinical encounter are precious. There are many tasks that need to be completed during the visit—questions to ask, problems to analyze and solve—and you may feel pressured to dive right in. But if you leap into these tasks without listening first, you may miss key information. Set aside charts, computers, phones, alarms and pagers that may be distractions so that you can give your full attention to the patient and find the golden moments that reveal the patients true concerns or symptoms. Use subtle body language cues to convey that you are listening intently. You can start by sitting so that you are near to and facing the patient. Lean toward them and make eye contact. It is important to make sure that your arms are not crossed—this can signal to the patient that you are closed off and not really listening.</li> </ul> <ul> <li> <strong>Listen for underlying feelings.</strong> Sometimes a patient’s feelings are on the surface, but other times they are hidden. A patient may bring up an emotional situation briefly and wait for the physician’s cue that it is okay to continue. Watch for feelings hidden in body language, facial expressions or other non-verbal cues and allow the patient to elaborate.</li> </ul> <ul> <li> <strong>Listen for underlying needs or values.</strong> Deep empathetic listening means being attuned to the underlying value or need that the emotion the patient is expressing is pointing to—for example, safety or security, honesty or integrity, autonomy or control, meaning or purpose, among many others.</li> </ul> <ul> <li> <strong>Remain present.</strong> Become comfortable with silence. Non-verbal body language such as an open and comfortable stance, eye contact, nodding your head or murmuring simple responses like “uh huh” or “oh” can show that you are listening without interjecting. Give the patient an opportunity to express feelings to completion. Their feelings and values will surface if they are given ample time to express themselves in a welcoming environment. Focus on the moments when the patient seems to display the most energy: more rapid speech, a change in facial expressions or more pronounced gestures. These signs can provide the clues to what the patient values most.</li> </ul> <ul> <li> <strong>Look for cues that the patient has finished.</strong> These cues might be a decrease in emotional intensity, a deep sigh or a shift in the focus of the conversation. At this point, it is natural to move to another stage of the communication process—either expressing yourself, attempting to solve a problem together or attending to the needed medical care needed.</li> </ul> <p> No one expects that you listen in this manner to all of your patients or coworkers all of the time. If you are new to empathetic listening, make it a goal to apply it with one person a day to learn how the process works best for you.</p> <p> Increasing administrative responsibilities due to regulatory pressures and evolving payment and care delivery models reduce the amount of time physicians spend delivering direct patient care. Training yourself to recognize emotional and body-language cues can help you defuse situations where a patient is dissatisfied or struggling to express themselves in a clear way.</p> <p> Check out the <a href="https://www.stepsforward.org/modules/empathetic-listening" rel="nofollow">module</a> for a more in-depth look at how the process of empathetic listening can improve your relationships with patients.</p> <p> There are seven new modules now available from the AMA’s STEPS Forward collection, bringing the total number of practice improvement strategies to 42, thanks to a grant from and collaboration with the Transforming Clinical Practices Initiative.</p> <p align="right"> <em>By AMA staff writer</em> <em><u>Troy Parks</u></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:6dc90ace-b9ae-4d14-bf2e-01fcc75341c5 Being in attendance: Where medicine and meditation merge http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_being-attendance-medicine-meditation-merge Mon, 19 Sep 2016 03:00:00 GMT <p> In a hospital setting, physicians are often called “attendings.” One expert in the merging of meditation and medicine recently spoke to physicians about the importance of making that word matter by being in attendance at each moment of the day to heal and maintain your own well-being so that you can be a better healer for your patients.</p> <p> At the start of a session at the International Conference on Physician Health in Boston, Jon Kabat-Zinn, PhD, professor of medicine emeritus and creator of the Mindfulness-Based Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School, led attendees in a mindfulness activity from the first moment to “drop in on your own presence in your mind.”</p> <p> “Befriend the present moment, by befriending the feeling and the sensations of the breath moving in and out of your body, because it’s always here,” he said. “Without any contrivance, you’re not forcing anything to happen, you’re simply tuning in to what’s already happening.”</p> <p> “You’re not trying to achieve any special feeling,” he said, “you’re simply attending … the present moment is really the only moment we are ever inhabiting.”</p> <p> Focusing on joy in practice, the conference brought together the best minds around the globe with attendees and presenters from the United Kingdom, Norway, New Zealand, Canada and the U.S., just to name a few.</p> <p> “It’s not merely work-life balance, which some people have the idea that there’s some magical work-life balance and if I only get that formula then it will all fall together for me,” Dr. Kabat-Zinn said. “There’s only life. And so if you don’t bring your life to work, there’s no life in work; and when you get home you have no energy for life either so we’re talking about one seamless whole.”</p> <p> “What is healing? My working definition of healing is coming to terms with things as they are,” he said. “It’s a process. You can, sooner or later, come to terms with the actuality of things … as they are, not as I want them to be, not as if we could magically fix them, but now.”</p> <p> “And it turns out that when you do this you recruit a seemingly infinite array of interior capacities and capabilities and intelligences that very often we have no idea that our mind thinks.”</p> <p> <strong>The most important muscle to exercise</strong></p> <p> Everyone needs to exercise and physicians offer that advice to their patients all the time. But the most important muscle to exercise is the muscle of your own presence of mind, Dr. Kabat-Zinn said. “ It’s the muscle of living the life that’s yours to live and living it in a way that’s ethical, that is generous and that is clear.”</p> <p> Burning yourself out by helping everybody else and ignoring where the source is coming from is not the way to wellness, he said. “Medicine and meditation—if you notice they kind of sound a little alike,” he said. “We now know about the plasticity of not just the brain but of the entire organism … medicine and meditation are linked at the etymological core. Meditation can actually transform your brain.”</p> <p> Dr. Kabat-Zinn started practicing meditation when he was a student at the Massachusetts Institute of Technology (MIT). “I had to, to survive MIT,” he told the audience. “It wasn’t optional. It was either protect my own mind or it would be consumed by the stuff going on.”</p> <p> Then he brought out his meditation cushion and sat comfortably on a table top on the stage.</p> <p> <strong>Just remove the arrow</strong></p> <p> “I want you to know that this is a behavior change,” he said. “You have to be willing to carve out 45 minutes a day, at least, 6 days a week. Who’s got time for that? The important thing is that the quality of our doing and the quality of joy that we can experience isn’t some kind of magical pot of gold at the end of some rainbow. It’s completely integrated into every aspect of life unfolding.”</p> <p> Thinking too much about where you’re going, where you’ve been, what could happen and what you want to happen can block your ability to be present—to be in attendance, he said. “Most of what we tell ourselves is not true and it seriously compounds the suffering.”</p> <p> “The Buddha actually recognized that … let’s say you get shot by an arrow,” he said. “Instead of taking out the arrow or addressing the how to do that, you actually want to know who shot it and why, where it came from, what the kind of wood it was, what the kind of feathers are—but wait a minute, now you’re shooting yourself with another arrow.”</p> <p> “Let’s say there’s an earthquake or a death in the family—that happens,” he said, “it’s part of life. How are we to deal with it? Well, if you shoot yourself with the other arrow of ‘you’re to blame for this yourself, nobody’s any good, I’m not any good’—do you hear that narrative? That’s what’s going on in the mind over time and it’s toxic.”</p> <p> <strong>How to get started</strong></p> <p> Practicing meditation has nothing to do with your posture, Dr. Kabat-Zinn said. You can do it lying down, sitting, standing, walking, running, chopping vegetables, in a chair, on the floor—as long as you’re being mindful and present in the moment it will be effective. There is no time when you are awake in which it is wrong to be present: to be fully awake.</p> <p> Often your mind seems to be “not getting with the program” right off the bat, he said. But each thought and emotion that comes is valid and must be recognized and allowed to pass.</p> <p> How do you overcome the overwhelming amount of thoughts that occupy your mind? “One way is to exercise the muscle, and that means practice,” Dr. Kabat-Zinn said. “You make time. I do it early in the morning before the day starts. You can even do it in bed, there’s no excuse.”</p> <p> Even if you’re anxious, being aware of your anxiety is in itself being present. Investigate that awareness. Do it for five minutes, ten minutes or an hour.</p> <p> “Play, not work, but play at the joy of being who you already are,” he said. “From the point of view of joy … it’s here already if we can only get out of our own ways.”</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:3a0842a0-d598-4b81-aef6-3b2e9f6de126 Court overturns physical therapy decision http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_court-overturns-physical-therapy-decision Fri, 16 Sep 2016 03:00:00 GMT <p> A positive decision for patients Thursday was made in the South Carolina Supreme Court to allow physician practices to employ physical therapists, ending a longstanding disagreement regarding how the practice of physical therapy should be regulated in the state.</p> <p> At stake in <em>Joseph v. South Carolina Department of Labor</em>, was whether physical therapists in South Carolina can provide treatment as direct employees of physicians to make that service more easily available for patients. The ruling: Physicians in South Carolina can now employ physical therapists in their practice.</p> <p> “This patient-centered decision from the Court supports our contention that integrated physical therapy services can be in the best interest of patients when handled ethically and in compliance with existing self-referral restrictions,” the South Carolina Orthopaedic Association said in a <a href="http://campaign.r20.constantcontact.com/render?m=1102224436421&ca=e3a52004-5f39-4d84-a310-13708d8bf323" target="_blank" rel="nofollow">statement</a>.</p> <p> <strong>What led to the overturn</strong></p> <p> The South Carolina Board of Physical Therapy has long sought to require physical therapists to provide their services directly to patients or through a practice group of physical therapists. However, other licensed health care professionals such as occupational therapists, speech pathologists and nurse practitioners may be employed by physicians in the state.</p> <p> In 2006, the South Carolina Supreme Court ruled in <em>Sloan v. South Carolina Board of Physical Therapy</em> that the state’s Physical Therapy Practice Act prohibited physical therapists from working in a physician’s office and providing physical therapy to the physician’s patients through what are referred to as “in-practice referrals.”</p> <p> The decision caused many problems for patients, physicians and physical therapists, changing the way physical therapy was practiced in South Carolina and making it more difficult for patients to access physical therapy services. That decision was overruled Thursday, allowing physical therapists to work directly with physicians to provide their services to patients.</p> <p> “In Sloan, this Court interpreted … the South Carolina Code as prohibiting a physical therapist from being employed by a physician when the physician refers patients to the physical therapist for services,” the Court said in the decision. “Contrary to that decision, we now find that the classification, which distinguishes physical therapists from other licensed health care professionals, has no rational relationship to the legislative purpose of the statute.”</p> <p> The <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page?" target="_self">Litigation Center of the AMA and State Medical Societies</a> and the South Carolina Medical Association jointly supported the plaintiffs, who were a physical therapist and two orthopedic surgeons. The now overruled <em>Sloan </em>decision had unnecessarily burdened patients’ access to health care services—an obstruction which the Litigation Center has worked hard to overcome.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a209e2df-8748-4836-9fd3-a3217bf3a9e1 Salary comparison reminds residents: Plan now http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_salary-comparison-reminds-residents-plan-now Wed, 14 Sep 2016 21:00:00 GMT <p> An infographic comparing the incomes of physicians and teachers underscores the need for comprehensive financial planning early in physicians’ careers. <a href="http://www.bestmedicaldegrees.com/salary-of-doctors/" rel="nofollow" target="_blank">“The Deceptive Salary of Doctors,”</a> published by bestmedicaldegrees.com, pulls data from the Association of American Medical Colleges, the Bureau of Labor Statistics and numerous other sources to demonstrate the huge costs of becoming a physician and maintaining a practice.</p> <p> It draws a stark conclusion: Over a lifetime, physicians make less per hour than teachers do. After loan debt, physicians can expect to make a little more than $4.7 million in their careers; teachers, a little less than $2.4 million. But physicians will work almost twice as many hours.</p> <p> The real value of the graphic, however, lies not as much in comparing the two professions as in providing a reminder that, with physicians’ working so many hours, they can easily overlook adequate financial planning that can make life easier later in their careers.</p> <p> Residents in particular need to prioritize financial preparedness. Although many enjoy a huge jump in income from their student years, a 2015 study by AMA Insurance found that 71 percent of young physicians feel somewhat or not very knowledgeable about financial planning.</p> <p> <em>AMA Wire®</em> regularly features financial planning advice for young physicians. Several resources can help you get ahead on financial planning for the future:</p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/need-now-secure-firm-financial-future" target="_self">What you need to do now to secure a firm financial future</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/5-financial-planning-tips-young-physician-should" target="_self">5 financial planning tips every young physician should know</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/need-negotiate-first-employment-contract" target="_self">What you need to know to negotiate your first employment contract</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/6-tips-live-budget-during-training" target="_self">6 tips for living on a budget during training</a></li> </ul> <p> Check back soon for takeaways from the <a href="https://www.amainsure.com/reports/2016-financial-preparedness-practicing-physicians/index.html?page=1" rel="nofollow" target="_self">2016 Report on U.S. Physicians’ Financial Preparedness</a> from AMA Insurance.</p> <p align="right"> <em>By AMA staff writer Tim Smith</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c47fceed-480c-4eea-8256-4da072ce7f1b Parental leave in GME: Two physicians recognized for research http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_parental-leave-gme-two-physicians-recognized-research Wed, 14 Sep 2016 15:00:00 GMT <p> Two physicians will conduct one of the first studies in more than 20 years on present-day parental leave across medical specialties in graduate medical education (GME). They were awarded the Joan F. Giambalvo Fund for the Advancement of Women grant for their work, announced Wednesday in conjunction with Women in Medicine Month.</p> <p> The AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/women-physicians-section.page?" target="_self">Women Physicians Section</a> (WPS) hosts <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/women-physicians-section/women-medicine-history.page?" target="_self">Women in Medicine Month</a> each September to acknowledge pioneering women, celebrate their accomplishments and help cultivate future women physicians. The <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/women-physicians-section/joan-f-giambalvo-memorial-scholarship.page?" target="_self">Joan F. Giambalvo Fund for the Advancement of Women</a> was established by the AMA-WPS and the <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation.page" target="_self">AMA Foundation</a> to offer funding specifically for health care researchers to identify and address the issues that affect women physicians and medical students.</p> <table align="right" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/5/e628b6a3-f5ba-4a56-9589-c27b39c83013.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/5/e628b6a3-f5ba-4a56-9589-c27b39c83013.Large.jpg?1" style="width:200px;height:300px;" /></a></td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/5/9a4877d3-a4f9-4cff-b5f3-02e1b54b9f8a.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/5/9a4877d3-a4f9-4cff-b5f3-02e1b54b9f8a.Large.jpg?1" style="width:200px;height:300px;" /></a></td> </tr> <tr> <td> <em><span style="font-size:10px;">Shobha W. Stack, MD, PhD</span></em></td> <td> <em><span style="font-size:10px;">Jennifer Best, MD</span></em></td> </tr> </tbody> </table> <p> The winners of this year’s award are Shobha W. Stack, MD, PhD, and Jennifer Best, MD, acting instructor and associate professor, respectively, in the Department of Medicine at the University of Washington. They are the principal investigators for the research project, “Childbearing among physicians in training: A cross-sectional survey of trends and factors.”</p> <p> <strong>Investigating the factors that influence parental leave</strong></p> <p> About 40 percent of physician trainees <a href="http://www.ama-assn.org/ama/ama-wire/post/residents-building-families-during-training" target="_self">plan to have a child during their GME training</a>, a study in the July issue of Academic Medicine found. Drs. Stack and Best have dug into a more focused aspect of family building in their research.</p> <p> Leading up to their study, Drs. Stack and Best found that, in 1983, 50 percent of children born to women physicians were born during residency training. A 1993 survey showed that the average trainee maternity leave was less than eight weeks. Yet, there was no concurrent assessment of the consequences of leave to the residents or the training programs.</p> <p> “The primary aims of our study are to characterize parental leave practices across specialties, determine the factors that influence its length and assess the effect of parental leave on trainee well-being and the training environment,” Dr. Stack said.</p> <p> “I have been deeply interested in the issues that women face in medical training since undergoing my own postgraduate years as a new mother,” Dr. Stack said. “With the help of the Giambalvo research grant, we will conduct the first study in more than 20 years specifically addressing present-day parental leave across medical specialties in graduate medical education.”</p> <p> “We are very grateful to the AMA’s Women Physicians Section for granting us the joint Giambalvo award, but more importantly for prioritizing this research that we hope will create a more sustainable environment for women in medicine,” Dr. Best said.</p> <p> The state of women in medicine is changing. In 2010, women accounted for more than half of the population—meaning female patients are the majority–yet women are still underrepresented in medicine, making up one-third of the physician workforce. But now almost one-half of students and residents are women.Learn more about how the AMA aims to increase the number and influence of women physicians in leadership roles through the AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/women-physicians-section.page?" target="_self">Women Physicians Section</a>.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ec09df34-b0a4-458a-8935-5a9e2d4720ed Physician efforts to reverse opioid epidemic quantified http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physician-efforts-reverse-opioid-epidemic-quantified Wed, 14 Sep 2016 03:00:00 GMT <p> When patients present with issues, physicians look to the most effective tools for treatment. The same is true in addressing an epidemic. While much more work remains to reverse the nation’s opioid epidemic, using tools such as prescription drug monitoring programs (PDMP), medication-assisted treatment and naloxone, physicians are making progress. A new fact sheet provides some evidence of that progress on a number of fronts.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/0/2287f968-50d8-4112-80d3-a4361e96f161.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/0/2287f968-50d8-4112-80d3-a4361e96f161.Full.jpg?1" style="height:1500px;margin:15px;float:right;width:318px;" /></a></p> <p> <strong>Focused prescribing practices</strong></p> <p> In a fact sheet released by the AMA, <a href="https://download.ama-assn.org/resources/doc/washington/ama-task-force-progress-on-reversing-opioid-epidemic-0816.pdf" target="_blank">physicians’ progress to reverse the nation’s opioid epidemic</a> was quantified showing new trends in the use of available tools. The data was collected from AMA surveys, IMS Health, the Drug Enforcement Administration Office of Diversion Control (DEA), the Substance Abuse and Mental Health Services Association (SAMHSA), the Centers for Disease Control and Prevention (CDC), and the American Journal of Public Health.</p> <p> In October 2015, the AMA and many medical and other health care organizations <a href="https://www.whitehouse.gov/the-press-office/2015/10/21/fact-sheet-obama-administration-announces-public-and-private-sector" rel="nofollow" target="_blank">joined</a> the President in Charleston, W.Va., to commit to clear metrics to reduce the nation’s opioid epidemic. Though there is still more to be done, the numbers show some progress.</p> <p> Every state in the nation saw a reduction in opioid prescribing in 2015, which amounted to a 10.6 percent decrease nationally, IMS Health reported. Though these decreases are important, physicians need to ensure that patients with pain receive comprehensive—and compassionate—treatment. While the nation’s opioid supply will almost certainly continue to decrease, providing patients with a full range of evidence-based, non-opioid and non-pharmacologic treatments becomes crucial.</p> <p> PDMP use can play a significant role in combating the epidemic. These tools contain information on whether a patient is receiving multiple prescriptions from multiple pharmacies and can be helpful in clinical decision-making. State-based PDMPs were checked nearly 85 million times in 2015, a 40 percent increase over 2014, an AMA survey found.</p> <p> Several states recently implemented PDMPs, including Pennsylvania in August. Registering for these tools is critical to reversing the opioid epidemic and has been a recommendation of the AMA’s <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page" target="_self">Task Force to Reduce Prescription Opioid Abuse</a> since its conception in 2014.</p> <p> Registration for PDMPs increased by over 150,000 physicians and other health care professionals nationally from 2014 to 2015 and these increases were seen in states with and without mandated PDMP use. </p> <p> “Physicians and other health care professionals have increased their <a href="http://www.ama-assn.org/ama/ama-wire/post/one-physician-uses-his-pdmp-patients" target="_self">use of the state’s [PDMP] every year</a>,” said Patrice A. Harris, MD, chair of the AMA Board of Trustees and the AMA Task Force to Reduce Prescription Opioid Abuse in <a href="http://www.theolympian.com/opinion/op-ed/article97894787.html" rel="nofollow" target="_blank">The Olympian</a>. “We need to address opioid addiction and overdose across the entire spectrum, from prevention to treatment.</p> <p> <strong>Education and medication assisted treatment increases</strong></p> <p> Between 2012 and 2016, the nation saw an 81 percent increase in physicians certified to treat substance use disorders, data from the Substance Abuse and Mental Health Services Association (SAMHSA) showed. That’s more than 33,000 physicians across all 50 states.</p> <p> Medication-assisted treatment, such as buprenorphine, can help patients with opioid use disorders recover safely and stick to their recovery plans. Prescriptions to help treat opioid use disorder increased by 11 percent from 2014 to 2015. These medications are becoming more common as substance use disorders are recognized as a chronic disease and not a moral failing.</p> <p> The AMA survey also showed that nearly 50,000 physicians had participated in educational activities related to opioid prescribing, pain management or other related areas since October 2015. The AMA will soon release continuing medical education tools including a primer on the opioid epidemic and two state-specific physician toolkits in Rhode Island and Alabama in cooperation with the state medical associations and governors’ offices. The toolkits will highlight key resources to help reduce opioid-related harm, provide guidance on prescribing practices and direct patients to additional resources in these states.</p> <p> <strong>Naloxone helps reduce overdose</strong></p> <p> Fifteen states saw reductions in the number of overdose deaths in 2014 compared to 2013. These reductions occurred in the midst of increased co-prescribing of naloxone, <a href="http://www.ama-assn.org/ama/ama-wire/post/antidote-3-things-consider-co-prescribing-naloxone" target="_self">the life-saving opioid overdose reversal antidote</a>. The second quarter of 2015 saw a massive 1,170 percent increase in naloxone prescriptions over the fourth quarter of 2013.</p> <p> “Naloxone can and will save lives, and while co-prescribing the drug is important, it’s simply not enough,” Dr. Harris said in an <a href="https://www.tribtalk.org/2016/09/13/reversing-the-opioid-epidemic-in-texas/" rel="nofollow" target="_blank">op-ed for TribTalk</a>. “Naloxone must be accessible and affordable. For this to happen, insurers must cover the medication and offer it to individuals at a reasonable price.”</p> <p> The physician role in the epidemic is an important one—and the physicians of the nation are recognizing that role and taking it on with vigor, as the numbers show. There is still much to be done, but the effort and motivation is there.</p> <p> The AMA and other organizations have long been pressing for state legislation to increase access to naloxone and, as of today, more than 45 states have naloxone access laws.</p> <p> <strong>For more on physician efforts to reverse the opioid overdose epidemic:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/talk-substance-use-disorders-patients" target="_self">How to talk about substance use disorders with your patients</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-team-up-treat-addiction-rural-areas" target="_self">Physicians team up to treat addiction in rural areas</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/entire-state-gets-one-naloxone-prescription" target="_self">Entire state gets one naloxone prescription</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/antidote-3-things-consider-co-prescribing-naloxone" target="_self">How naloxone can be a way to start the broader conversation about risk</a></li> </ul> <p align="right">  </p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:2b4e1ff5-c457-4c86-ad2a-58d22c8d7f7e Meaningful Use gets a meaningful change: 90-day reporting http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_meaningful-use-gets-meaningful-change-90-day-reporting Tue, 13 Sep 2016 04:00:00 GMT <p> The Centers for Medicare and Medicaid Services (CMS) have issued a proposed change that would make Meaningful Use more flexible for physicians by allowing them to report only for a 90-day period in 2016. Also included in the change is a hardship exemption for first time Meaningful Use participants to report once in 2017 to satisfy both Meaningful Use and the Advanced Care Information (ACI) performance category in the upcoming Merit-based Incentive Payment System (MIPS).</p> <p> Physicians have long called for the Meaningful Use program to be more flexible. In its <a href="https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1656-P.html" rel="nofollow" target="_blank">Outpatient Prospective Payment System proposed rule</a>, CMS announced it may grant a 90-day reporting period for Meaningful Use for 2016, rather than maintaining the current full-year reporting period, which will make it less difficult for physicians who are currently experiencing a number of other practice changes, including:</p> <ul> <li> Making the required system changes to certified electronic health record technology</li> <li> Implementing a new application programming interface to comply with Stage 3</li> <li> Preparing for a transition to the MIPS program in 2017 under the Medicare Access and CHIP Reauthorization Act (MACRA)</li> </ul> <p> Yet, there is still one major concern. The proposed change to the reporting period may not be finalized until November, which would leave physicians with less than 90-days left in the year to report on—which is exactly what happened last year when the policy was not finalized until after the start of the final reporting period so many physicians were not able to take advantage of the additional flexibilities.</p> <p> In a <a href="https://download.ama-assn.org/resources/doc/washington/letter-slavitt-re-cms-opps-asc-proposed-rule-6sept2016.pdf" target="_self">comment letter to CMS</a>, the AMA recommended that CMS issue guidance notifying physicians of the 90-day reporting period and begin educating physicians about the change as quickly as possible so they will still have enough time.</p> <p> The lack of alignment between Meaningful Use and the Physician Quality Reporting System (PQRS) in 2016 is also cause for concern. “If a physician would like his or her Meaningful Use electronic clinical quality measure requirement to count towards PQRS,” the AMA said in the comments, “the physician must report for a full 2016 calendar year, as opposed to taking advantage of the flexible 90-day reporting period.”</p> <p> To address this concern, CMS should allow the Meaningful Use 90-day reporting period to count toward successfully reporting quality for both PQRS and the Meaningful Use in 2016.</p> <p> CMS has made several other changes in the past two weeks. One gives physicians <a href="http://www.ama-assn.org/ama/ama-wire/post/macra-penalties-can-now-avoided-cms-says?utm_source=BulletinHealthCare&utm_medium=email&utm_term=091016&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend" target="_self">more flexibility and allows for an easier transition to MACRA in its initial year</a>. The other—changes to the Medicare Physician Fee Schedule—holds <a href="http://www.ama-assn.org/ama/ama-wire/post/medicare-fee-schedule-proposed-rule-needs-work" target="_self">several positive changes but still needs some work</a>.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9830da24-c6e4-412b-8527-e44a4fdc3d65 Ethics and interprofessionalism in medical education http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ethics-interprofessionalism-medical-education Mon, 12 Sep 2016 21:00:00 GMT <p> According to a 2015 Institute of Medicine report, interprofessional education (IPE) happens when health professions trainees learn, “with, from, and about each other to improve collaboration and the delivery of care.” Examine how IPE is benefiting physicians, students and patients and informing the ethics of collaboration for enhanced educational opportunities.</p> <p> The <a href="http://journalofethics.ama-assn.org/site/current.html" target="_self">September issue</a> of the <em>AMA Journal of Ethics®</em> considers the roles of medicine in motivating the clinical and ethical benefits of interprofessionalism for physicians, other health professionals and patients. Articles featured in this issue include:</p> <ul> <li> “<a href="http://journalofethics.ama-assn.org/2016/09/stas2-1609.html" target="_self">Teamwork in Health Care: Maximizing Collective Intelligence via Inclusive Collaboration and Open Communication.</a>” Teams are smartest when everyone feels free to speak up, and they function best when leadership is inclusive and patient-focused. Review research from the field of organizational behavior that sheds light on what makes for a collectively intelligent team.</li> </ul> <ul> <li> “<a href="http://journalofethics.ama-assn.org/2016/09/ecas2-1609.html" target="_self">Interprofessional Training: Not Optional in Good Medical Education.</a>” Interprofessional collaboration is a vital part of medical education, and teamwork will only become more important as physician shortages continue and medical care becomes more complex. When a medical student resists learning from a nurse-midwife on a rotation, how should a faculty member respond?</li> </ul> <ul> <li> “<a href="http://journalofethics.ama-assn.org/2016/09/mnar1-1609.html" target="_self">Decentering the Doctor: The Critical Value of a Patient Care Collective.</a>” Rehabilitation environments are cross-disciplinary, enabling patients to show rather than tell physicians what they can do, which helps remove barriers to rehabilitation. Find out what one physician learned in a hospital playroom about rehabilitation, interprofessional collaboration and patient-centered service delivery.</li> </ul> <ul> <li> “<a href="http://journalofethics.ama-assn.org/2016/09/pfor1-1609.html" target="_self">Overcoming Historical Separation Between Oral and General Health Care: Interprofessional Collaboration for Promoting Health Equity.</a>” Health equity can benefit from physician-dentist collaboration. Check out next steps for integrating oral and general health care.</li> </ul> <p> In the journal’s <a href="http://journalofethics.ama-assn.org/podcast/ethics-talk-sep-2016.mp3" target="_self">September podcast</a>, Lachlan Forrow, MD, associate professor of medicine at Harvard Medical School, discusses the benefits of interprofessional collaboration and the importance of biopsychosocial approaches to patient care.</p> <p> <strong>Take the ethics poll</strong></p> <p> <a href="http://journalofethics.ama-assn.org/2016/09/poll-1609.html" target="_self">Give your answer</a> to this month’s poll: True or false? Medical students being taught only by physicians is an indicator of the highest quality medical education.</p> <p> <strong>Submit an article</strong></p> <p> The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. <a href="https://amajournalofethics.msubmit.net/" rel="nofollow" target="_self">Submit your work</a> for publication.</p> <p align="right"> <em>By AMA staff writer Tim Smith</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1d92dad9-ccf3-4cfc-8365-5d5035e011b1 Medicare fee schedule proposed rule needs work http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_medicare-fee-schedule-proposed-rule-needs-work Fri, 09 Sep 2016 21:39:00 GMT <p> Physicians last week submitted comments to the Centers for Medicare and Medicaid Services (CMS) on its proposed rule to revise the Medicare Physician Fee Schedule and Part B. Some of the provisions align with physicians’ previous recommendations while others will require some changes, especially those that mean more costs for patients and undercut the Medicare Access and CHIP Reauthorization Act (MACRA).</p> <p> The AMA last week <a href="https://download.ama-assn.org/resources/doc/washington/letter-slavitt-re-mpfs-pr-2017-ama.pdf" target="_self">submitted a letter to CMS</a> urging changes throughout the proposed rule while also citing areas of agreement that should be finalized.</p> <p> Three of the proposed policies that physicians recommended changes to include:</p> <ul> <li> <strong>Collecting data on every 10-minute increment of patient care activities before and after each surgery or procedure.</strong> CMS proposed a new series of eight G-codes intended to collect data on the pre- and post-operative activities in 10- and 90-day global services.  The G-codes are based on place of service, complexity of patient, and completion time. Asking physicians and their staff to use 10-minute increments to document all their non-operating room patient care activities is by itself an incredible burden, and especially so during MACRA implementation—the most significant payment system change in 25 years.<br /> <br /> A significant weakness with these G-codes is the inability to match them with the E/M services assumed to be bundled in the current global surgical package.<br /> <br /> “Layering on a new regulation that requires reports based on 10-minute increments of service would <a href="http://www.ama-assn.org/ama/ama-wire/post/clicks-keyboards-stealing-face-time-patients" target="_self">burden physicians already attempting to comply with existing regulations</a> that require them to spend too much time with record keeping and too little with patients,” said AMA President Andrew W. Gurman, MD.<br /> <br /> The AMA and the RUC recommended that the data collection process should not include all services, as many surgical global codes are low volume which would make it difficult to find a meaningful sample, and urged CMS to adopt a data collection method that is limited in scope and uses a representative sample to better understand the necessary post-operative visits.</li> </ul> <ul> <li> <strong>Creating an add-on payment for services provided to patients with mobility-related disabilities.</strong> CMS proposed a new add-on code that would add a $44 fee for services rendered to patients with mobility-related disabilities. This proposal raises program integrity questions, creates unequal coverage for care of disable patients, and increases out of pocket costs for patients with disabilities. Based on the $44 add-on payment for physicians, patients with mobility-related disabilities would have an additional $9 copayment each time special equipment is required during a visit.<br /> <br /> CMS intends to fund the new add-on payment by eliminating the physician payment increase that Congress provided for 2017 in the MACRA legislation.<br /> <br /> The AMA and the Specialty Society RVS Update Committee (RUC) have offered to work with CMS to develop a more appropriate solution.</li> </ul> <ul> <li> <strong>Changing quality measures used to assess Accountable Care Organization (ACO) performance.</strong><span style="font-size:12px;"> </span>There are significant issues with CMS’ proposals to change the ACO quality measures and the risk adjustment model used by CMS for some of these measures.<br /> <br /> Physicians also urged CMS to avoid overly prescriptive regulations for ACOs’ use of health information technology and, instead, to recognize that ACOs are best equipped to improve the health of their patients when they are able to utilize health information technology in ways that best and most effectively meet the needs of those patients.</li> </ul> <p> The letter submitted to CMS also detailed several areas where physicians were in agreement with the proposal, including:</p> <ul> <li> <strong>Improved payment accuracy for primary care, care management, and patient-centered services</strong>. Specifically, the letter supported a separate payment for non-face-to-face prolonged Evaluation and Management services, separate payments for services furnished using the Psychiatric Collaborative Care Model, the implementation of other codes in the CPT family of Chronic Care Management services, and a separate payment to recognize the work of a physician in assessing and creating a care plan for beneficiaries with cognitive impairment. </li> </ul> <ul> <li> <strong>Expansion of the Diabetes Prevention Program. </strong>The letter commended CMS’ proposal to expand coverage of the Medicare Diabetes Prevention Program (DPP) model to Medicare patients at risk of developing type 2 diabetes. This expansion will help at risk seniors and people with disabilities lower their risk factors and prevent their condition from advancing.<br /> <br /> "CMS has offered a comprehensive approach in the new proposal—and some of it hits and some of it misses,” Dr. Gurman said. “The programmatic changes for prediabetes are exactly right."</li> </ul> <ul> <li> <strong>Addition of new telehealth codes. </strong>Physicians expressed their support for the new codes and asked CMS to develop a far more expansive set of strategic proposals that are cohesive and forward-looking in order to expand coverage and access to telehealth services for Medicare beneficiaries.</li> </ul> <p> The comment period for the proposed rule closed on Sept. 6. The AMA and RUC will continue working with CMS to make sure that these recommendations are finalized in a way that is beneficial for both physicians and their patients without adding unnecessary burdens and regulations to patient care processes.</p> <p> CMS has published a <a href="https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-07-07-2.html" rel="nofollow" target="_blank">fact sheet</a> that summarizes the proposed rule.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:cc755e8a-13e9-44c7-9bc9-4464725ec44a Treating the community as your patient http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_treating-community-patient Fri, 09 Sep 2016 21:00:00 GMT <p> Community health intervention can be a highlight of medical school for many students. But what differentiates successful programs from unsuccessful ones? Students with experience in both recently shared their thoughts, with advice distilled down to a simple concept: Listen to your community as you would an individual patient.</p> <p> The students were from Morehouse School of Medicine, in Atlanta, which offers a first-year Community Health course. They were speaking to medical and health professions students at the student-led Health Equity and Community-based Learning meeting, hosted by the University of California, Davis, School of Medicine, which is part of the AMA’s <a href="http://www.changemeded.org/" rel="nofollow" target="_self">Accelerating Change in Medical Education Consortium</a>.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/9/db0b7f54-1f90-4c30-b93e-3070256154e6.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/9/db0b7f54-1f90-4c30-b93e-3070256154e6.Large.jpg?1" style="float:right;margin:15px;" /></a></p> <p> One of the presenters, Stephany Rush, began by underscoring the need for the course—that good intentions alone won’t produce successful interventions.</p> <p> Rush had previously taken part in a private community service project that involved building community gardens in Atlanta. She and others on the project thought gardens were an obvious answer to some of the community’s most visible problems—poor diet and lack of access to healthy foods.</p> <p> “At the end of it, one lady, she came up to me and [asked], ‘What is this?’” Rush recalled.</p> <p> “This is a zucchini,” she replied.</p> <p> “I’ve never eaten this before,” the woman said. “I don’t even know how to cook this. What do I do with this?”</p> <p> Rush and her partners on the project realized then that they hadn’t truly listened to the community during their assessment and that the gardens were, in fact, not the right intervention.</p> <p> <strong>Identifying the community’s chief complaint</strong></p> <p> So what, then, typifies the right intervention? The other presenter, Collin Shumate, explained that students have to resist the urge to decide paternalistically what a community should want.</p> <p> “You’re treating the whole community as your patient,” he said. “So if you do a history and physical exam on a real person, you take stock of what ails them. In the same way, we’re looking for strengths and weaknesses of the community and what they need. What’s their chief complaint?”</p> <p> The Community Health course is taught by many of the same experts who teach in Morehouse’s Master’s in Public Health program. While medical students spend a year partnered with communities, their professors partner with sites, which are often day-care centers, homeless shelters and senior-living facilities, over several years to ensure continuity and facilitate longer-term interventions.</p> <p> Each intervention starts with a “windshield survey.” This is a walk or drive around the community to note a variety of social, environmental and economic factors, including ease of access to public transportation and the retail mix—whether there are more liquor stores than healthy grocery stores, for example—the state of housing, sidewalks and roads and the types of people one sees on the street, including children and the elderly.</p> <p> The survey helps drive interviews with key community members, people who grew up in the area or have lived in it for many years. If the community site is an elementary school, for example, students will interview not just teachers and principals but also parents, janitors and anybody who spends significant time there. The goal is to reveal what’s going on in the community beneath the surface and what its residents feel are their greatest needs.</p> <p> The results of the interviews are then taken to focus groups, where students have their findings evaluated and either confirmed or denied by members of the community.</p> <p> “At the end of these assessments, we have a composite of what the community has told us are the needs,” Rush said. “It’s interesting because, from the windshield surveys, we kind of have an idea of what we think, and it’s always totally different by the time we finish the focus groups what the communities tell us that they need.”</p> <p> <strong>When the intervention meets the community’s needs</strong></p> <p> To illustrate this point, Rush and Shumate broke the students into groups to discuss three case studies of community sites drawn from the Morehouse course: an early learning center, a senior living center and a homeless shelter.</p> <p> The groups worked through the various stages of needs assessments and were able to see, in each case, how different a community’s needs might appear from the perspectives of the windshield survey, the key interviews and the focus groups.</p> <p> Shumate noted, for example, that he initially saw his community as a food desert, but community members didn’t report that as their chief complaint. They were more concerned with mental health issues and the availability of helpful resources and social support.</p> <p> So instead of implementing an intervention consisting of community gardens or healthy food trucks, the community instead opted for a combination of parent social activities, a community resource guide with family, financial and health resources, stress management modalities and frequent blood pressure checks.</p> <p> The goal of all the interventions was two-fold—to improve health outcomes in the community and to concretize for students some of the concepts at the heart of the movement to change how medicine is taught and practiced in America.</p> <p> “Some people focus on the word disparities,” Shumate said, paraphrasing one of his professors. “But we want to focus on equity.”</p> <p> <strong>For more on the student-led meeting: </strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/working-upstream-achieve-quadruple-aim" target="_self">Working upstream to achieve the quadruple aim</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/death-zip-code-address-matters-genetics" target="_self">Death by ZIP code: When address matters more than genetics</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/students-deliver-care-homes-communities" target="_self">Students deliver care in homes, communities</a></li> </ul> <p align="right"> <em>By AMA staff writer Tim Smith</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:eeeb6b6e-e123-4f81-a535-46a2572cd1b8 MACRA penalties can now be avoided, CMS says http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_macra-penalties-can-now-avoided-cms-says Fri, 09 Sep 2016 01:00:00 GMT <p> Avoiding penalties under the Medicare Access and CHIP Reauthorization Act (MACRA) just got easier. The Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt Thursday announced that the final MACRA regulation will exempt physicians from any risk of penalties if they choose one of three distinct reporting options in 2017.</p> <p> In a <a href="https://blog.cms.gov/2016/09/08/qualitypaymentprogram-pickyourpace/" rel="nofollow" target="_blank">blog post</a>, Slavitt announced that CMS heard physicians’ concerns about the proposed start date for performance reporting under the new Medicare payment system and that the agency will offer three reporting options for the Merit-based Incentive Performance System (MIPS)—and if you choose one for 2017, you will not receive a negative payment adjustment in 2019.</p> <p> The options will be described fully in the final rule, but here are the basics:</p> <ul> <li> <strong>Option one: Test the program</strong><br /> As long as you submit some data to the Quality Payment Program, including data from after Jan. 1, you will avoid a negative payment adjustment, Slavitt said. This option is intended to ensure that the system is working and that physicians are prepared for broader participation in the coming years as they learn more.</li> </ul> <ul> <li> <strong>Option two: Partial-year reporting</strong><br /> Physicians can choose to report Quality Payment Program information for a reduced number of days. Your first performance period could begin well after Jan. 1 and your practice could still qualify for an incentive payment.<br /> <br /> Slavitt offered an example. “If you submit information for part of the calendar year for quality measures, how your practice uses technology and what improvement activities your practice is undertaking,” he said, “you could qualify for a small positive payment adjustment.”</li> </ul> <ul> <li> <strong>Option three: Full-year reporting</strong><br /> If your practice is ready to get started on Jan. 1, you can choose to report Quality Payment Program information for the full calendar year. Your first performance period would begin on Jan. 1, and if you submit information for the entire year your practice could qualify for a modest positive payment.</li> </ul> <ul> <li> <strong>Advanced Alternative Payment Model (APM) option. </strong><br /> This option is still available and qualified participants in advanced APMs will be eligible for five percent incentive payments in 2019.</li> </ul> <p> Choosing any of these options guarantees that you will not receive a negative payment adjustment.</p> <p> The announcement confirms that physician input is playing a critical role in the development of the final MACRA rule. Slavitt stated his appreciation for the constructive participation of physicians in the feedback process and added that CMS looks forward to further engagement with physicians to make sure the new Medicare payment system works for everyone, including patients.</p> <p> "By adopting this thoughtful and flexible approach, the Administration is encouraging a successful transition to the new law by offering physicians options for participating in MACRA,” said AMA President Andrew W. Gurman, MD, in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-09-08-ama-praises-administration-macra-changes.page" target="_self">statement commending Slavitt and Department of Health and Human Services Secretary Sylvia Mathews Burwell</a>.</p> <p> “This approach better reflects the diversity of medical practices throughout the country,” he said. "The AMA believes the actions that the Administration announced today will help give physicians a fair shot in the first year of MACRA implementation.”</p> <p> This kind of flexibility is what physicians were seeking throughout the draft rule comment period—and now it is a reality. The only way to receive a negative payment adjustment now is by not participating at all.</p> <p align="right"> <em>By AMA staff writer <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank">Troy Parks</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e129fc02-02aa-4e02-ad5c-5ab5cfeb627f Report reveals complexities of GME reform http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_report-reveals-complexities-of-gme-reform Wed, 07 Sep 2016 22:41:00 GMT <p> Graduate Medical Education (GME) is in need of changes that address the rapidly changing health care system and to better prepare physicians-in-training for the future. A new report asked physicians, residents and other stakeholders from around the nation to identify GME-related issues or concerns.</p> <p> A recent <a href="http://www.aahcdc.org/Policy/Issues/GME/GMEFullReport.aspx" rel="nofollow" target="_blank">report</a> from the Association of Academic Health Centers brings together the input of physicians and residents, several medical societies, accreditation bodies, regional experts and other organizations with GME interests to discuss the current state of GME and what changes could be made to meet future health care needs.</p> <p> <strong>What needs to change about GME</strong></p> <p> The roundtable discussions had similar themes across the board and pointed out the specific areas where changes to the structure and strategy of GME could lead to enhanced residency programs and better prepared physicians.</p> <p> Here are six of the themes that appeared in the discussions:</p> <ul> <li> <strong>Organizational conflict between teaching hospitals and medical schools.</strong> Because teaching hospitals are the recipients of most Medicare GME funding, conflict between those hospitals and the medical schools responsible for the teaching and accreditation of the programs was a key factor throughout the roundtables.<br /> <br /> Participants identified a clear lack of alignment in organizational missions, a lack of transparency in approaches and disparate yet overlapping areas of responsibility.<br /> <br /> “The overall funding of GME may need to be changed in order to adequately address the organizational conflict,” the report said.</li> </ul> <ul> <li> <strong>Private sector influence on the health care system.</strong> Roundtable participants said that market forces are driving a lot of the changes in the health care system, yet they also stated they feel unfamiliar or disconnected with entrepreneurial activity being done that will impact GME training programs.<br /> <br /> There was also recognition that entrepreneurs in the private sector could be very helpful in filling some of the training gaps where current programs do not have appropriate expertise or time to provide additional training. Learning from the private sector could enhance GME programs.</li> </ul> <ul> <li> <strong>Mental health and well-being of residents.</strong> Issues of mental health and wellness were identified in all discussions and residents were recognized as having an increased desire for confidential and easily accessed mental health resources in recent years. Factors contributing to this problem were also identified and include limited time off, increased responsibilities with fewer resources, threatened job satisfaction and more stress.<br /> <br /> <a href="http://www.ama-assn.org/ama/ama-wire/post/out-of-tragedy-comes-new-focus-resident-health">Wellness programs</a> were recognized as a critical and currently lacking component of GME programs for both faculty and residents.</li> </ul> <ul> <li> <strong>Revisions to program and accreditation structure.</strong> In every session, participants discussed the need for revisions to the structure of GME programs and the accreditation entities that incentivize and drive that structure.<br /> <br /> “The overwhelming consensus view was that medical schools need much more flexibility to properly train physicians of the future,” the report said. “If academic health centers were able to tailor programs to both medical students’ and residents’ areas of interest, the length of time of medical education, as well as the cost, might be significantly reduced.”</li> </ul> <ul> <li> <strong>Addressing difficulties providing health care to rural and underserved areas.</strong> Roundtable participants identified a need for training in environments in which future physicians will practice, rather than a one-size-fits-all approach in the clinical/hospital environment.<br /> <br /> It was also recognized that there is an overall shortage of physicians, residents and teaching faculty in rural and underserved areas due to lower salaries, which increases the challenges in repaying tuition debt, as well as a lack of opportunities for families.<br /> <br /> Technology, including telemedicine, was seen as a possible solution in this area, the report said. “However, it was emphasized that the current funding, reimbursement and regulatory schemes do not currently support the use of technology in many instances.”<br /> <br /> Greater inclusion of interprofessional partnerships and training were pointed to as critical for addressing limitations in current programs.</li> </ul> <ul> <li> <strong>More health care workforce planning is needed.</strong> Comprehensive and accurate workforce analyses were felt to be essential for a successful GME strategy. Workforce planning must be sufficient and focus on all health care providers, not just physicians.<br /> <br /> “Accreditation programs could be fashioned in such a way as to promote and support workforce needs in line with a comprehensive strategy,” the report said.</li> </ul> <p> <strong>On the matter of GME funding and further reform</strong></p> <p> Though the current structure of <a href="http://www.ama-assn.org/ama/ama-wire/post/new-funding-model-could-create-debt-medical-education" target="_self">GME funding</a> was intentionally left out of the discussions, it was clear to researchers that all participants believed that it is essentially broken. “There was a strong consensus that reworking the funding mechanism for GME could ameliorate a number of the issues raised,” the report said. “If designed properly, [a new funding structure] could facilitate GME programs that better fit today’s health care marketplace, enhance the roles of academic health centers … in residency programs, and support the changing health care delivery systems to support patient needs.”</p> <p> The roundtables were conceived in response to a 2014 National Academies of Sciences, Engineering and Medicine (formerly the Institute of Medicine) <a href="http://www.ama-assn.org/ama/ama-wire/post/gme-financing-system-needs-overhaul-iom-report" target="_self">report that called for transitioning the current GME system</a> to a transparent, performance-based system.</p> <p> The AMA has long advocated for and adopted numerous <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-medical-education/reports.page?" target="_self">policies and reports that support the modernization of GME</a>, including a report on the physician workforce shortage and approaches to GME financing (log in). At this year’s AMA Annual Meeting, delegates adopted policy to advocate for the appropriation of Congressional funding in support of the National Healthcare Workforce Commission, established under the Affordable Care Act, to provide data and healthcare workforce policy and advice to the nation and provide data that support the value of GME.</p> <p> Recently, the AMA supported the Creating Access to Residency Education Act (CARE) to expand funding for GME and improve access to health care for patients in underserved areas. The organization also supports the Resident Physician Shortage Reduction Act of 2015, to help increase the number of residency slots and address physician shortages.  </p> <p> The Accreditation Council for Graduate Medical Education (ACGME) recently launched the <a href="http://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being" rel="nofollow" target="_blank">Physician Well-Being initiative</a>, intended to create a learning environment that recognizes physician well-being as critical to their ability to deliver the safest, best possible care to patients. Also, the ACGME earlier this year announced its <a href="http://www.acgme.org/What-We-Do/Initiatives/Pursuing-Excellence/Overview" rel="nofollow" target="_blank">Pursuing Excellence in Clinical Learning Environments initiative</a>.</p> <p> Through its <a href="https://savegme.org/" rel="nofollow" target="_blank">SaveGME</a> campaign, the AMA continues to strongly urge Congress to protect federal funding. The campaign website offers many resources and ways to take action to improve GME.</p> <p> The AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education</a> initiative is also addressing some of these issues by supporting medical school projects that accelerate student progress, allowing them to enter residency sooner and contribute more rapidly to expanding the physician workforce. Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-students-first-hand-experience-serving-underserved" target="_self">how medical schools are embedding students</a> in real world environments to enhance the learning process.</p> <p align="right"> <em>By AMA staff writer <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank">Troy Parks</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f6fb90f1-6155-41be-a32d-0173853c3e4d New model of care offers MACRA advantage http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-model-of-care-offers-macra-advantage Wed, 07 Sep 2016 22:00:00 GMT <p> Applications are due on Sept. 15 for the Centers for Medicare and Medicaid Services (CMS) five-year primary care medical home model, Comprehensive Primary Care Plus (CPC+). This model builds on experience with an ongoing five-year pilot model by making significant improvements that could help participating physician practices succeed—and it could also help your practice during the upcoming Medicare Access and CHIP Reauthorization Act (MACRA) transition.</p> <p> Under MACRA, physicians can either participate in the new Merit-based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (APM). Qualifying APM participants are exempt from MIPS and earn five percent bonus payments each year, on top of the additional funding they can receive from the APM itself. One way to qualify for the Advanced APM track is to apply for CPC+.</p> <p> CPC+ is a five-year primary care medical home model that aims to provide more flexibility and support than is typically available in fee-for-service, especially for non face-to-face services such as proactive patient outreach, care coordination and development of treatment plans. Up to 5,000 practices will be selected to participate.</p> <p> The AMA is strongly encouraging interested practices to submit applications during the short application period which closes on Thursday, Sept. 15, giving physicians just six weeks to apply. Submit a CPC+ application via the <a href="https://app1.innovation.cms.gov/cpcplus" rel="nofollow" target="_blank">online portal</a> by 11:59 p.m. Eastern time that day. CMS has no plans to allow new applicants later in the five-year period.</p> <p> <strong>The advantages of new models of care</strong></p> <p> “Physicians like the upfront prospective payment as well as the potential for shared savings bonuses,” said William Golden, MD, medical director of Arkansas Medicaid, who played an essential role in the original pilot as well as the development of a statewide medical home in Arkansas. “It is a highly attractive model that is resulting in greater team-based care and, in many practices, better morale for the doctors, nurses and staff.”</p> <p> One of the major differences between the pilot and CPC+ is that shared savings under the pilot were regional, Dr. Golden said. “There were seven regions that got CPC, and all the docs in that region had to reach shared savings to get bonuses. It was very hard for a region to qualify.”</p> <p> In CPC+, the pool approach is out, the bonuses are paid up-front, and performance will be driven at the practice level, he said. “The opportunity for high-performing practices to earn bonuses is much greater.”</p> <p> “CPC+ lets physicians focus more on chronic disease management and prevention,” Dr. Golden said. “This new model incentivizes you to spend more time with the chronically ill and lets you manage you population in a much more efficient way without necessarily having them come into the office.”</p> <p> “It encourages phone management, televideo and alternative care,” he said. “It also encourages trying to avoid use of the emergency department … you’re really responsible for the outcomes of your panel.”</p> <p> “I think the patients have enjoyed it,” he said. “It takes away a lot of the overhead pressures in a busy primary care practice and it encourages alternative visit approaches and, frankly a lot of docs are saying, ‘This allows me to practice medicine in the way I wanted to and the previous reimbursement model didn’t let me.’”</p> <p> “Many of the practices have welcomed this change in orientation, they really like this way of doing business,” Dr. Golden said. “It means less burnout because it is a more targeted use of their time.”</p> <p> CPC+ is a multi-payer model, so other payers will join Medicare in making monthly care management and performance-based payments to participating physician practices. <a href="https://innovation.cms.gov/initiatives/Comprehensive-Primary-Care-Plus/" rel="nofollow" target="_blank">Learn more</a> about the 14 CPC+ regions and provisionally selected payers.</p> <p> CMS has offered several resources for practices that choose to apply. Get your questions answered in the <a href="https://innovation.cms.gov/Files/x/cpcplus-faqs.pdf" rel="nofollow" target="_blank">Practice FAQs</a>. Register for one of the 20 upcoming <a href="https://innovation.cms.gov/Files/x/cpcplus-practiceeventscalendar.pdf" rel="nofollow" target="_blank">CPC+ Practice Open Door Forums</a> in August and September. Watch the <a href="https://www.youtube.com/watch?v=0RyXKdpViP8&list=PLaV7m2-zFKpgXyFdYktqhUfgYcaGsSMPe&index=1" rel="nofollow" target="_blank">CPC+ Video Series</a> to get an overview of CPC+ payment innovations and care delivery transformation. Download the CPC+ toolkit: <a href="https://innovation.cms.gov/Files/x/cpcplus-brief.pdf" rel="nofollow" target="_blank">CPC+ In Brief</a>, <a href="https://innovation.cms.gov/Files/x/cpcplus-caredeliverybrief.pdf" rel="nofollow" target="_blank">CPC+ Care Delivery Transformation Brief</a>, and <a href="https://innovation.cms.gov/Files/x/cpcplus-paymentbrief.pdf" rel="nofollow" target="_blank">CPC+ Payment Innovations Brief and Case Studies</a></p> <p> <strong>Learn more about APMs:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/tracking-patients-between-visits-new-care-model" target="_self">Tracking patients between visits: A new care model</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/new-model-patient-care-face-face-visits" target="_self">New model makes patient care more than face-to-face visits</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/payment-model-design-needs-physician-led-new-report" target="_self">Payment model design needs to be physician-led: New report</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-developing-new-payment-models-their-specialties" target="_self">How doctors are developing new payment models for their specialties</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/whos-using-new-delivery-payment-models-1" target="_self">Who’s using new delivery and payment models?</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/payment-models-can-better-address-patients-needs" target="_self">Payment models that can help you better address patients’ needs</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/specialty-development-key-new-payment-models-success" target="_self">Specialty development key to new payment models’ success</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e9c59fcb-3b73-41bd-9f9a-1d3cb8c9b1e8 Clicks and keyboards stealing face time with patients http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_clicks-keyboards-stealing-face-time-patients Tue, 06 Sep 2016 22:00:00 GMT <p> Almost one-half of the physician workday is now spent on electronic health record (EHR) data entry and other administrative desk work while only 27 percent is spent on direct clinical face time with patients, a time-motion study published Monday in the <em>Annals of Internal Medicine</em> found. This finding is further proof that administrative burdens are directly affecting the patient-physician relationship. Though efforts are underway to make EHRs more practical for clinical use, there are ways to relieve this burden through team-based care.</p> <p> The <a href="http://annals.org/article.aspx?articleid=2546704" rel="nofollow" target="_blank">time-motion study</a>, conducted by experts at the AMA and Dartmouth-Hitchcock Health Care System, also found that for every hour of face-to-face time with patients, physicians spend nearly two additional hours on their EHR and other clerical desk work throughout the day.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/9/947cb82c-987b-4ea2-b93e-769d09eb3c03.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/9/947cb82c-987b-4ea2-b93e-769d09eb3c03.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Physicians do not feel these are the tasks that should be taking up a majority of their work day—they undercut the patient-physician relationship.</p> <p> “I am not surprised to hear these results, and I can tell you no one who practices medicine today would be surprised by them,” said AMA Immediate-Past President Steven J. Stack, MD, to entrepreneurs at MATTER, Chicago’s health care technology incubator. “But they highlight exactly why new technologies that can bring greater efficiencies to medicine are so important.”</p> <p> The time-motion study correlates with a <a href="http://www.jgme.org/doi/abs/10.4300/JGME-D-15-00240.1" rel="nofollow" target="_blank">study</a> published recently in the <em>Journal of Graduate Medical Education</em> that tracked the average <a href="http://www.ama-assn.org/ama/ama-wire/post/documentation-woes-study-tracks-residents-time-spent-ehrs" target="_self">“mouse miles”—or active time—residents spent using EHRs</a>. The study found that first-year residents spent an average of five hours per day on the EHR caring for a maximum of 10 patients.</p> <p> <strong>Taking back time for patients</strong></p> <p> The importance of the <a href="http://www.ama-assn.org/ama/ama-wire/post/patient-physician-relationship-central-medicine" target="_self">patient-physician</a> relationship is why some physicians are looking at ways to take back that stolen time. Kevin Hopkins, MD, a family physician at the Cleveland Clinic in Strongsville, Ohio, saw this happening in his practice and implemented a new team care model. “I was staring at the computer screen rather than looking at the patient,” he said. “This is one of the biggest complaints we get from patients.”</p> <p> “One day I realized that if I didn’t have to do this documentation I would really like my work,” Dr. Hopkins said. So he and his team developed templates specific to their practice and patients. He taught his staff how to use health maintenance reminders in their EHR to place orders for mammography screening, labs and immunizations. They also made workplace modifications such as installing curtains to offer privacy to patients while the medical assistant remains in the exam room to document, and a computer workstation in the hallway to allow Dr. Hopkins to make minor note edits between patients.</p> <p> “We have worked with the MAs to develop their multi-tasking skills,” he said. “They need to be typing, listening to me and watching what parts of the exam I am doing all at the same time. We trained them with shadowing and repetition.”</p> <p> “The MAs are more fully engaged in patient care than they have ever been and they enjoy their work,” he said. “They have increased knowledge about medical care in general and about their individual patients.”</p> <p> A module from the AMA’s <a href="https://www.stepsforward.org/" rel="nofollow" target="_self">STEPS Forward™</a> collection of practice improvement strategies can show you how to bring <a href="https://www.stepsforward.org/modules/team-documentation" rel="nofollow" target="_self">team documentation to your practice</a>. The collection offers several modules to help physicians relieve the burden of current EHR inefficiency, including <a href="https://www.stepsforward.org/modules/ehr-implementation" rel="nofollow" target="_self">EHR software selection and purchase</a> and <a href="https://www.stepsforward.org/modules/ehr-software-vendor-selection" rel="nofollow" target="_self">EHR implementation</a>.</p> <p> Other ways to alleviate administrative burdens included in the collection are modules on how to <a href="https://www.stepsforward.org/modules/patient-pre-registration" rel="nofollow" target="_self">adopt a patient pre-registration process</a>, implement <a href="https://www.stepsforward.org/modules/synchronized-prescription-renewal" rel="nofollow" target="_self">synchronized prescription renewal</a> and <a href="https://www.stepsforward.org/modules/patient-discharge-and-rooming" rel="nofollow" target="_self">expanded rooming and discharge protocols</a>.</p> <p> <strong>Findings ways to do less homework</strong></p> <p> The time-motion study also found that outside office hours, physicians spend another one to two hours of personal time each night doing clerical work—mostly related to EHRs. The findings suggest that documentation support with either dictation or documentation assistance services may increase direct clinical face time with patients.</p> <p> Jim Ingram, MD, a family physician in Auburn, Ind., saw some of the same issues that Dr. Hopkins saw at the Cleveland Clinic and took action as well. He now works with two certified medical assistants (CMA). One CMA rooms the patient, then updates the problem list, the medication list, and allergies and uses EHR templates to get as much history as possible.</p> <p> The CMA then leaves the room to huddle with Dr. Ingram and they review all of the information before performing the exam. This frees Dr. Ingram up to build the valuable trust that is needed for an effective patient-physician relationship. He is not staring at the computer in the exam room—he is looking at the patient.</p> <p> After the exam, Dr. Ingram and the CMA step outside of the exam room and review everything that was discussed and the treatment plan. He then joins the second CMA and repeats the process with the next patient.</p> <p> “I never come in on my day off or work in the evenings on notes like I used to,” he said. “I am much more relaxed during the visits and I am more thorough with my patients. I no longer have to flip through the chart looking for things or look away from the patient.”</p> <p> “The biggest return on investment was achieving a real sense of teamwork, increased joy in practice and getting rid of extra work at nights,” Dr. Ingram said. “Patients are better served by me and the CMAs, and patient satisfaction has increased.”</p> <p> <strong>Making EHRs interoperable, less burdensome for physicians</strong></p> <p> The time-motion study quantifies the results of an AMA study with the RAND Corporation that confirmed poorly designed EHRs and other administrative tasks have become obstacles to providing high-quality care to patients and are leading contributors to physician burnout.</p> <p> Late last year, the AMA and MedStar developed a new framework to evaluate the top EHR products, said Michael L. Hodgkins, MD, AMA vice president and chief medical information officer. “And only three vendors got perfect scores.”</p> <p> The <a href="http://www.ama-assn.org/ama/ama-wire/post/framework-evaluates-top-20-ehrs-dont-quite-measure-up" target="_self">EHR User-Centered Design Evaluation Framework</a> employs a 15-point scale intended to evaluate EHR vendors’ compliance with best practices for a user-centered design process to encourage the Office of the National Coordinator for Health Information Technology to raise the bar on federal usability certification.</p> <p> Also, the AMA’s grassroots campaign <a href="https://breaktheredtape.org/" rel="nofollow" target="_blank">BreakTheRedTape.org</a> in January held a town hall, in which physicians came together to offer solutions to <a href="http://www.ama-assn.org/ama/ama-wire/post/ehrs-need-physicians-offer-solutions-town-hall" target="_self">what EHRs need</a> and how they could work better for physicians and their patients.</p> <p> In 2014, a panel of experts led by AMA President Steven J. Stack, MD, developed and published <a href="http://www.ama-assn.org/ama/ama-wire/post/8-top-challenges-solutions-making-ehrs-usable" target="_self">eight top challenges and solutions</a> for improving EHR usability for physicians and their patients. These principles focus on leveraging the potential of EHRs to enhance patient care, improve productivity and reduce administrative costs</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/troy_amawire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:fe426cf1-1f53-492b-b047-c2bab735c7e5 LGBT residents provide insights to match applicants http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_lgbt-residents-provide-insights-match-applicants Tue, 06 Sep 2016 21:00:00 GMT <p> Matching for residency programs can be stressful for LGBT applicants. Is it okay to be out? How much should I reveal about my LGBT advocacy work? What should I do if an interviewer tries to determine my sexual orientation indirectly? Five LGBT residents, including one couple, recently took part in a webinar to share their experiences and answer these and other questions LGBT students commonly have before and during the match.</p> <p> The webinar, <a href="https://www.aamc.org/initiatives/diversity/468858/navigating.html" rel="nofollow" target="_self">Navigating the Residency Match as an LGBT Applicant</a>, co-hosted by the AMA and the Association of American Medical Colleges in August, addressed the rules governing questions that can be asked of program applicants and the concerns related to openly sharing one's identity during the interview process.</p> <p> It begins with what many applicants might not be aware of in detail. The National Residency Matching Program (NRMP) has established a <a href="http://www.nrmp.org/code-of-conduct/" rel="nofollow" target="_blank">Match Communication Code of Conduct</a> for all program directors and other interviewers. In summary, it specifies that they must commit to:</p> <ul> <li> <strong>Respecting an applicant’s right to privacy and confidentiality. </strong>Program directors and other interviewers are not allowed to ask identifying information about other programs you’ve applied to.<br />  </li> <li> <strong>Accepting responsibility for the actions of recruitment team members.</strong> Program directors assume responsibility for the actions of the entire interview team. Anyone who is a part of the interview selection process is representing the entire program, and responsibility goes all the way up to the program director.<br />  </li> <li> <strong>Refraining from asking illegal, coercive and non-job-related questions.</strong> Interviewers can’t ask questions about age, gender, religion, sexual orientation or family status, and they have to ensure that communication with applicants remains focused on whether the applicant fits within their program.<br />  </li> <li> <strong>Declining to require second visits or visiting rotations.</strong> Program directors can’t require visiting rotations—second visits—or imply that second visits are used in determining applicant placement on a rank order list. <br />  </li> <li> <strong>Discouraging unnecessary post-interview communication.</strong> Interviewers aren’t allowed to solicit or require post-interview communication from applicants or engage in post-interview communication that is disingenuous for the purpose of influencing applicants’ ranking preferences.</li> </ul> <p> So while some questions are off limits, sensitive subjects still come up. Many LGBT applicants look to the advice and anecdotes of other members of the LGBT community who have experienced the match.</p> <p> <strong>It starts on your application</strong></p> <p> Kaitlyn McCune, MD, an obstetrics and gynecology resident at Wake Forest Baptist Medical Center in North Carolina, recently applied for a military residency through the Air Force. She decided to be out from the start, and she took three main lessons away from the experience.</p> <p> “My first lesson is not to be afraid to be yourself,” Dr. McCune said. “I put the activities on my resume and was told by family members that I was waving my pride flag in people’s faces, and that I shouldn’t put my advocacy work that I had worked so hard on in medical school on my application.”</p> <p> But she decided to use it as a probe.</p> <p> “I sort of said, ‘Forget that,’” she said. “Because the Defense of Marriage Act and Don’t Ask Don’t Tell had been overturned, I took the stance that legally no one could touch me. They couldn’t discriminate against me. In reality, when I think back now, I realize that could have been a very bad move. It could have been very naïve, because these program directors in your interviews really carry a lot of weight in the military, so they could have rated me really poorly.”</p> <p> Dr. McCune took that approach in her civilian applications as well. She was proud of what she had done in advocacy and felt she shouldn’t have to omit it.</p> <p> “I was asked quite often about it,” she remembers. “One person…asked me, ‘What is your specific interest in LGBTQ health advocacy?’ And while he didn’t specifically ask me if I was gay, he sort of asked me the question that forced me to come out, and I did and it was fine. So I encourage you to take that risk if you’re comfortable with it.”</p> <p> <strong>Don’t shy away from questions of fit</strong></p> <p> Dr. McCune’s second lesson: Scope out the residents.</p> <p> “Those dinners beforehand are so incredibly important,” she said. “They’re your time to ask all the questions that you may be afraid to ask in an interview or wouldn’t be appropriate to ask in an interview. I always used that as my best resource for the feel of the program. I would drop my significant other status into casual conversation or ask residents about their significant others so that I could bring up my own.”</p> <p> The third lesson: Be honest and realistic about where you want to end up.</p> <p> “The military is a little bit different [from civilian programs], in that all the program directors get together,” she said. “So unlike civilian residency, you can’t tell every single one of them that that’s where you want to end up. If you were to [do that], when they all got together and talked about you, there would be a discrepancy.</p> <p> “They really encourage you in the military to be honest about whether you want a military residency, which [one] you want, and if you want a civilian residency, to ask for it. And that’s what I did. Civilian residency made the most sense for my life and my situation, and I asked for it and was logical and reasonable about my reasons for wanting it and was awarded it in the end.”</p> <p> Among the many other points Dr. McCune made, she noted that just two weeks after she matched at Wake Forest, North Carolina’s House Bill 2, the so-called “bathroom law,” passed.</p> <p> “I remember emailing my fantastic program director and program coordinator … just very upset, wondering how this was going to affect the program and how this was going to affect my situation,” she said. “They were wonderful and said, ‘This is not going to affect [you]. The university has come out and said they that do not support this and they support diversity and inclusion.’</p> <p> “So don’t be afraid to ask about those things. If you have concerns and the interview has gone well … and you see these concerning things either in hospital policy or in state laws, don’t be afraid to ask, ‘Hey how does this law affect this institution? Does it affect it at all?’”</p> <p> <strong>90 minutes of examples and advice</strong></p> <p> The webinar also features presentations by:</p> <ul> <li> <strong>Dre Irizarry, MD,</strong> surgery resident at Beth Israel Deaconess Medical Center. At the time of interviews, Dr. Irizarry had begun transitioning and was continuing to present as a female with a female partner.<br />  </li> <li> <strong>Chelsea Dawn Unruh, MD,</strong> chief family medicine resident at Providence St. Peter Family Medicine. Dr. Unruh was an IMG who had studied in Poland and wasn’t out during match.<br />  </li> <li> <strong>Jeffrey Eugene, MD, </strong>pediatrics resident at University of Pittsburgh Medical Center, and <strong>Joseph Langham, MD, </strong>pediatrics resident at University of Pittsburgh Medical Center. Drs. Eugene and Langham met during medical school. They would be the first same-sex couple from their school to go through match.</li> </ul> <p> It also includes a robust question-and-answer session. Among the many topics explored: What happens if things go wrong?</p> <p> <strong>Learn more about conducting a successful residency search:</strong></p> <ul> <li> Review the student’s <a href="http://www.ama-assn.org/ama/ama-wire/post/applying-residency-fourth-year-students-essential-checklist" target="_self">fourth-year essential checklist</a>.</li> <li> See <a href="http://www.ama-assn.org/ama/ama-wire/post/4-tricks-successful-residency-program-search" target="_self">4 tricks to a successful residency program search</a>.</li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-many-residency-programs-students-really-apply" target="_self">How many residency programs</a> do students really apply for?</li> <li> Read about the <a href="http://www.ama-assn.org/ama/ama-wire/post/2016-match-numbers" target="_self">record Match rate</a> for 2016.</li> </ul> <p>  </p> <p align="right"> <em>By AMA staff writer Tim Smith</em></p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:37ffb5a5-a40d-4068-82fa-7b96fc1d5c20 How to respond to bad online reviews http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_respond-bad-online-reviews Sat, 03 Sep 2016 02:00:00 GMT <p> In the age of online reviews, medical professionals have been accused of violating the Health Insurance Portability and Accountability Act (HIPAA) for how they responded to negative online reviews from patients. To avoid that pitfall and other missteps, here are some do's and don’ts for responding to online critics.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/4/e3a510d7-65c2-4bab-a403-13bd7bcbf2fa.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/4/e3a510d7-65c2-4bab-a403-13bd7bcbf2fa.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>The pitfalls</strong></p> <p> A <a href="https://www.propublica.org/article/stung-by-yelp-reviews-health-providers-spill-patient-secrets" rel="nofollow" target="_blank"><em>ProPublica</em></a> investigation earlier this year, co-published with the <a href="https://www.washingtonpost.com/news/to-your-health/wp/2016/05/27/docs-fire-back-at-bad-yelp-reviews-and-reveal-patients-information-online/" rel="nofollow" target="_blank"><em>The Washington Post</em></a><em>, </em>combed through more than 1.7 million patient Yelp public reviews and found dozens of instances where medical professionals’ responses to complaints led to disputes over patient privacy.</p> <p> In one case, a patient filed a complaint with the Office for Civil Rights within the U.S. Dept. of Health and Human Services, the office that enforces HIPAA. The patient claimed the dentist posted her personal information in response to a Yelp review, according to the investigation.</p> <p> In a 2013 California case, a hospital was fined $275,000 for disclosing patient information to the media without permission, “allegedly in retaliation for the patient complaining to the media about the hospital,” the article noted.</p> <p> These online reviews are going to happen because that is the nature of the internet’s presence in the modern medical landscape. So how do you handle them?</p> <p> <strong>The do's and don’ts of responding</strong></p> <p> With these pitfalls in mind, here are some dos and don’ts for physicians to consider when a patient posts a negative review.</p> <p> What to do:</p> <ul> <li style="margin-left:0.25in;"> <strong>Consider taking the response offline.</strong> Phone the patient or invite him or her into your office to sit down and talk about their concerns. Sometimes, the personal contact results in the patient taking down the negative review, or results in the patient adding an online review that lets other patients know your office is listening. <br />  </li> <li style="margin-left:0.25in;"> <strong>Speak about general policies and standard protocols if you chose to respond online. </strong>For example, if a patient is upset he did not receive an antibiotic, a physician could respond, not by mentioning anything about the specific patient, but instead by saying that office policy and standard medical practice is to determine if a patient has a viral or bacterial infection and to only prescribe antibiotics when there a bacterial infection is present.<br />  </li> <li style="margin-left:0.25in;"> <strong>Remember, one bad review will not destroy your online reputation.</strong> Patients look at a physician’s overall rating and when there are many good reviews, a few bad ones will not stand out as the norm.<br />  </li> <li style="margin-left:0.25in;"> <strong>Establish your own online profile.</strong> Get a professional headshot; make sure your information is up-to-date on your practice website, health rating websites such as Healthgrades and RateMDs, and other online sources.</li> </ul> <p> What not to do:</p> <ul> <li style="margin-left:0.25in;"> <strong>Don’t respond immediately. </strong>Take a deep breath and walk away. If you respond immediately, you may come across as angry. That won’t lead to anything productive.<br />  </li> <li style="margin-left:0.25in;"> <strong>Don’t disclose any information about the patient—don’t even acknowledge the person is a patient in your office.</strong> HIPAA still applies. Even if a patient has disclosed his or her information in an online review, remember that HIPAA prevents a physician from disclosing any information about a patient without the patient’s permission. A patient’s own disclosure is not permission for the doctor to disclose anything.</li> </ul> <ul> <li style="margin-left:0.25in;"> <strong>Don’t ignore criticism.</strong> Instead, objectively look at the criticism from the patient’s point of view and determine whether there is something you or your office can do differently.<br />  </li> <li style="margin-left:0.25in;"> <strong>Don’t shy away from online reviews. </strong>Ask your patients to rate and review you online. In most cases, reviews are positive. And remember that many positive reviews dilute many negative reviews.</li> </ul> <p> For more reading on how to manage an online presence:</p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/social-media-reap-benefits-avoiding-hazards" target="_self">Social media: How to reap the benefits while avoiding the hazards</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physician-behind-kevinmd-reveals-leverage-social-media" target="_self">Physician behind KevinMD reveals how to leverage social media</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/kevinmd-answers-doctors-top-social-media-questions" target="_self">KevinMD answers doctors’ top social media questions</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/will-social-media-impact-residency-fellowship-application" target="_self">Will social medial impact your residency, fellowship application?</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/manage-online-reputation-top-4-tips" style="font-size:12px;" target="_self">How to manage your online reputation: Top 4 tips</a></li> </ul> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:646d8ee9-b775-45eb-b89f-2a982f123fa7 Online DPP tackles challenges of location and participation http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_online-dpp-tackles-challenges-of-location-participation Fri, 02 Sep 2016 21:00:00 GMT <p> The Centers for Disease Control and Prevention’s (CDC) National Diabetes Prevention Program (National DPP) has been proven effective at helping participants make substantial and sustainable lifestyle changes. But up until now, adoption of the program has been greatly limited by challenges in enrolling patients into local programs and scaling the program beyond its brick-and-mortar settings. A new approach—providing the program digitally and remotely—is tackling both simultaneously.</p> <p> “Any kind of a health care professional telling someone, ’Look, you’ve got prediabetes, you need to make some lifestyle changes,’ just hopes and prays that the patient goes out and does it,” said Sean Duffy, co-founder and CEO of <a href="https://www.omadahealth.com/" rel="nofollow" target="_blank">Omada Health</a>, a San Francisco-based digital health startup. “But deep down they know that without the right support, there’s not likely going to be success.”</p> <p> So Omada has <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-patients-active-approach-diabetes-fight-online">partnered</a> with the AMA and <a href="https://intermountainhealthcare.org/" rel="nofollow" target="_blank">Intermountain Healthcare</a>, a Salt Lake City-based health system, to integrate Omada’s Program —one that goes online to overcome challenges of geography but that features a social experience similar to what a patient experiences in an in-person program—into the health system setting at Intermountain.</p> <p> <strong>Diabetes prevention must-haves: Simplicity and support</strong></p> <p> From a user-experience standpoint, the goal of the program is to include all of the instruments patients need to take action, as well as to remove any barriers to their use of the tools and support.</p> <p> When they begin the Omada program, each patient receives a welcome package that includes a wireless scale with an embedded cellular chip linked to the patient’s profile. The scale requires no setup beyond inserting the included batteries. Then, patients just step on the scale, and it instantly transmits their data, providing a baseline weight and a benchmark for progress in the program.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/13/91c11dc0-5fc8-4b76-8d6d-2cfc49657659.Full.png?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/13/91c11dc0-5fc8-4b76-8d6d-2cfc49657659.Large.png?1" style="margin:15px;float:right;" /></a></p> <p> But even the smartest, simplest technology wouldn’t be enough on its own. What makes Omada different from many other online DPPs is its human touch.</p> <p> “A lot of what’s needed for these intense programs used to only be available in person,” Duffy said. “That includes peer support, camaraderie, feeling like you’re not alone—a lot of the emotional dynamics that are involved in making lifestyle change successful and sustainable.”</p> <p> On the first day of the new-group kickoff, patients log in to the website and meet their personal health coach via live streaming or a recorded video. The coach’s job is to monitor their progress and give feedback in real time. Patients can then reach the coach at any time by private messaging, a group discussion board, text message, phone or video chat.</p> <p> The program features a food and activity tracker, where participants enter what they are eating, drinking and doing each day. Graphics indicate each person’s progress toward their five-to-seven percent weight-loss goal. The site also features “healthy competition” to help motivate patients and make them feel accountable to the group. As participants move along in the curriculum, they receive additional tools, such as a digital pedometer, to keep them motivated and aid their progress.</p> <p> <strong>Two phases meet patients’ changing needs</strong></p> <p> “We think of our program a lot like a symphony, where all these programs need to feel emotionally moving in the same way that Beethoven’s Fifth feels emotionally moving,” Duffy said. “You wouldn’t be able to create that feeling with just a bassoonist–you need all the instruments. Those are the scale, the coach, the group, the curriculum, the timeline, the goal setting, the food and activity tracking. And you can’t just have all the instruments play at once. You need them to play on a timeline—and you need someone conducting the symphony.”</p> <p> The proprietary curriculum, which was approved by the CDC’s Diabetes Prevention Recognition Program, is broken into two phases: Foundations and Focus. During Foundations, which lasts 16 weeks, patients are asked to complete one interactive health lesson each week. These tackle the physiological, social and psychological factors that may contribute to prediabetes. Key concepts are then reinforced through interactive games that give participants opportunities to apply what they are learning in real-life scenarios.</p> <p> Each participant and his or her coach have access to a private progress page, and each time the participant steps on the scale, a new data point is automatically added to their profile. Eighty percent of people who start the Foundations program successfully complete it, and a third lose more than seven percent body weight. Average weight loss after six months in the program is right around five percent.</p> <p> Once participants complete Foundations, they graduate into the Focus phase, designed to help them maintain their new habits over time. Each patient continues to get individual attention from a health coach, but they also join a broader peer support group and an expanded curriculum that focuses on overcoming real-life obstacles to staying healthy long term.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/11/e6abceac-1323-4d74-8b66-c57c2e2d4fa2.Full.png?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/11/e6abceac-1323-4d74-8b66-c57c2e2d4fa2.Large.png?1" style="margin:15px;float:left;" /></a><strong>The right partners and the right patients</strong></p> <p> The partnership with Omada and Intermountain expands on the <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes/prevent-diabetes-stat.page">AMA’s efforts to prevent type 2 diabetes</a> by giving physicians new tools and resources to better manage at-risk patients. It will create a roadmap for health care organizations across the country to integrate proven online prevention programs into physician referrals and clinical workflows.</p> <p> Before working with the AMA and Intermountain, Omada partnered primarily with health plans and employers, because those organizations hold the most financial risk when it comes to health care. In taking the next step and rolling out the program to health systems and partnering with an established group like the AMA, Omada sought to better integrate the program into the clinical workflows of hospitals, doctors and care teams. Intermountain fit the profile for a few reasons.</p> <p> For starters, Duffy noted, it’s a very forward-leaning company in the areas of prevention-oriented and value-based care, having recognized, as the <a href="http://www.nytimes.com/2016/02/18/business/a-novel-plan-for-health-care-cutting-costs-not-raising-them.html?_r=0" rel="nofollow" target="_blank"><em>New York Times</em></a> noted, that costs can be brought down by providing more care at the right times.</p> <p> But Intermountain was also an attractive partner because it has a largely rural patient population, which by its very nature is difficult to reach with in-person DPPs, and one in which prediabetes is prevalent. It’s estimated that more than 114,000 people in Intermountain’s service area have the condition.</p> <p> “For a big health system like Intermountain, that’s a clinical epidemic,” Duffy said. “At the same time, it’s an economic imperative, because they know as soon as someone who does not have diabetes proceeds to type 2, they’re going to cost their health care payer on average $8,000 to $10,000 more every year to treat.”</p> <p> <strong>Making referrals “one-clickable”</strong></p> <p> The goal is to initially enroll 250 patients in the program, which will have three phases. The first, which is now complete, involved determining which patients were eligible.</p> <p> The second and current phase is the referral piece, which involves determining which outreach approaches could be used to get patients into the program.</p> <p> The third phase will involve designing those outreach approaches, setting them up in physicians’ offices and then making sure Omada is delivering actionable information back to those care teams to create personalized patient plans.</p> <p> “What is the better version of the classic pamphlet that someone could leave with to learn more about the program?” Duffy asked, “… and how do we help doctors to communicate the key elements of the program in the way that is most likely to get the person to take action?”</p> <p> Omada and Intermountain will also exploit conventional channels like phone and fax to enable physicians’ offices to refer patients into the program directly. Plus they will explore EHR trigger referrals, so providers could set up Omada as an outpatient referral in the same way that they would order a visit with a specialist or send a patient to a lab for bloodwork.</p> <p> “We want to make this one-clickable,” Duffy said. “We want to get to the point where, when a provider is seeing a patient that is the right clinical fit for these programs, they can instantaneously refer.”</p> <p> <strong>Writing a best-practices playbook</strong></p> <p> Once they start enrolling patients, Duffy notes, it will be imperative to start getting data back to learn what kind of information—and what level of detail—best enables providers to take additional action.</p> <p> “That’s what the partnership is all about,” said Duffy, “finding ways that we can effectively create a referral system into a DPP and, at the same time, create a feedback loop where physicians get information as their patients go through the program that can impact the whole care plan.”</p> <p> “And that’s why we’re so excited about AMA’s participation, to come away with a best-practices playbook for how you can integrate a digital health solution into a clinical workflow. The implications of that are really widespread and exciting.”</p> <p> <strong>Learn more about the AMA’s work on diabetes prevention:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/groundbreaking-effort-prevent-diabetes-announced" target="_self">“Groundbreaking effort” to prevent diabetes announced</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/awareness-of-risk-status-key-prevention-of-diabetes" target="_self">Awareness of risk status key to prevention of diabetes</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physician-tested-tools-can-improve-patients-health" target="_self">Physician-tested tools can improve patients’ health</a></li> <li> <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes/prevent-diabetes-stat.page" target="_self">Prevent Diabetes STAT: Screen, Test, Act – Today™</a></li> <li> <a href="https://doihaveprediabetes.org/" rel="nofollow" target="_self">Do I have prediabetes?</a></li> </ul> <p>  </p> <p align="right"> <em>By AMA staff writer Tim Smith</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4dfdf38d-6607-4809-8250-141e56e257bb Working upstream to achieve the quadruple aim http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_working-upstream-achieve-quadruple-aim Fri, 02 Sep 2016 21:00:00 GMT <p> “None of us went into this work to achieve mediocrity, to achieve a sub-standard level of care,” said Rishi Manchanda, MD. “We’re in it for excellence. For professional satisfaction. For joy at work. For impact.” Although Dr. Manchanda was speaking to medical and health professions students at a recent AMA <a href="http://www.changemeded.org/" rel="nofollow" target="_blank">Accelerating Change in Medical Education Consortium</a> meeting, his talk held lessons for physicians at every stage of their careers.</p> <p> In fact, he said, the key to achieving satisfaction is achieving a higher standard of care. And he had advice for how to do that.</p> <p> “The better stream of care we can achieve has to involve understanding upstream issues,” he said. Upstream issues are the general socio-economic, cultural and environmental conditions—including living and working conditions, social and community networks and individual lifestyle factors—that lead to health problems and health care utilization downstream.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/8/90b877e8-e5be-4190-a863-e123190513f2.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/8/90b877e8-e5be-4190-a863-e123190513f2.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Dr. Manchanda, an internist and pediatrician and the president of <a href="http://www.healthbegins.org/" rel="nofollow" target="_blank">HealthBegins</a>, a provider of upstream tools and resources, was speaking at the student-led Health Equity and Community-based Learning meeting hosted by the University of California, Davis, School of Medicine. His presentation, “Upstreamist Doctors,” focused on achieving the quadruple aim: better care, lower total medical costs, more satisfied patients and more satisfied physicians.</p> <p> The key, he said, is the integration of social determinants in health care.</p> <p> <strong>Social determinants do affect public health</strong></p> <p> “Health care providers in the U.S. right now have no choice but to understand upstream issues better because there hasn’t been adequate investment in other social services,” Dr. Manchanda said. “Unlike all of our peer nations, we have more spending on health care than social services. That actually creates a scenario where you have a doctor talking about moving upstream.”</p> <p> To illustrate his point, he cited a pilot medical-legal partnership he initiated while serving as lead physician for homeless primary care at the VA West Los Angeles Medical Center.</p> <p> The challenge was how to provide better access to care and improve outcomes for high-utilizer homeless veterans. Instead of looking to add health care professionals to his staff, he brought in a public interest lawyer once a week to work with patients to identify unmet legal needs that were the drivers of their poor outcomes.</p> <p> “[For example], if you have a jaywalking ticket and that ticket goes unpaid, it becomes a misdemeanor,” he said. “That record now prevents you from getting housing.”</p> <p> The pilot cost the VA $525 per homeless veteran, but it had a return of more than six to one in disability and other cash benefits paid to patients. One hundred thirty-nine veterans participated in the program.</p> <p> “That’s over half a million dollars in benefits. If you’re a guy who can’t afford an apartment, consider what $3,600 does for you in terms of creating economic opportunity,” Dr. Manchanda said, adding that, over the 11-month span of the pilot, health care utilization decreased by 24 percent.</p> <p> “Is this better care? Is this a glimpse into the quadruple aim?” he asked the students. “Yes, when you see the quadruple aim in front of you, you have to name it. If you don’t name it, you forget it. If you forget it, you can’t replicate it.”</p> <p> Without integrating social determinants, he added, physicians are working with one hand behind their backs, and the quadruple aim cannot be achieved. But he’s confident many providers and policy makers are coming around to this idea.</p> <p> “Even though I’m a primary-care-trained provider, I’m not a specialist or a comprehensivist. I view myself as an upstreamist,” he said. “If we don’t name what we are as upstreamists, it’s hard for us to learn best practices, share them and actually amplify our impact.”</p> <p> <strong>For more on addressing social determinants in practice:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/death-zip-code-address-matters-genetics" target="_self">Death by ZIP code: When address matters more than genetics</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/students-deliver-care-homes-communities" target="_self">Students deliver care in homes, communities</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/volume-value-one-health-system-making-change" target="_self">From volume to value: How one health system is making the change</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/ways-chicago-health-network-improving-community-health" target="_self">Ways a Chicago health network is improving community health</a></li> </ul> <p align="right"> <em>By AMA staff writer Tim Smith</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:fc09e724-7d0c-454b-874f-ff8ba096baf1 A simple tool to ensure treatment plan effectiveness http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_simple-tool-treatment-plan-effectiveness Thu, 01 Sep 2016 21:15:00 GMT <p> The patient-physician relationship is a partnership that requires a two-sided dialogue in order to decide on the most effective treatment options. The Choosing Wisely® campaign from the American Board of Internal Medicine (ABIM) aims to promote conversations between patients and physicians to choose evidence-supported, low-risk, necessary care that is not duplicative of other tests or procedures already completed.</p> <p> Physicians want their patients to be well informed because it only makes their partnership in shared decision-making stronger. The goal of Choosing Wisely is not only to foster a conversation between physician and patient that helps them discuss when a test or procedure might not provide benefit to a particular patient but also to give patients the courage to question why a test or procedure is being done and what might be the potential benefits or harm.</p> <p> The campaign gathered more than 70 professional societies to create lists of “<a href="http://www.choosingwisely.org/doctor-patient-lists/" rel="nofollow" target="_blank">Things Providers and Patients Should Question</a>.” The recommendations cover tests, treatments and procedures commonly encountered in a variety of specialties, including:</p> <ul> <li> The American Society for Metabolic and Bariatric Surgery suggests avoiding routine postoperative antibiotics because extending the duration of prophylactic antibiotics may increase the risk of superinfection with Clostridium difficile and the development of antimicrobial resistance.</li> <li> The American Urogynecologic Society suggests avoiding the removal of ovaries at hysterectomy in pre-menopausal women with normal cancer risk because there is evidence from observational studies that surgical menopause may negatively impact cardiovascular health and all-cause mortality.</li> <li> The American Medical Society for Sports Medicine suggests that physicians avoid recommending knee arthroscopy as initial/management for patients with degenerative meniscal tears and no mechanical symptoms because degenerative meniscal tears may respond to non-operative treatments.</li> </ul> <p> The examples in the lists offer comprehensive guidance that can help physicians avoid procedures and tests that may not be necessary, and each bit of advice is supported by evidence detailed in the lists.</p> <p> <strong>How to use Choosing Wisely in practice</strong></p> <p> Though the lists are thorough and hold valuable, physician-authored recommendations, actively using them in practice means a slight change in culture and procedure.</p> <p> A new <a href="https://www.stepsforward.org/modules/choosing-wisely" rel="nofollow" target="_self">module</a> from the AMA’s <a href="https://www.stepsforward.org/" rel="nofollow" target="_self">STEPS Forward™</a> collection of practice improvement strategies offers steps that can help you implement Choosing Wisely into your practice:</p> <p style="margin-left:40px;"> <strong>1.   </strong><strong>Engage your physicians and medical staff</strong><br /> Centering the conversation around patient benefits will resonate more than discussions of waste and cost reduction. Pilot Choosing Wisely in one disease area or with one diagnosis first and see how it works before expanding.<br /> <br /> The recommendations are conversation starters, not mandates. As always, medical decision-making is based on the patient’s best interest. Remember, unique circumstances for individual patients may mean deviating from the recommendations.</p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>Engage your patients</strong><br /> The success of these materials depends on your ability to involve patients in a dialogue about the purpose of tests, treatments and procedures so they have a clear understanding of what’s necessary, that’s not and what could cause them harm.<br /> <br /> Initiate the dialogue by demonstrating empathy for your patient’s desires, needs and concerns—their cues will tell you when they are ready for you to introduce decision aids or patient education, which can be found in the module.</p> <p style="margin-left:40px;"> <strong>3.   </strong><strong>Establish an implementation plan</strong><br /> Implementation could take the form of a formal educational program, as well as checklists and protocols to help standardize the new processes. You may even choose to work with your IT department to embed Choosing Wisely recommendations into clinical decision support tools within the electronic health record (EHR).<br /> <br /> However, remember that the recommendations are intended to be starting points for conversation, not rigidly imposed guidelines and they should be treated as such if embedded in the EHR.<br /> <br /> To educate your practice, consider using the physician communication modules from Choosing Wisely. Physicians and medical staff can watch the videos and work through the modules during a scheduled team meeting.</p> <p style="margin-left:40px;"> <strong>4.   </strong><strong>Use data to understand and improve performance</strong><br /> Tracking and reporting will help determine the effectiveness Choosing Wisely is having on your practice. Sharing peer comparison data over time is one of the strongest interventions available for change, and should be part of any strategy.<br /> <br /> Ideas for improvement could come from reviewing data in your EHR, pre-printed order sheets, standing orders or ideas from your team members. Target the tests you suspect may be overused, inconsistently used or harmful to patients.<br /> <br /> Consider starting with clinical areas where the frequency of overuse is highest, such as lab testing or imaging. Another target area is any area where large amounts of variation exist. Review common tests and treatments by physician, establish a baseline and then compare and contrast to identify variability.</p> <p> There are seven new modules now available from the AMA’s STEPS Forward™ collection, bringing the total number of practice improvement strategies to 42, thanks to a grant from and collaboration with the <a href="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" rel="nofollow" target="_blank">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:aaff4dc5-6d9c-4c0f-a6d3-56626ac369ac Doctors who serve: Becoming a Navy flight surgeon http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_doctors-serve-becoming-navy-flight-surgeon Thu, 01 Sep 2016 02:19:00 GMT <p class="p1"> Physicians have a long history in the military from treating disease in the Civil War to treating battle wounds in field hospitals in Afghanistan. One emergency medicine resident is training now to become a Naval flight surgeon, and when he completes training, he will attach to a jet and helicopter squadron and deploy with those soldiers as their front line physician. Wherever they go, he will go—and then he will return to residency training.</p> <p class="p1"> After doing a one-month rotation in flight surgery last year with the Navy where he spent time on an aircraft carrier and steered a helicopter over the water, Josh Lesko, MD, a former emergency medicine intern in the Navy, decided it was right up his alley and headed to Pensacola, Fla., to continue his training. </p> <p class="p1"> “There are a couple of things that have a reputation—one is called 'the dunker,' which is where you are strapped into a helicopter simulator and it’s allowed to sink,” Dr. Lesko said. “When helicopters sink, they turn upside down. So we are about ten feet underwater strapped into the helicopter and have to learn how to get out with full gear on, with black out goggles so we can’t see … to simulate all the different ways we might be in a helicopter when it goes down.”</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/13/4ff0fbe9-88e0-42fe-ad1e-2fa1b198ddce.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/13/4ff0fbe9-88e0-42fe-ad1e-2fa1b198ddce.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p class="p1"> <b>Training to serve those who serve</b></p> <p class="p1"> There are three tracks for resident physicians in the Navy who decide to complete an operational tour before finishing training. The first, <a href="https://www.navy.com/careers/healthcare/medicine.html%22%20%5Cl%20%22ft-specialties-subspecialties" rel="nofollow" target="_blank"><span class="s1">General Medical Officer</span></a>, is a physician on a ship or in a clinic. The second, <a href="http://www.med.navy.mil/sites/nmotc/numi/UMOApply/Pages/default.aspx" rel="nofollow" target="_blank"><span class="s1">Undersea Medical Officer</span></a>, is a physician attached to a dive unit. And the third, <a href="http://www.med.navy.mil/sites/nmotc/nami/academics/Pages/FlightSurgeon.aspx" rel="nofollow" target="_blank"><span class="s1">Flight Surgeon</span></a>, is a physician attached to a flight squadron—which is what Dr. Lesko is training to be. </p> <p class="p1"> Several options exist for a flight surgeon, he said. There’s the opportunity to go with the Marines in one of their squadrons as well as isolated helicopter and jet squadrons, which usually have a couple hundred people in the unit. </p> <p class="p1"> “Then there are the Carrier Air Groups, which is what I want to be attached to,” he said. “In that case, you are one of two flight surgeons for six or seven different squadrons that comprise both of jets and helo[copters]. So you are on an aircraft carrier when you deploy.”</p> <p class="p1"> For flight surgery training, which is treated as a break from residency, Navymen go through three stages. The first phase is the same training that pilots and flight officers go through, which is five weeks of academic work on aerodynamics, weather, navigation, engines, flight rules and regulations.</p> <p class="p1"> In the second phase, called primary, they learn how to fly a plane and a helicopter. In the third phase, they spend six weeks learning physiology in abnormal conditions—or aerospace medicine—which teaches the medical trainees how to be better physicians specifically for this unique subset of pilot patients that they will be treating. </p> <p class="p1"> “It’s more than just classes,” Dr. Lesko said. “There’s a water survival component where we have to learn how to evacuate from a theoretical sinking ship … emergency egress from a helicopter that’s submerged, and more specific aeronautical tactics.”</p> <p class="p1"> “In the Air Force and the Army they don’t do the flight component,” Dr. Lesko said. “But the Navy’s belief is that to really understand what the pilots are going through and be part of the community we have to go through the same training as they do.”</p> <p class="p1"> For the majority of flight surgery residents there is a program called the Health Profession and Scholarship Program (HPSP). Residents apply to HPSP simultaneously with medical school, but residents also choose a military branch. If selected for HPSP, tuition and required costs are covered. In return, the resident owes “a year for a year” of service to that military branch. Residents in civilian programs often apply after or during residency. .</p> <p class="p1"> “We are really the first line for our squadron,” Dr. Lesko said. “We are their doctor; wherever they go, we go. Any incidents that happen on a plane or on a ship we have to handle. So we’re their clinic doc, but we’re also the safety officer and are part of any investigation into a crash to see if there was a human component that was at fault.”</p> <p class="p1"> <b>Physicians who deploy around the world</b></p> <p class="p1"> Any military aircraft that flies will have a flight surgeon attached to it. Marine One, the President’s helicopter, has a flight surgeon dedicated to it. There are international billets in Japan, Italy, Spain, Bermuda, the United Kingdom, and all over the United States. </p> <p class="p1"> “You’re going to be in a cool place and doing something fantastic,” Dr. Lesko said. “It’s an honor to be able to treat and serve those who serve and really be there for them and be a part of the mission of the Navy as a global force for good.” </p> <p class="p1"> “That’s part of the appeal,” he said. “One of my attendings put it best: What separates us from civilian doctors? Are we just doctors who wear uniforms or are we doctors who are out there training with them and deploying when they deploy? That’s what helped me make up my mind about flight surgery.”</p> <p class="p3" style="text-align:right;"> <i>By AMA staff writer</i> <a href="https://twitter.com/Troy_AMAWire%22%20%5Ct%20%22_blank" rel="nofollow"><span class="s2"><i>Troy Parks</i></span></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f15a93fe-610a-4845-abc6-a39e22bbf0de Precision medicine: What to know about cell-free DNA screening http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_precision-medicine-cell-dna-screening Wed, 31 Aug 2016 08:00:00 GMT <p> With more women seeking tests for common chromosome conditions in pregnancy, many are now opting for newly developed non-invasive cell-free DNA (cfDNA) screening. But like all screening tests, it has limitations and isn’t appropriate for all patients. Find out how cfDNA works and which of your patients may benefit from the screening.</p> <p> A <a href="https://cme.ama-assn.org/Activity/4435528/Detail.aspx" target="_blank">new continuing medical education (CME) module,</a> developed by AMA in partnership with Scripps Translational Science Institute and The Jackson Laboratory, is helping physicians understand what the test detects, which patients benefit most from it, what to consider when ordering the test and a lot more.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/2/be794bfb-b040-4105-9291-c8956c38cb98.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/2/be794bfb-b040-4105-9291-c8956c38cb98.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>First, how cfDNA screening works</strong></p> <p> Prenatal cfDNA screening detects small fragments of fetal DNA released by placental cells into the mother’s blood stream. cfDNA screening looks for a relative increase or decrease in specific regions of the fetal DNA that would suggest the presence of a chromosome condition.</p> <p> The screening is now being offered for trisomies 21, 18 and 13. Some tests also include sex chromosome conditions and a few conditions caused by chromosomal micro-deletions or micro-duplications, but research is still underway to verify their clinical validity. Unlike other maternal serum screening tests, cfDNA cannot detect structural birth defects, so additional testing may be necessary.</p> <p> Screening for cfDNA is not a diagnostic test, but rather a screening test. Results can only determine if a woman is at increased or decreased risk for chromosome conditions. If the results suggest an increased risk, more extensive diagnostic testing is needed.</p> <p> <strong>Who benefits most from it?</strong></p> <p> While originally offered only to women at high risk for chromosome conditions, many professional societies now support offering cfDNA screening to women in the general obstetric population. Women at high risk for chromosome conditions include those of advanced maternal age and women with a positive screening test or who have a previous child with a chromosome condition.</p> <p> The <a href="https://cme.ama-assn.org/Activity/4435528/Detail.aspx" target="_blank">CME module</a> covers numerous topics to help physicians determine if prenatal cfDNA screening is right for a patient, including:</p> <ul> <li> Benefits and limitations of the test</li> <li> Interpreting results</li> <li> Considerations when ordering the test</li> <li> Indications and contraindications</li> <li> Counseling women who are considering the test</li> </ul> <p> The module also features point-of-care guidance about prenatal cfDNA screening, access to a predictive value calculator, comparisons of cfDNA screening to other prenatal screening and testing options and other tools for physicians, including resources physicians can share with patients.</p> <p> <strong>Test your knowledge: A case study</strong></p> <p> Megan is 30 years old and at 12 weeks gestation in her first pregnancy. She is worried about invasive testing but still wants to learn as much as possible about pregnancy risks. She read online about cfDNA screening and is interested in cfDNA as an alternative for chorionic villus sampling (CVS) or amniocentesis. What would you tell Megan about whether cfDNA screening is appropriate for her? Can cfDNA screening take the place of CVS or amniocentesis?</p> <p> Case studies like these are included in the module and enable you to test your knowledge of cfDNA and practice applying it to patient scenarios. </p> <p> You can also dig deeper into the benefits and limitations of cfDNA screening, find answers to logistical issues—like how to work with genetics experts and how to find labs that offer the test—and easily compare cfDNA screening to other prenatal testing options.</p> <p> The prenatal cfDNA screening module is the second in the Precision Medicine for Your Practice education series. Genetic testing is a key element of precision medicine, a tailored approach to health care that accounts for the individual variability in the genes, environment and lifestyle of each person.</p> <p> <a href="http://www.ama-assn.org/ama/ama-wire/post/much-carrier-screening">The first module</a>, covering expanded carrier screening, was released in July. Future topics will include precision medicine and its applications in oncology, neurology and cardiology.</p> <p> <strong>Find out more about precision medicine:</strong></p> <ul> <li> <a href="https://cme.ama-assn.org/Activity/4320591/Detail.aspx" target="_blank">Precision Medicine For Your Practice: Expanded Carrier Screening module</a></li> <li> <a href="https://download.ama-assn.org/resources/doc/csaph/x-pub/a16-csaph3.pdf" target="_self">The Precision Medicine Initiative: Report of the AMA Council on Science and Public Health</a></li> <li> <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/precision-medicine.page" target="_self">What is precision medicine?</a></li> <li> <a href="http://www.ama-assn.org/ama/pub/physician-resources/medical-science/genetics-molecular-medicine/education-research.page" target="_self">Personalized medicine resources for physicians</a></li> </ul> <p align="right"> <em>By AMA staff writer Tim Smith</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c27e6123-b02f-4fe4-82be-bdd832fb31d5 Get the revised Code of Medical Ethics http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_revised-code-of-medical-ethics Tue, 30 Aug 2016 21:00:00 GMT <p> The AMA’s <em>Code of Medical Ethics</em> is regularly cited as the medical profession's authoritative voice in legal opinions and in scholarly journals. It was adopted at the first AMA meeting in 1847, and while much has changed in medicine since, this founding document—the first uniform code of ethics of its kind—is still the basis of an explicit social contract between physicians and their patients. At the AMA Annual Meeting this year, delegates voted to update the AMA <em>Code.</em></p> <p> The revised edition is the culmination of an eight-year project to modernize the AMA <em>Code's</em> ethical guidance for relevance, clarity and consistency. It represents the first comprehensive review of the AMA <em>Code</em> in more than half a century.</p> <p> One of the goals of the modernization was to make the AMA <em>Code</em> simpler to navigate and related opinions easier to find so that physicians could more readily apply it to their daily practice of medicine. Changes include:</p> <ul> <li> A more intuitive chapter structure so that guidance is easy to find</li> <li> A uniform format for opinions so that guidance is easy to read and apply</li> <li> A single, comprehensive statement on each topic</li> <li> Harmonized guidance on related issues</li> </ul> <p> The updated AMA <em>Code</em> also features a new preface to clarify the different levels of ethical obligation in the various ethical opinions.</p> <p> It is available in three formats: e-book, hard cover and commemorative. Visit the <a href="https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2770011&navAction=push#usage-tab" target="_blank">AMA Store</a> for more information or to order online. AMA members receive a 20 percent discount on this product and others from the AMA Store. If you’re not a member, <a href="https://commerce.ama-assn.org/membership/" target="_blank">join today</a>.</p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:53adb49a-a643-4c70-b539-add09a0e124c Peer-review confidentiality critical, but under threat http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_peer-review-confidentiality-critical-but-under-threat Tue, 30 Aug 2016 20:48:00 GMT <p> Without confidentiality, the peer-review process cannot be an effective tool for improving quality of care. A case before the Supreme Court of Pennsylvania could establish rules that narrow the scope of peer-review protected materials, harming the process.</p> <p> At stake in <em>Reginelli v. Boggs</em>, is whether the Pennsylvania Peer Review Protection Act (PRPA) privilege against legal discovery should apply when an independent contractor of a hospital reviewed the performance of a physician on the hospital’s medical staff.</p> <p> <strong>How the situation unfolded</strong></p> <p> Eleanor Reginelli presented to the emergency department at Monongahela Valley Hospital (MVH) with chest and back pains. Marcellus Boggs, MD, an emergency medicine physician at MVH, ordered and interpreted the results of an electrocardiogram and blood work. He diagnosed Mrs. Reginelli with gastro-esophageal reflux disease and discharged her that day.</p> <p> Five days later, Mrs. Reginelli experienced the same symptoms. An ambulance transported her to the emergency department of a different hospital where she was told she was experiencing a heart attack. She subsequently suffered permanent heart damage.</p> <p> Dr. Boggs was an employee of Emergency Resource Management, Inc. (ERMI), which had been hired as an independent contractor to staff MVH’s emergency department. Mrs. Reginelli and her husband sued Dr. Boggs, MVH and ERMI for medical liability.</p> <p> As part of discovery in the case, the plaintiffs deposed Brenda Walther, MD, the medical director of the MVH emergency department and an ERMI employee. Dr. Walther disclosed that she maintained a performance file on Dr. Boggs, which included peer-review evaluation required by ERMI.</p> <p> The plaintiffs called on MVH to produce the evaluation file, but MVH objected based on a claim of peer-review privilege in the PRPA. The trial court ordered production of the file, finding that MVH could not claim privilege for a document it had neither generated nor maintained. On appeal, the Pennsylvania Superior Court affirmed and the case is now on appeal before the Pennsylvania Supreme Court.</p> <p> <strong>An agreement for unity in providing quality care</strong></p> <p> A 2010 “Emergency Department Services Agreement” outlined the relationship and respective duties between MVH and ERMI, noting that the hospital wished to have ERMI provide certain services to facilitate the operation of the emergency department, including the provision of qualified emergency medicine physicians.</p> <p> The agreement also included materials on quality improvement and peer-review. ERMI was to conduct clinical reviews and provide regular reports to the hospital for its peer-review process. Hospitals commonly use independent contractors to fulfill staffing needs, and those employees then become members of the hospital staff as well as the contractor.</p> <p> ERMI is a medical practice in the specialty of emergency medicine. During the contract’s term, it was the sole provider of emergency service to MVH. Dr. Walther, the ERMI employee who served as the emergency department’s medical director, was effectively the department chairman for MVH as well.</p> <p> Monitoring physician performance and sharing the results was an integral part of measuring compliance with and achieving the quality of care goals. ERMI did not make decisions independently of MVH, and MVH could unilaterally choose not to re-credential a physician when it thought that action was warranted.</p> <p> <strong>Medical organizations take a stand</strong></p> <p> “Peer review is an important tool in improving the quality of health care,” said the <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page" target="_self">Litigation Center of the AMA and State Medical Societies</a> in an amicus brief defending the PRPA. “The willingness to criticize peers that an effective review process requires cannot occur without ironclad confidentiality.”</p> <p> “Here, the medical director of a hospital emergency department reviewed treatment records of a department physician,” the brief said. “That is the paradigm for protected activity under the Peer Review Protection Act.”</p> <p> The Superior Court erred in concluding that ERMI had destroyed any privilege that may have existed by sharing Dr. Boggs’ performance file with MVH, the brief said. This fails to recognize the cooperative nature of the MVH-ERMI agreement. MVH chose to have the person best suited to evaluate the competency of the emergency department physicians, the department’s medical director, perform the reviews.</p> <p> Both Dr. Walther and Dr. Boggs worked for a third party with whom the hospital had contracted to run and staff the emergency department. “Superior Court incorrectly thought that the entity’s status as an independent contractor deprived its work product of protection,” the brief said. “Nothing in the [PRPA] imposes that rule.”</p> <p> “The performance review of a hospital emergency department physician by its medical director is a peer review-protected activity,” the brief said. “It is irrelevant that the hospital had contracted with a third party to staff and run the emergency department.”</p> <p> <strong>Current medical liability cases in which the Litigation Center is involved:</strong></p> <ul> <li> Find out how a <a href="http://www.ama-assn.org/ama/ama-wire/post/challenge-medical-liability-law-could-complicate-pre-suit-process?utm_source=BulletinHealthCare&utm_medium=email&utm_term=081316&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend" target="_self">challenge to medical liability law could complicate pre-suit process</a>.</li> <li> Learn how a case <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-lead-unlimited-awards-of-punitive-damages" target="_self">could lead to unlimited awards of punitive damages</a>.</li> <li> Get the details on a <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-extend-medical-liability" target="_self">case that could extend medical liability</a>.</li> <li> Find out how one case could <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-increase-liability-exposure-redefine-injury" target="_self">increase liability exposure and redefine injury</a>.</li> <li> Learn what one case <a href="http://www.ama-assn.org/ama/ama-wire/post/liability-suit-seeks-change-informed-consent" target="_self">intends to change about informed consent</a></li> </ul> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow">Troy Parks</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d5b2f266-97f1-49da-8693-d10556e4ef5d 7 takeaways from ethics of image-sharing pathology tweet chat http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_7-takeaways-ethics-of-image-sharing-pathology-tweet-chat Mon, 29 Aug 2016 22:00:00 GMT <p> As pathologists embrace image-sharing on social media for educational and informational purposes, patient privacy can be a concern. How can pathologists navigate the tumultuous waters of the digital world while still reaping the benefits? A recent tweet chat gathered the answers and resources.</p> <p> The <a href="http://journalofethics.ama-assn.org/" target="_blank"><em>AMA Journal of Ethics</em></a> (@<em>JournalofEthics</em>) joined the AMA (@AmerMedicalAssn) to co-host a tweet chat with two expert pathologists.</p> <p> Genevieve (Eve) Crane, MD, (@EveMarieCrane) is a research/clinical fellow in the Dept. of Pathology and the Children's Research Institute at UT Southwestern Medical Center in Dallas pursuing stem cell research and serves as a section editor for social media at the <em>Archives of Pathology & Laboratory Medicine</em> and as an ambassador for the United States and Canadian Academy of Pathology.</p> <p> Jerad M. Gardner, MD, (@JMGardnerMD) is an assistant professor at the University of Arkansas for Medical Sciences (UAMS), where he practices dermatopathology and sarcoma pathology. He is chair of social media for the United States and Canadian Academy of Pathology (USCAP) and the American Society of Dermatopathology (ASDP). He is deputy editor-in-chief at <em>Archives of Pathology & Laboratory Medicine </em>and manages social media for the journal. </p> <p> Here are the top seven questions from the tweet chat, along with resources that can help you in your practice:</p> <p> <strong>1. Why is image-sharing useful for pathologists on social media, and what are some potential ethical pitfalls?</strong></p> <p> Takeaway: It can enable free, global teaching of pathology and facilitate recognition of the rarest conditions, but patient-identifying details must never be posted. Consult <a href="http://cphs.berkeley.edu/hipaa/hipaa18.html" target="_blank" rel="nofollow">the list of 18 HIPAA identifiers</a>.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/12/885c4d7a-23b7-435f-ac3f-5b705099a734.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/12/885c4d7a-23b7-435f-ac3f-5b705099a734.Large.png?1" /></a></p> <p> <strong>2. What inspired you to write the article? Are there problematic situations you wanted to respond to?</strong></p> <p> Takeaway: Those who make institutionalrules are often neither doctors nor Twitter-savvy. In addition, there is a lot of apprehension around sharing images, and even some legal departments are not sure what is legal or ethical.</p> <p> “I wanted to have published literature to use when others claim #SoMe not good for #MedEd,” Dr. Gardner tweeted.</p> <p> “I also feared lack of guidelines and good info would result in unnecessary restrictions,” Dr. Crane tweeted.</p> <p> <strong>3. You wrote the following in your recent article. How does that play out, especially on social media? </strong></p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/15/e06c08c6-394f-4b3a-af11-440cc914a772.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/15/e06c08c6-394f-4b3a-af11-440cc914a772.Large.png?1" /></a></p> <p> Takeaway: Pathologists see the mechanisms underlying most diseases social media might bring out the teacher in all of us, but the format is particularly powerful for pathology.</p> <p> “We see mechanism underlying most diseases,” Dr. Gardner tweeted. “All docs want to know WHY. We can show/explain why.”</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/5/043e12fa-09c1-4f1b-b55d-f66f0609c965.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/5/043e12fa-09c1-4f1b-b55d-f66f0609c965.Large.png?1" /></a></p> <p> <strong>4. Are there situations where a pathology image shouldn’t be shared on social media? Give an example?</strong></p> <p> Takeaway: The image should not be shared any time the pathology is linked to a high-profile event, such as a widely reported crime or the death of a celebrity.</p> <p> The <em>AMA Journal of Ethics®</em> offered an article from the August 2016 issue, “<a href="http://journalofethics.ama-assn.org/2016/08/msoc2-1608.html" target="_blank">Public Figures, Professional Ethics, and the Media,”</a> which discusses the death of superstar musician Prince and how the media’s coverage led to the release of his medical records. </p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/5/b6b266d1-52fc-4480-b58f-7d7ca0791f11.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/5/b6b266d1-52fc-4480-b58f-7d7ca0791f11.Large.png?1" /></a></p> <p> <strong>5. What are some of the merits/drawbacks of social media vs. print-based journal case reporting?</strong></p> <p> Takeaway: Among the merits: It has faster publication, reaches a broader audience and provides ongoing discussion. One of its drawbacks is that it is not peer-reviewed.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/1/ced60644-da12-4c4c-81da-21e4c347127b.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/1/ced60644-da12-4c4c-81da-21e4c347127b.Large.png?1" /></a></p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/10/6b22db0a-5e06-442b-9aff-6e8da263dcfc.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/10/6b22db0a-5e06-442b-9aff-6e8da263dcfc.Large.png?1" /></a></p> <p> <strong>6. What are some takeaways for how other clinicians should use social media?</strong></p> <p> Takeaway: Social media is a powerful way to interact with other physicians and the public, plus it can play a crucial role in patient-centered research and engaging patients.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/3/3eb59747-c0fc-4bcd-93b8-bb301679ccca.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/3/3eb59747-c0fc-4bcd-93b8-bb301679ccca.Large.png?1" /></a></p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/5/ef7977a3-8cd7-4e8c-852a-ae8a4dab6492.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/5/ef7977a3-8cd7-4e8c-852a-ae8a4dab6492.Large.png?1" /></a></p> <p> <strong>7. Do the challenges of online sharing via social media differ across platforms (i.e. Facebook, Twitter, Figure1)?</strong></p> <p> Takeaway: The privacy concerns are the same across platforms, but it is important to know each platform’s audience and tailor your approach accordingly.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/10/f26ebdcd-3bd4-4252-aa7b-ac24c27677ee.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/10/f26ebdcd-3bd4-4252-aa7b-ac24c27677ee.Large.png?1" /></a></p> <p> If you missed the tweet chat, visit <a href="https://storify.com/AmerMedicalAssn/the-ethics-of-image-sharing-social-media-and-patho" target="_blank" rel="nofollow">the Storify for this #AHealthierNation chat</a> to see all of Dr. Crane’s and Dr. Gardner’s answers and tweets from participants in a chronological recap of the event.</p> <p> You can also check out Drs. Crane and Gardner's recent article published in <em>AMA Journal of Ethics</em>, <a href="http://journalofethics.ama-assn.org/2016/08/stas1-1608.html" target="_blank">"Pathology Image-Sharing on Social Media: Recommendations for Protecting Privacy While Motivating Education."</a></p> <p align="right"> <em>By AMA staff writer Tim Smith</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9ed0874c-3568-4754-899e-8ef9e0555b3e Interactive tool reveals where physicians are needed http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_interactive-tool-reveals-physicians-needed Mon, 29 Aug 2016 20:00:00 GMT <p> The distribution of the health care workforce has major implications for residents, physicians, advocates, policymakers and, of course, patients. An updated mapping tool can help you better grasp that distribution and how it relates to population health and professional opportunities.</p> <p> The AMA <a href="http://www.ama-assn.org/ama/pub/advocacy/state-advocacy-arc/health-workforce-mapper.page#free-tool" target="_self">Health Workforce Mapper Version 2.0</a> is a customizable, interactive tool that illustrates the geographic distribution of the health care workforce. Users can filter physician and non-physician health care professionals by specialty and employment setting at the state, county and metropolitan levels.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/12/15af7f30-449f-46df-8c48-922ab843ea56.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/12/15af7f30-449f-46df-8c48-922ab843ea56.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> The mapper also features geographic and policy data relevant to the health care workforce, including health professional shortage areas, hospital locations and population indicators. This data can be used to:</p> <ul> <li> Help residents determine which regions are most in need of physicians in their given specialty</li> <li> Help practices distinguish possible areas of both deficiency and overlap and identify high-priority areas for workforce expansion</li> <li> Help advocates demonstrate to policymakers the geographic distribution of the health care workforce to assist them in making appropriate, evidence-based decisions</li> </ul> <p> For example, with just three clicks, a user could determine that 49 of Ohio’s 88 counties lack a single geriatrician; that 18% of Belmont County’s 70,000 residents are over the age of 65; and that Delaware County’s population increased more than 58% from 2000 to 2010.</p> <p> Basemaps provide further detail in the form of geographic features, highways, health care facilities and health policy areas, including primary care health provider shortage areas and medically underserved areas and populations.</p> <p> <strong>Includes all specialties, plus population health data</strong></p> <p> The new version of the mapper incorporates every specialty and subspecialty in the <a href="http://www.ama-assn.org/ama/pub/about-ama/physician-data-resources/physician-masterfile.page" target="_self">AMA Physician Masterfile</a> and the <a href="https://npiregistry.cms.hhs.gov/" rel="nofollow" target="_blank">CMS National Provider Identifier database</a>, including non-physician specialties. It also includes resident physicians.</p> <p> The tool’s new Population Health Explorer displays a variety of population health factors, including:</p> <ul> <li> Morbidity and mortality rates per health indicator</li> <li> Health care access and quality, from percent uninsured to hospital readmission rate</li> <li> Health behaviors, such as smoking and alcohol use</li> <li> Demographics, including age and race</li> <li> More than a dozen social environment factors</li> </ul> <p> For example, a user can quickly determine that Douglas County has the highest rate of uninsured people under 19 years of age in Illinois.</p> <p> <a href="http://www.ama-assn.org/ama/pub/advocacy/state-advocacy-arc/health-workforce-mapper.page#free-tool" target="_self">Access</a> to the mapper is free and open to the public. AMA members may export customizable Excel files ranking health workforce and demographic data by county.</p> <p> The AMA Health Workforce Mapper was developed in collaboration with the American Academy of Family Physicians (AAFP) Robert Graham Center and HealthLandscape, and it was funded by the AMA Scope of Practice Partnership. For more information about the mapper, contact the <a href="mailto:Kristin%20Schleiter%20%3cKristin.Schleiter@ama-assn.org%3e" rel="nofollow">AMA Advocacy Resource Center</a>.</p> <p align="right"> <em>By AMA staff writer Tim Smith</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:168f1628-f435-4485-a58b-39570d454801 Restoring joy in practice through team-based care http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_restoring-joy-practice-through-team-based-care Mon, 29 Aug 2016 01:00:00 GMT <p> While health systems across the country are implementing team-based care, few are doing it in exactly the same way. But many are doing it for the same reasons.</p> <p> “There’s never any straightforward or easy patient anymore,” said James Jerzak, MD, of Bellin Health, in Green Bay, Wisc. “In Wisconsin, the copays and the deductibles are huge. So every office visit is jammed with a lot of questions, and it can be really overwhelming to the individual clinician.”</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/2/3cb72f99-d618-4f24-9200-08d4e0f5ebf7.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/2/3cb72f99-d618-4f24-9200-08d4e0f5ebf7.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Dr. Jerzak, a family medicine physician, made his remarks in a recent presentation, “Restoring Joy in Practice through Team-Based Care,” at the University of Illinois at Chicago (UIC). UIC is a part of the <a href="http://glptn.org/" rel="nofollow" target="_blank">Great Lakes Practice Transformation Network</a>, a regional group that encompasses Illinois, Indiana and Michigan. Practice transformation networks are peer-based learning networks designed to coach, mentor and assist physician practices and health care systems.</p> <p> Team-based care, he explained, is a means to an end: effective population health management. But it can deliver another, equally positive effect.</p> <p> “This is what solves the burnout problem in this country,” he said. “It’s not some of these other things that put band-aids on it. You have to take away the causes of burnout—the EHR demands and the demands of the complicated visits.”</p> <p> Bellin Health is a relatively small health system, with 35 clinics, one hospital and about 150 physicians and other health care professionals. It is primarily fee-for-service, and its leadership knows the impending shift to value-based payment will require changes in how care is delivered.</p> <p> <strong>Expanding some roles, narrowing others</strong></p> <p> The best way to improve quality measures, Dr. Jerzak has found, is to get the physician out of the picture and let the team handle a lot of tasks.</p> <p> To do this, Bellin Health is implementing a team-based care model that, for starters, greatly expands the roles of medical assistants and licensed practical nurses to serve as care team coordinators (CTCs). Following standard rooming procedures, the CTC:</p> <ul> <li> Populates visit diagnoses from problem list</li> <li> Sets up one-year refills</li> <li> Identifies the visit agenda</li> <li> Identifies and addresses care gaps</li> <li> Pulls up appropriate template</li> <li> Starts documentation</li> </ul> <p> Here’s how it works.</p> <p> The physician enters the room without a computer and, after a warm handoff, addresses the patient. The CTC remains in the room, continuing documentation in the background so the physician can focus on the patient and MD-level work.</p> <p> The CTC then reviews tests, provides some health coaching and motivation to the patient and makes sure the patient understands the care plan. The CTC also enters orders for consults, new medications and tests and acts as patient advocate.</p> <p> Meanwhile, the physician returns to a computer station in a colocation space to edit documentation and review and sign off on orders. The patient’s chart is usually closed before the physician goes on to the next exam room.</p> <p> <strong>Why team-based care works to restore joy in practice</strong></p> <p> “The thing I find most satisfying in this is empowering the staff,” Dr. Jerzak said. “I love it when I’m in the room and I’ll say to the care team coordinator, ‘Let’s have case management involved,’ and they look at me and say, ‘I already ordered it.’ We don’t need the clinician to be approving everything when it’s obvious it has to be done.”</p> <p> Other lessons Dr. Jerzak said Bellin Health learned from adoption of team-based care:</p> <ul> <li> Colocation is critical and can be done without any extra staff</li> <li> Electronic messaging is very inefficient and should be avoided</li> <li> The number one thing in team-based care is personality—being able to work with the people around you</li> </ul> <p> Dr. Jerzak noted that burnout is not limited to physicians—in fact, it affects all health care professionals—and he thinks team-based care has the potential to restore joy not just to physicians but to everyone involved.</p> <p> “When we’re in our pod and people are working, I often times stop and think that it’s just fun to do this again,” he said. “I think patients really pick up on that too.”</p> <p> <strong>Learn more about team-based care and physician health</strong></p> <p> The AMA offers a free <a href="https://www.stepsforward.org/modules/team-based-care" rel="nofollow" target="_self">team-based care training module</a> in its STEPS Forward™ collection of practice improvement strategies to help physicians make transformative changes to their practices. Other modules include <a href="http://www.ama-assn.org/ama/ama-wire/post/lean-strategies-boston-practice-improve-patient-care" target="_self">starting Lean health care</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/volume-value-one-health-system-making-change" target="_self">implementing daily huddles</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/8-steps-address-ehr-woes-team-documentation" target="_self">addressing EHR woes with team documentation</a>.</p> <p> Thirty-five modules are available, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" rel="nofollow" target="_blank">Transforming Clinical Practices Initiative</a>.</p> <p> Bellin Health will be hosting a team-based care <a href="http://www.bellin.org/appointments-registration/team-based-care-training-camp" rel="nofollow" target="_blank">Training Camp</a> Nov. 1-3 at Lambeau Field, in Green Bay, and the <a href="http://www.cvent.com/events/icph-2016/event-summary-0da4ec4f01eb44a7b26f797dc1055561.aspx" rel="nofollow" target="_self">International Conference on Physician Health</a>, a collaboration of the AMA, the Canadian Medical Association and the British Medical Association, will showcase research and perspectives about Increasing Joy in Medicine for physicians Sept. 18-20 in Boston.</p> <p align="right"> <em>By AMA staff writer Tim Smith</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:daacdc3d-9949-4f31-937d-ba5324236795 Med student meets metaphor: Comics in med school http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_med-student-meets-metaphor-comics-med-school Sun, 28 Aug 2016 22:00:00 GMT <p> In medical school, there are few opportunities for students to stop, pause and reflect on where they’ve been, who they’ve become and where they are going. At Penn State College of Medicine, one physician professor is using comics to teach medical students how to creatively reflect on their experiences as they form their professional and personal identity.</p> <p> For seven years, Michael Green, MD, an internist and bioethicist at Penn State where he is vice chair of the department of humanities and director of the program in bioethics, has taught a class called “Comics in Medicine.”<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/3/e913c7bc-50ff-4180-8365-f008815e040d.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/3/e913c7bc-50ff-4180-8365-f008815e040d.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> “The purpose of art is washing the dust of daily life off our souls,” Pablo Picasso said. And that’s what the “Comics in Medicine” course is all about, according to Dr. Green. When it comes to understanding an important experience, talking about it is good, writing about it may be better, but finding a creative way to express feelings visually can help the artist—or student—better grasp what the experience was all about.</p> <p> “Medical school is an intense experience,” Dr. Green said. “It’s like running a marathon at sprint speed—you never slow down. During this course, [medical students] get to slow down, pause and try to make sense of who they are right now.” And, the juxtaposition of words and images in the comic format provides an effective medium for students to reflect on the formative experiences of medical school.</p> <p> In an <a href="http://journals.lww.com/academicmedicine/pages/articleviewer.aspx?year=2015&issue=06000&article=00025&type=fulltext" target="_blank" rel="nofollow">article</a> published in <em>Academic Medicine</em>, Dr. Green describes five distinct themes that appear in students work: How I found my niche, the medical student as patient, reflections on a transformative experience, connecting with a patient and the triumphs and challenges of becoming a doctor.</p> <p> “The medium of comics frees students up to express themselves metaphorically in ways they might not be inclined to do otherwise,” he said. “One troubling theme that comes up again and again is how students feel powerless and mistreated. And so they depict people who are supposed to be their role models and mentors in less than flattering ways.”</p> <p> “There’s always a grain of truth in dark humor,” he said. “A lot of times students depict their attending physicians and mentors as monsters, using imagery from horror fiction and film. Though it’s over the top and exaggerated, the images nevertheless reveal how students perceive their place in the medical hierarchy.”</p> <p> <strong>Are we in Gotham or med school?</strong></p> <p> Penn State College of Medicine is home to the first department of humanities at a U.S. medical school and has pioneered many innovative techniques for teaching humanities in the medical school setting.</p> <p> “The humanities department plays a very prominent role in the curriculum at Penn State,” Dr. Green said, “and the comics course is but one example of innovations that are taking place throughout the curriculum.”</p> <p> Comics in Medicine is a month-long course where students meet twice a week for two and a half hours. In a hybrid seminar-workshop style, students experience three types of activities:</p> <p style="margin-left:40px;"> <strong>1.   </strong><strong>Reading comics and graphic narratives about medical themes.</strong> “There are many book-length graphic narratives that have been published over the past decade that address medical themes such as experiences with illness, dealing with cancer and stories about the medical system,” Dr. Green said.</p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>Drawing and brainstorming.</strong> Another aspect of the course is “engaging in creative activities where we practice drawing, creative writing or brainstorming ideas,” Dr. Green said.</p> <p style="margin-left:40px;"> <strong>3.   </strong><strong>Completing a comic narrative.</strong> “From the first day of class students are working on a final project, which is to tell their own story about a formative experience they’ve had during medical school in the format of a comic. This is a very labor intensive, time-consuming and challenging activity,” he said.<br /> <br /> “We spend a lot of time workshopping, where they start out with the idea then write a draft and make sketches,” Dr. Green said. “They eventually turn it into a comic that we publish in booklets and post online.”</p> <p> <strong>Med students and the adventures of clinical training</strong></p> <p> Often, the student who walks into the course is different from the student who walks out the door at the end, Dr. Green said. And every time he teaches the course, Dr. Green asks the students what they expect out of it.</p> <p> “Initially, my expectation was that I’d get a lot of students who’d say they were lifelong fans of comics and love to draw,” he said. “But most students say they don’t read graphic novels and they can’t draw.”</p> <p> “But they’re interested,” he said. “They say it sounds fun or they want to do something different and new. I ask them how relevant they think comics are to their medical education; and by  the end of the class the numbers go up dramatically.”</p> <p> “One of the reasons I teach using comics is that I think the process of carefully reading and creating comics involves skills that are relevant to being a doctor,” Dr. Green said.</p> <p> “I’ve had students say, for example, after reading a graphic novel where there are images of how doctors are portrayed, they’ve never noticed how it makes somebody feel if you’re talking to them and your back is turned toward the computer,” he said. In one of the course materials, “the doctor is giving bad news about cancer and has a huge smile on her face and the family can’t understand why she’s smiling. The students say, ‘Wow, I do that, I smile when I get nervous and never knew that was so offensive.’”</p> <p> Students practice the skill of paying close attention to detail by drawing their own comics. “You have to really concentrate and be an observer of the world around you if you want to accurately depict a scene where a doctor is interacting with a patient,” he said. “You have to think about their body position, the expression on their face and where the patient is situated in relation to the doctor.” And how students make these choices in their own work reveals a great deal about how they see themselves within the medical culture.</p> <p> More and more, the humanities are part of the medical school curriculum. Another example  art is medical school is Mark Stephens, MD, a family physician and professor at the Uniformed Services University in Maryland, who is using art to give students time for self-exploration. Through the <a href="http://www.ama-assn.org/ama/ama-wire/post/masks-comics-art-of-med-school-part-one?utm_source=BulletinHealthCare&utm_medium=email&utm_term=082016&utm_content=students&utm_campaign=article_alert-morning_rounds_weekend" target="_self">making of masks</a>, students explore the ultimate question: Who am I?</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:bb228699-a5e4-47d7-967f-0b331e23ae02 Donate to the AMA Foundation: International Medical Graduates Honor Fund http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_donate-ama-foundation-international-medical-graduates-honor-fund Fri, 26 Aug 2016 13:00:00 GMT <p> The AMA Foundation supports the efforts of physicians and other volunteers working at free clinics to provide quality, affordable health care. The program awards $10,000 grants to physician-led free clinics. To date, over $1.6 million has been awarded to 81 free clinics across the country.</p> <p> IMG physicians – members are invited to support the physician-led free clinics in the United States through the AMA Foundation's <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/healthy-communities-healthy.page?" target="_blank"><em>Healthy Communities/Healthy America</em></a><a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/healthy-communities-healthy.page?"> program</a>. Many IMG physicians have donated to kick-off this funding initiative. The IMG Section goal is to raise $250,000, at which point investment income from this endowment fund can be awarded to physician-led free clinics.</p> <p> Consider donating and support this great funding initiative. <a href="http://www.ama-assn.org/go/amafoundation" target="_self">Donate or learn more</a>.</p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b8b161d7-ae4b-4997-8b44-6875934f602e Death by ZIP code: When address matters more than genetics http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_death-zip-code-address-matters-genetics Thu, 25 Aug 2016 21:00:00 GMT <p> Health inequity has left many communities around the nation with health disparities that are out of their control. Understanding the concept of how socioeconomic and environmental factors play a major role in population health is the most effective way to reshape our traditional health narrative.</p> <p> Anthony Iton, MD, senior vice president of healthy communities at the California Endowment, recently spoke to medical students at the University of California, Davis, School of Medicine during the AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page">Accelerating Change in Medical Education</a>  consortium meeting on health equity and community-based learning.</p> <p> When Dr. Iton left Montreal years ago for medical school at Johns Hopkins in Baltimore, he was given a tour of the city by an upperclassman. As they drove through East Baltimore he was shocked.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/12/b87f64b8-cf80-454e-ac38-924a235ed470.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/12/b87f64b8-cf80-454e-ac38-924a235ed470.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> “East Baltimore looked to me like Beirut,” he said, “with bombed out buildings and cars up on their axels and little mangy dogs running around and babies playing in and amongst all of this and I thought, how is this possible?”</p> <p> “I had never seen anything like this in my life,” he said. “[The upperclassman] saw my mouth agape, and he said, ‘What’s wrong with you?’ And I said, ‘When was there a war here?’”</p> <p> “We conveniently overlook the fact that there has been a narrative in this country,” Dr. Iton said, “and this narrative shapes policy, and that policy creates conditions.”</p> <p> “We of course know what’s happened in Baltimore more recently,” he said. “For those of us who have spent time in Baltimore, this has been happening for forty years. Baltimore has been a roiling insurrection for literally half a century because of these conditions. And yet we act surprised when we see it erupt all of a sudden.”</p> <p> Scott County Indiana has had an outbreak of HIV which puts their incidence rate higher than sub-Saharan Africa, Dr. Iton said. “Scott County Indiana is 98.5% white. Yet it has the very same socioeconomic situations as East Baltimore.”</p> <p> “We end up seeing devastating disease in clinics because of the social policies that leave people essentially bereft of the resources that they need to be able to manage and navigate a healthy life,” he said. “What is the social contract in East Baltimore? What is the social contract in Scott County?”</p> <p> Dr. Iton thought hard about all of this inequality as he went through medical school and one question arose in his mind: Does your ZIP code matter more than your genetic code when it comes to your health?</p> <p> <strong>Investigating the root causes of health inequity</strong></p> <p> When he became the health director for Alameda County, California, Dr. Iton had access to the database of death certificates which details how someone died, their age, race or ethnicity and where they lived. And those four pieces of data can reveal a lot about patterns of death in a community over time.</p> <p> What they found after looking back several years was that “there are places where you pay a price in loss of life because of your address,” he said. They expanded their research to many other cities and “everywhere we looked we found life-expectancy differences in the same city on the order of 15-20years.”</p> <p> “In an ideal world … where you live shouldn’t predict how long you live,” he said, “but we do not live in an ideal world. What drives health is beyond just health behaviors and access to the doctor…. There’s a whole host of environmental and social determinants that are actually much more influential on our health trajectories, and we have no organized practice for dealing with them.”</p> <p> “We know that much of what affects our health happens outside the doctor’s office,” he said. “We know increasingly more about stress [and] various different policy-mediated factors that shape how our bodies respond. The things that we make difficult for people in life—getting health insurance, getting access to primary care—these are stressors that are unnecessary that actually change our physiology.”</p> <p> Stress, or the release of cortisol, can have major implications for health, Dr. Iton said. “When you walk into a low income community, cortisol levels are high. People are constantly being threatened. Most of these threats are policy-mediated threats. They’re not somebody with a gun or a hammer, although that happens. It’s often the inability to meet your basic needs with the resources you have at your disposal.”</p> <p> “So you’re constantly bathed in cortisol and when that happens that stimulates hypertension, cardiovascular disease, glucose intolerances, insulin resistance, inflammation, decreases your immune responses and causes atrophy and cell death in critical parts of our brains,” he said. “Low income people and wealthy people in this country are physiologically different,” Dr. Iton said. “Not because they were born that way, but because we made them that way through policy.”</p> <p> “When you’re seeing health disparities, you’re only seeing the tip of the iceberg,” he said. “You’re not seeing all the underlying, structural inequities that produce those disparities. And then we try to treat those disparities with pills and brochures.”</p> <p> <strong>A framework for change</strong></p> <p> “When I was in medical school, I knew something was happening, I just didn’t have words for it,” Dr. Iton said. “I would see patients that seemed so frazzled and stressed and sick, and the frame that I was taught is that I have to teach this person how to live in 15 minutes.”</p> <p> The Bay Area Regional Health Inequities Initiative developed a framework “which tries to understand how we design strategies to intervene in what we’re seeing,” Dr. Iton said. “It came together out of frustration with the medical model, [which] really didn’t provide the tools for intervening in the broader forces that were creating inequity in our society.”</p> <p> “It starts with this notion that when you see premature death, whether it be infant mortality or shortened life expectancy, you think about diseases and injury and the burden of those things,” he said. “We spend a lot of time trying to change people’s behaviors with health education … and then we try to get them access to health care and intervene in the downstream cascade…. You have to think about what are the factors upstream that are working at the societal level.”</p> <p> “We know if you don’t have access to healthy food it’s much less likely that you’re going to eat healthy food,” he said. “We know that if you don’t have access to parks and recreation it’s much less likely that you’re going to exercise and do the things that we tell people to do all the time.”</p> <p> These consequences are systemic. It causes not just health consequences but also disparities in education and employment opportunities. “The solutions are about enlisting the very people who are experiencing those inequities, building their social, political and economic power, so that they can participate in reshaping these policies,”</p> <p> Check out “<a href="https://www.youtube.com/watch?v=Eu7d0BMRt0o" rel="nofollow" target="_blank">A Tale of Two ZIP Codes</a>,” a video from Health Happens Here that gives a practical example of how where you live can affect your health.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:79977e27-ec8c-48e8-85c9-90e693ef7395 Register for 19th Interim Meeting of AMA-IMG Section http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_register-19th-interim-meeting-of-ama-img-section Thu, 25 Aug 2016 14:00:00 GMT <p> The AMA Interim Meeting will take place Nov. 11-14 in Orlando. The AMA International Medical Graduates section will host several events for its members.</p> <p> <strong>Planned events include:</strong></p> <ul> <li> <strong>AMA 13th Research Symposium and Reception: 1– 7:30 p.m. on Friday, Nov. 11</strong><br /> Come to hear educational sessions, oral research presentations and view abstracts by our IMG ECFMG-certified candidates who are waiting residency.  The medical students and residents are also a part of this AMA Research Symposium.</li> </ul> <ul> <li> <strong>AMA-IMG Section reception and Congress: 5:30–7:30 p.m. on Saturday, Nov. 12</strong><br /> Come network with colleagues, participate in a meditation exercise and discuss policy items for the IMG Section and House of Delegates reports/resolutions of interest.<br /> <br /> Featured speaker: Humayun Chaudhry, DO, MS, MACP, CEO/President, Federation of State Medical Boards.</li> </ul> <ul> <li> <strong>Busharat Ahmad, MD, Leadership Development Program: 2-3 p.m. on Sunday, Nov. 13</strong><br /> Come and learn about how to be an effective physician leader and follower. Featured speaker: Nestor Ramirez-Lopez, MD, “Followership, The Other Face of Leadership.”</li> </ul> <ul> <li> <strong>AMA-IMGS & Minority Affairs Delegates Caucus: 8:30-9:30 a.m. on Monday, Nov. 14</strong><br /> Review reference committee reports and discuss strategies for supporting IMG Section and House of Delegates policy items.</li> </ul> <p> Bring a colleague or a friend and take advantage of these events.  To register, visit the <a href="http://www.ama-assn.org/go/i16-img" target="_self">AMA-IMG webpage</a>, <a href="mailto:img@ama-assn.org" rel="nofollow">email</a> the AMA-IMG section or call (312) 464-5397 for more information. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e7b38a77-6fcb-4adb-8e18-63918d20f517 Surgeon General mails letters to America’s physicians http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_surgeon-general-mails-letters-americas-physicians Thu, 25 Aug 2016 03:00:00 GMT <p> Check your mailbox over the next two weeks—there should be a letter from U.S. Surgeon General Vivek H. Murthy, MD, calling on all physicians throughout the nation to raise awareness and further efforts to end the opioid overdose epidemic.</p> <p> Physicians are in a unique position of leadership when it comes to this epidemic—they are on the front lines witnessing the impact every day from emergency department overdoses to substance use disorder treatment. The letter asks directly for physicians’ help to solve and bring an end to the opioid overdose epidemic.</p> <p> “We will educate ourselves to treat pain safely and effectively,” Dr. Murthy said in the <a href="http://turnthetiderx.org/" rel="nofollow" target="_blank">letter</a>, suggesting physicians examine the <a href="http://turnthetiderx.org/treatment/" rel="nofollow" target="_blank">many resources</a> from the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration and the National Institute on Drug Abuse.</p> <p> “We will screen our patients for opioid use disorder and provide or connect them with evidence based treatment,” he said. “We can shape how the rest of the country sees addiction by talking about and treating it as a chronic illness, not a moral failing.”</p> <p> <strong>Awareness can make a difference</strong></p> <p> This style of raising awareness has worked before. In 1988, U.S. Surgeon General C. Everett Koop, MD, sent a seven-page brochure, “Understanding AIDS,” to all 107 million households in the country. The mailing raised awareness that the AIDS epidemic affected every one and not just a small group of Americans. The opioid epidemic the country now faces similarly affects those of all ages, races and economic status.</p> <p> Dr. Murthy earlier this month launched <a href="http://turnthetiderx.org/" rel="nofollow" target="_blank">TurnTheTideRx.org</a>, where physicians can take a pledge and make a commitment to end the opioid crisis.</p> <p> “Years from now, I want us to look back and know that, in the face of a crisis that threatened our nation, it was our profession that stepped up and led the way,” he said in the letter.</p> <p> <strong>Physician efforts already underway</strong></p> <p> Steven J. Stack, MD, AMA immediate-past president, in May issued an <a href="http://www.huffingtonpost.com/steven-j-stack/confronting-a-crisis-an-o_b_9911530.html" rel="nofollow" target="_blank">open letter to America’s physicians</a> calling on them to re-examine prescribing practices and help reverse the epidemic. “We must accept and embrace our professional responsibility to treat our patients’ pain without worsening the current crisis,” he said.</p> <p> The AMA <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page?" target="_self">Task Force to Reduce Prescription Opioid Abuse</a> has been working to raise awareness of the crisis for almost two years. The task force put forth <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse.page?" target="_self">recommendations for physicians</a> to register for and use state prescription drug monitoring programs, educate themselves on pain management and safe prescribing, support increased access to naloxone, reduce the stigma of substance use disorder and enhance access to comprehensive treatment.</p> <p> <strong>For more on what physicians can do:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/treating-substance-use-disorder-family-physician" target="_self">Treating substance use disorder as a family physician</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/one-physician-uses-his-pdmp-patients" target="_self">How one physician uses his PDMP to help patients</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/antidote-3-things-consider-co-prescribing-naloxone" target="_self">The antidote: 3 things to consider when co-prescribing naloxone</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/pain-expert-judge-opioid-treatment-not-patient" target="_self">Pain expert: Judge the opioid treatment, not the patient</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-steps-talking-patients-substance-use-disorder" target="_self">3 steps for talking with patients about substance use disorder</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:030a28c9-30c4-43d6-a54d-43b7a96b42e6 This year’s most influential people in health care http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_this-years-influential-people-health-care Wed, 24 Aug 2016 21:39:00 GMT <p> Among the attorneys general, administrators, justices, senators and representatives, many physicians made <em>Modern Healthcare’s</em> annual list of the 100 Most Influential People in Healthcare. This year, 17 AMA members were honored.</p> <p> AMA President Andrew W. Gurman, MD, made the list at No. 27 just two months after his <a href="http://www.ama-assn.org/ama/ama-wire/post/sitting-sidelines-involved">inauguration</a>. Dr. Gurman recently spoke out against the <a href="http://www.ama-assn.org/ama/ama-wire/post/doj-states-side-patients-physicians-file-block-insurance-mergers">mergers of four major health insurers</a> and will lead AMA efforts as the Medicare Access and CHIP Reauthorization Act begins next year.</p> <p> Robert Wachter, MD, made the list at No. 58. Dr. Wachter is an associate chairman of the department of medicine at the University of California—San Francisco, which is a founding member of the AMA’s Accelerating Change in Medical Education Consortium.</p> <p> These physicians and AMA members joined such notables as President Barack Obama at the No. 1 spot, Centers for Medicare and Medicaid Services Acting Administrator Andy Slavitt came in at No. 10, and Secretary of the U.S. Department of Health and Human Services Sylvia Mathews Burwell at No. 5. The honorees were nominated by their peers and voted on by both readers and senior editors of <em>Modern Healthcare</em>.</p> <p> Other AMA members include:</p> <ul> <li> No. 29: Delos “Toby” Cosgrove, MD, president and CEO of the Cleveland Clinic</li> <li> No. 30: John Noseworthy, MD, president and CEO of the Mayo Clinic in Rochester, Minn.</li> <li> No. 41: Atul Gawande, surgeon, professor, writer and researcher at Harvard Medical School and Harvard School of Public Health in Boston</li> <li> No. 44: Gary Kaplan, MD, chair and CEO of the Virginia Mason Health System in Seattle</li> <li> No. 47: Georges Benjamin, MD, executive director of the American Public Health Association</li> <li> No. 51: Halee Fischer-Wright, MD, president and CEO of the Medical Group Management Association</li> <li> No. 53: Francis Collins, MD, PhD, director of the National Institutes of Health in Bethesda, Md.</li> <li> No. 62: J. Mario Molina, MD, president and CEO of Molina Healthcare Inc</li> <li> No. 65: Mark Chassin, MD, president and CEO of the Joint Commission in Oakbrook Terrace, Ill.</li> <li> No. 77: Tejal Gandhi, MD, president and CEO of the National Patient Safety Foundation in Boston</li> <li> No. 78: Jonathan Perlin, MD, PhD, president of clinical services and chief medical officer of HCA in Nashville and chair of the American Hospital Association</li> <li> No. 88: Eugene Washington, MD, president and CEO of Duke University Health System</li> <li> No. 96: Patrick Soon-Shiong, MD, chairman and CEO of NantHealth</li> <li> No. 97: Victor Dzau, MD, president of the National Academy of Medicine</li> <li> No. 98: Troyen Brennen, MD, executive vice president and chief medical officer of CVS Health</li> </ul> <p> <a href="http://www.modernhealthcare.com/section/100-most-influential-2016" target="_blank" rel="nofollow">Read about</a> this year’s top physician leaders and <a href="http://www.modernhealthcare.com/community/100-most-influential/2016/" target="_blank" rel="nofollow">see the full list</a> at <em>Modern Healthcare.</em></p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:34dd52c9-ff27-4296-a30a-9edf56f1289e Using neurosurgical solutions to manage chronic pain http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_using-neurosurgical-solutions-manage-chronic-pain Tue, 23 Aug 2016 21:16:00 GMT <p> Back pain is one of the most common ailments chronic pain patients face. For some, a neurosurgical approach can offer much relief and may be an alternative to long-term opioid therapy. Here’s what one neurosurgeon and member of the AMA Task Force to Reduce Prescription Opioid Abuse had to say about treating patients with chronic pain and the Task Force’s efforts to end the opioid overdose epidemic.</p> <p> <strong>Treating chronic back pain in neurosurgery</strong></p> <p> Jennifer Sweet, MD, is a neurosurgeon at University Hospitals Case Medical Center in Cleveland and the physician representative for the American Association of Neurological Surgeons on the AMA <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page" target="_self">Task Force to Reduce Prescription Opioid Abuse</a>. Dr. Sweet sees patients with chronic pain who have what is called failed back surgery syndrome.</p> <p> “When patients are referred to me they’ve had big spine fusions and they’re still not getting better,” she said. “If patients don’t tolerate systemic opioids, or if high-dose opioids still don’t manage their pain, then I can offer another option. Interventions such as intrathecal pain pumps can provide the pain relief patients need, without all the side effects of systemic opioids.</p> <p> “While this has traditionally been reserved for patients with cancer pain,” she said, “we are now realizing the potential benefit for chronic pain patients without terminal disease.”</p> <p> The intrathecal pain pump delivers opioids locally to the area where the patient is experience pain through the spinal fluid. “It helps them get off the systemic opioids so they have less chance for addiction and less of the side effects,” Dr. Sweet said. “Over the last five years, it has become increasingly common to utilize these therapies for patients with isolated back pain from Failed Back Surgery Syndrome and even for neuropathic pain.”</p> <p> “I don’t think it’s going to solve the major opioid epidemic,” she said, “but it may help treat patients who are truly debilitated by their pain, who have few alternative options.”</p> <p> “I also see a big opportunity to really re-introduce into our pain management treatment algorithm other non-opioid medications, such as anti-inflammatory agents, antidepressants and anti-epileptics," Dr. Sweet said. "There are many more drugs available than just opioids, and a multimodal approach may represent another key strategy.”</p> <p> Most of the patients Dr. Sweet sees want to get off of their pain medications. “They’re scared that they can’t get the pain medications easily, it’s becoming more and more difficult,” she said. “Their quality of life is not enjoyable and they don’t like the side effects.”</p> <p> “If we determine the intrathecal pain pump is the best option, we do a trial and if they benefit from the trial we’ll implant the intrathecal pump in a small outpatient procedure,” she said. “All patients also must see a pain psychologist, and we will often refer patients to an addiction specialist when necessary to manage any physical or psychological opioid dependency or other co-occurring issue.”</p> <p> “For the right patient, neuromodulatory approaches such as intrathecal pain pumps can be life-changing,” Dr. Sweet said.</p> <p> <strong>Dr. Sweet talks Task Force, prevention and education </strong></p> <p> Nationwide there are many efforts underway to combat the opioid epidemic from all angles. The AMA Task Force to Reduce Prescription Opioid Abuse has been in this fight for several years, enlisting the help of physician members who are working to end the epidemic through several goals.</p> <p> “The task force has been addressing a lot of important things,” she said. “First of all, getting physicians to register with their prescription drug monitoring programs (PDMP) so that we can look up patients, and every time we prescribe opioids we are documenting that so that other physicians can see who’s prescribing, how much and when.”</p> <p> “We’re also trying to sort out the difference between a chronic type of pain, like the back pain patients that I see, versus an acute pain which would be when we prescribe opioids postoperatively,” she said. “Are there other types of medications that can be administered or other treatment options? So education is a tremendous focus of the task force.”</p> <p> Another important effort the task force has made is “getting the message out there that legislation needs to change to increase naloxone availability,” Dr. Sweet said. “Also, it’s important to have greater access to addiction specialists in the community ready to treat these patients.”</p> <p> “One of the areas where I think the biggest changes need to occur is in physician education,” she said. “And one of the ways we can do this is by <a href="http://www.ama-assn.org/ama/ama-wire/post/neurosurgery-pain-management-curricular-breakthroughs" target="_self">teaching young physicians</a> who are in their residencies that there are other options besides just opioids, although opioids do have their place in reducing pain, that there are other medications and that can help in prevention.”</p> <p> ”We have a lot of work to do,” she said, “and neurosurgeons are very glad to help the task force’s efforts efforts in prevention, education and advocating for patients.”</p> <p> <strong>For more on the opioid epidemic and how physicians can help:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/treating-substance-use-disorder-family-physician" target="_self">Treating substance use disorder as a family physician</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/one-physician-uses-his-pdmp-patients" target="_self">How one physician uses his PDMP to help patients</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/antidote-3-things-consider-co-prescribing-naloxone" target="_self">The antidote: 3 things to consider when co-prescribing naloxone</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/pain-expert-judge-opioid-treatment-not-patient" target="_self">Pain expert: Judge the opioid treatment, not the patient</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-steps-talking-patients-substance-use-disorder" target="_self">3 steps for talking with patients about substance use disorder</a></li> </ul> <p style="text-align:right;"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c9eeedca-3355-4d69-80ab-0d9e35161902 What it’s like to be in sleep medicine: Shadowing Dr. Chervin http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_its-like-sleep-medicine-shadowing-dr-chervin Tue, 23 Aug 2016 20:29:00 GMT <p> As a medical student, do you ever wonder what it’s like to be a sleep specialist? Here’s your chance to find out.</p> <p> Meet Ron Chervin, MD, a sleep specialist and featured physician in <em>AMA Wire’s</em>® <a href="http://www.ama-assn.org/ama/ama-wire/blog/ShadowMe_Specialty/1" target="_self">“Shadow Me” Specialty Series</a>, which offers advice directly from physicians about life in their specialties.</p> <p> Read his insights to help determine whether a career in sleep medicine might be a good fit for you.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/2/c734ba8d-88bc-4b71-922c-1c0dff7364f6.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/2/c734ba8d-88bc-4b71-922c-1c0dff7364f6.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>“Shadowing” Dr. Chervin</strong></p> <p> <strong>Specialty:</strong> Sleep medicine</p> <p> <strong>Practice setting:</strong> Academic medical center</p> <p> <strong>Years in practice:</strong> 22</p> <p> <strong>A typical day in my practice:</strong></p> <p> I usually arrive at my office by about 8:20 a.m., after I drop my kids off at school, and I typically leave my office between 6:00 and 8:00 p.m. Sometimes there is then an hour or two of email to catch up on from home in the evening.</p> <p> On weekends, I often work one additional short day, for about six hours. During my time at work, I have a varied portfolio that includes seeing my own patients with sleep disorders, assisting sleep medicine fellows in seeing their patients and reviewing sleep studies with fellows to teach them how to interpret the data and provide optimal patient care.</p> <p> I spend a substantial portion of my time—typically one-third or more of my work hours over the past two decades—on clinical sleep research, which means managing teams of staff members and collaborators, as well as analyzing and reporting data or writing new grant applications. I also spend many hours on administrative issues for a large academic sleep center, on mentorship of junior faculty and fellows and on national service, primarily through the American Academy of Sleep Medicine (AASM). This academic year, I am serving as President for the AASM.</p> <p> <strong>The most challenging and rewarding aspects of caring for patients in sleep medicine:</strong></p> <p> Sleep-wake disorders often have a serious, pervasive impact on health, productivity, quality of life and enjoyment of waking hours. When we are not able to figure out a diagnosis, or provide effective treatment, we can face desperate patients and family members, not to mention frustrated physicians.</p> <p> On the other hand, the most rewarding aspect of sleep medicine is that for the vast majority of patients, we do arrive at a logical diagnosis and, more importantly, highly effective treatment. For the patient, this can be life-changing. When this is my patient, I have the pleasure and satisfaction of knowing I’ve contributed something with enormous benefit.</p> <p> <strong>Three adjectives to describe the typical physician in sleep medicine:</strong></p> <p> Creative. Happy. Passionate.</p> <p> <strong>How my lifestyle matches or differs from what I envisioned in med school:</strong></p> <p> My lifestyle involves more hours at work than I would have predicted in medical school. However, I believe this is a consequence of my choice to pursue an academic career with a traditional tripartite focus—patient care, research and education—rather than an embedded feature of sleep medicine.</p> <p> Many clinicians in sleep medicine do manage to create an excellent work-life balance and juggle sleep medicine with raising a family. Physicians who are on call in this field can receive questions from a sleep laboratory at times but almost never have to leave home because of night call. Patients wait to discuss their sleep problems during daytime office hours, and there are only very rare medical emergencies in sleep medicine.</p> <p> Despite ongoing changes in types of studies for sleep disorders and in insurance coverage, sleep medicine continues to offer reasonable payment, a highly rewarding multidisciplinary practice and bright promise for the future. This is because:</p> <ul> <li> Healthy sleep is increasingly seen as vital to almost every other aspect of good health</li> <li> Sleep medicine still has far too few physician specialists to address sleep disorders that are highly prevalent</li> <li> The essential contributions that sleep physicians make to health systems will be highly valued as medicine increasingly adopts alternative care organization (ACO) models for health care</li> </ul> <p> <strong>The main skills every physician in training should have for sleep medicine but won’t be tested for on the board exam:</strong></p> <ul> <li> The wisdom to value a good medical history and put testing results into perspective</li> <li> The patience to dissect the complicated health and psychological backgrounds that present together for many people with insomnia</li> <li> The ability to communicate and teach well, even in non-academic settings, as every sleep physician is involved with education of colleagues as well as patients about sleep disorders and their impact</li> </ul> <p> <strong>One question every physician in training should ask themselves before pursuing sleep medicine: </strong></p> <p> Do you find obstructive sleep apnea fascinating? Although dozens of sleep disorders exist, this one condition is to sleep medicine as diabetes is to endocrinology. Sleep apnea affects a wide range of other health conditions, and as a neurologist I have been fascinated for many years by profound effects of sleep apnea on neurologic conditions, the brain, cognition and behavior, especially in children. Others can be fascinated by its intimate relationships with pulmonary disease, metabolism, endocrine function or immune function. However, it may be hard to be a sleep physician if you find obstructive sleep apnea boring.</p> <p> <strong>Three books every medical student in sleep medicine should be reading:</strong></p> <p> American Academy of Sleep Medicine. <em>International classification of sleep disorders, 3rd ed</em>. Darien, IL: American Academy of Sleep Medicine, 2014.</p> <p> Olson EJ, Winkelman JW, editors; for the American Academy of Sleep Medicine. <em>Case book of sleep medicine, 2nd ed</em>. Darien, IL: American Academy of Sleep Medicine, 2015.</p> <p> Dement WC, Vaughan C. <em>The promise of sleep</em>. New York: Delacorte Press, 1999.</p> <p> <strong>One online resource they should follow: </strong></p> <p> <a href="http://www.twitter.com/aasmorg" target="_blank" rel="nofollow">www.twitter.com/aasmorg</a></p> <p> <strong>A quick insight I’d give students who are considering sleep medicine:</strong></p> <p> Sleep medicine is a field defined by fellowship rather than residency training. You can enter sleep medicine from a background in internal medicine, pulmonary medicine, family medicine, neurology, psychiatry, pediatrics, otolaryngology or anesthesiology. Choose a pathway that you find most fascinating and most rewarding.</p> <p> However, keep in mind that a sleep medicine fellowship after training in one of the eligible traditional fields can lead to a highly rewarding full-time or part-time focus on helping people with the one-third of their lives spent asleep, and the other two-thirds that depend heavily on healthy function during that one-third.</p> <p> <strong>If I had a mantra or song to describe my life in this specialty, it’d be:</strong></p> <p> Achieving optimal health through better sleep (the vision of the American Academy of Sleep Medicine)</p> <p> <strong>Want to learn more about your specialty options?</strong></p> <ul> <li> Read more profiles in <em>AMA Wire’s</em> <a href="http://www.ama-assn.org/ama/ama-wire/blog/ShadowMe_Specialty/1" target="_self">Shadow Me Specialty Series</a> to learn additional insights from physicians in such specialties as <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-endocrine-surgery-shadowing-dr-krishnamurthy" target="_self">endocrine surgery</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-obesity-medicine-shadowing-dr-lazarus" target="_self">obesity medicine</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-neurology-shadowing-dr-govindarajan">neurology</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-nephrology-shadowing-dr-desai">nephrology</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-otolaryngology-shadowing-dr-gillespie">otolaryngology</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-vascular-surgery-shadowing-dr-aziz">vascular surgery</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-infectious-disease-shadowing-dr-schmitt" target="_blank">infectious disease</a>, among others.</li> <li> Check out the AMA’s <em>Choosing a Medical Specialty</em> <a href="http://www.ama-assn.org/resources/doc/membership/x-ama/choosing-a-medical-specialty-resource-guide.pdf" target="_blank">resource guide</a> (member log in required).</li> <li> Be sure to avoid these <a href="http://www.ama-assn.org/ama/ama-wire/post/5-things-students-overlook-choosing-specialty" target="_blank">5 common mistakes students make</a> when choosing a specialty.</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:99d0a2fb-09a9-46b5-9547-47ce05571583 Lean strategies help a Boston practice improve patient care http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_lean-strategies-boston-practice-improve-patient-care Tue, 23 Aug 2016 04:00:00 GMT <p> A clinician’s highest priority is caring for patients, not running an office. But what if inefficiencies in a practice’s operations get in the way of patient care? For Harvard Vanguard Medical Associates, the solution was Lean health care.</p> <p> At Harvard Vanguard’s Boston office, the room where the weekly clinical operations meeting is held is aptly named Mission Control. It serves as the hub of Harvard Vanguard’s implementation of Lean health care, which was developed to improve efficiency and give physicians more time with patients.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/15/6d42c1ea-e65f-4816-af78-5fc8432ceb0d.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/15/6d42c1ea-e65f-4816-af78-5fc8432ceb0d.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> This is where improvement specialists, physicians and nurses together tackle their list of open improvement issues, by identifying barriers, assigning responsibilities and establishing due dates. They also review the status of recent “Rapid Improvement Events”—one‑ and two‑week intensive Lean activities—as well as longer‑term projects.</p> <p> <strong>Press 1 for improvement</strong></p> <p> One recent Rapid Improvement Event involved optimizing the automated phone triage system. Formerly, the only option callers received was, “Press 1 for medical advice.” But when the team reviewed call data, they quickly learned that most calls were for refills, followed by appointments and then medical advice.</p> <p> So they reordered the automated options accordingly. Now option 1 connects patients to someone who can assist with refills; option 2 is for appointments and so on.</p> <p> It was a simple change that has enabled Harvard Vanguard to more quickly get calls to the right people to meet patients' needs.</p> <p> <strong>Standardizing helps; following up helps more</strong></p> <p> Obviously, not all of the practice’s operations are automated, so standardizing work is the cornerstone of Harvard Vanguard's Lean philosophy. For every work process, there is a clearly defined series of steps for those who do that work, and each task has been mapped for how it feeds into larger processes.</p> <p> To help all staff members standardize their processes, team members periodically observe each other in informal peer‑to‑peer audits. If a worker completes a process correctly, the auditor shows a green card. If the work is done incorrectly, the auditor shows an orange card.</p> <p> The purpose of the audit is not to embarrass workers who make mistakes but to determine how consistently a process actually occurs and whether a member of the team needs assistance or additional training.</p> <p> <strong>Implementing Lean: A lot of the work has already been done for you</strong></p> <p> Lean is more than a method—it’s also a mindset. Lean thinking leads to cultural change, where all team members are empowered to identify sources of inefficiency and create innovative solutions to address problems.</p> <p> An <a href="https://www.stepsforward.org/modules/physician-wellness" rel="nofollow" target="_self">online module</a> in the AMA’s STEPS Forward™ collection of practice improvement strategies explains how to implement Lean into your practice and includes:</p> <ol> <li> Descriptions of common Lean methods to help physicians select the right ones for their practices</li> <li> Six steps to help implement Lean improvements</li> <li> Answers to common questions and concerns about Lean thinking and methods</li> <li> Vignettes, like this one about Harvard Vanguard, describing how practices are successfully using Lean techniques to organize workflows and provide better patient care</li> </ol> <p> It also includes a process map toolkit to help practices visually map their process flows like Harvard Vanguard did. Process maps help identify what's working, what’s not and where more subtle opportunities for improvement may exist.</p> <p> Indeed, Harvard Vanguard remains committed to Lean only because its process improvement team has seen it work outside of Mission Control—by eliminating time-eating practices in the workday and freeing up clinicians to spend that time with their patients.</p> <p> Some practices, however, find it daunting to implement practice transformation without outside support, so the module also has a customizable search feature to help physicians find local consultants who are skilled in practice transformation and have expertise in specialized functional areas.</p> <p> Thirty-five STEPS Forward modules are now available, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" rel="nofollow" target="_blank">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer Tim Smith</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:be4bc02d-e4ec-40b6-97b4-10e096951162 Liability suit seeks change to informed consent http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_liability-suit-seeks-change-informed-consent Sat, 20 Aug 2016 00:00:00 GMT <p> A case before the Supreme Court of Pennsylvania could have major implications on how physicians obtain informed consent prior to a surgery.</p> <p> At stake in <em>Shinal v. Toms</em>, is whether a patient’s informed consent to surgery can be predicated on information provided in part by a physician’s assistant, as opposed to just the physician. Both the Medical Care Availability and Reduction of Error Act (MCARE) and common law have made it the physician’s duty to see that the proper information is conveyed, but the question is whether delegating tasks to qualified professionals is also within the bounds of the law and common medical practice.</p> <p> <strong>How the case unfolded</strong></p> <p> In 2004, Megan Shinal underwent surgery to remove a tumor, but it regrew and by 2008 she was experiencing severe headaches and was referred to Steven A. Toms, MD, for a second surgery.</p> <p> This type of surgery—the removal of a craniopharyngioma, a very serious and recurrent rumor located deep in the base of the brain—is one of the most complex surgeries in all of neurosurgery. For this reason, there were numerous important surgical decisions to be made, some by the surgeon and some collaboratively with the patient.</p> <p> The major decisions were which of two surgical approaches to take—through the nose and the sphenoid bone, or through the skull—and whether to remove the entire tumor or leave a portion of the tumor in place. Removing the entire tumor usually produces a better long-term outcome, but involves more surgical risk. One of those risks is a potential rupture of the carotid artery, which can cause serious injuries. Yet, the alternative to surgery would be to accept disability and then death as near inevitable outcomes.</p> <p> Dr. Toms testified that he and Ms. Shinal discussed this issue at length and that she had agreed that he would determine during the surgery whether he should remove the entire tumor.</p> <p> The complaint filed by Ms. Shinal and her husband at first included a detailed negligence claim, but this theory was abandoned before trial. Instead, the plaintiffs asserted that Dr. Toms had not advised of the risk of damage nor adequately explained the risks and complications associated with the surgical approach, particularly the risks and benefits of a total vs. partial tumor removal.</p> <p> They asserted that, because Dr. Toms’ physician assistant had provided the information to inform the consent, and not Dr. Toms himself, Mrs. Shinal had not been adequately informed and did not provide consent.</p> <p> <strong>What has been provided, not who provided it</strong></p> <p> Informed consent doctrine has focused on providing the patient with appropriate information to make a knowledgeable decision to proceed or to forgo surgery. Neither common law nor statute has prescribed who must provide the information.</p> <p> The record reflected that Dr. Toms’ staff had provided certain information to Ms. Shinal and the trial court properly instructed the jury to consider the testimony.</p> <p> “Imposition of a duty is quite different from mandating that the physician provide all of the information,” the Litigation Center of the AMA and State Medical Societies said in an amicus brief. “Physicians’ delegation of some of their duties to other health care professionals while maintaining liability if those delegated services are not properly performed is commonplace.”</p> <p> “Surgeons may be the ‘captain of the ship,’ and liable for a crew member’s errors, but they do not work alone and need not personally perform every task,” the brief said. “The trend of delegating will only be more common in the future as medical care seeks greater efficiencies.”</p> <p> The brief asked the Court to affirm the decision that information relative to obtaining a patient’s informed consent could be provided by qualified staff on behalf of the surgeon.</p> <p> <strong>Current medical liability cases in which the Litigation Center is involved:</strong></p> <ul> <li> Find out how a <a href="http://www.ama-assn.org/ama/ama-wire/post/challenge-medical-liability-law-could-complicate-pre-suit-process?utm_source=BulletinHealthCare&utm_medium=email&utm_term=081316&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend" target="_self">challenge to medical liability law could complicate pre-suit process</a>.</li> <li> Learn how a case <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-lead-unlimited-awards-of-punitive-damages" target="_self">could lead to unlimited awards of punitive damages</a>.</li> <li> Get the details on a <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-extend-medical-liability" target="_self">case that could extend medical liability</a>.</li> <li> Find out how one <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-increase-liability-exposure-redefine-injury" target="_self">case could increase liability exposure and redefine injury</a>.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0c0cd52b-e8f6-465a-899b-a5f1cb989538 Prepping for USMLE Step 2? Here’s a commonly missed question http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_prepping-usmle-step-2-heres-commonly-missed-question Sat, 20 Aug 2016 00:00:00 GMT <p> The United States Medical Licensing Examination® (USMLE®) Step 2 is a formidable test, so <em>AMA Wire</em>® is providing frequent expert insights to help you prepare for it. Take a few minutes here to work through another of the most-missed USMLE Step 2 test prep questions and view an expert video explanation of the answer from Kaplan Medical.</p> <p> Once you’ve got this question under your belt, be sure to test your knowledge with <a href="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" target="_self">other posts in this series</a>.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong></p> <p> A 27-year-old immigrant from El Salvador has a 14 x 12 x 9-cm mass in her left breast. It has been present for seven years and has slowly grown to its present size. Her grandmother has breast cancer and her father has prostate cancer. Physical examination shows that the mass is firm, nontender, rubbery and completely movable, and it is not attached to the overlying skin or the chest wall. There are no palpable axillary nodes or skin ulceration.</p> <p> Which of the following is the most likely diagnosis?</p> <p style="margin-left:40px;"> A. Chronic cystic mastitis</p> <p style="margin-left:40px;"> B. Cystosarcoma phyllodes</p> <p style="margin-left:40px;"> C. Inflammatory breast cancer</p> <p style="margin-left:40px;"> D. Intraductal papilloma</p> <p style="margin-left:40px;"> E. Mammary duct ectasia</p> <p>  </p> <p> <object data="http://www.youtube.com/v/bJJzX_igqV4" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/bJJzX_igqV4" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/bJJzX_igqV4" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowFullScreen" value="true" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object></p> <p>  </p> <p>  </p> <p> <strong>The correct answer is B. </strong></p> <p> <strong>Kaplan says, here’s why: </strong><br /> Cystosarcoma phyllodes occurs in young women and grows to a huge size over many years, and yet spares the skin, the nodes and the underlying chest wall. There is no particular connection with Central America, but often these tumors are seen in immigrants of limited financial circumstances who have had no access to medical care in their own countries.</p> <p> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer.</em></p> <p> <strong>Choice A:</strong> Chronic cystic mastitis also known as fibrocystic changes of the breast, is seen in women of reproductive age who complain of tender and lumpy breasts preceding the menstrual cycle. Large cysts can develop in this disease, but not to the huge size described in the vignette.</p> <p> <strong>Choice C:</strong> Inflammatory breast cancer presents most often in older women complaining of swollen, edematous, erythematous breast with or without ulceration. Obstruction of lymphatic vessels accounts for the edematous appearance of the breast.</p> <p> <strong>Choice D:</strong> Intraductal papilloma is the most common cause of bloody nipple discharge. These tumors are tiny, just a few millimeters in diameter, and are located in the ductal lumen.</p> <p> <strong>Choice E:</strong> Mammary duct ectasia is a benign process due to subacute inflammation of the ductal system. Patients present with nipple discharge (sticky and of various colors), noncyclic breast pain, nipple retraction, and/or subareolar mass.</p> <p> <strong>One tip to remember:</strong></p> <p> Cystosarcoma phyllodes is a slow-growing and usually benign (90%) tumor that may reach very large and impressive sizes in premenopausal patients. The tumor is freely mobile, usually 4-5 cm, smooth, and well-circumscribed. All tumors should be resected after diagnosis has been established.</p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a755d501-3efb-45b6-a605-4eabfebc8052 Students deliver care in homes, communities http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_students-deliver-care-homes-communities Thu, 18 Aug 2016 22:06:00 GMT <p> Serving patients with unmet health needs is taking on a new meaning for medical students as they provide care for urban and rural patients both in patients’ homes and in their communities. The experiences also are providing clarity about the social determinants of health and the importance of continuity of care as students become more attuned to their patients’ needs.</p> <p> The immersions into the clinics and greater community are part of the schools’ work with the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education Consortium</a>. The consortium, working to modernize and reshape the way physicians are trained, brings leaders from schools together to share ideas and experiences with new programs that are designed to improve competency, leadership and patient care through innovations that bridge the curriculum gap between medical school and practice.</p> <p> Students from the consortium schools recently came together at University of California, Davis, School of Medicine to share their experiences and gain insights from experts that they can put into practice throughout their careers.</p> <p> <strong>Taking health care to patients’ homes in Florida</strong></p> <p> Students at Florida International University Herbert Wertheim College of Medicine are embedded directly into underserved households in Miami-Dade County.</p> <p> Students very early on see first-hand the challenges that some patients face in taking care of their health, and they gain skills to help the whole patient, said Onelia Lage, MD, FIU HWCOM’s chief of education and faculty development in the Department of Humanities Health and Society.</p> <p> “They learn to address the social determinants of health for households, participate in health education, provide clinical monitoring of blood pressure, medication reconciliation, vital signs … and address social, behavioral, educational and legal needs,” she said.</p> <p> The Green Family Foundation Neighborhood Health Education Learning Program (NeighborhoodHELP™) introduces first-year medical students during the NHELP orientation and the community practicum to the school’s community outreach team, which has relationships with more than 160 community partners. During their second, third and fourth years, students are part of an interprofessional team that includes at least one of the following: nursing, social work and physician assistant students. They go into households together to take care of individual families.</p> <p> “Working with an interprofessional group in their preclinical years aims to prepare students to more effectively work with interprofessional teams later on,” Dr. Lage said.</p> <p> The program has been teaching students this way for a decade.</p> <p> Students say that they have become more knowledgeable about cultural differences, more comfortable working with interprofessional students, and more empathetic and sensitive to households’ needs, Dr. Lage said.</p> <p> <strong>Bringing basic science to life in Washington </strong></p> <p> During the first week of medical school, students across University of Washington School of Medicine’s six regional campuses in five states embed themselves in a primary care setting. More than 250 preceptors in areas such as family medicine, internal medicine and pediatrics are helping the students with the hands-on learning. The change in the medical school curriculum took place in the fall of 2015.</p> <p> “From the students’ perspective, it is probably their favorite part of the new curriculum,” said Michael J. Ryan, MD, the medical school’s associate dean for curriculum. “It makes the basic science they are learning stick much better because they are seeing how the science works [with real patients].”</p> <p> It also reminds people why they went to medical school. “As they get burnt out on basic science, students can say ‘Yes. This is why I am in medical school,’ ” Dr. Ryan said.</p> <p> For many students, working in a primary care setting reinforces the reasons they usually say they chose to go to medical school in the first place. The foundational science course can be challenging; seeing patients throughout the foundations phase makes the students say, “’Yes, this is why I am in medical school,’” he said.</p> <p> The embedding is often in primary care offices in smaller rural communities, and students are there long enough to gain an appreciation for the continuity of care. For example, medical students are able to see a patient throughout the various stages of a pregnancy or an illness. And the students don’t just shadow a physician. They are expected to take patient histories and explore what brought the patient into the office.</p> <p> “We are hearing that in their first year, some students have more confidence in talking to and assessing patients than previous students had,” Dr. Ryan said.</p> <p> Going forward, students also will get hands-on experiences to learn about the health system, health systems science, and patient safety and quality initiatives.</p> <p> <strong>Interested in more med ed innovations?</strong></p> <p> These schools aren’t the only ones with innovative programs that embed medical students into patient care in their communities. <a href="http://www.ama-assn.org/ama/ama-wire/post/med-schools-focus-quality-improvement-patient-safety">Read more</a> about how three other schools in the consortium are giving students this hands-on experience.</p> <p> Additionally, <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" target="_blank">Consortium</a> founding members <a href="http://www.ucdmc.ucdavis.edu/medschool/" target="_blank" rel="nofollow">University of California, Davis, School of Medicine</a>; <a href="http://www.pennstatehershey.org/web/college/" target="_blank" rel="nofollow">Penn State College of Medicine</a>; and <a href="https://medschool.vanderbilt.edu/" target="_blank" rel="nofollow">Vanderbilt University School of Medicine</a>, along with <a href="http://www.msm.edu/" target="_blank" rel="nofollow">Morehouse School of Medicine</a>, which joined the consortium in January, also have programs aimed at placing students in underserved communities so they can help patients and gain experience in the community.</p> <p> You also can read more about consortium work in these articles:</p> <ul> <li> Review <a href="http://www.ama-assn.org/ama/ama-wire/post/9-challenges-medical-educators-want-solve-right-now" target="_self">9 med ed challenges</a> educators and consortium members want to solve right now.</li> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/creating-impossible-key-innovations-solutions-med-ed" target="_self">how educators are creating the impossible</a> for future physician training.</li> <li> Discover the <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">current projects</a> the consortium’s 11 founding members have underway.</li> </ul> <p align="right"> <em style="font-size:12px;">By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8a85c342-c186-4d8b-a2de-a7b023b4cba6 Treating substance use disorder as a family physician http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_treating-substance-use-disorder-family-physician Thu, 18 Aug 2016 03:00:00 GMT <p> Patients with substance use disorders may experience stigma that can interfere with treatment options. But when substance use disorders are recognized and treated as a chronic disease, that stigma can be reduced. </p> <p> Treating patients with substance use disorders in a family medicine setting can be a unique situation because physicians are often treating other members of the patient’s family as well. At first, patients may be reluctant to discuss substance use but once the condition is out in the open, having the family involved can be beneficial.</p> <p> “I really think it’s an advantage,” said Sarah Fessler, MD, a family physician and president-elect of the Rhode Island Medical Society. “I care for the whole family and it always becomes a family effort to help someone and keep them in sobriety. People definitely have a much better chance of succeeding if they have that family support,” she said.</p> <p> <strong>Working with patients who feel like family </strong></p> <p> Primary care physicians, especially those in family medicine, know many of their patients very well and have established a long-term relationship. That can be advantageous when a patient begins to show signs of a substance use disorder.</p> <p> “It’s interesting and tricky,” Dr. Fessler said, “but that’s where it’s helpful to know the person and have a relationship so there’s a certain amount of trust already there. Usually, you get a sense that there’s something else going on when an interaction doesn’t go the way you expect it to in the office.”</p> <p> “Sometimes I realize that someone has an alcohol problem, for instance, when they end up in the emergency room for an alcohol-induced injury or an overdose,” she said. “In those cases it’s pretty easy to bring it up with the patient.”</p> <p> “It’s not always that straight forward,” she said. “Sometimes you have to read between the lines a little bit. You know the patient well enough, just like if they were a close family member, you wonder … and by knowing someone in a longitudinal way it’s easier to see that something is going on.”</p> <p> Acknowledging that the patient’s demeanor has changed by asking, “You don’t seem like yourself today, is something going on?” is a way to begin the conversation, Dr. Fessler said. “You open the door to them, let them know they can ask you for help, and identify yourself as a resource.”</p> <p> “It becomes a much easier conversation once substance abuse is out in the open,” she said. “And there’s nothing that cements a relationship like reaching out to the patient and offering them help.”</p> <p> <strong>Reducing stigma in the primary care setting</strong></p> <p> Once the physician and patient have had a conversation about substance use and have determined that it would be best to seek treatment, the primary care setting can be a great place for that treatment to occur. Some patients feel more comfortable when their substance use disorder is treated in the same way as any other medical condition, which can also reduce the stigma.</p> <p> Dr. Fessler uses medication-assisted treatment (MAT) in her practice and is a waivered buprenorphine prescriber. She has been practicing family medicine in a community health center for 22 years.</p> <p> “I remember hearing a fellow health center director talk about [MAT] in a very positive way,” she said. “I also remember thinking, ‘I don’t know, it seems like there’re so many barriers to making this work in our office.’”</p> <p> “But over time, with the opioids crisis, people were moving to even more dangerous forms of opioids,” she said. “I’d seen people overdose and realized that a lot of my existing patients had problems they needed some help with and I decided I should take another look.”</p> <p> So Dr. Fessler took the training to become a waivered buprenorphine prescriber, and now her practice treats opioid use disorders in house. Her practice is hoping to expand the program to all the primary care physicians in the office because of the positive impact of MAT.</p> <p> “We are intending to have this as part of our primary care practice,” she said, “taking care of patients’ other needs as well as their substance abuse problems.”</p> <p> Dr. Fessler and her primary care colleagues are treating many patients with substance use disorders as well. “I view it as another chronic medical problem like high blood pressure and diabetes,” she said. “It’s something we can help them with and I’ve seen some really positive results—people whose lives were spinning out of control really get things under control, get back to work and repair their relationships.”</p> <p> “It’s not easy for everyone and a lot of people have trouble getting on buprenorphine, staying on it and using it correctly, and they’ll relapse,” Dr. Fessler said. “I took another step back and I thought, well my diabetic patients don’t always stay on their meds either and come to the office and their sugars are really high. But we talk about what worked and what didn’t work, and it seems that that’s human nature. You can keep trying different angles with each patient and eventually it might stick.”</p> <p> A barrier that has arisen is that some patients don’t show up for the induction of buprenorphine treatment. “Staff is all geared up to help somebody with their induction and they don’t show up, because that’s the nature of substance abuse,” she said. “Sometimes, when it comes down to the wire they aren’t ready.”</p> <p> “You just keep trying,” Dr. Fessler said. “I leave the door open.”</p> <p> “If somebody doesn’t show we’ll do a follow-up phone call and I’ll often do that myself,” she said. “They often don’t pick up because they know it’s our office calling, but I’ll leave a message and I’ll say, ‘Sorry we didn’t’ see you, I know this is a hard thing to start, sometimes people just aren’t ready, but if you want to try again the door is always open; or if you’d like to talk about a different kind of treatment I’d be glad to do that too.”</p> <p> “[Patients] really appreciate being able to come to a primary care provider and not to a substance abuse treatment office,” Dr. Fessler said. “At a primary care provider where they already feel connected and they’re just another patient in the waiting room sitting beside other people who don’t have that same problem, they’re able to shake some of the stigma off. And I think that helps them too.”</p> <p> “The goal is to normalize it,” she said. “[Substance abuse disorder] is just something that happens, it’s another chronic medical problem and should be treated that way.”</p> <p> <strong>A collaboration to provide more resources</strong></p> <p> The AMA, RIMS and officials from the Rhode Island Department of Health and the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals recently announced a partnership to develop and distribute a statewide educational toolbox for healthcare providers to help reverse the state's opioid epidemic. Rhode Island and Alabama are the two states participating in this pilot program with the AMA.</p> <p> The pilot program will build a toolbox—available online and in print—that incorporates the best information from the AMA, the state medical societies and state health officials. Physicians and other health care professionals will have access to key data, valuable resources and practice specific recommendations they need to enhance their decision-making when caring for patients suffering from chronic or acute pain and opioid use disorders, as well as for patients needing overdose prevention education.</p> <p> The toolbox will be released in September, and the AMA, the state medical societies and state officials will work together to distribute it throughout Rhode Island. “I hope it makes all this much easier and demystifies a lot of it for physicians who are considering being substance abuse treatment providers,” Dr. Fessler said.</p> <p> “It’s going to be really helpful to expand our treatment in Rhode Island by just having that support for docs who are on the fence, or are not sure,” she said. “But there’s a long way to go and there’s still way too many overdoses and misconceptions on appropriate treatment of pain. I hope it’s a model for other states.”</p> <p> Reducing the stigma of substance use disorders and enhancing access to treatment for those who have a disorder is one of the <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse.page" target="_self">five things physicians can do to prevent opioid abuse</a>, recommended by the <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page?" target="_self">AMA Task Force to Reduce Opioid Abuse</a>, which physicians convened to help the nation move closer to the goal of ending the opioid epidemic.</p> <p> <strong>For more on treating substance use disorders:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/one-physician-uses-his-pdmp-patients" target="_self">How one physician uses his PDMP to help patients</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/antidote-3-things-consider-co-prescribing-naloxone" target="_self">The antidote: 3 things to consider when co-prescribing naloxone</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/pain-expert-judge-opioid-treatment-not-patient" target="_self">Pain expert: Judge the opioid treatment, not the patient</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-steps-talking-patients-substance-use-disorder" target="_self">3 steps for talking with patients about substance use disorder</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9174e58a-d50c-49d8-ab29-447355d4104a USMLE Step 1 stumper: Can you answer it correctly? http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_usmle-step-1-stumper-can-answer-correctly Thu, 18 Aug 2016 03:00:00 GMT <p> The United States Medical Licensing Examination® (USMLE®) Step 1 exam is notorious for pushing the limits of medical students’ knowledge, so you might like to know which test prep questions are commonly missed. Check out this month’s question that Kaplan Medical says stumps most students, and view an expert video explanation of the answer.</p> <p> Welcome to this month’s installment of the <em>AMA Wire</em>® series, Tutor talk: Tips from Kaplan Medical on the most missed USMLE test prep questions from Kaplan’s Qbank: Step 1. Each month, we’re revealing the top questions physicians in training miss on the USMLE, a helpful analysis of answers and videos featuring tips on how to advance your test-taking strategies. See <a href="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" target="_self">all posts in this series</a>.</p> <p> Think you have what it takes to rise above your peers? Test your USMLE knowledge below.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong></p> <p>  </p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/3/703b6547-2c18-40cf-9379-be02106284ac.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/3/703b6547-2c18-40cf-9379-be02106284ac.Large.jpg?1" /></a></p> <p>  </p> <p> The diagram shows changes in blood pressure and heart rate in an animal with intact reflexes in response to drug X (agonist) and drug Y (antagonist). Assume that the antagonist's effects will last for the duration of the experiment and that the agonist's effects are transient. Drug X and drug Y are most likely to be which of the following?</p> <p style="margin-left:40px;"> A.  X=Isoproterenol/Y=Atropine</p> <p style="margin-left:40px;"> B.  X=Isoproterenol/Y=Phentolamine</p> <p style="margin-left:40px;"> C.  X=Isoproterenol/Y=Propranolol</p> <p style="margin-left:40px;"> D.  X=Norepinephrine/Y=Atropine</p> <p style="margin-left:40px;"> E.  X=Norepinephrine/Y=Phentolamine</p> <p style="margin-left:40px;"> F.  X=Norepinephrine/Y=Propranolol</p> <p>  </p> <p> <object data="http://www.youtube.com/v/4mMJB8bLsZI" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/4mMJB8bLsZI" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/4mMJB8bLsZI" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowFullScreen" value="true" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object></p> <p>  </p> <p>  </p> <p> <strong>The correct answer is D. </strong>A good approach for such questions is the process of elimination.</p> <p> <strong>Kaplan says, here’s why:</strong></p> <p> Because the agonist raises arterial blood pressure, it must be a pressor, such as norepinephrine (NE). Isoproterenol, a beta agonist, would cause a decrease in blood pressure by vasodilation; therefore, choices A, B, and C can be immediately eliminated. The decrease in heart rate is due to a baroreceptor reflex. The increased blood pressure leads to increased parasympathetic and decreased sympathetic tone to the heart.</p> <p> The next step is to see if any antagonists can be eliminated. Drug Y alone causes no change in blood pressure but an increase in heart rate. Phentolamine (choice E), an alpha antagonist, can be eliminated because this should decrease blood pressure by blocking sympathetic tone to arterioles. Propranolol (choice F), a beta antagonist, would be expected to cause a small decrease in blood pressure and a decrease in heart rate. So choices E and F can be eliminated.</p> <p> Every option except choice D has been eliminated, but working through choice D would still be a good idea. Atropine blocks muscarinic receptors, but has virtually no effect on blood pressure because the muscarinic receptors in the vasculature (M3 receptors) are not innervated and therefore have no tone. However, blocking M2 receptors on the SA node results in an increase in heart rate due to the removal of the dominant parasympathetic tone that normally slows the heart.</p> <p> Administration of NE after atropine would still lead to the alpha-1 receptor-mediated vasoconstriction, thus increasing blood pressure. However, because atropine is still blocking muscarinic receptors in the SA node when NE is administered the second time, there is no slowing of the heart rate because it was primarily mediated by increased parasympathetic activity. Therefore the direct beta-1 adrenergic effects of NE on the SA are unopposed and the heart rate increases. This is consistent with the drug trace in the question.</p> <p> <strong>One key tip to remember:</strong></p> <p> When looking at drug traces, always think about blood pressure first and then heart rate second. Changes in blood pressure will be due to a direct effect on blood vessels and changes in heart rate may be due to either a baroreceptor effect or a direct effect on the heart.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:575e078c-51d1-4eee-9263-d6f2c8fe518b Masks, comics and the art of med school: Part one http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_masks-comics-art-of-med-school-part-one Wed, 17 Aug 2016 04:15:00 GMT <p> At a military medical school in Maryland, one physician professor is using art to give students time for self-exploration. Through the making of masks, students explore the ultimate question: Who am I?</p> <p> Medicine is both science and art. And for three years now at the Uniformed Services University of the Health Sciences (USU), medical students, at a particular phase in the curriculum when they are at high risk for burnout, have taken part in a collaborative mask-making exercise to promote self-exploration and personal identity formation.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/1/fc094cb4-ea69-405b-81d7-c4398801561b.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/1/fc094cb4-ea69-405b-81d7-c4398801561b.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> The university’s curriculum is a bit different than that of other medical schools. After 18 months of preclerkship, 12 months of clerkship, and a two-month study block for Step 1, students begin the mask-making exercise.</p> <p> Students are given blank masks and little direction other than examples of previous USU students and military service members who have gone through the art therapy program at the <a href="http://www.wrnmmc.capmed.mil/NICoE/SitePages/index.aspx" rel="nofollow" target="_blank">National Intrepid Center of Excellence </a>(NICoE). “We don’t want to tell them what should go on their masks,” said Mark Stephens, MD, a family physician and professor of family medicine at USU in Bethesda, Md. “That’s not our place, that is theirs…. As we frame the activity, we are very nonspecific in terms of giving them ample personal creative space.”</p> <p> “Most students choose to put something on the outside [of the mask], and most of the time it’s an explorative narrative of the mask that they present to the world,” he said. But some students draw and paint on the inside of the masks as well.</p> <p> “There are two canvases there for students to create a mask,” he said. “What do we present to the outside world? That’s what a lot of people say is the outer part of the mask. For the students who have chosen to draw on the inside, the theme that I see the most is insecurity.”</p> <p> At the time of the activity, “we have our own internal burnout data suggesting that a fair amount of them are emotionally exhausted, have a fair amount of depersonalization and a relatively low sense of personal accomplishment—the three domains of burnout,” Dr. Stephens said.</p> <p> “Just like you need to know the narrative of the patient to take optimal care of them, you need to know the narrative of self-identity to be true to self in the context of patient care,” he said. “If you bury your true sense of self long enough, there’s some real danger for both the individual and the patient.”</p> <p> “I see the mask making as very complementary in what I would call a self-narrative,” Dr. Stephens said. “I’m a big believer in the central importance of professional identity formation on the journey of becoming a physician.”</p> <p> “The mask making, for me, has been a wonderful journey of self-exploration and identity formation for our students,” he said. “I feel like, in many ways, medical education sets up situations where people are forced to put elements of themselvesto the side or ignore them—whether that’s an ethical conflict or feeling your way through failure.”</p> <p> <strong>How the mask-making exercise began</strong></p> <p> Art therapy at NICoE on the Walter Reed National Military Medical Center campus in Bethesda is part of a comprehensive and integrative treatment <a href="http://www.nationalgeographic.com/healing-soldiers/" rel="nofollow">program for active duty service members</a> with traumatic brain injury and underlying psychological health conditions.</p> <p> One day, Dr. Stephens was visiting NICoE’s art therapy studio when he met Melissa Walker, an art therapist who has worked with over one thousand active duty service members to create masks that are “magnificent works of art,” Dr. Stephens said.</p> <p> “There was a real connection,” he said, “in terms of the role of mask making in identity and self-exploration for our medical students.”</p> <p> Dr. Stephens and Ms. Walker collaborated to develop the mask-making exercise for USU medical students. From that partnership was born an activity that is now spreading to several other institutions in the context of self-exploration and professional identity formation.</p> <p> Working with collaborators such as Karlen Bader, in the department of family medicine, Lara Varpio, MD, in the department of internal medicine, and recently graduated senior medical students Sara Wilson, MD, and Kimera Joseph, MD, the team performed an extensive qualitative analysis on a subset of the student masks. </p> <p> Some of the themes identified are disturbing or haunting. They often depict a sense of identity conflict, numbness, emptiness or hollowness. It is important to recognize and externalize those feelings in order to deal with or overcome them, Dr. Stephens said. Students tend to bury or ignore those feelings. </p> <p> "In this context, the broader the space between true and projected self, the more identity dissonance or role confusion there is going to be," Dr. Stephens said. "I see that as having real implications for patient care." </p> <p> Medical students at a school like USU have to play multiple roles. They are not only medical students, they are also military officers. “The question is,” he said, “are the students of the uniformed services the same as other medical students?”</p> <p> Through a partnership with Penn State University and the University of California, Irvine, Dr. Stephens hopes to find an answer. “We’re going to look at a series of students over time,” he said, “because what we think is students who enter the door are different than students heading out for their first clinical clerkship who are different than students who are ready to graduate…. Phases of identity formation on the professional continuum are iterative.”</p> <p> Watch <em>AMA Wire®</em> in the coming weeks for the second part of a series on the arts and humanities in medical school, featuring Michael Green, MD, of Penn State University, who has developed the course, “Comics in Medicine.” In the course, fourth year medical students examine their clinical experiences through long-form graphic narratives. </p> <p> <strong>For more on student burnout:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-school-burnout-care-of-yourself?utm_source=BulletinHealthCare&utm_medium=email&utm_term=081316&utm_content=students&utm_campaign=article_alert-morning_rounds_weekend" target="_self">Medical school burnout: Taking care of yourself</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/student-wellness-blueprints-curriculum-of-future">Student wellness: Blueprints for the curriculum of the future</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/ward-off-burnout-peer-network-may-impact-think">Ward off burnout: Your peer network may impact more than you think</a></li> </ul> <p align="right"> <em>By AMA staff writer <a href="https://twitter.com/Troy_AMAWire" rel="nofollow">Troy Parks</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7457729e-ecad-4ebe-89c3-fc1cdba92724 CDC discusses updated guidelines in Zika virus webinar http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_cdc-discusses-updated-guidelines-zika-virus-webinar Mon, 15 Aug 2016 21:00:00 GMT <p> The AMA and the Centers for Disease Control and Prevention (CDC) recently held a webinar to provide an update for physicians and other clinicians on the status of the Zika virus outbreak and the latest clinical guidance to help them diagnose and manage patients and prevent further transmission.</p> <p> “As the Zika virus outbreak continues to evolve and more Americans become impacted by the virus,” said AMA President <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/board-trustees/our-members/andrew-gurman.page?" target="_self">Andrew W. Gurman, MD</a>,” we must ensure that our nation’s physicians, and all clinicians, are prepared to handle possible cases of the virus and are equipped with the most up-to-date information to answer patients’ questions.”</p> <p> The webinar, “Preparing for Zika transmission in the United States,” is available online at the AMA’s <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/zika-resource-center.page" target="_self">Zika Virus Resource Center</a>. Experts provided details of the latest epidemiological and clinical aspects of the current Zika outbreak, implications for pregnant women and the CDC’s most up-to-date clinical guidance to support health care professionals in combatting and preventing complications.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/15/61aff7d1-8979-476f-af9e-449a55a6d799.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/15/61aff7d1-8979-476f-af9e-449a55a6d799.Large.jpg?1" style="float:right;margin:15px;" /></a></p> <p> <strong>Updated pregnancy guidelines</strong></p> <p> There is emerging data indicating Zika virus RNA can be detected for prolonged periods of time in some pregnant women. The CDC hopes to increase the proportion of pregnant women with Zika virus infection who receive a definitive diagnosis by expanding real-time reverse transcription polymerase chain reaction (rRT-PCR) testing.</p> <p> Testing recommendations vary according to the type and timing of possible exposure. “Possible exposure” is defined as travel to or living in an <a href="http://www.cdc.gov/zika/geo/index.html" rel="nofollow" target="_blank">area with Zika virus</a>, or sex without barrier protection, such as a condom, with a partner who has traveled to or lives in these areas. The CDC stressed that all pregnant women should be asked at each prenatal visit if they have had one of these exposures.</p> <p> For symptomatic pregnant women, the CDC recommends:</p> <ul> <li> Those evaluated less than two weeks after symptom onset should receive Zika virus rRT-PCR testing of both serum and urine</li> </ul> <ul> <li> Those evaluated two to 12 weeks after symptom onset should first have a Zika virus immunoglobulin (IgM) test; if this result is positive or equivocal, serum and urine rRT-PCR should be performed</li> </ul> <p> The CDC also delivered recommendations for testing of asymptomatic pregnant women. A flowchart detailing testing and recommendations is available on the <a href="http://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm" rel="nofollow" target="_blank">CDC's website</a>.</p> <p> <strong>Preventing sexual transmission</strong></p> <p> Because the Zika virus can be sexually transmitted, the CDC offered new guidance for couples at risk, including:</p> <p> Couples in which a woman is pregnant:</p> <ul> <li> Pregnant women with sex partners who live in or have traveled to an area with active Zika virus transmission should consistently and correctly use barriers against infection during sex or abstain from sex for the duration of the pregnancy</li> </ul> <p> Couples who are not pregnant and are not planning to become pregnant:</p> <ul> <li> Couples in which a partner had confirmed Zika virus infection or clinical illness consistent with Zika virus disease should consider using barrier methods against infection consistently and correctly or abstain from sex as follows:</li> <li style="margin-left:40px;"> Men with Zika virus infection for at least 6 months after onset of illness</li> <li style="margin-left:40px;"> Women with Zika virus infection for at least 8 weeks after onset of illness</li> <li> Couples in an area without active Zika transmission in which one partner traveled to or resides in an area with active Zika virus transmission but did not develop symptoms of Zika virus disease should consider using barrier methods against infection or abstaining from sex for at least 8 weeks after that partner departed the Zika-affected area</li> <li> <p> Couples who reside in an area with active Zika virus transmission might consider using barrier methods against infection or abstaining from sex while active transmission persists.</p> </li> </ul> <p> The <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/zika-resource-center.page" target="_self">webinar</a> also includes up-to-date statistics on the spread of Zika in the U.S., recommendations for counseling women and men living in areas with ongoing spread of Zika virus who are interested in conceiving, and the use of standard precautions to prevent the spread of Zika in the health care setting.</p> <p> <strong>Congress must provide more resources</strong></p> <p> With an increasing number of Zika cases confirmed in the U.S., including this week’s news of the death of a newborn baby with Zika-linked microcephaly, the AMA continues to call on policymakers on Capitol Hill to immediately make the necessary resources available to combat the growing threat of the virus and protect public health. Congress failed to pass legislation to deploy a robust public health response to the Zika virus before it adjourned for summer recess.</p> <p> The AMA will also continue to update its online <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/zika-resource-center.page" target="_self">Zika Virus Resource Center</a> with the latest Zika-related information from CDC and other trusted organizations to support health care professionals’ efforts to prevent and combat complications from the virus.</p> <p style="text-align:right;"> <em>By AMA staff writer Tim Smith</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:802601e7-9c22-45d1-ae1e-d3cb8b4f5e1f Out of tragedy comes a new focus on resident health http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_out-of-tragedy-comes-new-focus-resident-health Mon, 15 Aug 2016 20:56:00 GMT <p> After news that a star surgical resident, who had recently left Stanford to pursue a fellowship, had committed suicide, the residency program leadership decided to create a new structure that addresses the underlying issues affecting resident health and promotes a healthier work-life balance.</p> <p> <strong>Shifting toward work-life balance in residency</strong></p> <p> When Greg Feldman, MD, a general surgery resident from Stanford University, took his own life during his fellowship in Chicago, the general surgery department was shocked at the news. He had been one of the most accomplished resident physicians the program had ever seen. He was warm and outgoing and seemed happy.</p> <p> One fellow trainee described him as “extremely good at balancing his work and non-work life and cared about getting other residents to have fun both at work and outside the hospital.”</p> <p> During the healing process, the program leadership decided to take action to get to the heart of what affects resident health and began to develop a wellness program for residents.</p> <p> <a href="https://med.stanford.edu/gensurg/education/BIL.html" target="_blank" rel="nofollow">Balance in Life</a> is a holistic, multifaceted program with the primary mission to support and promote the physical, psychological, social and professional well-being of general surgery residents and to provide them with the tools they will need to successfully navigate life as a surgeon.</p> <p> <strong>The four parts of a healthy medical life</strong></p> <p> Residents are trained in everything they need to know in the clinical setting so that they can be the most effective physicians possible, but why can’t residents also receive training in maintaining work-life balance?</p> <p> The Balance in Life program focuses on four aspects of a healthy professional and personal lifestyle:</p> <ul> <li> <strong>Physical.</strong> Residents have 24-hour access to the Goodman Surgical Education Center which holds a residents-only refrigerator stocked with healthy food and drinks. Also available for residents is an “After Hours” guide that provides all the names of local primary care physicians, OB-GYNs and dentists recommended by colleagues. It also includes a list of gyms, fitness centers, grocery stores, movie theaters, restaurants and places for hiking and biking in the area.<br /> <br /> Residents are encouraged—and expected—to schedule regular dental and primary care appointments. Even if they can’t find an appointment time outside clinical duty hours, program faculty will make the time available if necessary. At the program director bi-annual meetings, residents are asked if they have seen their primary care physician and dentist.</li> </ul> <ul> <li> <strong>Psychological.</strong> Every Tuesday morning residents meet on a rotating schedule with Lisa Post, PhD, a clinical psychologist at Stanford with expertise in coaching high-performance teams. The meetings are mandatory and strictly confidential.<br /> <br /> The goal of the meetings is to facilitate difficult conversations about challenges residents face in both their personal and professional lives.</li> </ul> <ul> <li> <strong>Professional.</strong> Each September, first and second year general surgery residents are paired with fourth—and fifth-year residents to act as mentors throughout the year. The pairs are expected to meet at least three times per year and the program provides gift cards to coffee houses and other places for the meetings.<br /> <br /> Each class also elects a representative to the program directors to create an avenue for residents to discuss issues that arise and cultivate solutions constructively.</li> </ul> <ul> <li> <strong>Social.</strong> The social chair is responsible for organizing events that promote socializing among residents and to continue their extracurricular interests, which have included dinners, sporting events, happy hours, wine tastings and hiking.<br /> <br /> Team-building, camaraderie and communication among residents is also important to Balance in Life. So each year a full-day offsite retreat is provided for residents, which has included team sailing in the San Francisco Bay and a high-ropes course in the Santa Cruz Mountains.</li> </ul> <p> Balance in Life has created a strong sense of community among residents and remains deeply embedded in the ethos of the training program. Residents feel they are part of an environment where asking for help is welcomed, encouraged and supported.</p> <p> An <a href="https://www.stepsforward.org/modules/physician-wellness" target="_self" rel="nofollow"><u>online module</u></a> in the AMA’s STEPS Forward™ collection of practice improvement strategies explains what is needed to prevent burnout among physician trainees, based on lessons learned by successful residency wellness programs. </p> <p> Thirty-five modules now are available, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</p> <p> <strong>Explore other wellness solutions for residents and fellows:</strong></p> <ul> <li style="margin-left:18.75pt;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-essential-art-of-balancing-emotion-logic" target="_self">The physician’s essential art of balancing emotion and logic</a></li> <li style="margin-left:18.75pt;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/residents-beating-burnout-theatre" target="_self"><u>Residents are beating burnout with help from the theatre</u></a></li> <li style="margin-left:18.75pt;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/one-program-achieved-resident-wellness-work-life-balance"><u>How one program achieved resident wellness, work-life balance</u></a></li> <li style="margin-left:18.75pt;"> <u><a href="http://www.ama-assn.org/ama/ama-wire/post/ways-residents-found-conquer-burnout" target="_self">Ways residents have found to conquer burnout</a></u></li> <li style="margin-left:18.75pt;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/ward-off-burnout-peer-network-may-impact-think" target="_self"><u>Ward off burnout: Your peer network may impact more than you think</u></a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow"><em><u>Troy Parks</u></em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a6451460-56bf-4444-b715-8bc992a29e5c Physicians and veterinarians join forces for wellness http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-veterinarians-talk-wellness Sun, 14 Aug 2016 16:36:00 GMT <p> <em>An AMA Viewpoints post by AMA Immediate-Past President Steven J. Stack, MD, and American Veterinary Medical Association President Joe Kinnarney, DVM</em></p> <p> It’s been said that one person can’t change the world. Still, one person can make a difference.</p> <p> Each of us, physicians and veterinarians alike, needs to be that one person when it comes to wellness. Many of our colleagues are struggling with wellness issues and they need our help. We need to be compassionate listeners, not judgmental or cynical or proud. We need to help lift the stigma too often associated with wellness struggles, and we need to be there for our colleagues when they face those struggles. It starts with us—and it starts now.</p> <p> Compassion fatigue, burnout, depression and anxiety: These words have become all too common in the vocabulary of physicians and veterinarians alike. Our doctors are at risk, and we can no longer look the other way. For the first time, the leadership of the AMA and the American Veterinary Medical Association (AVMA) are working together to bring more awareness to the important issue of wellness among health care professionals.</p> <p> This joint column is a reflection of our early efforts. Both organizations have devoted time, energy and resources to addressing the mental health crisis in our respective professions. But, we must all begin to work more closely together—to share resources, passion and commitment—to break down the stigma and lead our colleagues on a brighter path to well-being. We can save lives.</p> <p> <strong>Efforts to take action, build resources</strong></p> <p> The AMA has made physicians’ wellness and ability to thrive a top priority. In fact, one of our three strategic focus areas is Professional Satisfaction and Practice Sustainability. As part of this initiative, we have created our <a href="https://www.stepsforward.org/" rel="nofollow" target="_self">STEPS Forward</a>™ collection of practice improvement strategies. These are online modules, which offer proven solutions by physicians for physicians.</p> <p> Three modules are specifically focused on physician wellness: One gives steps for <a href="http://www.ama-assn.org/ama/ama-wire/post/7-steps-prevent-burnout-practice" target="_self">preventing burnout</a>, another outlines solutions for enhancing joy in practice and mitigating stress, and a third focuses on ways to promote the well-being of physicians in training.</p> <p> Other modules provide ways to improve elements of the practice environment that can be risk factors for burnout, such as improving work flow through<a href="http://www.ama-assn.org/ama/ama-wire/post/8-steps-address-ehr-woes-team-documentation" target="_self"> team documentation</a>, expanded rooming and discharge protocols, <a href="http://www.ama-assn.org/ama/ama-wire/post/10-steps-pre-visit-planning-can-produce-big-savings" target="_self">pre-visit planning</a> and synchronized prescription renewal.</p> <p> We’re also hosting the International Conference on Physician Health, September 18–20 in Boston. This collaborative conference of the AMA, the Canadian Medical Association, and the British Medical Association will explore the theme “Increasing Joy in Medicine.” The conference showcases research and perspectives into physicians’ health and offers practical, evidence-based skills and strategies to promote a healthier medical culture for physicians.</p> <p> And we’re also working to prepare the next generation of physicians to be more fully equipped to thrive in the evolving health care landscape and to fully embrace a lifelong commitment to wellness—both for them and their colleagues.</p> <p> Wellness among physicians in training is an increasing focus for medical schools that are members of the AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education Consortium</a>. In fact, the medical community is coming together to address this issue from every part of the professional continuum, from training through retirement.</p> <p> You can learn more about the work underway at specific medical schools, residency programs, health systems, and medical organizations at <a href="http://www.ama-assn.org/ama/ama-wire/blog/MedEd_News/1" target="_self"><em>AMA Wire®</em></a>.</p> <p> As an association, the AVMA has recommitted itself to addressing issues related to wellness. Our Future Leaders program, which provides an opportunity for AVMA members who have been out of veterinary school for 15 years or less to take the next step in leadership and service to our profession, has focused on wellness for three years running.</p> <p> Program participants have helped develop continuing education programming at our annual convention and have developed a more-comprehensive <a href="https://www.avma.org/professionaldevelopment/personal/peerandwellness/pages/default.aspx?utm_source=prettyurl&utm_medium=print&utm_campaign=mktg&utm_term=wellness" rel="nofollow" target="_blank">wellness webpage</a> for veterinarians that now adds a validated self-assessment tool to our already extensive array of resources. This year’s class has developed a wellness plan for veterinary practices.</p> <p> In 2016, the AVMA hosted a Veterinary Wellness Roundtable that brought together representatives from across the profession to discuss the mental health crisis and what we can all do to address it. At the AVMA Convention in August, Dr. Dan Siegel spoke to thousands of attendees about the human mind and how we can use it to create strategies for increasing mental health.</p> <p> It is our hope the AVMA can serve as a trusted convener of the many groups that have an interest in veterinarians’ wellness and can help ensure the development and success of programs that will help all those we call colleagues and friends. We invite you to join us by bringing your perspective and helping build strength and momentum toward addressing these issues.</p> <p> <strong>What’s needed now</strong></p> <p> From our students to our seasoned professionals, we need to create, strengthen and enhance programs and resources that lift the veil of silence and stigma so that we can begin attending to our own well-being as healthcare professionals.</p> <p> We need to contribute energy and resolve to help our colleagues, both through the actions of our associations and as individuals. This problem has existed for many, many years, and the conversation has only recently heated up. We will not let this go like others have in the past. We want to turn the heat up even more. The conversation around this issue has started and we will keep it going.</p> <p> We encourage you to help start the change in your profession. Have open conversations about mental health, and work to break down the stigma. Although our respective professions have slightly different risk factors for mental health issues and wellness problems, we can work together because these are ultimately human problems, and are not specific to what type of medicine we practice or what species we treat.</p> <p> We challenge you to support each other. We are all in this together; no one should feel as though he or she is alone or deserves to be stigmatized, labeled, or rejected. Change can indeed start with one person, and that person resides in each of us.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:44dd020b-285f-489a-a006-06b7f19c63ec How Medicare regulatory penalties will change http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_medicare-regulatory-penalties-will-change Fri, 12 Aug 2016 22:00:00 GMT <p> Regulatory penalties under the current Medicare payment system have been rising, overwhelming physicians with reporting burdens just to avoid payment cuts. But how will financial penalties and bonuses change in the new system? Under the Medicare Access and CHIP Reauthorization Act (MACRA), regulatory penalties starting in 2019 will be much less severe, and physicians will have greater opportunity for bonuses.</p> <p> <strong>How MIPS will be different</strong></p> <p> The current pay-for-performance programs—the Physician Quality Reporting System (PQRS), the value-based payment modifier (VBM) and the Meaningful Use electronic health record program—each judge physicians separately on various metrics.</p> <p> Under MACRA, physicians who remain in Medicare’s fee-for-service program will participate in the Merit-based Incentive Payment System (MIPS). Though improvements to the proposed regulatory framework are needed for implementing MIPS, there is no question that the system offers improvements over current Medicare law.</p> <p> MIPS consolidates and better aligns the separate quality and performance measurement programs that currently affect physicians’ payments. It adds one new component—clinical practice improvement activities—with a menu of more than 90 activities through which physicians can demonstrate high-value services and receive credit.</p> <p> The current system includes quality measures that overlap and sometimes conflict. For instance, a physician who did not successfully report under PQRS automatically received a second negative payment adjustment under the VBM. With MIPS, that will no longer be the case. In addition, CMS is proposing to reduce the number of quality measures that physicians must report, as well as allowing greater flexibility in their choice measures.</p> <p> Also in the current system, the Meaningful Use and PQRS programs were scored on a pass/fail approach, which required physicians to be 100 percent successful on all reporting requirements to avoid penalties.</p> <p> Under the MIPS, physicians will receive partial credit for elements they are able to report on successfully, have the chance to earn bonuses if they score above average performance thresholds and avoid penalties if they meet those thresholds.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/11/fd6a2a39-c74e-42e9-abfa-633dfcf7fd4b.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/11/fd6a2a39-c74e-42e9-abfa-633dfcf7fd4b.Full.jpg?1" /></a></p> <p> As the table illustrates, financial risk regarding penalties will be significantly less under MIPS than it was under the previous system. The future severity of VBM penalties and bonuses under prior law is unknown because CMS ceased proposing them after MACRA passed; prior to MACRA’s passage, the penalties and potential bonuses increased each year.</p> <p> MIPS is characterized by not only a change in penalties but also a new bonus structure that increases as the program moves forward each year. Learn more about MACRA in the AMA’s <a href="file:///C:/Users/trparks/Downloads/16-0384-advocacy-macra-action-kit%20(1).pdf" target="_self" rel="nofollow">MACRA Action Kit</a>.</p> <p> <strong>Learn more about MACRA and Medicare quality reporting:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/changes-shore-up-small-practices-under-new-medicare-payment-system" target="_self">Changes needed to help small practices succeed under MACRA</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/later-start-date-could-ease-transition-new-medicare-system" target="_self">Later start date could ease transition to new Medicare payment system</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/key-changes-new-medicare-payment-system-needs" target="_self">Key changes the new Medicare payment system needs</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-useful-changes-meaningful-use" target="_self">Three useful changes to Meaningful Use</a></li> </ul> <p>  </p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:3fbab577-aef1-4e3f-89b2-d278f5d17ffc Get the new Principles of ICD-10-CM Coding http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-principles-of-icd-10-cm-coding Fri, 12 Aug 2016 21:00:00 GMT <p> The fourth edition of <em>Principles of</em> <em>ICD-10-CM Coding</em> provides the tools needed for physicians and payers to accurately and effectively use the ICD-10-CM code set. It clarifies the new diagnosis codes in detail to assist in making correct coding choices.</p> <p> Updated to include the 2017 code set, it helps health care professionals learn how to make correct decisions when selecting diagnosis codes from the ICD-10-CM code set. It is written for all skill levels and is appropriate for both self-learners and the classroom. It will help you:</p> <ul> <li> Understand the purpose of ICD-10-CM and its relationship to the reimbursement process</li> <li> Understand and apply coding conventions when assigning codes</li> <li> Interpret basic coding guidelines for outpatient care</li> <li> Assign ICD-10-CM codes to the highest level of specificity</li> <li> Properly sequence ICD-10-CM codes</li> </ul> <p> Some key features of the fourth edition include:</p> <ul> <li> Conventions and terminology used in the ICD-10-CM coding system</li> <li> Real-life chart notes</li> <li> ICD-10-CM guidelines for coding</li> <li> Chapter checkpoint exercises</li> </ul> <p> Visit the <a href="https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2730001&navAction=push#usage-tab" target="_self">AMA Store</a> for more information or to order online. AMA members receive a 20 percent discount on this product and others from the AMA Store. If you’re not a member, <a href="https://commerce.ama-assn.org/membership/" target="_self">join today</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:96e50a6c-b5a6-42b0-b43e-2adff672949f Register for the Interim Meeting by November 5 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_register-interim-meeting-november-5 Fri, 12 Aug 2016 15:00:00 GMT <p> Register for the American Medical Association Young Physicians Section (YPS) Interim Meeting, which will take place on Nov. 11 at the Walt Disney World Swan and Dolphin Resort, Orlando, Florida.</p> <p> The AMA-YPS Interim Assembly Meeting is the ideal venue for young physicians to take a stand and become a force for change for the future of medicine. This year’s meeting offers a variety of events, including leadership training, policy discussion and education sessions.</p> <p> The deadline to submit <a href="mailto:yps@ama-assn.org" rel="nofollow">resolutions</a> for consideration at the Interim Business Meeting of the AMA YPS is Sept. 30.</p> <p> <a href="http://www.ama-assn.org/go/i16-yps">Register</a> for the meeting by 3 a.m. Eastern Time Nov. 5.</p> <p> <strong>Send your accomplishments for the AMA-YPS Activities Report</strong></p> <p> Have you been elected President of your medical society? Did you receive an appointment to serve on a special committee? Are you the recipient of a distinguished honor? Share your recent achievement in organized medicine with the AMA-YPS.  Please forward your accomplishments to <a href="mailto:yps@ama-assn.org" rel="nofollow">yps@ama-assn.org</a> by September 16, 2016.</p> <p> <strong>YPS Involvement Opportunities</strong></p> <p> Please see below for various opportunities to participate in YPS committees and leadership positions.  To sign up or get more information, email the <a href="mailto:YPS@ama-assn.org" rel="nofollow">AMA-YPS</a>.</p> <ul> <li> YPS Convention Committees (sign up by September 30). <span style="font-size:12px;">Please consider volunteering for the section’s reference, handbook review or credentials committee. </span></li> </ul> <ul> <li> AMA-YPS Leadership Position:  Alternate Delegate (nomination forms due October 14). <span style="font-size:12px;">If you would like to get more involved in organized medicine, consider running for an open seat on the AMA-YPS Governing Council. </span><a href="http://www.ama-assn.org/resources/doc/yps/x-pub/nomination-form-2017.doc" style="font-size:12px;">Nomination forms</a><span style="font-size:12px;"> for alternate delegate will be accepted until Friday, October 14 in order to be posted on the AMA-YPS website.  Please note that nomination forms will be accepted until Friday, November 11 during the 2016 AMA-YPS Interim Assembly meeting.</span></li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:91f14b8f-4d04-4d25-b48f-ea5e96a6e134 Medical students get first-hand experience serving the underserved http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_medical-students-first-hand-experience-serving-underserved Thu, 11 Aug 2016 22:00:00 GMT <p> Medical schools are finding effective ways to embed students into their communities to care for underserved patients and gain hands-on experience that could change both how and where they ultimately practice medicine. See how some students and schools are making a difference.</p> <p> The immersions into the clinics and greater community are part of the schools’ work with the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education Consortium</a>. The consortium, working to modernize and reshape the way physicians are trained, brings leaders form schools together to share ideas and experiences with new programs that are designed to improve competency, leadership and patient care through innovations that bridge the curriculum gap between medical school and practice.</p> <p> Students and faculty from the consortium schools are coming together today and tomorrow at University of California, Davis, School of Medicine for a meeting on Health Equity and Community-based Learning to share their experiences and gain insights from experts that they can put into practice throughout their careers.</p> <p> <strong>Working with medically underserved in Texas</strong></p> <p> University of Texas Rio Grande Valley School of Medicine opened its doors to its first students this summer, and they soon will deploy into communities throughout the medically underserved Lower Rio Grande Valley.</p> <p> The students started the year studying biochemistry and clinical skills. In about six weeks, they will select or be assigned to a family medicine clinic in the <em>colonias</em>. These impoverished rural settlements are in unincorporated areas along the U.S.-Mexico border, where most residents were born in the U.S. and are under 18. The population is indigenous to the valley and typical of other underserved patient groups in the area.</p> <p> Students will conduct exams and practice their clinical skills as they assume the care of a family with their preceptor. In addition, they will work with a team that provides integrated care to connect patients with behavior health and other resources.</p> <p> “They are not just starting early; they are starting in a unique environment,” said Francisco Fernandez, MD, founding dead of the Rio Grande Valley School of Medicine. “It will help students better understand the needs of their patients in their environments.”</p> <p> And the hope is that the students who come into medical school with high altruistic values and a desire to advocate for patients will keep those feelings going forward, Dr. Fernandez said. Often those two things decline by the time medical students are in their third year, he said.</p> <p> “The students are where they can do the most good. They are able to look and see the impact they are having on patients,” he said. “I think that will stay with them.”</p> <p> <strong>Embedding in urban and rural community health centers  </strong></p> <p> A.T. Still University School of Osteopathic Medicine in Arizona opened in 2007. Working in partnership with the National Association of Community Health Centers, it pioneered a total immersion training model, in which students are embedded in 12 urban and rural community health centers during their second, third and fourth years of medical school.</p> <p> “It is combining pubic health and primary care,” said Joy H. Lewis, DO, PhD, chair of ATSU SOMA’s Department of Public Health and director of public health and practice-based research. “Students have the benefit of living in the community and working with providers dedicated to serving underserved patients and whole communities.”</p> <p> Dr. Lewis said students gain confidence early on in interviewing patients. In the community setting, students then become adept at exploring people’s stories a little deeper, and they learn to evaluate and address the social determinants of health. For example, students learn to ask patients questions, such as who helps them look after their children or why they are not taking their medication as directed.</p> <p> “In community health centers, students can work with patients to find the resources they need, such as connecting them with a free exercise program at the community recreation center or a farmers market,” Dr. Lewis said.</p> <p> Students also have a chance to develop and complete a community-oriented primary care project. By being embedded in the community, students figure out what the needs are, evaluate those needs and develop a strategy to implement change. The teams compete for the privilege of presenting their community project results at a national conference of community health centers.</p> <p> And when students graduate, Dr. Lewis said, they express interest in primary care, community service, community health and continuing to work in underserved areas.</p> <p> <strong>Hands-on experience in New York FQHCs</strong></p> <p> Students at Sophie Davis Program in Biomedical Education/CUNY School of Medicine enter a seven-year BS/MD program that prepares students to become primary care physicians in medically underserved areas. The school has partnered with numerous federally qualified health centers (FQHC) in New York City, and students are embedded in the health centers for three years, beginning in the third year of the seven-year program.</p> <p> During the third year, students shadow their physician preceptors and develop their clinical history-taking skills. They also learn about team-based care in an FQHC and rotate with nurses, dieticians and social workers to learn about how each professional contributes to patient care. The medical students are trained as health coaches, and they begin to meet with patients in that role, helping them identify health-related behavioral changes, such as exercise and diet changes. They follow up with those patients longitudinally.</p> <p> Students return to the same FQHC during the next two years of their longitudinal clinical experience and assist with value-added tasks, such as medication reconciliation and developing and disseminating patient education tools.</p> <p> “We hope that the biggest benefit for students in this experience will be the opportunity to understand deeply how FQHCs currently address the health needs of communities, to recognize the value of team-based care and other innovations in primary care delivery, and to be inspired to choose careers in primary care in underserved areas,” said Rosa Lee, MD, assistant dean for clinical science curriculum and associate medical professor in the Department of Medical Education.</p> <p> Third-year students last year were the first to take part in the new curriculum. Preliminary feedback is that they enjoyed the experience and appreciated the introduction to team-based care in an FQHC.</p> <p> “The students … are looking forward to returning to the clinical sites, especially as they gain more knowledge and skills to participate more fully in clinical activities at these health centers,” Dr. Lee said.</p> <p> <strong>Interested in more med ed innovations?</strong></p> <p> These schools aren’t the only ones with innovative programs that embed medical students into patient care in their communities.</p> <p> <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" target="_self">Consortium</a> founding members <a href="http://www.ucdmc.ucdavis.edu/medschool/" rel="nofollow" target="_blank">University of California, Davis, School of Medicine</a>; <a href="http://www.pennstatehershey.org/web/college/" rel="nofollow" target="_blank">Penn State College of Medicine</a>; and <a href="https://medschool.vanderbilt.edu/" rel="nofollow" target="_blank">Vanderbilt University School of Medicine</a>, along with <a href="http://www.msm.edu/" rel="nofollow" target="_blank">Morehouse School of Medicine</a>, which joined the consortium in January, also have programs aimed at placing students in underserved communities so they can help patients and gain experience in the community.</p> <p> You can read more about consortium work in these articles:</p> <ul> <li> Review <a href="http://www.ama-assn.org/ama/ama-wire/post/9-challenges-medical-educators-want-solve-right-now" target="_self">9 med ed challenges</a> educators and consortium members want to solve right now.</li> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/creating-impossible-key-innovations-solutions-med-ed" target="_self">how educators are creating the impossible</a> for future physician training.</li> <li> Discover the <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">current projects</a> the consortium’s 11 founding members have underway.</li> </ul> <p align="right"> <em style="font-size:12px;">By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:689a822f-3a28-427c-80b9-ab8c9b5c4c4a How a new transitions model helped one patient http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-transitions-model-helped-one-patient Wed, 10 Aug 2016 21:49:00 GMT <p> After discharge it has often been up to the patient to adhere to medication regimens and alert their physician to any complications or confusion, but patients don’t always have the tools or circumstances to make this an easy task. Learn how a new transitions model helped one patient take charge of his health and better understand and adhere to his care plan.</p> <p> The <a href="http://www.ama-assn.org/ama/ama-wire/post/hospital-home-model-safer-transitions" target="_self">SafeMed model</a> was developed at the University of Tennessee in partnership with Methodist Le Bonheur Healthcare in Memphis. It was designed with the strengths of primary care in mind and relies on a collaborative team effort from physicians, pharmacists, nurses and community health workers to form a support network for high-risk and high-needs patients as they transition from the hospital to the outpatient setting.</p> <p> <strong>Helping one patient take charge of his health</strong></p> <p> Mr. S had multiple chronic conditions—coronary artery disease, congestive heart failure, chronic kidney disease, hypertension, and a history of depression and cocaine use.</p> <p> He was initially admitted to the hospital because his automatic implantable cardioverter-defibrillator kept firing, causing severe emotional and physical discomfort.</p> <p> Social risk factor screening indicated that he had low to moderate social support at home. Mr. S was on Medicaid and received government disability assistance. His complex medical history and lack of social support made Mr. S an obvious candidate for the intensive care transitions services provided by the SafeMed program and he was enrolled.</p> <p> Over the next three days of his hospitalization, the SafeMed team—which included a nurse practitioner, a pharmacist, a pharmacy technician and a licensed practical nurse community health worker—worked to develop rapport with Mr. S and assess his unique needs.</p> <p> Because of his limited income, cost was a major barrier for Mr. S’ medication adherence, the pharmacist learned. So the pharmacist and the pharmacy technician helped Mr. S simplify his medication regimen, made sure he was paying the lowest possible cost for his medications and reviewed his plan following discharge.</p> <p> When he left the hospital, they gave him a patient-friendly medication list describing each of his medications.</p> <p> The team learned that, because Mr. S had many negative health care experiences in the past, he didn’t feel comfortable describing why it was difficult for him to follow medical advice and felt judged when he talked to medical professionals.</p> <p> The nurse practitioner and the community health worker counseled him on how to share his concerns with his physicians and worked closely with him to prioritize, schedule and arrange transportation for his outpatient visits following discharge.</p> <p> They also gave him educational materials, including a congestive heart failure symptom tracker to help him know when he needs to contact the physician.  At discharge, the nurse practitioner worked with the pharmacist to complete a brief SafeMed continuity of care document to send to his primary care physician and cardiologist before his follow up appointments.</p> <p> <strong>Staying involved through the continuum of care</strong></p> <p> The community health worker visited Mr. S in his home and reviewed his patient-friendly medication list and congestive heart failure symptom tracker. She learned that Mr. S did not have full comprehension of the self-management care guidelines he had been given in the hospital.</p> <p> They discussed his care plan in greater detail along with his health goals, which included outpatient medical follow-up as a priority and diet and exercise as secondary goals.</p> <p> In a bi-weekly case review meeting to discuss Mr. S’ needs and care plan, the community health worker met with the entire SafeMed team to refine the approach to Mr. S’ care. The team decided that the community health worker should attend his outpatient cardiology follow-up visit to assist him in communicating his concerns to the physician.</p> <p> This support made Mr. S more comfortable discussing issues regarding the circumstances that led to his defibrillator’s repeated firing and he revealed to the cardiologist that it always occurred during sexual activity.</p> <p> The cardiologist was able to fine-tune the device in response to Mr. S’ activity level to help him avoid future unnecessary shocks.</p> <p> Because the SafeMed team facilitated communication between Mr. S and his Medicaid case manager, he was able to get the assistance he needed with medications and home services. With the help of counseling, ongoing education and a supportive care team, Mr. S is meeting his health goals, attending his follow-ups, walking in his neighborhood and exercising daily for cardiac rehabilitation.</p> <p> The SafeMed team helped him speak up for himself and get the care he needed most, Mr. S said. He looks back positively on the experience.</p> <p> Mr. S was not receptive initially, according to the SafeMed team. But, once he understood that the SafeMed team members were there to help him, he was able to take the actions he needed to gain control of his health and avoid further hospitalization.</p> <p> <strong>Learn how to implement the SafeMed model in your practice</strong></p> <p> A new module on <a href="https://www.stepsforward.org/modules/safemed-transition-care" target="_self" rel="nofollow">using the SafeMed model for transitions of care approach </a>is one of eight new modules recently added to the AMA’s <a href="https://www.stepsforward.org/modules" target="_self" rel="nofollow">STEPS Forward™ </a>collection of practice improvement strategies to help physicians make transformative changes to their practices.</p> <p> The University of Tennessee Health Sciences Center contributed this STEPS Forward module after <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-teach-their-secrets-success" target="_self">winning</a> the AMA-MGMA Practice Innovation Challenge. The module can help practice teams implement the SafeMed model, which enables them to work closely with patients to build strong relationships that make it easier to coordinate and manage their care.</p> <p> Thirty-five modules now are available, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</p> <p> <em>AMA Wire®</em> explores many of the other <a href="http://www.ama-assn.org/ama/ama-wire/blog/STEPS_Forward/1" target="_self">modules</a>, including why your practice needs a health coach and four questions to ask to find out if your patients have unmet needs.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:dd015988-74be-43a1-8372-d3e0cda58bb5 More residents building families during training http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_residents-building-families-during-training Wed, 10 Aug 2016 21:47:00 GMT <p> Having children isn’t easy, but intense medical training, limited parental leave and a shrinking workforce make building a family even more difficult. With more residents working to build their families during training, a new study looks at the trends and calls on graduate medical education (GME) to improve policies to increase work-life balance for residents.</p> <p> <strong>Who is having children and when</strong></p> <p> According to a 1983 survey, about 13 percent of female residents became pregnant during residency. More recently, that number has increased significantly, demonstrating that residents are spending their GME years building families.</p> <p> About 40 percent of physician trainees plan to have a child during their graduate medical education training, according to a <a href="http://journals.lww.com/academicmedicine/Fulltext/2016/07000/Pregnancy_and_Parental_Leave_During_Graduate.27.aspx" target="_blank" rel="nofollow">study</a> in the July issue of <em>Academic Medicine</em>.</p> <p> Researchers gathered information about pregnancy, institutional policies and parental leave from nearly 650 male and female trainees at Mayo School of Graduate Medical Education sites in Minnesota, Florida and Arizona. Among the physicians in training, 41 percent had children and 7 percent were currently pregnant themselves or had a partner who was pregnant.</p> <p> Among the 41 percent who had children, researchers learned:</p> <ul> <li style="margin-left:9pt;"> <strong>Most pregnancies occur during the GME years.</strong> Among the 398 pregnancies researchers had details on, about three quarters of pregnancies occurred during GME.</li> </ul> <ul> <li style="margin-left:9pt;"> <strong>More men report having children than women</strong>. About 35 percent of female residents reported having children compared to 47 percent of male residents.</li> </ul> <ul> <li style="margin-left:9pt;"> <strong>Both women and men plan to have more children during training.</strong> About one third of women and 35 percent of men said they planned to have their next child during their current training program. While another 18 percent of women and 17 percent of men planned to have their next child during their next training program.</li> </ul> <p> Some residents and fellows were waiting to become parents until after GME training. A majority of women said that having a child would extend training, interfere with fellowship plans and they were also concerned about potential pregnancy complications. However, the study found that the number one concern about having children for men was financial hardship.</p> <p> <strong>A call for parental leave, other policy changes</strong></p> <p> The research revealed that mothers took a median five to eight weeks for maternal leave, while fathers took less than one week of parental leave. Among women who took leave, researchers discovered that 40 percent still participated in career-related activities during that time, often for research. Women also wrote papers, studied for exams or pursued advanced degrees or other training.</p> <p> Most institutions, including the Mayo Clinic, have formalized parental leave policies. While leave policies that include part-time options, flexible scheduling and specific policies for pregnancy improve the situation for trainees returning to work after childbirth, the authors of the study said those policies alone may be insufficient in addressing the burden trainees perceive when colleagues take parental leave—a reduced workforce within the programs.</p> <p> The majority of trainees surveyed—59 percent—did not have a child. Two-thirds of those residents and fellows said they planned to have a child at some point in the future.</p> <p> Approximately one-half of both male and female trainees who were childless, but planned to have children at the time of the study, told researchers they hoped to do so during their current or next training program.</p> <p> “Program directors must address the challenges related to pregnancy and parental leave for this growing group of both male and female trainees,” study authors said.</p> <p> The growth of training programs and flexible—nonteaching—attending staff physician services may alleviate workforce issues, researchers said. “But such options might not be available on demand and thus will require planning and resources to implement.”</p> <p> Study authors said institutions should “pursue policies and practices to minimize the effects of parental leave on the workforce as trainees build their families.”</p> <p> <strong>Read more about residency and parenthood:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/making-residency-family-friendly" target="_self">Making residency more family friendly</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/impact-of-parenthood-residency" target="_self">The impact of parenthood on residency</a></li> </ul> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:2d5540d5-11ed-433b-b038-b592b06645b1 Physician wellness: A global collaboration http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physician-wellness-global-collaboration Tue, 09 Aug 2016 21:00:00 GMT <p> Researchers and physicians around the world are facing the same issue—keeping physicians healthy in a rapidly changing health care environment. Learn what one physician researcher from Mayo Medical School had to say about the need for a global collaboration to share approaches to physician, resident and medical student health and well-being.</p> <p> “Meeting with researchers from around the globe helps us get outside of our little box and think more broadly, get new ideas and approaches that we wouldn’t have thought about otherwise,” said Lotte Dyrbye, MD, professor of medicine at Mayo Medical School, who will participate in a panel on medical education at the International Conference on Physician Health™. This year, the conference will be held in Boston, Sept. 18-20.</p> <p> <strong>How changing med ed relates to physician well-being</strong></p> <p> Mayo Medical School is a member of the first cohort of the AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education</a> (ACE) consortium which awarded $11 million in grants to 11 leading medical schools for major medical education innovations in 2013. This year a second cohort of 21 additional medical schools joined the consortium.</p> <p> There is a definite link between medical education and physician well-being, Dr. Dyrbye said. She has studied burnout in medical education since 2004.</p> <p> “Either you can be totally unprepared and go into this new health care delivery field and feel unempowered to make a difference,” she said, “and you can end up feeling demoralized, burnt out and unhappy … or you can take another approach.”</p> <p> “You can equip yourself with the other skills that you need to really thrive in the evolving health care system by understanding quality improvement,” she said. For example, “by having a good concept of how you can improve your diabetes metrics.”</p> <p> “If you have the skill set and you feel empowered, not only can you reach the new goals and expectations,” Dr. Dyrbye said, “but you’re also likely able to be more of a change agent to shape health care delivery in a way that will benefit patients.”</p> <p> The response Mayo has taken with their grant is to better <a href="http://www.ama-assn.org/ama/ama-wire/post/student-wellness-blueprints-curriculum-of-future" target="_self">equip the next generation of physicians</a> to practice within the new and evolving systems for two reasons, Dr. Dyrbye said:</p> <ul> <li> So they don’t feel as overwhelmed and are better able to manage personally and also meet new goals of care.</li> </ul> <ul> <li> So that they have the skills they need to shape and influence what health care delivery looks like in the future—to be willing to step up and be an advocate for change.</li> </ul> <p> <strong>Physicians gathering in Boston</strong></p> <p> The <a href="http://www.cvent.com/events/icph-2016/event-summary-0da4ec4f01eb44a7b26f797dc1055561.aspx" rel="nofollow" target="_blank">International Conference on Physician Health</a> is an opportunity to learn how researchers and physicians from around the world are working to improve physician health and well-being. Although the conference is a collaboration of the AMA, the Canadian Medical Association and the British Medical Association, researchers from around the world will be in attendance.</p> <p> Other speakers include:</p> <ul> <li> Jon Kabat-Zinn, PhD, professor emeritus at the University of Massachusetts Medical School and founder of the Center for Mindfulness in Medicine, Health Care and Society and its Mindfulness-based Stress Reduction Clinic.</li> </ul> <ul> <li> Christine Sinsky, MD, vice president of the AMA’s professional satisfaction and practice sustainability initiative and author of “From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider.”</li> </ul> <ul> <li> Suzie Brown, MD, a congestive heart failure/cardiac transplant specialist at Vanderbilt University Medical Center and singer-songwriter who writes songs to process her life and medical career.</li> </ul> <p> <strong>For more on physician, resident and medical student wellness:</strong></p> <ul> <li> Learn Dr. Dyrbye’s <a href="http://www.ama-assn.org/ama/ama-wire/post/student-sos-7-ways-avoid-distress-medical-school" target="_self">six ways to avoid “distress” in medical school</a></li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/deliberate-mentorship-can-med-students" target="_self">how deliberate mentorship can help med students</a></li> <li> Examine the <a href="http://www.ama-assn.org/ama/ama-wire/post/double-edged-sword-doctors-great-also-drives-burnout" target="_self">double-edged sword—what makes doctors great also drives burnout</a></li> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-reset-room-battle-burnout" target="_self">how a “reset room” is helping medical professionals in Minnesota</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:27833f97-7bd7-4265-b24b-9268599c2fd4 A primary care model for the new Medicare payment system http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_primary-care-model-new-medicare-payment-system Mon, 08 Aug 2016 22:46:00 GMT <p> <span style="font-size:12px;">The Centers for Medicare and Medicaid Services (CMS) recently announced the open application period for physician practices to participate in a new, nationwide primary care payment model. Comprehensive Primary Care Plus (CPC+) is a primary care medical home that could qualify physicians for the incentive payment for Advanced </span><a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" style="font-size:12px;" target="_self">Alternative Payment Model</a><span style="font-size:12px;"> (APM) participants under the new Medicare Access and CHIP Reauthorization Act (MACRA) starting in 2019.</span></p> <p> In designing CPC+, CMS tried to build on physicians’ experience with its predecessor medical home model and give participating practices better opportunities for success. Physicians want to be able to deliver comprehensive, high-quality care for each patient in the most effective way and without a rigid payment system that doesn’t provide the resources they need. Several APMs that are <a href="http://www.ama-assn.org/ama/ama-wire/post/testing-new-payment-models-one-pilot-programs-success" target="_self">already in use</a> as pilots have proven that APMs can be effective for this purpose.</p> <p> CPC+ is a five-year primary care medical home model that aims to provide more flexibility and support than is typically available in fee-for-service, especially for non face-to-face services such as proactive patient outreach, care coordination and development of treatment plans. Up to 5,000 practices will be selected to participate.</p> <p> The AMA has strongly encouraged interested practices to submit applications during the short application period which closes on Thursday, Sept. 15, giving physicians just six weeks to apply. Submit a CPC+ application via the <a href="https://app1.innovation.cms.gov/cpcplus" target="_blank" rel="nofollow">online portal</a> by 11:59 p.m. Eastern time that day. CMS has no plans to allow new applicants later in the five-year period.</p> <p> CPC+ is a multi-payer model, so other payers will join Medicare in making monthly care management and performance-based payments to participating physician practices. CMS has provisionally selected 57 payer partners, including commercial insurers, state Medicaid agencies, Medicaid managed care organizations and Medicare Advantage plans in 14 regions across the nation. <a href="https://innovation.cms.gov/initiatives/Comprehensive-Primary-Care-Plus/" target="_blank" rel="nofollow">Learn more</a> about the 14 CPC+ regions and provisionally selected payers.</p> <p> <strong>Two tracks for success in CPC+</strong></p> <p> Practices that are selected for participation will have the option to choose one of two CPC+ tracks for different types of payments. Both tracks promote high quality and high value care and practices will receive prospective performance-based incentive payments.</p> <ul> <li> <strong>Track one:</strong> Includes a monthly fee in addition to regular Medicare fee-for-service payments.</li> </ul> <ul> <li> <strong>Track two:</strong> Practices will receive a monthly fee, but also a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments to grant greater flexibility in how they deliver care.<br /> <br /> <span style="font-size:12px;">In this track, practices can deliver more comprehensive services for patients with complex medical and behavioral health needs.</span></li> </ul> <p> CMS has offered several resources for practices that choose to apply. Get your questions answered in the <a href="https://innovation.cms.gov/Files/x/cpcplus-faqs.pdf" target="_blank" rel="nofollow">Practice FAQs</a>. Register for one of the 20 upcoming <a href="https://innovation.cms.gov/Files/x/cpcplus-practiceeventscalendar.pdf" target="_blank" rel="nofollow">CPC+ Practice Open Door Forums</a> in August and September. Watch the <a href="https://www.youtube.com/watch?v=0RyXKdpViP8&list=PLaV7m2-zFKpgXyFdYktqhUfgYcaGsSMPe&index=1" target="_blank" rel="nofollow">CPC+ Video Series</a> to get an overview of CPC+ payment innovations and care delivery transformation. Download the CPC+ toolkit: <a href="https://innovation.cms.gov/Files/x/cpcplus-brief.pdf" target="_blank" rel="nofollow">CPC+ In Brief</a>, <a href="https://innovation.cms.gov/Files/x/cpcplus-caredeliverybrief.pdf" target="_blank" rel="nofollow">CPC+ Care Delivery Transformation Brief</a>, and <a href="https://innovation.cms.gov/Files/x/cpcplus-paymentbrief.pdf" target="_blank" rel="nofollow">CPC+ Payment Innovations Brief and Case Studies</a></p> <p> <strong>Learn more about APMs:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/tracking-patients-between-visits-new-care-model" target="_self">Tracking patients between visits: A new care model</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/new-model-patient-care-face-face-visits" target="_self">New model makes patient care more than face-to-face visits</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/payment-model-design-needs-physician-led-new-report" target="_self">Payment model design needs to be physician-led: New report</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-developing-new-payment-models-their-specialties" target="_self">How doctors are developing new payment models for their specialties</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/whos-using-new-delivery-payment-models-1" target="_self">Who’s using new delivery and payment models?</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/payment-models-can-better-address-patients-needs" target="_self">Payment models that can help you better address patients’ needs</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/specialty-development-key-new-payment-models-success" target="_self">Specialty development key to new payment models’ success</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:3b23c00d-4ccb-45d3-8d1a-3f32e8ffca7f Medical school burnout: How to take care of yourself http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_medical-school-burnout-care-of-yourself Mon, 08 Aug 2016 22:43:00 GMT <p> The pressures of medical school can have a major impact on students’ mental health and wellness. A group of medical students recently gathered to discuss these pressures and maintaining mental health during medical school. Learn what an expert had to say about taking care of yourself during medical school and how students are taking their own steps toward improving their own mental health and wellness.</p> <p> “Doctors actually live pretty healthy lives,” Joshua Nathan, MD, said to medical students at the 2016 AMA Annual Meeting. “If you look at the mortality rates, we tend to live at least as long if not longer than other people.”</p> <p> Dr. Nathan is an assistant professor of clinical psychiatry and director of the mood and anxiety disorders program at the University of Illinois, Chicago (UIC).</p> <p> “Where we suffer the most is mental health,” he said. “Depression and anxiety can certainly interfere with being empathetic. We have to talk about mental health and wellness in students without stigmatizing it.”</p> <p> <strong>Barriers to mental health: From the student perspective</strong></p> <p> “What are the barriers that you guys face?” Dr. Nathan asked, opening the session to conversation. “What are the challenges to your mental health?”</p> <p> “Part of it is stigma,” one student said. “The other part is time. One of my roommates was struggling with mental health issues and she was seeing someone, but when she got to third year she didn’t really have time to continue seeing this person and so she relapsed because she didn’t have time to take care of herself.”</p> <p> “We could probably do a lot better taking care of ourselves,” another student replied, “but also to take care of each other. We are in a unique position to understand and relate to one another. It’s getting a little better, but we’re still bred to be competitive and to not put ourselves out there if we are having a bad day.”</p> <p> “We’re often scared to seek treatment for depression,” a third student said. “We’re afraid of how it might affect our career.”</p> <p> “I think for first and second year students especially, people don’t know the difference in whether this is a normal amount of stress or is this diagnostic anxiety or depression,” another student offered. “A lot of people think, ‘this is med school, I’m stressed out all the time, this is just normal.’ Opening that discussion up and telling students, ‘no you can actually get through this and we can help you out’ would help.”</p> <p> <strong>Anticipating the causes of stress and burnout</strong></p> <p> “When we talk about physical health we do a great job,” Dr. Nathan said. “But how do you prevent mental illness? How do you prevent burnout?”</p> <p> According to Dr. Nathan, the best thing to do is identify the things we can anticipate. “We know there might be a heavy workload,” he said. “Some things about the work that we do in medicine we can change, but some things we can’t. But we can anticipate both of those things. The things that we can change maybe we can do something about that.”</p> <p> “There is quite literally more to know now than there was 50 years ago [when it comes to medical education],” he said. “Genetics wasn’t a big part of medicine then, but it is now. And the stuff that was part of medicine 50 years ago is still part of medicine. There’s just more information to know.”</p> <p> “There are also some things we can’t change,” he said. “In part of the work I’m doing with empathy, believe it or not, we all get less empathic as we get through medical school. We start out idealistic, ‘this is awesome we’re going to help people’—and then we actually meet patients.”</p> <p> Dr. Nathan developed the Clinicians Acting to Reinforce Empathic Skill (C.A.R.E.S) course at UIC, which includes an empathy development workshop and mental health and wellness training for medical students.</p> <p> “With patients, things aren’t quite as we envision them to be,” he said. “We actually distance ourselves emotionally from what’s happening. We can anticipate this because we know that it happens.”</p> <p> “That’s when you start to talk about tools,” he said. “What can we do when things start to get hard? Because we know they’re going to.”</p> <p> “No matter how much pressure we take off before that, at some point you realize people are dying—and sometimes we can’t help them,” Dr. Nathan said. “Death is a part of life and we can start to accept that but it’s tougher than we expected it to be.”</p> <p>  “How many people are going to med school in the same city as their parents? How many of you are more than a five hour drive from your parents?” he asked.</p> <p> “You get removed from your friends, you get removed from your family, you’re thrown into a heavy workload, your supports are far away, the things you’re used to are far away,” he said. “That’s a real challenge to trying to figure out how to take care of yourself in a brand new place and connect to your supports.”</p> <p> <strong>How three students overcome barriers</strong></p> <p> “So what do we do when it does start to get hard?” Dr. Nathan asked. “When we start to feel sad, when we start to feel stressed by the burden of having to take care of somebody?”</p> <p> Three students offered ways they have found to deal with the pressures of medical school and continue to grow both emotionally and clinically as a medical student:</p> <ul> <li> <strong>Peer support:</strong> “I live with four other people in my year and one of the things that works for us is coming together at the end of the day to cook dinner. We talk to each other so we have a really good support system. Five of us live there together. When you see a death, which definitely happens and that’s something hard, it’s really nice to have people to talk to about that.”</li> </ul> <ul> <li> <strong>Carving out time for exercise: </strong>“First year was really tough, there were a lot of exams and I was extremely busy. I realized I had changed my routine. I didn’t take care of myself as much and I wondered, ‘Why do I feel like cr@p all the time?’ And so now, in anticipation of third year, I brought exercise back into my life. I stopped exercising in first year because I didn’t feel like I had enough time. I would eat all day [while] studying and I gained weight and I felt so unhealthy. I realized that running again would make me feel good and I needed to be more mindful of that. Carving out [time for exercise] no matter how busy I was or how stressed out school made me changed things.”</li> </ul> <ul> <li> <strong>Journaling:</strong> “I’m a rising MS4 and I’m part of a bioethics program where we were tasked to, for every single clinical rotation we’d taken, write three journal entries. I have found that there’s something about a blank piece of paper and being required to write about my experiences that is very cathartic. It has helped me understand the harsh feelings I’ve had about surgery or really happy feelings I’ve had about psych or pediatrics. It’s sort of an all-encompassing thing that it’s okay to feel this huge range of emotions and that’s allowing me to grow and deal with the good and the bad and the feelings in the middle.”</li> </ul> <p> <strong>Learn more about physician burnout and solutions:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/student-wellness-blueprints-curriculum-of-future" style="font-size:12px;" target="_self">Student wellness: Blueprints for the curriculum of the future</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/ward-off-burnout-peer-network-may-impact-think" style="font-size:12px;" target="_self">Ward off burnout: Your peer network may impact more than you think</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/stopping-burnout-top-priority-physicians-training" style="font-size:12px;" target="_self">Stopping burnout a top priority for physicians in training</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physician-burnout-compares-general-working-population" style="font-size:12px;" target="_self">How physician burnout compares to general working population</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank">Troy Parks</a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e7403765-8693-4359-a316-47f51f536c40 Changes to shore up small practices under new Medicare payment system http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_changes-shore-up-small-practices-under-new-medicare-payment-system Fri, 05 Aug 2016 19:56:00 GMT <p> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;">The final rule for the new Medicare payment system is expected by November, yet the draft rule issued in April has many physicians in small or rural practices concerned that proper considerations have not been taken to set them up for success.</span></span></p> <p> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;">When Congress enacted the Medicare Access and CHIP Reauthorization Act (MACRA), it recognized the unique challenges of small and rural practices and required that special consideration be given to these practice types. But, the <a href="https://www.federalregister.gov/articles/2016/05/09/2016-10032/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm" rel="nofollow" target="_blank">proposed rule</a> provides only limited flexibility for small and rural physicians, which may jeopardize their ability to successfully participate.</span></span></p> <p> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><strong>The infamous “table”</strong></span></span></p> <p> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;">If you are in a small or rural practice, or a health professional shortage area, by now you’ve heard about the regulatory impact analysis table the Centers for Medicare and Medicaid Services (CMS) included in the MACRA proposed rule. Although many observers claimed that this table showed that the <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-merit-based-incentive-program.page" target="_self">Merit-based Incentive Payment System</a> (MIPS) would negatively impact most physicians in solo and small practices.</span></span></p> <p> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;">But, the table doesn’t actually present a clear picture of the likely impact under MIPS for five reasons:</span></span></p> <p style="margin-left:40px;"> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;">1.   It doesn’t reflect the accommodations in the proposed rule that are intended to provide flexibility to small practices</span></span></p> <p style="margin-left:40px;"> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;">2.   It only looks at 2014 quality and resource use data and omits performance in the Advancing Care Information and Clinical Practice Improvement Activities categories</span></span></p> <p style="margin-left:40px;"> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;">3.   It includes many non-physician health professionals such as dentists and chiropractors, who were previously not eligible to participate in Medicare’s quality and resource use programs</span></span></p> <p style="margin-left:40px;"> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;">4.   It includes specialties and practices that may be exempt from certain MIPS measures or categories</span></span></p> <p style="margin-left:40px;"> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;">5.   It is based on 2014 data when physicians and other clinicians in many solo and small practices did not report their performance</span></span></p> <p> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;">Unfortunately, it is not possible to develop an accurate estimate of MIPS impacts, but it is clear that there are several changes CMS could make in the proposed MIPS policies that would improve the likelihood of success for physicians in solo, small, rural and health professional shortage area practices.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/3/f9dd2ba7-4ef8-494d-937f-af10841fdaa9.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/3/f9dd2ba7-4ef8-494d-937f-af10841fdaa9.Large.jpg?1" style="margin:15px;float:right;" /></a></span></span></p> <p> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><strong>What needs to change before November</strong></span></span></p> <p> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;">In a <a href="https://download.ama-assn.org/resources/doc/washington/ama-macra-comments-27june2016.pdf" target="_self">comment letter</a> to CMS, the AMA outlined a number of recommendations to help these physicians succeed under MACRA:</span></span></p> <ul> <li> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><strong>Increase the low volume threshold to exempt more physicians.</strong> The proposed rule would exempt from MIPS physicians and groups with less than $10,000 in Medicare allowed charges and fewer than 100 unique Medicare patients per year. It its comments, the AMA recommended that physicians with less than $30,000 in Medicare allowed charges per year or fewer than 100 unique Medicare patients.<br /> <br /> The key word above—other than the $20,000 increase to the threshold—is the word “or.” That provides two possibilities that create a safety net for physicians in solo and small practices.</span></span></li> </ul> <ul> <li> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><strong>Compare practices to their peers rather than larger or more advanced entities.</strong> If peers are compared to peers, group size or specialty is no longer the determining factor to a practice’s success.<br /> <br /> The scoring methodology should not provide distinct advantages for practices simply because they are large or part of a hospital system, and should not penalize others for their size or unique patient population.<br /> <br /> Also, CMS should revise the rule using a consistent definition of small practices across performance categories so that physicians don’t qualify for one accommodation but not others.</span></span></li> </ul> <ul> <li> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><strong>Lower reporting burdens for small, rural and similarly situated practices.</strong> CMS should include explicit exemptions and lower thresholds throughout the proposed rule for physicians in these practice types.<br /> <br /> Incorporating specific accommodations into each of the four MIPS categories as well as approving alternative payment models specifically designed for small and mid-sized practices will provide the flexibility these practices need for success.</span></span></li> </ul> <ul> <li> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><strong>Provide education, training and technical assistance to small practices. </strong>Physicians in small or rural practices will need assistance to help them onboard the new programs—and this assistance should start as soon as possible.<br /> <br /> Help desks and staff ready to assist physicians when they have questions about the program should be provided by CMS as well as other educational information.<br /> <br /> The AMA is developing several resources that will soon be available. Check out the AMA’s <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-physician-payment-reform.page" style="font-size:12px;" target="_self">MACRA resources</a> for more information on the new Medicare payment system.</span></span></li> </ul> <ul> <li> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><strong>Allow participation in virtual groups as soon as possible.</strong> The MACRA statute included the concept of virtual groups to help assist small practices. However, CMS proposes not to implement the groups until the 2018 performance period. CMS needs to form these groups as soon as possible.<br /> <br /> Smaller practices will need more time to learn about virtual groups to make them effective. CMS should provide a timeline for this implementation and offer significant flexibility in forming these groups including no initial, annual or other limits placed on the maximum number of groups approved each year—or required geographic proximity or specialty composition of the groups.</span></span></li> </ul> <p> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;">The MACRA rules are still in the draft phase. The AMA continues to work with CMS to make sure that all practice types and sizes are provided the flexibility to be successful in the new program.</span></span></p> <p> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;">For more information on how to prepare for the new Medicare payment systems, review the AMA’s <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-new-payment-systems.page" target="_self">MACRA checklist</a>, or check out the AMA’s <a href="https://www.stepsforward.org/" rel="nofollow" target="_self">STEPS Forward™</a> collection of practice improvement strategies that can help your practice <a href="https://www.stepsforward.org/modules/value-based-care" rel="nofollow" target="_self">prepare for value-based care</a>.</span></span></p> <p> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><strong>Learn more about the new Medicare payment system:</strong></span></span></p> <ul> <li> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><a href="http://www.ama-assn.org/ama/ama-wire/post/later-start-date-could-ease-transition-new-medicare-system" target="_self">Later start date could ease transition to new Medicare payment system</a></span></span></li> <li> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><a href="http://www.ama-assn.org/ama/ama-wire/post/key-changes-new-medicare-payment-system-needs" target="_self">Key changes the new Medicare payment system needs</a></span></span></li> <li> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><a href="http://www.ama-assn.org/ama/ama-wire/post/4-steps-prepare-medicares-new-payment-systems" target="_self">4 steps to prepare for Medicare’s new payment system</a></span></span></li> <li> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><a href="http://www.ama-assn.org/ama/ama-wire/post/3-principles-driving-new-medicare-payment-systems" target="_self">3 principles driving the new Medicare payment system</a></span></span></li> </ul> <p align="right"> <span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></span></span></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9d705a23-c89c-4509-a789-7519b6aa60d5 Med schools focus on quality improvement, patient safety http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_med-schools-focus-quality-improvement-patient-safety Thu, 04 Aug 2016 15:25:00 GMT <p> Improving quality and safety has been a focal point in medical education for more than a decade, but improvements have not been dramatic. Here’s a look at how some medical schools are changing their curriculum—and cultures—to make greater strides through their work with the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education Consortium</a>.</p> <p> <strong>Thinking about safety improvement and taking action in Georgia</strong></p> <p> Emory University School of Medicine in Atlanta this fall continues its project to create a standardized education in quality improvement and patient safety among its medical students, residents, fellows, faculty, affiliated physicians and interprofessional colleagues spread among four different health systems.</p> <p> Students that entered last fall were part of the first class that will experience all of the quality improvement and patient safety activities being added into each year of the school’s undergraduate curriculum.</p> <p> “Hopefully, going forward, students will have a more robust toolset and if something happens they will get involved and make a change,” said Nathan O. Spell, MD, chief quality officer at Emory University Hospital and an associate professor of medicine at Emory.</p> <p> New this fall, third year medical students will be excused from clinical rotation so they can come back to the classroom and talk about their first-person experiences with patient safety and quality improvement.</p> <p> “When they come back, we can ask, ‘What did you see? How did you analyze the situation? How did you react? Did someone report what happened?’” Dr. Spell said. “We want to try to get people to think critically about what happened, analyze it, think about how it can be changed and make [that] change.”</p> <p> Faculty members are being taught to think this way as well. Emory this fall will continue to educate them about patient safety and quality improvement through a development course. Faculty members will come to the class with a project in mind and be placed on a team with a physician trainee and an interprofessional colleague throughout the course.</p> <p> “We want the faculty to be talking about patient safety and quality improvements with the same vocabulary that trainees are using,” Dr. Spell said, noting that most faculty members did not go through medical training that focused on the subjects in the way Emory is now.</p> <p> There also will be a set time for the teams to present an oral report on their projects. Last year, they presented posters with no oral portion, Dr. Spell said.</p> <p> <strong>Expanding patient safety initiatives in Michigan</strong></p> <p> Based on feedback from faculty and students in a pilot program, Michigan State University College of Osteopathic Medicine is getting ready to roll out its curriculum for all students entering clerkship in September.</p> <p> The tweaked initiative incorporates quality improvement elements and an expanded patient safety component.</p> <p> “The feedback indicated there was more time available within the didactic timeframes to allow for it,” said Saroj Misra, DO, director of clinical clerkship curriculum and associate professor of family and community medicine at MSU College of Osteopathic Medicine.</p> <p> The changes create a more comprehensive approach to patient safety, including developing new initiatives based on quality improvement, she said, noting that “the added benefit is that students will be able to achieve a Basic Certificate from the Institute for Healthcare Improvement in patient safety and quality improvement, which may be valuable as they apply for residency programs.”</p> <p> The faculty in the pilot program said they found the curriculum easy to implement and students found the curriculum valuable. Students were surprised by what they “didn’t know that they didn’t know” when it came to patient safety, Dr. Misra said.</p> <p> MSU also is updating the curriculum for GME programs across Michigan to use as part of a statewide initiative for residency training in patient safety.</p> <p> “We have been pleased to see the support of our students, faculty and partner institutions in this initiative,” Dr. Misra said. “Having a unified system of education has proved to be valuable to our partners in healthcare.”</p> <p> <strong>More hands-on experiences in North Carolina</strong></p> <p> Students entering their first year of medical school at Brody School of Medicine at East Carolina University this fall will find a new immersion course that focuses on health systems and provides hands-on experience through simulations, patient navigation and interprofessional shadowing.</p> <p> The new approach is part of Brody’s ongoing longitudinal health systems science curriculum that includes components that begin the first week of medical school, continue through foundational science courses and clinical rotations and culminate with a transition to residency capstone course during a student’s final year of medical school.</p> <p> Brody also recently welcomed its second cohort of Leaders in Innovative Care (LINC) Scholars, a program that accepts up to 10 students per year. The students will graduate with enhanced training and applied experience in health systems science, including patient safety, quality improvement, populations health and team-based care.</p> <p> Over the summer, the scholars gained patient navigation experience and presented their suggestions for improvement to health systems leaders, participated in an interprofessional panel to understand the importance of an interprofessional team, attended a North Carolina legislative session and met with representatives, and interviewed with health systems leaders, said Luan Lawson, MD, MAEd, an assistant professor at Brody and the assistant dean of curriculum, assessment and clinical academic affairs.</p> <p> The school also launching a new group of faculty in the Teachers of Quality Academy (TQA) 2.0, which will provide faculty development in patient safety and quality improvement so they are prepared to lead frontline clinical transformation while teaching and modeling these concepts for the next generation of learners.</p> <p> Curriculum changes are having a real world impact, Dr. Lawson said. TQA faculty members have an extensive list of completed and ongoing clinical quality improvement projects, she said.</p> <p> “One faculty member commented that the [TQA] had changed the way he approaches his practice in that he now views the world through a quality improvement lens,” Dr. Lawson said. “This same physician created an enhanced recovery after surgery program that lowered costs and improved quality for patients undergoing complex abdominal procedures. He attributes being able to do this to what he learned through the TQA.”</p> <p> <strong>Read more about consortium schools</strong></p> <p> In addition to changing what medical students are learning about patient safety and quality improvement, consortium schools are taking new approaches to how they <a href="http://www.ama-assn.org/ama/ama-wire/post/med-schools-training-tomorrows-physician-leaders" target="_self">prepare physician leaders.</a> They also are <a href="http://www.ama-assn.org/ama/ama-wire/post/4-ways-schools-paving-new-path-residency" target="_self">paving new paths to residency</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/michigan-relaying-student-competency-residency-programs" target="_self">relaying student competency to residency programs</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/one-school-training-students-rural-medicine" target="_self">training students for rural medicine</a>. </p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:faad1b3a-3dd6-4aa1-bd17-52d922fdeb51 A healthy environment makes healthier patients http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_healthy-environment-healthier-patients Wed, 03 Aug 2016 21:32:00 GMT <p> Public health has always been a major concern for physicians, but continued pollution and energy overconsumption have caused many health and safety issues. As part of a green initiative based in Florida—and now used in 24 states and 14 countries—some physician practices are taking action to reduce their energy consumption to save money and promote a healthier environment for their patients—the public.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/13/52010ce4-a0bc-47bf-bd87-e3c49e30b744.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/13/52010ce4-a0bc-47bf-bd87-e3c49e30b744.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> My Green Doctor, developed through the collaboration of the World Medical Association, the Florida Medical Association and the Florida Academy of Family Physicians, is a free comprehensive environmental sustainability program designed to help medical practices save energy and promote healthier practices among their patients.</p> <p> “It’s really up to individuals,” said Todd Sack, MD a gastroenterologist in Florida and editor of <a href="http://www.mygreendoctor.org/" rel="nofollow" target="_blank">MyGreenDoctor.org</a>. “Physicians, as role models of our communities, if we’re thinking about environmental health and how important it is for our patients and our community, then it’s easier for our patients also to adopt these environmental practices.”</p> <p> <strong>How it works</strong></p> <p> The program—developed by physicians—was set up to give physicians tools with two important goals, he said, to create a healthier office environment and to save the physicians money on their utility bills and supplies.</p> <p> “A test group out of Escambia County, Florida … implemented what we recommended,” Dr. Sack said, “and they’re saving their office about $2,000 per doctor per year.”</p> <p> “[An important] component of My Green Doctor is teaching these concepts to our patients,” he said, “whether it’s in the exam room or the waiting room. We want to give doctors tools … to teach better environmental health practices.”</p> <p> My Green Doctor offers seven free workbooks on topics ranging from solid waste and recycling to drug disposal and chemicals. The first workbook, energy efficiency, offers dozens of energy efficient action and education choices for an office to consider, including:</p> <ul> <li> Adopt a thermostat policy for your office—74 degrees in the summer and 68 degrees in the winter.</li> <li> Change all incandescent light bulbs to compact fluorescent bulbs.</li> <li> Turn off your hot water. Most offices can safely turn off hot water heaters with no adverse health consequences.</li> </ul> <p> <strong>How it’s working in Escambia County</strong></p> <p> “Doctors are everywhere, they can have a great influence in their community,” said John Lanza, MD, director of the Florida Department of Health in Escambia County, one of the first locations to implement the My Green Doctor program.</p> <p> “[Physicians] have the ability to pick and choose to a great extent the type of paper that they use in their offices, and various other things to control energy usage in their offices … but they also have the ability to pass this information on to their patients.”</p> <p> In Escambia County’s offices, they reduced the amount of hot water being used, shut off over half of the fluorescent lights and installed sensor faucets in all of the restrooms and hand washing stations. The implementation of an electronic health record also greatly reduced the amount of paper they used.</p> <p> “We saved about 108,000 pounds of carbon dioxide generated. Because of the fact that we have our lights turned off and we’re not burning gas,” Dr. Lanza said. In the first year of participation, 2011, “we saved about $20,000 on utility costs.”</p> <p> Getting involved is easy and free for all practices. Visit <a href="http://www.mygreendoctor.org/" rel="nofollow" target="_blank">MyGreenDoctor.org</a> to <a href="http://www.mygreendoctor.org/register-now/" rel="nofollow" target="_blank">register</a> and get started in your practice.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4fc389d3-c373-4ce8-ab95-716442a41399 Measuring residents’ moral courage http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_measuring-residents-moral-courage Wed, 03 Aug 2016 21:29:00 GMT <p> At the heart of being a physician is caring for those who can’t care for themselves, so a healthy sense of moral courage is an important quality to nurture among physicians in training. New research has found a promising way to measure moral courage and pointed to differences based on gender, length in residency and religiousness.</p> <p> Interns and residents from two Northeastern academic medical centers were tested in 2013, when researchers employed a pioneering test that called on trainees to anonymously complete a survey about moral courage, empathy and speaking up about patient safety.</p> <p> For the purposes of this experiment, moral courage is defined as the willingness to stand up for and act on one’s ethical beliefs despite barriers, such as medical hierarchy and concerns about evaluations and career opportunities.</p> <p> “Such courage is critical to physicians’ commitment to act in the best interest of patients,” said the researchers in a <a href="http://journals.lww.com/academicmedicine/Abstract/publishahead/Measuring_Moral_Courage_for_Interns_and_Residents_.98449.aspx" target="_blank" rel="nofollow">report published in <em>Academic Medicine</em></a>. Their study is the first known attempt, they said, to measure moral courage in physicians, and their survey model could help educators measure the effectiveness of medical school education in ethics.</p> <p> In its first run, the survey tool revealed some provocative results:</p> <ul> <li> <strong>Women are less likely than men to act on their moral beliefs.</strong> “These findings are consistent with prior research demonstrating gender-based differences of empowerment and confidence for physicians in training,” the report said. “More research to confirm and better understand these differences is needed.”</li> </ul> <ul> <li> <strong>Residents were more likely to show moral courage than interns.</strong> Researchers said interns’ reluctance to act could be linked to their “greater susceptibility to the conforming pressures in the clinical environment that may conflict with their own moral values.”</li> </ul> <ul> <li> <strong>Survey results showed religious trainees were no more likely than nonreligious trainees to act on their values.</strong> “In the context of the doctor-patient relationship, other motivators, such as a sense of fiduciary duty to patients, may motivate morally courageous behavior regardless of the religiousness of the physician,” the authors said.</li> </ul> <p> In the survey, 352 subjects in internal medicine and surgical specialties reacted to statements intended to gauge moral goals, moral agency and endurance of threats. Statements included:</p> <ul> <li> I do what is right for my patients, even if it puts me at risk (e.g., legal risk or risk to reputation).</li> <li> My patients and colleagues can rely on me to exemplify moral behavior.</li> <li> I use a guiding set of principles from my profession to help determine the right thing to do for my patients.</li> </ul> <p> The researchers concluded that their tool advances the scrutiny of moral courage at a time when medical schools are investing more resources in the study of ethics, “and may help researchers and educators identify deficits, track progress on a set of desired behaviors in response to curricular interventions, and better understand the foundations of physician behavior.”</p> <p> By its very use, their measurement model could underline the importance of moral courage as an educational and institutional priority, the authors said.</p> <p> They said future research should examine the relationship between scores on their model and measurements of burnout and other factors that affect physicians.</p> <p> <strong>For more on ethics and related topics, consult other AMA resources:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/code-of-medical-ethics-modernized-first-time-50-years" target="_self">AMA <em>Code of Medical Ethics</em> modernized for first time in 50 years</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-ethical-role-mental-illness" target="_self">The physician’s ethical role in mental illness</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/focus-training-treating-patients-intellectual-disabilities" target="_self">Focus on training: Treating patients with intellectual disabilities</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/medicine-law-important-ethical-questions" target="_self">Ethical questions concerning medicine and the law</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/ethics-committees-exploring-past-present-future" target="_self">Ethics committees: Exploring the past, present and future</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/new-era-of-high-value-care-meets-medical-ethics" target="_self">New era of high-value care meets medical ethics</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a39f5820-c38d-46de-a15b-ac40354b284a Learn about Strategies for financial wellness: The basics http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_learn-strategies-financial-wellness-basics Wed, 03 Aug 2016 16:00:00 GMT <p> Join us for dinner, drinks and an exclusive opportunity to learn about strategies that will help promote your financial wellness. The dinner will take place Friday Sept. 30 from 6 to 9 p.m. at Hotel Sorrento in Seattle, Wash.</p> <p> The evening kick off this meeting with three short presentations covering:</p> <ul> <li> Navigating the employment contract process</li> <li> Preparing for your financial future</li> <li> Getting your financial questions answered</li> </ul> <p> Following the presentations, we will break into small groups to take a deeper dive into these topics. Get your questions answered by experienced financial professionals, attorneys and physicians who have real-world experience.</p> <p> The event is free for AMA members. <a href="https://apps.ama-assn.org/mtgregcvent/register/search?ECODE=432bacb6-3e1a-4a61-b066-9ce70aec75bc">Register and learn more</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:3c50cf45-63ae-4569-a616-ae631f40bd6c Register to attend the AMA-IMG Section Interim Meeting http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_register-attend-ama-img-section-interim-meeting Wed, 03 Aug 2016 15:00:00 GMT <p> Register today for the American Medical Association International Medical Graduates (IMG) Section Interim Meeting to be held Nov. 10-12 at Walt Disney World Swan and Dolphin Resort in Orlando. Invite a colleague or friend to become involved in the AMA’s policymaking meeting, participate in Section events and hone your leadership skills.</p> <p> All IMG Section meetings will be held at the Dolphin, including:</p> <ul> <li style="margin-left:0.25in;"> <strong>The 14th annual AMA Research Symposium and reception: Friday Nov. 11, 1–7:30 p.m.</strong><br /> Hear educational sessions, oral research presentations and view abstracts by AMA-IMG Section ECFMG-certified candidates who are waiting residency. Featuring the work of AMA members from the medical student and resident sections as well, the symposium typical showcases the research of more than 600 participants.</li> </ul> <ul> <li style="margin-left:0.25in;"> <strong>AMA-IMG Section reception and congress: Saturday Nov. 12, 5:30–7:30 p.m.</strong><br /> Network with colleagues and discuss policy items for the AMA-IMG Section as well as AMA House of Delegates reports and resolutions of interest.<br /> <br /> Invited guest speakers: Humayun Chadhury, DO, CEO and president of the Federation of State Medical Boards; Thakor Patel, MD, adjunct associate professor of medicine at the Uniformed Services of the Health Sciences, Bethesda, Maryland.<br />  </li> <li style="margin-left:0.25in;"> <strong>Busharat Ahmad, MD, Leadership Development Program: Sunday Nov. 13, 2–3 p.m.</strong><br /> Learn what it takes to be an effective physician leader through followership. Featured speaker: Nestor Ramirez-Lopez, MD, “Followership, the Other Face of Leadership”<br />  </li> <li style="margin-left:0.25in;"> <strong>AMA-IMG Section and AMA Minority Affairs Section delegates caucus: Monday Nov. 14, 8:30–9:30 a.m.</strong><br /> Review reference committee reports and discuss strategies for supporting both the AMA-IMG Section and relevant AMA House of Delegates policy items.</li> </ul> <p> <a href="http://www.ama-assn.org/go/i16-img">Registration</a> will close on November 5. <a href="http://www.swandolphin.com/groupres/AMA16/" rel="nofollow">Book your hotel reservations</a> now. For more information, email <a href="mailto:img@ama-assn.org" rel="nofollow">img@ama-assn.org</a> or call the AMA-IMG Section at (312) 464-5397.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0c53ff7e-23c1-4565-8f9e-bde9b01d6282 Participate in IMG Section Online Member Forum http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_participate-img-section-online-member-forum Wed, 03 Aug 2016 14:00:00 GMT <p> The International Medical Graduates Section (IMGS) Online Member Forum will provide comments and testimony for resolutions being considered for the November Interim Meeting Aug. 31 – Sept. 7. Engage with the AMA-IMG Section by providing your comments for the resolutions.</p> <p> You can review the resolutions by visiting <a href="https://www.surveymonkey.com/create/?sm=gRja_2FnPCEUoqbsKh5wyofsZed_2FGJAHwlbpLbQQo1tNk_3D" rel="nofollow">SurveyMonkey</a>. After your review, select your choice of support or non-support for each resolution. Your comments are also welcome.</p> <p> Please note you will also be requested to approve the resolutions presented during the ratification period Sept. 12 –16. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:fca8f695-f2d6-48bf-a26c-fb04d2fbc97e Neurosurgery makes pain management curricular breakthroughs http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_neurosurgery-pain-management-curricular-breakthroughs Tue, 02 Aug 2016 21:37:00 GMT <p> Leaders in neurosurgery have taken a hands-on approach to training residents with an eye toward filling knowledge and skill gaps—one such gap is pain management. Learn how they’re making strides in preparing residents for the board exam and more effective patient care.</p> <p> Neurosurgery “boot camps” were created in 2009 to help fill in some of the knowledge gaps in resident training. Neurosurgeons in training attend one boot camp at the start of internship and another before becoming a junior resident.</p> <p> “The boot camps … use extensive simulation labs with ICU crises where you have a mannequin on a table with an ICU monitor,” said Christopher Winfree, MD, an assistant professor of neurological surgery at the Columbia University College of Physicians and Surgeons in New York City. “They go through all kinds of scenarios. The important thing is to have the residents trained across all of the topics they need to know.”</p> <p> The Neurological Surgery Milestone Project, developed in 2013, was created to further formalize the content of residency training. The content addresses areas such as procedural skills, professionalism and interpersonal relations with colleagues and patients. The Milestones also facilitate resident assessment to make sure residents are making appropriate progress as they go through their training.</p> <p> <strong>Training neurosurgical residents in pain management</strong></p> <p> Six years ago, Dr. Winfree became president of the pain section of the two major neurosurgery groups, the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. The executive committees asked him to make pain management in neurosurgery more prominent.</p> <p> Dr. Winfree developed a module for the resident boot camp that includes everything residents need to know about pain management in neurosurgery. Topics covered include different types of pain, neuropathic pain medications, how opioids work, treatment ladders, chronic and acute pain management, caring for patients with opioid dependence or substance use disorder, and buprenorphine treatment.</p> <p> “I thought that would be an excellent opportunity to teach pain management at a boot camp level so the interns and junior residents are not only getting comprehensive neurosurgical training but also a focus—at least in one module—on pain,” he said.</p> <p> <strong>Making sure the knowledge sticks</strong></p> <p> “Everybody likes to think that when you institute a new curriculum, it’s going to be great,” Dr. Winfree said. “But we had no data to prove that. Further, we had neurosurgery residents and attendings not doing so well in the pain sections on their board exams.”</p> <p> “People weren’t really getting it and weren’t really learning what they needed to learn,” he said. “We tried to address that with the boot camp [and] the milestones, and that was a good start, but we were still making little progress on board exam performance.”</p> <p> As a member of the editorial board of the Self-Assessment Neurological Surgery (SANS), which writes the board exam questions, Dr. Winfree wrote 150-200 questions, vetted by the Board, for a rotating practice exam, which includes a different set of 100 questions each year. Using the results from these tests, they can now see how the residents are doing on the sections regarding pain.</p> <p> Some of these pain questions are used at the boot camp sessions. The residents study the material and take a test before they arrive and then are tested again at the end of the course.</p> <p> In Dr. Winfree’s pain lecture, he talks about pain management for neurosurgery, including craniotomy, spine surgery, post-operative pain management, use of non-opioid medications, the treatment ladder, management of specific chronic pain conditions and much more.</p> <p> “We’re trying to get away from passive learning, because how many times have we all sat in lectures and retained probably 10 percent,” he said. “When you have somebody study ahead of time and test them on it ahead of time, then show it to them in person, where they can sit one-on-one with faculty members in these sessions, and then you test them on it again, they have this stuff for life.”</p> <p> “This isn’t just stuff that the residents blow off,” he said. “They study [it]. They’re professionals, and we treat them like professionals. But we test them also. We make sure that they know the material.”</p> <p> “Every question has an explanation at the end,” he said. “It’s self-assessment, but it’s not just yes, no, you got it right or wrong. The residents get an explanation as to <em>why</em> the answer is right or wrong.”</p> <p> <strong>Changing the curriculum at Columbia</strong></p> <p> Dr. Winfree is also changing how he teaches neurosurgical residents at Columbia University Medical Center. “I would give talks on the material,” he said, “and randomly call the residents after and quiz them about the lecture—and the results were terrible. It was almost like the residents did not attend the lecture.”</p> <p> “The whole passive, didactic learning thing is 20th century,” he said. “What we’ve been actively trying to do is get things to the 21st century. Now, instead of just giving a random talk on neuro for pain, I designed a curriculum that directly follows the milestones.”</p> <p> Every week, residents training with Dr. Winfree present a case, and the group addresses the topic. Instead of a long lecture, the residents’ case study lasts 15 minutes, with Dr. Winfree moderating. “Studies have shown that an educated person’s attention span for a talk is 18 minutes,” he said. “That’s why TED Talks are 18 minutes and contain stories, because a story represents a cognitive hook that allows a person to pay attention more.”</p> <p> “It’s not a lot of PowerPoint and bullet presentations,” he said. “It’s images that reinforce the stories that are being told … so it captivates the residents’ attention. It’s active learning, not passive learning.”</p> <p> So how have the residents responded? They like it, a lot.</p> <p> “Nobody wants to sit through an hour lecture,” Dr. Winfree said. “We’ve been doing these boot camp courses every year now, and every time we do it, we survey the residents. Every resident says, ‘Get rid of the didactic lectures, we’re falling asleep, [and] we’re not learning anything.’”</p> <p> “What does work is a shorter, case-based set of scenarios,” he said, commenting on survey results and exam performance data. “We’re not having hour-long lectures, we’re doing 15 minute small group sessions to go over all of those things, and the residents are responding.”</p> <p style="text-align:right;"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:222f35ed-ecac-4ef0-9c96-ae548ca038c9 Challenge to medical liability law could complicate pre-suit process http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_challenge-medical-liability-law-could-complicate-pre-suit-process Tue, 02 Aug 2016 21:34:00 GMT <p> A medical liability case, even if successful, can cause financial, emotional and reputational harm to a physician—and also to the patient who brings the suit. A 2013 amendment to the Florida Medical Liability Act, which requires the plaintiff to release relevant health information to determine whether a claim for medical liability is meritorious, is under threat in the Florida Supreme Court.</p> <p> At stake in <em>Weaver v. Myers</em> is whether the Florida Medical Malpractice Act, which requires the plaintiff to authorize the release of otherwise confidential health information as a condition of bringing a lawsuit for medical liability, is valid. Both a trial court and the Florida First District Court of Appeals confirmed the amendment’s validity.</p> <p> Florida’s pre-suit investigation process was intended to allow both claimants and potential defendants the opportunity to determine whether a medical liability claim has merit and to encourage early resolution of claims between the parties. This process can avoid costly and time-consuming proceedings through a less complicated pre-suit process that allows both parties to examine the evidence.</p> <p> <strong>What happened</strong></p> <p> Emma Weaver, widow and representative of Thomas C. Weaver, sued her late husband’s physician, Stephen C. Myers, MD, for medical liability. However, she did not want to allow Dr. Myers’ attorneys to interview the other physicians who had treated her deceased husband. She asserted that the Florida constitution and a regulation promulgated under the Health Insurance Portability and Accountability Act (HIPAA) to protect patient privacy invalidated the Florida Medical Malpractice Act.</p> <p> When a case goes into suit, the Rules of Civil Procedure allow parties to have a fair chance to fully explore their opponents’ medical condition when that condition has been placed at issue. For example, a defendant may even require the plaintiff to sit for a compulsory medical examination by another physician of their choosing.</p> <p> The Florida Medical Malpractice Act was passed in response to a common complaint from advocates and clients on both sides: Medical liability lawsuits take too long to be brought to resolution. The intent of the act was to reduce the cumbersome and expensive process of discovery. A formal deposition can disrupt the physician practice and displace patients in that physician’s schedule.</p> <p> “The time, expense and potential asymmetry of information can be cured by allowing the current law to stand,” said the Litigation Center of the AMA and State Medical Societies in an amicus brief. “A phone call between defense counsel and the treating physician can serve to facilitate the same information that would be revealed during a formal deposition.”</p> <p> Allowing the claimant to withhold key information unfairly prejudices potential defendants and circumvents the goals of the pre-suit investigation process.</p> <p> “If the right to this informal discovery is removed,” the brief said, “the result will be to return to an uneven playing field and the inability to avoid cumbersome and costly formal discovery.”</p> <p> <strong>Current medical liability cases in which the Litigation Center is involved:</strong></p> <ul> <li> Learn how a case <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-lead-unlimited-awards-of-punitive-damages" target="_self">could lead to unlimited awards of punitive damages</a>.</li> <li> Get the details on a <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-extend-medical-liability" target="_self">case that could extend medical liability</a>.</li> <li> Find out how one <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-increase-liability-exposure-redefine-injury" target="_self">case could increase liability exposure and redefine injury</a>.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4447326b-bc52-4cdd-b68f-77fbe9b887ce Ethics in pathology: Images, the media and diagnosis http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ethics-pathology-images-media-diagnosis Mon, 01 Aug 2016 21:40:00 GMT <p> When Prince died in April, details of his death and autopsy slowly trickled into the public sphere, but isn’t patient health information private? Examine this and other complex ethical questions that pathologists face in practice and how media and publicity can complicate these matters even more.</p> <p> The <a href="http://journalofethics.ama-assn.org/site/current.html" target="_blank">August issue</a> of the <em>AMA Journal of Ethics®</em> considers neglected ethical issues in pathology practice, including shifts in social and cultural attitudes toward autopsy, cautions about the use of social media for sharing images, how to communicate about errors or pathology results and what the death of Prince tells us about the public and professional obligations of physicians who interact with the media. Articles featured in this issue include:</p> <ul> <li> “<a href="http://journalofethics.ama-assn.org/2016/08/stas1-1608.html" target="_blank">Pathology image-sharing on social media: Recommendations for protecting privacy while motivating education.</a>” With a rising interest in social media use by pathologists, use of pathology images on these channels is being debated. Particularly photographs of dermatologic conditions and from gross examination or autopsy suggest a need for professionals to adopt practical social media guidelines that can help mitigate breach of privacy risk to patients.</li> </ul> <ul> <li> “<a href="http://journalofethics.ama-assn.org/2016/08/msoc2-1608.html" target="_blank">Public figures, professional ethics, and the media.</a>” If health information is private, why does the public know so much about Prince’s death? Death certificates and autopsy reports contain personal information protected under the Health Insurance Portability and Accountability Act (HIPAA). Examine the critical ethical questions that have not yet been settled about whether and when this information should be made public.</li> </ul> <ul> <li> “<a href="http://journalofethics.ama-assn.org/2016/08/ecas3-1608.html" target="_blank">I might have some bad news: Disclosing preliminary pathology results.</a>” When, if ever, is it appropriate for cytopathologists to share preliminary diagnostic impressions with patients at the bedside? Investigate communication strategies for navigating uncertainty that apply not only to pathologists but to all clinicians.</li> </ul> <ul> <li> “<a href="http://journalofethics.ama-assn.org/2016/08/imhl1-1608.html" target="_blank">The use of visual arts as a window to diagnosing medical pathologies.</a>” In medical school, the art of observation and learning to look can be taught using the humanities—especially visual arts such as paintings and film. Learn how the curriculum at Australia’s Bond University uses art to build students’ diagnostic skills.</li> </ul> <p> In the journal’s <a href="file:///I:/Communications%20Documents/Morning%20Rounds%20Daily/Week%20of%2008_01_2016/Final/journalofethics.ama-assn.org/podcast/ethics-talk-aug-2016.mp3" target="_blank" rel="nofollow">August podcast</a>, Theonia Boyd, MD, associate professor of pathology at Harvard Medical School, discusses ethical issues pathologists face when conducting autopsies and obtaining specimens.</p> <p> <strong>Take the ethics poll</strong></p> <p> <a href="http://journalofethics.ama-assn.org/site/poll.html" target="_blank">Give your answer</a> to this month’s poll: When communicating about errors—whether to clinicians or patients—what should pathologists say to help conversations about errors go smoothly?</p> <p> <strong>Submit an article</strong></p> <p> The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. <a href="https://amajournalofethics.msubmit.net/" target="_blank" rel="nofollow">Submit your work</a> for publication.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1d49ed44-aa6d-4e53-a1d0-a1a0c7c03df6 Making the pitch: How to take your innovations to market http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_making-pitch-innovations-market Mon, 01 Aug 2016 21:37:00 GMT <p> Students and physicians often find they have a tech idea that could improve care, but how to ignite interest among financial backers is another thing altogether. Find out what venture capitalists and other funders have to say about making a pitch that will get your idea to market.</p> <p> <strong>Giving wings to your dreams</strong></p> <p> Many innovations in medical technology, devices and software never take flight because their creators don’t know how to present them, financiers said. They offered the dos and don’ts of making a pitch during a session at the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_self">2016 AMA Annual Meeting</a> in Chicago.</p> <p> Omar Maniya, a Harvard Business School graduate, medical student in his final year at Georgetown University School of Medicine and medical student member of the AMA Board of Trustees, summed up the anatomy of a pitch with a favorite acronym, BALZAC:</p> <ul> <li> <strong>Brevity.</strong> “That is the absolute No. 1 thing,” Maniya said.</li> <li> <strong>Audience.</strong> Know the inside story on every person who will be hearing your pitch.</li> <li> <strong>Language.</strong> Take care with medical jargon, and gear your terminology to your audience.</li> <li> <strong>Zoom level.</strong> Know when to drill down into the details of a topic and when to keep it light.</li> <li> <strong>Analogies.</strong> Link your ideas to things your audience can relate to; illustrating your pitch with stories from the outside world.</li> <li> <strong>Confidence.</strong> Be the master of your project. “If you are not the most knowledgeable person in that room about your idea, you should not be in that room,” Maniya said.</li> </ul> <p> Washington venture capitalist Arnab Sarker said the successful pitcher knows his or her product and its industry, can explain the problem the product will solve, fields a quality team (including members with clinical experience) and has a sound business plan. The last aspect is a feature that many medical students fail to include, he said.</p> <p> <strong>Watch for stumbling blocks</strong></p> <p> Sarker named common weaknesses that can sour a pitch:</p> <ul> <li> A lack of understanding about how venture capitalists make their money</li> <li> More than two people presenting the pitch</li> <li> Slides with too many words</li> <li> Forgetting to consider regulatory issues</li> <li> Using language that is wrong for the setting</li> </ul> <p> <strong>Fueling the world of innovation</strong></p> <p> Students and physicians can find other resources to help make their ideas a reality. One resource is <a href="http://idealabsincubator.org/" target="_blank" rel="nofollow">IDEA Labs</a>, a student-run biomedical entrepreneurship incubator based at Washington University in St. Louis. In partnership with the AMA, IDEA Labs has expanded to the University of Minnesota, the University of Pennsylvania and Harvard/MIT. Chapters are being started at the University of Michigan and Tulane/Louisiana State University.</p> <p> IDEA Labs enables students from medical, engineering and business backgrounds to collaborate in identifying the needs of clinicians and meeting them with marketable products.</p> <p> The AMA’s collaboration with IDEA Labs underscores the association’s expanding role in supporting health care innovation. The AMA is deeply involved in driving transformative health care innovation as the organization ramps up efforts to bridge the gap between creative idea development and the realities of patient care.</p> <p> In addition to the collaboration with IDEA Labs, the AMA’s innovation ecosystem includes:</p> <ul> <li> An expanded partnership with <a href="http://matterchicago.com/" target="_blank" rel="nofollow">MATTER</a>, Chicago’s health care technology incubator, to allow entrepreneurs and physicians to collaborate on the development of new technologies, services and products in a simulated health care setting.</li> <li> An investment as founding partner in <a href="https://www.health2047.com/" target="_blank" rel="nofollow">Health2047</a>, a San Francisco-based health care innovation company that combines strategy, design and venture disciplines, working with companies, physicians and entrepreneurs to improve health care.</li> <li> A total of $50,000 in prizes to the three winners of the <a href="https://www.innovatewithama.com/" target="_blank" rel="nofollow">AMA Healthier Nation Innovation Challenge</a>, which recently invited medical students, residents and physicians from across the country to submit their ideas.</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c4b49145-7dfc-4b61-be09-343ee923d987 Register for 14th Annual Research Symposium http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_register-14th-annual-research-symposium Mon, 01 Aug 2016 15:00:00 GMT <p> Don’t miss the opportunity to register for the AMA 14<sup>th</sup> Annual Research Symposium. Medical students, residents and ECFMG-certified candidates awaiting residency are invited to showcase their research.  The deadline to submit your abstracts is Wednesday, August 17<sup>th</sup>.</p> <p> Participants may submit abstracts in the following categories:</p> <ul> <li> Clinical Vignette</li> <li> Clinical Medicine</li> <li> Improving Health Outcomes (cardiovascular disease, diabetes)</li> </ul> <p> Register, submit your abstracts or obtain more information on the <a href="http://www.ama-assn.org/go/researchsymposium">Research Symposium web page</a>.</p> <p> Judges are also needed to help mentor tomorrow’s physicians.  Email <a href="mailto:researchsymposium@ama-assn.org" rel="nofollow">researchsymposium@ama-assn.org</a> if you are interested in becoming a judge for this exciting event.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d261c8d3-10e1-4f71-bc06-01e0e0755330 AMA-WPS Women in Medicine Symposium http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-wps-women-medicine-symposium Mon, 01 Aug 2016 14:00:00 GMT <p> <u><a href="http://click.ama-assn.org/t/gcdbaBTuQABC6MzGwaDBlGAVFmaaaaGS7BLXIKAmaa?r=4@04y8&b=nfpadslp_pXf.Zrj&o=c&0=&o=4194503z5x&SB@ZMV@Khtvihqwbu@Xgauy@33BzA743&ZMV" target="_self"><u>Register</u></a></u> by September 19 to attend the first-ever American Medical Association Women Physicians Section (WPS) Women in Medicine Symposium. Held in conjunction with the AMA’s Women in Medicine Month, this symposium will help attendees tackle priority issues that women physicians face in medicine today.</p> <p> This event features a tour of the AMA headquarters, dynamic presentations, panel discussions and breakout sessions covering:</p> <ul> <li> Physician resiliency and burnout</li> <li> Women of impact: overcoming obstacles in daily practice</li> <li> Personal wellness break</li> <li> Participate in the AMA’s national listening tour</li> </ul> <p> This event will take place on Thursday, Sept. 22, from 12:30 to 5 p.m. in Chicago at AMA Plaza, 330 N. Wabash Ave. The registration fee is $25 for AMA physician members, $10 for student and resident members, and $95 for nonmembers. If you invite a colleague during registration and they sign up, you will receive a 50% discount off your registration fee to be refunded at a later time.</p> <p> Please contact the <a href="mailto:wps@ama-assn.org" rel="nofollow">AMA-WPS</a> with any questions.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:eb1f2379-d31a-4761-8d64-965bb0f11b35 Strategies for financial wellness: The basics http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_strategies-financial-wellness-basics Mon, 01 Aug 2016 14:00:00 GMT <p> Join us for dinner, drinks and an exclusive opportunity to learn about strategies that will help promote your financial wellness on Friday, Sept. 30 from 6-9 p.m. at the Hotel Sorrento in Seattle.</p> <p> We will kick off the evening with three short presentations covering:</p> <ul> <li> Navigating the employment contract process</li> <li> Preparing for your financial future</li> <li> Getting your financial questions answered</li> </ul> <p> Following the presentations, we will break into small groups to take a deeper dive into these topics. Get your questions answered by experienced financial professionals, attorneys and physicians who have real-world experience.</p> <p> The event is free for AMA members. The fee for nonmembers is $99 and for guests $49. <a href="https://apps.ama-assn.org/mtgregcvent/register/search?ECODE=432bacb6-3e1a-4a61-b066-9ce70aec75bc">Learn more and register</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:2091a540-fdab-4f45-8b81-c43c46955a48 Speak up about gaps in residency training http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_speak-up-gaps-residency-training Mon, 01 Aug 2016 12:00:00 GMT <h3> <span style="font-size:9pt;font-family:Arial, sans-serif;font-weight:normal;">A new project, led by the AMA, will conduct informal meetings in-person and by phone with selected residents and fellows to understand their needs, challenges, training gaps and aspirations. The goal of the project is to develop or enhance resources and services to help during training.</span></h3> <h3> <span style="font-size:9pt;font-family:Arial, sans-serif;font-weight:normal;">The discussion will take approximately 30 minutes. If you are interested, please <a href="mailto:rfs@ama-assn.org" rel="nofollow">email the Residents and Fellows Section</a> with the day and time most convenient for you. </span></h3> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7dac099e-8197-4ce5-8579-96a46ae7d04e How deliberate mentorship can help med students http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_deliberate-mentorship-can-med-students Sun, 31 Jul 2016 22:00:00 GMT <p> Mentorship can help medical students hone their clinical skills and improve their patient interactions, but mentors can also guide students through tough times both in school and their personal lives. Stanford has implemented a medical school mentorship program that builds a community atmosphere to support their students.</p> <p> Stanford University Medical Center in 2010 launched the Stanford Committee for Professional Satisfaction and Support to help physicians balance the increasing demands of practice environments. The guiding principle of the committee is that the professional fulfillment of clinicians is inextricably linked to quality, safety and patient-centeredness.</p> <p> The medical school also recognized that it wasn’t just physicians in practice who needed support, but the medical students needed support thorughout their rigorous training as well. That’s why they implemented the <a href="http://med.stanford.edu/e4c.html" rel="nofollow" target="_blank">Educators-4-Care program</a>, which pairs five to six medical students with a faculty member who serves as teacher, mentor and colleague for the duration of their time at the school of medicine.</p> <p> <strong>Supporting students throughout med school</strong></p> <p> “It gives students a person to go to when they’re in stress because we really get to know the students well,” said Lars Osterberg, MD, associate professor of medicine at Stanford School of Medicine and director of the Educators-4-Care (E4C) program.</p> <p> “It’s a deliberate mentoring … which gives them a more personalized and dedicated mentorship,” he said. “Unlike the old paradigm of med school where the students had to find a mentor on their own … because some students don’t always find the right person and don’t always have someone to reach out to.”</p> <p> Stanford is part of the <a href="https://sites.tufts.edu/lci/" rel="nofollow" target="_blank">Learning Communities Institute</a>, a nonprofit organization that works to improve health care education across the continuum of learning. The organization fosters scholarship, professional development and the centrality of relationships among learners and teachers as a way to promote compassionate, patient-centered care, physician well-being and lifelong learning.</p> <p> Mentors guide students in clinical skills training and patient interactions, but they also check in with the students regularly to make sure they’re doing well personally, Dr. Osterberg said. “We have definitely noticed a change in the culture, our students are much stronger clinically … and they’ve dramatically improved since the inception of the E4C program.”</p> <p> “We had a lot of students who ended up coming to us in the beginning of our program that we didn’t anticipate,” he said, “who had life events that occurred during medical school, that we think could have avoided some really bad things, like even possible suicide…. With the pressures of med school there is often depression, and the first person they’d go to is often the E4C faculty.”</p> <p> Stanford measures aspects of their students’ wellness and empathy. “Students usually decline in their empathy skills during their clinical years,” he said. “[But] our students haven’t declined as they did in the past. We feel like the learning communities model really does fulfill that supportive role and is reflected in the students’ well-being.”</p> <p> <strong>How the program has affected faculty</strong></p> <p> The program surveyed the faculty who are involved as mentors and the response was that being a mentor is very rewarding. “The faculty have commented that being involved as a mentor in the learning community motivated them to stay in academia and [continue to be] a mentor,” he said. “They love seeing their students grow and seeing that they are making a difference in students’ lives.”</p> <p> “It also creates a community of other faculty of like-minded people that are trying to make a difference in medical education,” Dr. Osterberg said. “Part of every mentor’s conversation [with students] is just checking in to see how they are doing emotionally, mentally and physically.”</p> <p> The Educators-4-Care program was highlighted in a module on <a href="https://www.stepsforward.org/modules/physician-burnout" rel="nofollow" target="_self">preventing physician burnout</a> from the AMA’s <a href="https://www.stepsforward.org/modules/physician-burnout" rel="nofollow" target="_self">STEPS Forward™</a> collection of practice improvements initiatives. Other available modules on burnout cover preventing resident and fellow burnout and improving physician resiliency.</p> <p> Thirty-five modules now are available in the STEPS Forward collection, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" rel="nofollow" target="_blank"><u>Transforming Clinical Practices Initiative</u></a>.</p> <p> Physicians and experts from around the world will gather Sept. 18-20 in Boston for the <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page"><u>International Conference on Physician Health™</u></a>. This collaborative conference of the AMA, the Canadian Medical Association and the British Medical Association will showcase research and perspectives into physicians’ health and offer practical, evidence-based skills and strategies to promote a healthier medical culture for physicians.</p> <p> The conference also will include a panel highlighting innovative changes in American, British and Canadian medical school curricula and their potential to positively impact physician health in the future. Liselotte Dyrbye, MD, and William Tierney, MD, both representatives of the AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education Consortium</a>, will be panelists. Richard E. Hawkins, MD, vice president of medical education programs at the AMA, will moderate. <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page?" target="_blank"><u>Learn more and register</u></a>.</p> <p> <strong>For more on how practices and organizations are preventing physician burnout:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-reset-room-battle-burnout" target="_self">Physicians take to “reset room” to prevent burnout</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/mayo-clinic-battling-burnout" target="_self"><u>How the Mayo Clinic is battling burnout</u></a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/4-physician-recommended-steps-work-home-life-balance" target="_self"><u>4 physician-recommended steps to work- and home-life balance</u></a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow">Troy Parks</a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d986e710-aefd-4516-9e97-15295b8f9eb1 New model makes patient care more than face-to-face visits http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-model-patient-care-face-face-visits Fri, 29 Jul 2016 18:21:00 GMT <p> Two things that physicians want for their patients are more stability and fewer visits to the emergency department. But often the services that are needed to do so are unbillable, and the resources are hard to find otherwise. A new care model for oncologists intends to solve this problem by providing the resources needed to closely manage patients’ care in-between their face-to-face treatments to reduce complications.</p> <p> The American Society of Clinical Oncology (ASCO) developed the patient-centered oncology payment model, an alternative payment model (APM) that focuses on two things: making sure the patient is taken care of in a way that prevents complications, which helps them progress toward improved overall health, and ensuring physicians have the necessary resources to provide that quality care.</p> <p> “The current system is flawed in many ways because it doesn’t pay for the services and the support that patients need and want,” said Robin Zon, MD, an oncologist and member of the ASCO’s Oncology Payment Reform and Implementation Workgroups. “But physicians are paying for it in a number of other ways in order to be able to deliver those services to the patient.”</p> <p> “What’s happened over time,” she said, “is that practices aren’t able to accommodate those expenses to be able to optimally care of the patient. There are services that the patient is receiving and needs, but they’re non-reimbursable services.”</p> <p> <strong>How the model works</strong></p> <p> “We developed a system that does three major things,” Dr. Zon said. The model shifts the focus away from typical fee-for-service, holds physicians accountable for high-quality care and makes physicians accountable for only those services they are able to control.</p> <p> So how does the payment model work, and what kind of difference will it make? Dr. Zon gave an example of a patient we will call John:</p> <ul> <li> <strong>Before the new model</strong><br /> Three years ago, before the patient-centered oncology payment model, John would go into a small practice for his chemotherapy. Then he would head home afterwards with instructions to call the office with any concerns or questions. The next day he didn’t feel very good. But he didn’t want to bother the doctor, thinking it was a normal reaction to the chemotherapy or the underlying cancer, so he didn’t call the office. Since this is a small office, there is no extra staff to conduct outbound triage to check on John. Two days later he had severe diarrhea and nausea and ended up so dehydrated that he had to go to the emergency department.</li> </ul> <ul> <li> <strong>After the new model</strong><br /> Now, John goes into a practice that has implemented the patient-centered oncology model. The next day, an outbound triage nurse calls him at home and asks how he is doing. John says he’s not feeling too great. The nurse says, “Let me talk to the doctor and get back to you.” The nurse calls John again with recommendations from the doctor based on how he is feeling and reeducates him on how to use his supportive care medications.<br /> <br /> The nurse calls again the next day to see if John is feeling any better. John says he’s feeling a little better but not perfect. The nurse responds, “Let me talk to the doctor again.” The next phone call to John includes some adjustments in hydration and diet, as well as recommendations on how to use the supportive medications. In the end, they’re able to help John get through those initial three days, and he never ends up at the hospital.</li> </ul> <p> “The exciting thing about this model is that the focus really is on the patient, which is why I like the name of the model so much,” she said. “It’s patient-centered, meaning the [payment] supports the resources needed to provide the care the patient needs and wants. This is opposed to the current system of [paying] only for face-to-face visits, which does not care for the patient between these encounters.”</p> <p> <strong>Three payment options in the model</strong></p> <p> “Our philosophy, from the ASCO perspective,” she said, “is that really what we should be designing is a [payment] system that supports the services that patients need and deserve and want,” not just those that are provided when the patient comes into the practice for a visit or chemotherapy.</p> <p> ASCO designed a system that has three payment options for oncologists:</p> <p style="margin-left:40px;"> <strong>1.   </strong><strong>Care management payments.</strong> This approach takes the existing E/M codes and adds care management codes during an episode of care. An episode of care is defined as a period of time that a patient receives chemotherapy, approximately six months.<br /> <br /> Calculating the total cost for time and resources was the next step. Currently, when physicians see a new patient they are paid X by an E/M code. The amount of time and resources spent in the new patient evaluation and treatment planning is really X plus Y, which is the care management component. But physicians are only paid for X.<br /> <br /> The care management payment would also persist during active treatment and would “help pay for things like outbound triage nurses that check on patients,” Dr. Zon said. “After the active payment period, there would be a short period of continued care management because there is management of the after effects of treatment that do require resources from the office, and [they don’t] require a face to face visit.”<br /> <br /> “Right now, we only get paid for face to face encounters,” she said, “but we do so much more for patients that is beyond face to face and not billable.”</p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>Monthly payments.</strong> In this option, there are monthly fees for treatment design and then for active treatment and follow up. The intention is to better support the array of services that are needed when a patient is first diagnosed with cancer and to allow more flexibility in how care is delivered to the patient. The monthly fee would replace the E/M codes with monthly payment codes.<br /> <br /> This option would significantly reduce the number of codes required for billing. The doctor is then responsible for allocating the resources in a manner that supports the services required for the patient’s care.</p> <p style="margin-left:40px;"> <strong>3.   </strong><strong>Bundled payment.</strong> A bundled payment is paid to the physician. It includes not only the oncology practice costs but also other costs such as tests, hospitalizations and possibly drugs.<br /> <br /> It is yet to be decided if the bundled payment will be paid ahead of time or after delivery of services.</p> <p> “It’s important to stress in all three of the options there is a transitioning away from fee-for-service to what we are calling value-based patient-centered care which includes accountability,” Dr. Zon said. “In fact, the model includes providers being measured with regards to delivery of quality care, but only for the services that oncologists can control.”</p> <p> The big difference between this APM and the Center for Medicare and Medicaid Innovation’s Oncology Care Model is that physicians are only held accountable for the areas they can control, she said. For example, “if the patient has a cardiac event under our APM … that would not be included in our requirements to attest to delivering quality care because we can’t control what the cardiologist thinks is necessary for that patient.”</p> <p> “Other demonstration projects have actually have shown … that just by providing the money for care management as well as non-face-to-face, non-reimbursable services,” she said, “that you’re able to reduce … some of the biggest cost [drivers] in health care, which is acute hospitalizations.”</p> <p> ASCO is currently testing the model in several pilot programs and plans to present this model to the Physician-Focused Payment Model Technical Advisory Committee (PTAC)—a committee of experts who will advise CMS on APMs for the new Medicare payment system.</p> <p> Watch for a podcast interview from <a href="https://reachmd.com/" rel="nofollow" target="_blank"><u>ReachMD</u></a> in the coming weeks with Dr. Zon.</p> <p> Listen to a <a href="https://reachmd.com/programs/focus-on-public-health-policy/rise-specialist-driven-alternative-payment-models-american-medicine/8241/" rel="nofollow">podcast interview</a> with Lawrence Kosinski, MD, who discusses his APM, SonarMD. Also, learn about <a href="http://www.ama-assn.org/ama/ama-wire/post/tracking-patients-between-visits-new-care-model" target="_self">Dr. Kosinski’s APM</a> at <em>AMA Wire®.</em></p> <p> <strong>Learn more about APMs:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-developing-new-payment-models-their-specialties" target="_self"><u>How doctors are developing new payment models for their specialties</u></a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/better-health-costs-one-practices-value-based-care-outcomes" target="_self"><u>Better health, costs: One practice’s value-based care outcomes</u></a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/testing-new-payment-models-one-pilot-programs-success" target="_self"><u>Testing new payment models: One pilot program’s success</u></a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/volume-value-one-health-system-making-change" target="_self"><u>From volume to value: How one health system is making the change</u></a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/payment-model-design-needs-physician-led-new-report" target="_self"><u>Payment model design needs to be physician-led, new report</u></a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow"><em><u>Troy Parks</u></em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:2888b9b6-a34c-4e42-92f2-5ba57db1318c Join a CDC, AMA webinar on Zika virus http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_join-cdc-ama-webinar-zika-virus Thu, 28 Jul 2016 21:22:00 GMT <p> The Centers for Disease Control and Prevention (CDC) and the AMA will host a webinar to update clinicians on the current state of the Zika virus outbreak and the latest clinical guidance.</p> <p> The webinar will feature two experts from the CDC who will offer valuable information to help health care professionals <a href="http://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm?s_cid=mm6529e1_e" rel="nofollow">diagnose and manage</a> patients with possible Zika virus infection and explain the latest <a href="http://www.cdc.gov/mmwr/volumes/65/wr/mm6529e2.htm?s_cid=mm6529e2_e" rel="nofollow" target="_blank">clinical guidance</a> on preventing transmission:</p> <ul> <li> Susan Hills, MBBS, CDC medical epidemiologist, will present an update on the epidemiological and clinical aspects of the current outbreak.</li> <li> Kiran Perkins, MD, CDC medical officer, will discuss the implications for pregnant women, including the CDC’s updated interim clinical guidance.</li> </ul> <p> The presentations will be followed by a question and answer session with webinar participants.</p> <p> The webinar will take place during the Department of Health and Human Services’ health provider “Week of Action” on Zika virus. <a href="https://cc.readytalk.com/r/u89qo24bddm1&eom" rel="nofollow" target="_blank">Register</a> to participate in the webinar on Wednesday, Aug. 10, from 7 to 8 p.m. Eastern time.</p> <p> The AMA continues to update its <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/zika-resource-center.page" target="_self">Zika Resource Center</a> to provide the latest on the outbreak to the public, physicians and other health care professionals.</p> <p> <strong>Learn more about Zika virus and what you can do:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-call-funding-strategies-control-zika" target="_self">AMA delegates call on lawmakers to act immediately on Zika funding</a></li> </ul> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/can-now-address-zika-outbreak" target="_self">What you can do now to help address a U.S. Zika outbreak</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c1654b0b-478e-40a0-b329-0f706f08afcc Rethinking how physicians learn to prevent, manage chronic disease http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_rethinking-physicians-learn-prevent-manage-chronic-disease Wed, 27 Jul 2016 20:55:00 GMT <p> As the number of patients with chronic conditions continues to climb, so do the rates of burnout among physicians. Fundamental changes to how physicians approach chronic care are taking shape in medical schools across the country—and these changes may improve the health and well-being of both patients and physicians.</p> <p> <strong>The growing burden of chronic disease</strong><a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/13/570b5e2b-abc8-473a-8dc6-4737c0477766.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/13/570b5e2b-abc8-473a-8dc6-4737c0477766.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Physician educators from nearly two dozen medical schools recently came together for an AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education Consortium</a> meeting to hear from population health experts and learn about each other’s efforts to enhance chronic disease curricula so students are equipped to thrive in their profession and help their patients lead healthier lives.</p> <p> “Almost half of all Americans have at least one chronic disease, and 13 percent have more than three,” said Omar Hasan, MD, vice president of <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_self">Improving Health Outcomes</a> at the AMA.</p> <p> Dr. Hasan pointed to data showing that the number of people between 25 and 44 years of age who had more than one chronic condition more than doubled between 1996 and 2005. Those numbers are only expected to further increase, with 157 million Americans predicted to have more than one chronic disease by 2020.</p> <p> The most common chronic conditions are diabetes, mental and behavioral disorders, heart disease and cancer. Many of the risk factors for developing these conditions reflect the modern lifestyle—dietary risks, smoking, high body mass index, physical inactivity, alcohol use, high blood pressure and high fasting plasma glucose.</p> <p> Whether patients already have a chronic condition or are at risk of developing one, patient care today should look vastly different from several decades ago when most care was focused on acute medical needs. But most physicians still go through training under a model concentrated on the care of acute conditions.</p> <p> Having a chronic disease—especially if a patient has more than one condition—also “adds considerable complexity to the office experience,” Dr. Hasan said. “The more medications patients come in with, the more time it takes to reconcile …. That adds a lot of complexity to health care delivery.”</p> <p> And that complexity is only compounded by operating in a care delivery model or office space that is based on providing care for acute conditions.</p> <p> <strong>Preparing medical trainees for the new paradigm</strong></p> <p> “What are the skills our folks would need in the real world?” said Pamela Allweiss, MD, medical officer for the Division of Diabetes Translation at the Centers for Disease Control and Prevention. “We have to interact with patients in a different way.”</p> <p> Dr. Allweiss spoke about her experience working with academic medical centers to make hands-on clinical changes in the resident curriculum around diabetes care management. The care took on a form different from traditional residency training, putting an emphasis on team-based care, incorporating group visits into care plans and building patients’ involvement in their own care.</p> <p> The results showed that patients with diabetes received more care to keep them healthy, leading to better health outcomes. For instance, the program led to a 300 percent increase in the number of patients who received two Hemoglobin A1c tests each year. Residents, meanwhile, mastered important competencies, such as interacting with patients in a more engaging way and collaborating with an interprofessional care team that can provide more comprehensive care without overly burdening the physician.</p> <p> Trainees also need to get first-hand experience with the realities of outpatient care for patients with chronic diseases. Whereas traditional training often instills a sense of professional accomplishment in seeing a patient through an acute episode of care, day-to-day care for patients with chronic diseases means ongoing management of conditions from which patients may never recover and overlapping issues that could land a patient in the hospital.</p> <p> Christine Sinsky, MD, AMA vice president of <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/steps-forward.page" target="_self">professional satisfaction</a>, noted that there are five main challenges for chronic care:</p> <ul> <li> Chaotic office visits with overfull agendas</li> <li> Inadequate support for patient care</li> <li> Poorly functioning health care teams</li> <li> Vast amounts of time spent on documentation and administrative requirements, which leaves many physicians feeling as though they spend more time on these activities than delivering patient care</li> <li> Electronic health record work that often has become the physician’s responsibility when it previously could have been handled by other members of the health care team</li> </ul> <p> “Care of the patient requires care of the providers,” Dr. Sinsky said. “The only way we can get to the Triple Aim … is to consider the fourth aim of professional well-being.”</p> <p> And that depends on operational efficiencies designed around today’s health care needs, she said. For physicians in ambulatory care, that means customizing the care delivery model with chronic care in mind—from the configuration of the team to set-up of the office space.</p> <p> Dr. Sinsky said it’s also important to train students and residents in these sorts of environments. “How can medical schools expose medical students to the most functional forms of practice? Right now, we expose our students to some of the least functional modes of care delivery. And then we wonder why they aren’t choosing the specialties we need.”</p> <p> Marshall H. Chin, MD, the Richard Parrillo Family Professor of Healthcare Ethics, who specializes in health disparities at the University of Chicago Pritzker School of Medicine, said it’s important for students to really understand the problems in patient care if they are to thrive in the new health care paradigm.</p> <p> “For most of us in medical school,” Dr. Chin said, “we teach students very little of how often we fall short of the mark.” He also noted the danger of students feeling disempowered, which is why the University of Chicago also embeds “an advocacy component into addressing chronic disease and health disparities.”</p> <p> Exposing medical trainees to the shortcomings of the current system and activities that can help improve how care is delivered can cultivate an openness to change that can better serve both patients and physicians.</p> <p align="right"> <em>By AMA Wire editor</em> <a href="https://twitter.com/amy_amawire" target="_blank" rel="nofollow"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ca4bd416-fbfb-4516-8cc6-dd210b5008bc Supercharge career skills at the AMA Research Symposium http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_supercharge-career-skills-ama-research-symposium Wed, 27 Jul 2016 20:50:00 GMT <p> Each fall physicians in training have a chance to spotlight their research projects before leaders of the medical community. Find out how the AMA Research Symposium can boost your visibility, build your CV and expand your network. Last year’s symposium winners also offer tips for competitors.</p> <p> Symposium participants compete for cash prizes and benefit from the chance to present their findings before experts in their fields. The symposium takes place Nov. 11-12 during the 2016 AMA Interim Meeting at Walt Disney World Swan and Dolphin Resort in Orlando.</p> <p> <strong>Build credibility, polish your CV</strong></p> <p> Discussing your research before a reputable panel of judges can set you on the fast track to credibility and advance your career. Michael Lause won the student biochemistry category last year with a presentation on esophageal carcinoma.</p> <p> “Participating in the AMA Research Symposium was definitely a boost to my CV,” said Lause, now a third-year student at the Ohio State University School of Medicine. “It provided me an opportunity to put an exclamation point on a successful summer research project. I put this award on my resume, and I do feel it will serve as a positive factor in any job or endeavor in the future.”</p> <p> <strong>Build your professional skills</strong></p> <p> “The feedback and questions I received at the AMA Research Symposium helped me shape my presentations,” Tanya Khasnavis said. “I also refined some of my research graphs to be more easily presentable.”</p> <p> Khasnavis, a third-year student at the Medical College of Georgia and last year’s winner in the neurobiology category for work on Lesch-Nyhan disease, said she has published two papers based on her research topic.</p> <p> Simply applying and being accepted to the symposium provided a learning experience, Lause said.</p> <p> “More than this, though, are the intangible skills,” he said, “like designing an efficient yet aesthetically appealing poster and captivating an audience through compelling public speaking. All of this shines through on a CV when you have presented at a national research conference.”</p> <p> Eric Melancon, MD, winner in the improving health outcomes category in the residents division for his research on COPD test results, said the symposium even improved his clinical care skills.</p> <p> “I took my information and data to how I approach patient care, and improved on overall quality of care,” said Dr. Melancon, who recently completed his training at the University of Alabama at Birmingham family medicine program.</p> <p> <strong>Invaluable networking</strong></p> <p> Last year, nearly 400 of the country’s brightest medical students, residents, fellows and international medical graduates (IMG) presented and discussed their research among hundreds of AMA Interim Meeting attendees. Presenters also met symposium judges from medical schools, residency programs and hospitals.</p> <p> “The symposium was a wonderful way to meet my peers and share our research experiences,” Khasnavis said. “It has served as an invaluable element of my medical school experience.”</p> <p> For Lause, the symposium allowed him to drill deeper into the workings of the medical world: “It exposed me to the mission and mechanics of the AMA, and now I am an alternate delegate for my region. It got me involved in the politics of medicine, and that is a major benefit from the symposium.”</p> <p> <strong>Hints and tips for competitors</strong></p> <p> Last year’s winners offered advice for their peers considering the 2016 symposium. Abhishek Maiti, MD, the resident group’s overall podium winner for research on renal cell carcinoma, underlined the value of a presentation that is concise and at the same time engaging.</p> <p> “I think a good presentation needs to convey the complex nature of your research but be simple enough for the audience to quickly understand,” he said.</p> <p> Lause said confidence can play a major role in any project: “The best advice I can give is to present your research as the most important thing in the world of science,” he said. “Your energy and passion will be contagious, and your presentation elevated. The award winners are often the people who convince the judges that their results are going to drastically change the landscape within that field of medicine.”</p> <p> Other winners echoed the idea that projects should offer new insights into the practical realities of clinical care.</p> <p> “I would suggest any new presenters choose a subject that every physician can relate to, and one that will not only enhance your medical knowledge but improve patient care,” Dr. Melancon said. “In the end, that is why we are here.” </p> <p> Students, residents and IMGs all report a symposium experience that not only builds skills, networks and careers, but ignites a new kind of excitement about their profession.</p> <p> “I absolutely loved it and would encourage all medical students and residents to participate,” Dr. Maiti said. “Thanks to the AMA for creating such an opportunity.”</p> <p> <strong>Submit your research for the symposium</strong></p> <p> Members of the AMA are eligible to take part in the symposium. Research submissions this year are being accepted in these groups:</p> <ul> <li> <strong>For students: </strong>Submit your abstract for one of eight categories—biochemistry/cell biology, cardiovascular disease/diabetes, clinical outcomes and health care improvement, immunology/infectious disease/inflammation, neurobiology/neuroscience, public health and epidemiology, radiology/imaging, or surgery/biomedical engineering.<br />  </li> <li> <strong>For residents and fellows: </strong>Submit your abstract for one of three categories—clinical vignette, clinical medicine (this includes quality improvement, health policy, clinical research and medical education) or improving health outcomes (cardiovascular disease and diabetes).<br />  </li> <li> <strong>For IMGs: </strong>If you are certified by the Educational Commission for Foreign Medical Graduates and awaiting residency, you can submit your abstract for one of three categories—clinical medicine, clinical vignette or improving health outcomes (cardiovascular disease and diabetes).</li> </ul> <p> Each eligible participant may submit only one abstract and must submit his or her research using the symposium’s online submission form.</p> <p> Abstracts are due Aug. 17. See the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/news-events/research-symposium.page" target="_self">symposium web page</a> for key registration details, submission guidelines and more. The annual AMA Research Symposium is organized by the AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section.page" target="_self">Medical Student Section</a>, the AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/resident-fellow-section.page?" target="_self">Resident and Fellow Section</a> and the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/international-medical-graduates.page?" target="_self">AMA-IMG Section</a>.</p> <p> <strong>Planning to present or publish your own research? Don’t miss these must-have resources:</strong></p> <ul> <li> Learn how to publish your research like a pro with <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-like-pro-5-expert-strategies-innovative-research" target="_self">these five strategies</a>.</li> <li> Bookmark <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-top-journals-physicians-training" target="_self">this list</a> of the top journals that accept research from physicians in training.</li> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/research-published" target="_self">how to get your research published</a>.</li> <li> Follow <a href="http://www.ama-assn.org/ama/ama-wire/post/9-top-tips-getting-published-medical-journal" target="_self">these 9 expert tips</a> for getting published in a medical journal.</li> <li> Remember that publishing (like research) is a learning process, so if your paper gets rejected—don’t worry. Here’s <a href="http://www.ama-assn.org/ama/ama-wire/post/research-paper-got-rejected-heres-handle" target="_self">how to handle it.</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ca0d9bd3-b01e-4ada-b43e-a1354f7dc30b Network with academic colleagues Nov. 11 in Seattle http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_network-academic-colleagues-nov-11-seattle Wed, 27 Jul 2016 14:00:00 GMT <p> Academic physicians can <a href="https://apps.ama-assn.org/mtgregcvent/register/search?ECODE=b1754ab3-89e8-4ed5-b41a-a71a423d325f" target="_self">register now </a>to attend the 2016 AMA Academic Physicians Section (APS) Interim Meeting, Nov. 11 at the Grand Hyatt in Seattle. This event will be held prior to the annual meeting of the Association of American Medical Colleges, taking place Nov. 11-15.</p> <p> The meeting begins at 1 p.m. (with an optional new member orientation/update at 10 a.m.). Meeting registration is free of charge.</p> <p> Plan to attend this important event so that you can:</p> <ul> <li> Hear an update on the progress of the AMA's <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education.page" target="_self">Accelerating Change in Medical Education</a> Consortium</li> <li> Play a role in developing AMA medical education policy by reviewing, debating and voting on reports and resolutions to go before the AMA House of Delegates</li> <li> Participate in an education session on health systems science, the third pillar of medical education that has emerged from the work of the AMA’s Accelerating Change in Medical Education Consortium.</li> <li> Enjoy a networking reception with your academic physician colleagues nationwide, along with representatives of the 32 member medical schools of the AMA’s Accelerating Change in Medical Education Consortium</li> <li> Hear an update on the <a href="http://www.ama-assn.org/ama/pub/membership/membership-benefits/for-academic-physicians.page" target="_self">Academic Leadership Program</a>, which offers 20 percent or higher discounts on AMA dues for medical school deans and faculty</li> </ul> <p> More details to come soon. Be sure to check the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/section-medical-schools.page" target="_self">AMA-APS web page </a>to stay apprised of updates. Also, read a <a href="http://www.ama-assn.org/ama/ama-wire/post/ama-academic-physicians-section-2016-ama-annual-meeting-highlights" target="_self">summary</a> of the June 2016 AMA-APS meeting.</p> <p> The AMA welcomes your feedback: Please <a href="mailto:section@ama-assn.org" rel="nofollow" target="_self">email the section</a> or call (312) 464-4635.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:3f660db6-a92c-4b5d-95e7-77f181b144d8 From hospital to home: A model for safer transitions http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_hospital-home-model-safer-transitions Tue, 26 Jul 2016 21:00:00 GMT <p> Patients with multiple chronic conditions, polypharmacy and unmet social needs are often at risk for serious drug therapy problems during the transition from hospital to home. A new model has made these transitions safer and decreased hospital admissions and emergency department visits for patients.</p> <p> Developed by the University of Tennessee in partnership with Methodist Le Bonheur Healthcare in Memphis, the SafeMed model uses a primary care-based team, which includes physicians, pharmacists, nurses and community health workers, to form a support network for high-risk and high-needs patients as they transition from the hospital to the outpatient setting.</p> <p> A new <a href="https://www.stepsforward.org/modules/safemed-transition-care" target="_self" rel="nofollow">module</a> from the AMA’s STEPS Forward™ collection of practice improvement initiatives can help practice teams implement the SafeMed model, which enables them to work closely with patients to build strong relationships that make it easier to coordinate and manage their care.</p> <p> <strong>How they did it in Memphis</strong></p> <p> The University of Tennessee Health Sciences Center, which contributed this STEPS Forward module after <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-teach-their-secrets-success" target="_self">winning</a> the AMA-MGMA Practice Innovation Challenge, saw 30 percent fewer hospitalizations, 44 percent fewer 30-day readmissions and 52 percent fewer ED visits for patients with multiple chronic conditions and frequent ED visits in just six months.</p> <p> The SafeMed program starts with a report every morning that tells the clinic which of its assigned patients have been hospitalized in the last 24-72 hours. The nurse leader uses the report to determine which patients might benefit from SafeMed care transitions support so that home visits by a community health worker can be scheduled.</p> <p> Community health workers meet with the SafeMed team physician, pharmacist and nurse leader to address specific medication problems or care management issues identified during home visits. They also meet with the SafeMed team leaders on a weekly or monthly basis to conduct case reviews and refine care plans.</p> <p> Participating patients are invited to regular clinic-based SafeMed peer group support and education sessions, where they suggest topics for discussion and ask questions to help them better navigate the health system. Each patient is asked to remain in the program for at least three months to receive the full benefit of the approach.</p> <p> <strong>Getting started in your practice</strong></p> <p> The SafeMed approach used in Memphis can be adapted by individual practices to reduce drug therapy problems, patient morbidity and mortality resulting from preventable drug therapy problems, and avoidable hospital readmissions. It can also lower costs and improve medication adherence, disease management and overall patient health.</p> <p> The Health Sciences Center followed four steps to implement the SafeMed program:</p> <p style="margin-left:40px;"> <strong>1.   </strong><strong>Develop a care transitions plan.</strong> Regular team meetings are important in the planning process. Think about how to scale the model to fit your practice’s needs and take care of patients.</p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>Identify complex patients who are good candidates for the program.</strong> Pinpoint the most vulnerable patient populations that will receive the greatest benefit from intervention by the SafeMed team.</p> <p style="margin-left:40px;"> <strong>3.   </strong><strong>Assemble and train the SafeMed team.</strong> First, select a leader to designate team leads and hire any additional staff you need to make the plan work. A typical team consists of three team leaders—a physician, a nurse, a pharmacist. The full team may include two community health workers, one pharmacy technician and one licensed practical nurse, medical assistant or health coach.<br /> <br /> Team members should be knowledgeable about practice work flows and chronic disease symptoms, signs, medications and treatment. All team members should receive training in motivational interviewing, patient advocacy, transitions of care and mental health issues.</p> <p style="margin-left:40px;"> <strong>4.   </strong><strong>Start the transition process and refine the plan over time.</strong> Use your electronic health record (EHR) to identify patients who meet your practice’s criteria so they can be flagged for the transitions team immediately in the event of an ED visit or hospital admission. The daily report will help you identify eligible patients. Track performance to better understand the impact and make improvements to the process.</p> <p> <strong>More practice resources</strong></p> <p> The module on <a href="https://www.stepsforward.org/modules/safemed-transition-care" rel="nofollow">using the SafeMed model for transitions of care approach </a>is one of eight new modules recently added to the AMA’s <a href="https://www.stepsforward.org/modules" target="_self" rel="nofollow">STEPS Forward</a> collection of practice improvement strategies to help physicians make transformative changes to their practices. Thirty-five modules now are available, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</p> <p> <em>AMA Wire</em> explores many of the other <a href="http://www.ama-assn.org/ama/ama-wire/blog/STEPS_Forward/1" target="_self">modules</a>, including why your practice needs a health coach and four questions to ask to find out if your patients have unmet needs.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9dcda6bc-d5d0-436c-85e1-b19303d86796 Physicians, patients take active approach to diabetes fight-online http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-patients-active-approach-diabetes-fight-online Tue, 26 Jul 2016 14:45:00 GMT <p> A new project underway is creating a roadmap for large health care organizations to partner with their patients to fight off type 2 diabetes when they are most at risk of developing the disease. The program spurs patients to make the necessary behavioral changes and gives care teams the data they need to keep their patients healthy.</p> <p> The project is a collaboration of the AMA, <a href="https://www.omadahealth.com/" rel="nofollow" target="_blank">Omada Health</a>, a digital behavioral medicine company, and <a href="https://intermountainhealthcare.org/" rel="nofollow" target="_blank">Intermountain Healthcare</a> in Utah, an industry leader in the adoption of innovative prevention care strategies to reduce costs while providing high-quality care.</p> <p> The group Tuesday announced a new effort aimed at reducing the alarming number of adults who develop type 2 diabetes. The project will allow Intermountain physicians and care teams to track their patients’ progress through an evidence-based online diabetes prevention program offered by Omada.</p> <p> “This collaboration expands upon the <a href="https://doihaveprediabetes.org/" rel="nofollow" target="_blank">AMA’s robust efforts</a> to prevent type 2 diabetes in this country through the scalable adoption of proven innovative tools and resources that can help physicians better manage patients with chronic conditions,” said AMA President Andrew W. Gurman, MD, in a press release. “Together we hope to showcase a continuum of care model that bridges technology and clinical care in a way that hasn’t been done before.”</p> <p> <strong>Improving patient care</strong></p> <p> Access to real-time actionable data from Omada allows care teams to create specific, proactive touch points with patients to support their completion of the program.</p> <p> Participating in evidence-based diabetes prevention programs can reduce the risk of developing type 2 diabetes by nearly 60 percent, research has shown. Up to 90 percent of people with prediabetes are unaware that they have the condition. It’s estimated that one in 20 adults—more than 114,000 people—are living with prediabetes within Intermountain’s service area.</p> <p> “Intermountain’s integration of the Omada program, and [the] AMA’s focus on ensuring digital tools work to empower providers will give patients with prediabetes another proven option to meet their care needs,” said Omada Health CEO Sean Duffy. “It will also give physicians and their care teams additional treatment options and actionable data to better understand how to deliver lasting lifestyle change for those in need of it.”</p> <p> Last year, Omada became the first digital health company to publish <a href="http://www.jmir.org/2015/4/e92/" rel="nofollow" target="_blank">peer-reviewed results demonstrating</a> that program participants maintained reductions in body weight and average blood sugar levels—critical indicators of diabetes progression—two years after beginning the program.</p> <p> <strong>Learn more about preventing type 2 diabetes:</strong></p> <ul> <li> Take an inside look at <a href="http://www.ama-assn.org/ama/ama-wire/post/inside-look-physicians-success-story-prediabetic-patient" target="_self">one physician’s success story as a prediabetic patient</a></li> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/diagnose-prediabetes" target="_self">how to diagnose prediabetes</a></li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/minnesota-practice-preventing-diabetes-can" target="_self">how a practice in Minnesota is preventing diabetes</a></li> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/3-simple-steps-address-prediabetes-practice" target="_self">three steps you can take to address prediabetes in your practice</a></li> <li> Check out the AMA-CDC initiative <a href="http://www.ama-assn.org/sub/prevent-diabetes-stat/for-health-care-professionals.html" target="_self">Prevent Diabetes STAT: Screen, Test, Act—Today™</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:bf349e9e-5f1a-4168-a165-1598bf4756dd 3 ways to battle the “July effect” in teaching hospitals http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_3-ways-battle-july-effect-teaching-hospitals Mon, 25 Jul 2016 21:24:00 GMT <p> Each summer new residents and faculty figure out the layout of large facilities and meet a host of new teammates and patients. They also struggle with efficiency, quality and patient safety during the dawn of the academic year.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/6/a33d307a-d9e8-4f9d-8640-42d4718cddff.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/6/a33d307a-d9e8-4f9d-8640-42d4718cddff.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> But there are ways to combat the legendary “July effect” that involve a more collaborative mindset among internal medicine trainees, attending physicians and faculty. A new report calls for novel strategies, some borrowed from aviation and other industries with a keen concern for safety, and all designed to boost teamwork, communications and effectiveness among the key players in the clinical setting.</p> <p> <strong>Promise and problems</strong></p> <p> “While teaching hospitals have long relied on the triad of attending physician, senior resident and intern to provide team-based care, new teams providing care in July are paradoxically part of the problem,” said the authors of a <a href="http://journals.lww.com/academicmedicine/Fulltext/2016/07000/Why_July_Matters.12.aspx?WT.mc_id=HPxADx20100319xMP" rel="nofollow" target="_blank">commentary published in <em>Academic Medicine</em></a>.</p> <p> The authors said that studies show costs, hospital stays and patient mortality peak in July. They outlined three policies to roll back the July effect:</p> <p style="margin-left:40px;"> <strong>1.   </strong><strong>Improving leadership</strong>. A select group of “July-able” attendings, known for their dynamic style, teaching prowess and ability to foster camaraderie, take the lead in teaching trainees. They encourage autonomous decision making, with early and direct feedback as a tool for improvement. Teaching hospitals identify and develop these master educators and put them in place well before July.</p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>Pairing good leaders with good followers</strong>. Senior residents are groomed and selected on the basis of their ability to mentor new interns. Grooming includes interdisciplinary rounds, which cultivate resident education and improve relationships with nurses. “Taking full advantage of nurses’ experience is of paramount importance,” the authors said.</p> <p style="margin-left:40px;"> <strong>3.   </strong><strong>Cultivating bidirectional communication</strong>. A free-flowing, bidirectional communications system is nurtured, encouraging a willingness to report unexpected events to attendings. Health care institutions can borrow from other “institutions that seek to avoid catastrophe,” such as aviation, nuclear power and firefighting. Airlines, with their interdisciplinary conferences, checklists for daily activities, directed feedback and debriefing methods that focus on actionable improvement ideas, are worth studying as a model.</p> <p> <strong>Don’t miss the fireworks</strong></p> <p> The authors called for further study of the July effect, especially determining whether reproducible and transferable practices are already in use and worth adopting in more hospitals.</p> <p> The authors said the reforms they propose could transform the troubled academic year transition into a positive mentoring and growth experience for interns, faculty and senior residents.</p> <p> “Most important, such reforms will allow teaching hospitals to provide consistent care to our patients 365 days per year,” the authors concluded. “As we do so, getting sick in July may become problematic for one reason only—missing the fireworks.”</p> <p> <strong>Additional information to help in the transition to residency:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/10-concepts-will-thrive-intern" target="_self">10 concepts that will help you thrive as an intern</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/7-things-need-succeed-medical-intern" target="_self">7 things you need to know to succeed as a medical intern</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/6-key-factors-build-residents-trust-interns" target="_self">http://www.ama-assn.org/ama/ama-wire/post/6-key-factors-build-residents-trust-interns</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-essential-art-of-balancing-emotion-logic" target="_self">The physician’s essential art of balancing emotion and logic</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/resident-burnout-unearthing-bigger-picture" target="_self">Resident burnout: Unearthing the bigger picture</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/making-residency-family-friendly" target="_self">Making residency more family friendly</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8fe47abd-6510-43a0-8ba7-d811a91d2286 USMLE Step 2: This month’s question to beat http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_usmle-step-2-this-months-question-beat Mon, 25 Jul 2016 20:13:00 GMT <p> Getting ready for the United States Medical Licensing Examination® (USMLE®) Step 2 is no easy feat, but we’re sharing expert insights to help give you a leg up. Take a look at the exclusive scoop on this month’s most-missed USMLE Step 2 test prep question. Think you have what it takes to rise above your peers? Test your USMLE knowledge, and view an expert video explanation of the answer from Kaplan Medical.</p> <p> Once you’ve got this question under your belt, be sure to test your knowledge with <a href="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" target="_self">other posts in this series</a>.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong></p> <p> A 14-year-old girl comes to the physician because of heavy menstrual bleeding that began with menarche two years ago. Her menstrual periods last eight to 10 days and occur approximately every 28 days. Her last menstrual period ended three days ago. Vital signs are temperature 37.0ºC (98.6ºF), blood pressure 110/70 mm Hg, pulse 90/min and respirations 18/min. Physical examination shows a slender, calm girl who is in no distress but appears pale. The remainder of the examination is unremarkable. Laboratory studies show:</p> <ul> <li> WBC:  7,000/mm<sup>3</sup></li> <li> Hb:  9 g/dL</li> <li> Hct:  27%</li> <li> Plt:  250,000/mm<sup>3</sup></li> </ul> <p> Which of the following is the most appropriate next step in management?</p> <p style="margin-left:40px;"> A. Begin a transfusion of packed red blood cells</p> <p style="margin-left:40px;"> B. Order a pelvic ultrasound to rule out polycystic ovaries</p> <p style="margin-left:40px;"> C. Order coagulation profile</p> <p style="margin-left:40px;"> D. Reassure that heavy bleeding is caused by anovulatory cycles</p> <p style="margin-left:40px;"> E. Start oral contraceptive therapy</p> <p>  </p> <p> <object data="http://www.youtube.com/v/kFwU_ZhdNpE" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/kFwU_ZhdNpE" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/kFwU_ZhdNpE" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowFullScreen" value="true" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object></p> <p>  </p> <p>  </p> <p>  </p> <p> <strong>The correct answer is C.</strong></p> <p> <strong>Kaplan says, here’s why: </strong><br /> Dysfunctional uterine bleeding (in this case, menorrhagia, or prolonged menstrual bleeding that occurs at regular intervals and lasts more than seven days) is often the presenting symptom of a blood dyscrasia. The most common inherited disorder of bleeding, von Willebrand disease, is generally transmitted as an autosomal-dominant trait and is more commonly diagnosed in women, because it might present with heavy bleeding at menarche as in the vignette.</p> <p> Lab findings associated with von Willebrand disease are normal PT and either normal or slightly prolonged aPTT. Platelet count is normal. Bleeding time is increased, however, because vWF is required for normal binding of platelets to blood vessels. Factor VIII and vWF are usually decreased. Ristocetin activity (vWF activity) is always abnormal. von Willebrand disease is often not diagnosed until severe bleeding after surgery or when noted on menarche. Patients who have von Willebrand disease often have family histories of abnormal bleeding.</p> <p> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer.</em></p> <p> <strong>Choice A:</strong> Transfusion of packed red blood cells is incorrect. The patient in the question is not unstable (mild tachycardia, stable blood pressure), and because she is not currently bleeding, she can be managed as an outpatient without the need of a transfusion.</p> <p> <strong>Choice B:</strong> Pelvic ultrasound to rule out polycystic ovaries is incorrect. Although polycystic ovary syndrome is a common cause of dysfunctional uterine bleeding, it is marked by irregular cycles and heavy bleeding (menometrorrhagia). The patient here is not typical of polycystic ovary syndrome in that she is not overweight.</p> <p> <strong>Choice D:</strong> Reassurance that heavy menstrual bleeding is likely secondary to anovulatory cycles is incorrect. Although dysfunctional uterine bleeding is often secondary to anovulatory cycles in the first few years after menarche, what distinguishes this patient’s bleeding is that she began with heavy, prolonged periods at menarche. The patient’s anemia also demands that further diagnostic studies be done.</p> <p> <strong>Choice E:</strong> Oral contraceptive therapy is incorrect. Once von Willebrand disease is diagnosed, the treatment of oral combined contraceptives and oral iron therapy can be started, but it would be incorrect to begin treatment without performing further diagnostic studies first.</p> <p> <strong>One tip to remember:</strong></p> <p> Von Willebrand disease is the most common inherited bleeding disorder and should be thought of when a young girl presents with heavy bleeding since the onset of menses. von Willebrand factor (vWF) is instrumental in linking platelets to endothelial cells and acts as a carrier for clotting factor VIII, which is found at low levels and has a short half-life if vWF is absent. Laboratory testing for vWF antigen, vWF activity and factor VIII activity is usually enough to make the diagnosis.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d8e258ff-1eca-4124-8895-547ecdd92953 Banning expert testimony from liability cases: Court decides http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_banning-expert-testimony-liability-cases-court-decides Fri, 22 Jul 2016 19:57:00 GMT <p> Can trial courts block physicians’ expert witnesses from testifying in medical liability cases? One Wisconsin court recently did, leaving it to the court of appeals to decide whether a physician defendant has the right to present expert testimony that differs from that of the plaintiffs.  </p> <p> At stake in <em>Bayer v. Dobbins</em> was whether trial court had properly excluded expert testimony regarding injuries to a newborn that had resulted in complications in the birthing process.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/8/ae468d49-d0e7-4298-b8f4-2e8cf9fc1cb5.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/8/ae468d49-d0e7-4298-b8f4-2e8cf9fc1cb5.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>What happened in Wisconsin </strong></p> <p> Leah Bayer was delivering her child under the care of Brian D. Dobbins, MD, when the progress of the delivery slowed and she began to show signs of exhaustion. Dr. Dobbins made the decision to use a vacuum to advance the child down the birth canal.</p> <p> The child’s shoulder became stuck inside the canal, causing shoulder dystocia, a condition in which the fetal shoulder becomes lodged on the maternal pelvis. A shoulder dystocia is considered an emergency because it can lead to compression of the umbilical cord, which can compromise blood flow and oxygen supply to the child.</p> <p> After using two “traction” maneuvers, Dr. Dobbins was able to successfully deliver the child. But the child had reduced movement of her right arm and was ultimately diagnosed with a permanent right brachial plexus injury—which severely limited her ability to use her right arm and hand.</p> <p> The Bayers sued Dr. Dobbins, claiming that he had used excessive traction during the delivery. Dr. Dobbins contended that he had appropriately used only gentle downward traction to deliver the child and that the injury was caused by maternal forces of labor, including the forces associated with contractions and pushing.</p> <p> In support of Dr. Dobbins’ medical care, the defense tendered as expert witnesses four well-known medical scientists whose testimony was supported by dozens of peer-reviewed medical studies. Many of the studies had been published by or were connected with the American College of Obstetricians and Gynecologists (ACOG). One of the studies Dr. Dobbins proffered as evidence concluded that the condition “has been shown to occur entirely unrelated to traction ….” The study was published by ACOG in 2014.</p> <p> Before the trial began, the Bayers filed a motion asking the circuit court to exclude all expert testimony relating to Dobbins’ theory that maternal forces of labor caused the injury, arguing that the experts’ opinions were unreliable because the Bayers’ biochemical engineering expert had disproved the maternal forces theory in 2007 using a simulator.</p> <p> The trial court ultimately ruled in favor of the Bayers and excluded the defendant’s expert witnesses. It also determined that the medical literature was “inappropriate” because it did not adequately differentiate between permanent and temporary brachial plexus injuries.</p> <p> <strong>On appeal, court reverses decision</strong></p> <p> A Wisconsin Court of Appeals granted Dr. Dobbins’ appeal of the order that prevented his expert witnesses from testifying.</p> <p> Citing the ACOG study, the <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page" target="_self">Litigation Center of the AMA and State Medical Societies</a> and the Wisconsin Medical Society said in an amicus brief, “This resource, which Dr. Dobbins’ experts used to support their opinions, is an example of a systematic review of observational studies. … publications like this represent some of the best evidence available to physicians in medical decision making.”</p> <p> “This court has the opportunity with this case to provide significant guidance to Wisconsin’s trial courts,” the brief said. “The society can envision no more logical source of determining the reliability of such evidence than medicine’s own standards of reliability.”</p> <p> Last week, the Wisconsin Court of Appeals ruled that, because competing scientific theories were presented, it was for the jury to decide which of the theories best fit the facts of the case.</p> <p> “If experts are in disagreement,” the court said in the decision, “it is not for the court to decide ‘which of the several competing scientific theories has the best provenance.’”</p> <p> As a result of the decision, Dr. Dobbins’ expert witnesses and the medical literature supporting their testimony will be allowed in the case.</p> <p> <strong>Current medical liability cases in which the Litigation Center is involved:</strong></p> <ul> <li> Learn how a case <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-lead-unlimited-awards-of-punitive-damages" target="_self">could lead to unlimited awards of punitive damages</a>.</li> <li> Get the details on a <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-extend-medical-liability" target="_self">case that could extend medical liability</a>.</li> <li> Find out how one <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-increase-liability-exposure-redefine-injury" target="_self">case could increase liability exposure and redefine injury</a>.<br />  </li> </ul> <p style="text-align:right;"> <em style="font-size:12px;">By AMA staff writer</em><span style="font-size:12px;"> </span><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" style="font-size:12px;" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:13759ca5-7e56-41a1-8d97-070ca9d53216 Don’t be stumped: This month’s USMLE Step 1 question http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_dont-stumped-this-months-usmle-step-1-question Fri, 22 Jul 2016 19:55:00 GMT <p> When it comes to taking exams, not all questions are created equal. If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 1 exam, you need this exclusive scoop on one of the most commonly missed USMLE test prep questions. Find out what this month’s challenging question is, and view an expert video explanation of the answer from Kaplan Medical.</p> <p> Welcome to this month’s installment of the <em>AMA Wire</em>® series, Tutor talk: Tips from Kaplan Medical on the most missed USMLE test prep questions from Kaplan’s Qbank: Step 1. Each month, we’re revealing the top questions physicians in training miss on the USMLE, a helpful analysis of answers and videos featuring tips on how to advance your test-taking strategies. See <a href="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" target="_self">all posts in this series</a>.</p> <p> Think you have what it takes to rise above your peers? Test your USMLE knowledge below.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong></p> <p> A 39-year-old African-American man comes to the physician because of anorexia, malaise, dark urine and upper abdominal discomfort. His temperature is 37.9ºC (100.2ºF). Physical examination shows scleral icterus and moderate right upper quadrant tenderness. The liver is palpable below the right costal margin. Laboratory studies show:</p> <ul> <li> HBsAg:  positive</li> <li> HBsAb:  negative</li> <li> Anti-HBc IgM:  positive</li> <li> HBeAg:  positive</li> </ul> <p> Which of the following will most likely change in his serologic findings when this patient enters the window period?</p> <p style="margin-left:40px;"> <strong>A.</strong> He will become HBcAg-positive</p> <p style="margin-left:40px;"> <strong>B. </strong>He will become HBc IgG-positive</p> <p style="margin-left:40px;"> <strong>C.</strong> He will become HBeAg-negative</p> <p style="margin-left:40px;"> <strong>D.</strong> He will become HBsAb-positive</p> <p style="margin-left:40px;"> <strong>E.</strong> He will become HBsAg-negative</p> <p>  </p> <p> <object data="http://www.youtube.com/v/poPJl58Y2_0" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/poPJl58Y2_0" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/poPJl58Y2_0" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowFullScreen" value="true" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object></p> <p>  </p> <p>  </p> <p> <strong>The correct answer is E.</strong></p> <p> <strong>Kaplan says, here’s why: </strong><br /> This patient has acute hepatitis B. The “window period” refers to that period in infection when neither hepatitis B surface antigen (HBsAg) nor its antibody (HBsAb) can be detected in the serum of the patient. It is an immunologically mediated phenomenon caused by the precipitation of antigen-antibody complexes in their zone of equivalent concentrations and, thereby, their removal from the circulation.</p> <p> Because of this, the first thing that will happen in the window period is that the serum will become negative for the surface antigen (HBsAg) as that antigen is precipitated out of the serum by developing levels of its specific antibody (HBsAb). Serologic tests conducted during the window period will be positive for HBcAb and HBeAb.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/1/b52e1979-94bd-4e03-a120-2302453c7bc1.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/1/b52e1979-94bd-4e03-a120-2302453c7bc1.Large.jpg?1" style="margin:15px;" /></a></p> <p> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer.</em></p> <p> <strong>Choice A:</strong> HBcAg is not typically measured in the serum during the symptomatic phases of hepatitis B infection. It would be found before the patient develops symptoms and would likely remain present as long as the patient has an active HBV infection, regardless of whether the patient is in the window period or not.</p> <p> <strong>Choices B and C:</strong> Levels of anti-HBc IgG and HBeAg do not have a relationship to the window period. The antibody against the main core of the virus (HBcAb) is used to diagnose history or presence of an infection since it is the first antibody made by the patient, and it will remain in the body well after resolution of a HBV infection or in patients with chronic HBV infections. The HBeAg (a second core antigen) is found in the blood when virions are also present in the bloodstream. It is therefore used as a measure of how infectious the patient would be.</p> <p> <strong>Choice D:</strong> Levels of HBsAb will not be detectable until there is antibody excess and the patient is leaving the window period.</p> <p> <strong>Key tips to remember:</strong></p> <ul> <li> During the “window period” of hepatitis B infection, neither hepatitis B surface antigen (HBsAg) nor its antibody (HBsAb) can be detected in the serum of the patient.</li> <li> This is due to precipitation of antigen-antibody complexes in their zones of equivalence and, thereby, their removal from the circulation.</li> <li> Serologic tests conducted during the window period will be positive for HBcAb and HBeAb.</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:cd2dfb49-bf6a-4ca4-b415-f063fc3a69f6 Submit your recent achievements to the AMA-YPS http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_submit-recent-achievements-ama-yps Fri, 22 Jul 2016 14:00:00 GMT <p> In preparation for the 2016 AMA Young Physicians Section (YPS) Activities Report, the section is requesting information on your recent achievements in organized medicine. </p> <p> <a href="mailto:yps@ama-assn.org" rel="nofollow">Email your accomplishments</a> to the section by Sept. 15. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9fe7b8b6-7f28-4a07-b402-3c0dd80a43b6 DOJ, states side with patients and physicians-file to block insurance mergers http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_doj-states-side-patients-physicians-file-block-insurance-mergers Thu, 21 Jul 2016 22:23:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/5/787faf50-2e7e-40f2-8504-fdc60f4bae64.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/5/787faf50-2e7e-40f2-8504-fdc60f4bae64.Large.jpg?1" style="margin:15px;height:150px;width:100px;float:left;" /></a><em>An AMA Viewpoints post by AMA President Andrew W. Gurman, MD</em></p> <p> Prospects for major health insurance consolidation took a major hit when the U.S. Department of Justice (DOJ) and a number of states filed antitrust lawsuits Thursday to block both the Aetna, Inc.-Humana, Inc. and Anthem, Inc.-Cigna Corp. mergers. The DOJ asserted that the mergers would substantially lessen competition.</p> <p> When something comes up that could negatively affect our patients and the quality and affordability of the care they receive, physicians take the lead and engage policymakers. With the same drive that put us through late nights in med school, carried us through the intensity of our residencies and continues to push us every day to go the extra mile for our patients and their families, we took these mergers on—and our voices were heard.</p> <p> Creating even larger goliaths would be unacceptable—and I said so in a public <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-07-21-statement-doj-health-insurer-mergers.page" target="_self">statement</a> today. Federal and state officials have a strong obligation to enforce antitrust laws to protect patients by ensuring a competitive marketplace that operates in patients’ best interests.</p> <p> The DOJ’s action is a significant step toward the kind of marketplace that doesn’t put the insurers first but rather puts patients first. And that’s what we as physicians care about most.</p> <p> <strong>Physicians fight to protect patients </strong></p> <p> Both mergers were announced in July of last year. My colleague, Immediate-past President Steven J. Stack, MD, responded swiftly with a statement detailing how the mergers would increase health insurance market concentration and reduce competition in both the market for the sale of health insurance and in the market in which health insurers purchase physician services, ultimately resulting in further patient injury due to a decrease in the quality and quantity of available physician services. Neither development is something we as physicians can allow.</p> <p> At the outset of the DOJ and state investigation of these mergers, the AMA was armed by our annual market studies on competition in health insurance and by an AMA study published in a leading academic journal establishing that a previous merger—United Health Group Inc.’s 2008 merger with Sierra health services—resulted in higher premiums.</p> <p> Over the course of the next year, we physicians took it upon ourselves to <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-stand-up-against-mergers-of-powerful-insurers" target="_self">stand up against the mergers</a> of these powerful insurers by submitting testimony in congressional and state proceedings and preparing memoranda to state and federal officials investigating the mergers. In this effort, the AMA joined with state medical societies and gained the assistance of influential lawyers and economists to gather the evidence and present the arguments against the mergers to the DOJ, state attorneys general and state insurance departments.</p> <p> I <a href="http://judiciary.house.gov/index.cfm/hearings?ID=020363B9-F9EF-4623-8E67-28A0B260675A" rel="nofollow" target="_blank">testified</a> at a congressional hearing examining the proposed mergers and the impact they would have on competition in September, urging them to closely scrutinize the mergers and utilize enforcement tools at their disposal to protect patients and preserve competition.</p> <p> Two weeks before, my colleague, Barbara L. McAneny, MD, who is a member of the AMA board of trustees, <a href="http://judiciary.house.gov/index.cfm/hearings?ID=417B9E62-CB8D-4FC7-905D-40F39B91E5E7" rel="nofollow" target="_blank">testified before Congress</a> with a similar message. Together, we carried that message into the 2015 AMA Interim Meeting, where the AMA House of Delegates passed <a href="http://www.ama-assn.org/ama/pub/news/news/2015/2015-11-17-consumer-access-health-care.page" target="_self">new policy</a> that emphasized the need for active opposition to consolidation in the health insurance industry that could result in anticompetitive markets.</p> <p> In December, the AMA identified the “big 17”—states where the mergers would have the greatest impact—and formed a coalition to block the mergers. A survey was developed relating to the monopsony issues raised by the proposed mergers and sent out to physicians in those states. Physician feedback was included as the big 17 coalition drafted letters sent to the DOJ.</p> <p> What’s important is that the medical community came together under this coalition, not with the intention of fighting the goliath companies that would be formed by the mergers, but rather to prevent them from happening. The physician voice is stronger when we can all come together under the same leadership.</p> <p> As the letters were drafted and sent, we continued to lay on the pressure and the argument of the coalition became stronger and harder to refute.</p> <p> Last month, the California Department of Insurance issued a letter urging the DOJ to <a href="http://www.ama-assn.org/ama/ama-wire/post/california-joins-growing-opposition-insurer-mergers" target="_self">block the Anthem-Cigna merger</a>. The insurance commissioner based this conclusion on a March 29 <a href="http://www.ama-assn.org/ama/ama-wire/post/experts-stand-against-insurance-mergers" target="_self">public hearing</a> that included testimony and written comments from the public, patient advocates, experts on health insurance mergers, and both the AMA and the California Medical Association (CMA).</p> <p> Jointly with the CMA, we filed a comprehensive, evidence-based <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/competition-anthem-cigna-merger-full.pdf" target="_self">analysis</a> (log in) explaining why the merger should be blocked. At the hearing, our top antitrust attorney testified that the consequences of the proposed merger would have long-term consequences for health care access, quality and affordability.</p> <p> Similarly, Missouri, with our input, took a hard stand against Aetna’s acquisition of Humana in May when the Missouri Department of Insurance issued a cease-and-desist <a href="http://insurance.mo.gov/documents/findings-fact-5-24-16.pdf" rel="nofollow" target="_blank">order</a> preventing the companies from doing any post-merger business in Missouri’s Medicare Advantage markets and some commercial insurance markets.</p> <p> All of these efforts raised awareness and ultimately led to this moment today—on the cusp of a win for our patients.</p> <p> Today’s news is especially gratifying. The DOJ /state suit against Anthem-CIGNA incorporates the AMA’s concerns that the merger would result in a health insurer buyer “monopsony” power over the physician marketplace. The suit against Aetna adopts the AMA’s long-held and strenuously argued view that Medicare Advantage is a separate market that would suffer antitrust injury by the proposed Aetna-Humana merger. Finally, the AMA is thankful the state Attorneys General, like Florida, who listened to the physicians’ concerns and joined the lawsuits.</p> <p> <strong>The fight isn’t over yet</strong></p> <p> A merger of this magnitude would compromise physicians’ ability to advocate for their patients—something we consider an integral part of our place in society. In practice, market power allows insurers to exert control over clinical decisions, which undermines our relationships with patients and eliminates crucial safeguards of patient care.</p> <p> On the other hand, competition can lower health insurance premiums, enrich customer service and spur inventive ways to improve quality and lower costs. Patients benefit when they can choose from many different insurers that are competing for their business by offering coverage that patients want and at competitive prices.</p> <p> The suit filed by the DOJ is not the end—yet. Both companies have stated that they plan to fight the battle in court and challenge the DOJ lawsuit. The AMA will remain engaged in this process and relentless in our quest to preserve competition in the health insurance marketplace. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:64a8593e-052c-446f-8bc6-ef1aad5d22bc 3 useful changes to Meaningful Use http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_3-useful-changes-meaningful-use Wed, 20 Jul 2016 20:40:00 GMT <p> The Centers for Medicare & Medicaid Services (CMS) has proposed changes to the Meaningful Use program that are intended to relieve physician reporting burdens. Those changes include reducing the 2016 reporting period to 90 days.</p> <p> Based on feedback from the health care community, the proposed changes “better support physicians in providing beneficiaries with the right care at the right time,” CMS Acting Administrator Andy Slavitt said in a <a href="https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-07-06.html" target="_blank" rel="nofollow">press release</a>. These changes were detailed in the 2017 Hospital Outpatient Prospective Payment System (OPPS) proposed rule released last week.</p> <p> <strong>What changed?</strong></p> <p> The AMA continues to drive home the message that the current problems of the Meaningful Use program must not be carried forward—and the changes recently proposed in the OPPS to Meaningful Use are a good start.</p> <p> Physicians around the country are expecting similar thoughtfulness from CMS about reducing burdens under Medicare’s Merit-based Incentive Payment System (MIPS) when the Medicare Access and CHIP Reauthorization Act (MACRA) final rule is released in the fall.</p> <p> Here are three key changes to Meaningful Use in the proposed rule:</p> <ul> <li style="margin-left:0.25in;"> <strong>90-day reporting period in 2016.</strong> The OPPS proposed rule would allow physicians, hospitals and critical access hospitals (CAH) to use any 90-day, continuous reporting period between Jan. 1 and Dec. 31, 2016, rather than the full calendar year reporting period currently required under Meaningful Use.<br /> <br /> CMS has also proposed a 90-day electronic health record (EHR) reporting period for clinical quality measures. However, the rule does not make any changes to the Physician Quality Reporting System (PQRS) reporting period, so if you are using clinical quality measures to satisfy PQRS reporting, you will still need to report clinical quality measures for a full calendar year in 2017.</li> </ul> <ul> <li style="margin-left:0.25in;"> <strong>Hardship exception for new participants.</strong> CMS proposed 2017 as the first performance period for MACRA. But 2017 is also the last year first-time Meaningful Use participants may attest to avoid penalties in 2018. The result is that a first-time participant would be required to report for both Meaningful Use and the Advancing Care Information (ACI) category under MIPS to avoid a payment adjustment 2018.<br /> <br /> In the OPPS proposed rule, however, CMS stated its intent to provide first-time participating physicians the opportunity to apply for a significant hardship exception from the 2018 payment adjustment.<br /> <br /> Physicians wishing to apply for the hardship exception will need to submit an application by Oct. 1, 2017, to demonstrate their eligibility. While the application has not yet been released, CMS indicates that it will require an explanation of why, based on the physician’s particular circumstances, meeting requirements of the Meaningful Use program for the first time in 2017 while also reporting on measures for the ACI performance category of MIPS would result in significant hardship.<br /> <br /> The AMA pressed CMS for the hardship exception for 2017 and will continue to work toward making this process simple for physicians.</li> </ul> <ul> <li style="margin-left:0.25in;"> <strong>Changes to measures and threshold reductions.</strong> CMS is also proposing to eliminate or reduce objectives and measures for eligible hospitals and CAHs attesting under the Meaningful Use program for calendar year 2017 and subsequent years.<br /> <br /> Some of these changes are intended to help align the hospital Meaningful Use program with MIPS when it is implemented beginning next year.<br /> <br /> For example, CMS proposed to eliminate the clinical decision support and computerized physician order entry objectives and measures for eligible hospitals and CAHs. Additionally, the threshold for the health information exchange measure requiring physicians to create a summary of care will be reduced from more than 50 percent to more than 10 percent.<br /> <br /> The secure messaging threshold for eligible hospitals and CAHs will be reduced from more than 25 percent to more than 5 percent in Stage 3 because patients who are in the hospital for an isolated incident may not have a reason to follow up with the hospital via secure messaging.</li> </ul> <p> For more information on these proposed changes, take a look at the OPPS proposed rule <a href="https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-07-06.html" target="_blank" rel="nofollow">fact sheet</a> from CMS.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:403c1e49-7d53-4554-b38e-1eb29d9dd095 Tracking patients between visits: A new care model http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_tracking-patients-between-visits-new-care-model Tue, 19 Jul 2016 22:24:00 GMT <p> As the health care system transitions to value-based care, new models of care will be a critical part of the new Medicare payment system. Learn how one physician is using a new model of care to track patients in between face-to-face visits in his practice.</p> <p> <strong>What patients and submarines have in common</strong></p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/14/80c69407-af56-4fa1-ae77-1757f2f1f2b2.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/14/80c69407-af56-4fa1-ae77-1757f2f1f2b2.Large.jpg?1" style="margin:15px;float:right;" /></a>Imagine your patients, as you probably do every day, out in the world living their lives. You may wonder if their treatment is working, their medication is causing any side effects, their blood pressure is rising or any number of possibilities that could be percolating unknown—but you can’t find out until they come in for their next visit or call your practice or head to the hospital with an emergency.</p> <p> “Patients are like submarines … out there submerged,” said Lawrence Kosinski, MD, a gastroenterologist and founder and chief medical officer of <a href="http://www.sonarmd.com/" rel="nofollow" target="_blank">SonarMD</a>. “We can’t see them; we don’t know how they are [because] they only come in when they’re in trouble. Which means that, number one, they have to recognize that they’re in trouble and, number two, realize that they can’t fix it themselves …. So we need a sonar system to ping them.”</p> <p> Two years ago, Dr. Kosinski created SonarMD, a web-based platform that pings patients once a month with a set of validated questions, which allows his practice to get out ahead of any complications or progressing medical issues before an emergency occurs. And his practice has been using it since June of last year.</p> <p> <strong>How it works</strong></p> <p> Dr. Kosinski led the development of an initiative known as Project Sonar, which is an intensive medical home for the management of Crohn’s disease created in partnership with Blue Cross Blue Shield of Illinois. SonarMD is the platform that coordinates with their electronic health record (EHR) system to help identify emerging health issues before they result in hospitalization.</p> <p> “What we’ve created is a sonar system that pings patients in between their face-to-face visits,” Dr. Kosinski said. “One of the main issues that results in high complication rates in the patient population is that they don’t recognize they’re deteriorating when they’re deteriorating. They don’t call the physician; they don’t reach out for help, and bad things can happen to patients in the long-run.”</p> <p> “If we ping them in between visits with a structured set of questions,” he said, “we get to intervene before anybody realizes things are getting bad.”</p> <p> Working with Blue Cross Blue Shield of Illinois, Dr. Kosinski’s practice enrolls all of their inflammatory bowel disease (IBD) patients in SonarMD. “[The insurer] pays us a monthly management fee for these patients, and part of that payment goes to the medical practice, and part of the payment goes to SonarMD to manage the platform [and] the data,” he said.</p> <p> The patient has an initial enrollment visit, and a nurse care manager works with the patient to set up an action plan for the goals they want to accomplish. “We assess barriers to attaining those goals,” Dr. Kosinski said. “It creates a team-based approach of physicians and nurse care managers interacting with patients.”</p> <p> The pings go out automatically on the first Monday of every month with a set of questions to identify and track symptoms and developing conditions. It takes patients about one minute to answer all of the questions, and SonarMD calculates a “Sonar Score.” If the score is rising, that means something may be wrong, and the nurse care manager coordinates with the physician to contact the patient or bring the patient in for a visit.</p> <p> Since they began using the SonarMD platform, Dr. Kosinki’s patients have responded at a rate of approximately 80 percent. </p> <p> “We built parameters into an algorithm so that the scores change colors at certain levels,” he said. If the physician needs to be brought in, the nurse care manager goes into the EHR and sends a message to alert the physician that a patient’s score is rising. The nurse care managers monitor about 100 patients each.</p> <p> “We’ve demonstrated a 10 percent decrease in cost of care in these patients over a year,” he said, “driven largely by a 50 percent decline in inpatient costs. So we’re keeping them out of the hospital, we’re keeping them healthy, we’re keeping the costs down, and the patients are happy.”</p> <p> SonarMD started with IBD patients, but Dr. Kosinski and his colleagues have expanded it to irritable bowel syndrome and are now working on expanding it to End Stage Liver disease and Gastroesophogeal Reflux disease. “Our goal is to be able to handle over 50 percent of the encounters for a gastroenterologist so we can actually function as an alternative payment model (APM),” he said.</p> <p> Making sure that SonarMD fits into the new payment system as a qualified APM is a challenge, he said.</p> <p> “We’re trying very hard to do everything we have to stay in the game,” Dr. Kosinski said, speaking as a member of the governing board of the American Gastroenterological Association. “It’s very important that we are part of the solution to the problem.”</p> <p> Listen to a <a href="https://reachmd.com/programs/focus-on-public-health-policy/rise-specialist-driven-alternative-payment-models-american-medicine/8241/" rel="nofollow">podcast interview </a>with Dr. Kosinski, and watch in the coming weeks for an interview with Robin Zon, MD, who will discuss her oncology APM and MACRA.</p> <p> <strong>Learn more about APMs:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-developing-new-payment-models-their-specialties" target="_self">How doctors are developing new payment models for their specialties</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/better-health-costs-one-practices-value-based-care-outcomes" target="_self">Better health, costs: One practice’s value-based care outcomes</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/testing-new-payment-models-one-pilot-programs-success" target="_self">Testing new payment models: One pilot program’s success</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/volume-value-one-health-system-making-change" target="_self">From volume to value: How one health system is making the change</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/payment-model-design-needs-physician-led-new-report" target="_self">Payment model design needs to be physician-led, new report</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c9983801-83fe-45c7-b3cc-85a631b36d51 What’s keeping PrEP under wraps http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_whats-keeping-prep-under-wraps Tue, 19 Jul 2016 20:49:00 GMT <p> PrEP, or pre-exposure prophylaxis, is a safe and effective medication that can prevent at-risk patients from contracting HIV, yet the treatment is not widely known by physicians or the patient base that could benefit most from it. Learn what HIV experts say about the treatment and the obstacles to integrating it into primary care practice.</p> <p> <strong>Getting the word out</strong></p> <p> PrEP reaches a small proportion of the Americans who could benefit from it, experts said at an education session by the AMA LGBT Advisory Committee during the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_self">2016 AMA Annual Meeting</a>.</p> <p> “What’s really interesting about it is a lot of people haven’t heard about it,” said Magda Houlberg, MD, chief clinical officer of the Howard Brown Health Center in Chicago. “You’d think people would want to shout it from the mountains.”</p> <p> PrEP consists of tenofovir/emtricitabine, a once-a-day prevention option for HIV-negative men and women that reduces the risk of HIV. While the U.S. Food and Drug Administration approved PrEP in July 2012, a <a href="http://www.cdc.gov/vitalsigns/hivprep/index.html" target="_blank" rel="nofollow">2015 survey by the Centers for Disease Control and Prevention</a> (CDC) found that 34 percent of primary care physicians and nurses had never heard of it. The CDC offers more information on PrEP at its <a href="http://www.cdc.gov/hiv/risk/prep/index.html" target="_blank" rel="nofollow">website on HIV/AIDS</a>.</p> <p> <strong>What gets in the way of adoption</strong></p> <p> Obstacles to use remain, said panelist Noël Gordon, Jr., HIV specialist with the Human Rights Campaign. While 1.2 million Americans could benefit from the treatment, about 4 percent of them have used it, he said.</p> <p> He named several factors that have slowed adoption of PrEP:</p> <ul> <li> <strong>Unawareness.</strong> Just 25 percent of gay and bisexual men have heard of PrEP, Gordon said.</li> <li> <strong>Low self-perception of risk.</strong> “I once talked to a friend and asked him what he thought his risk was, and he said low,” Gordon said. “Then I asked him if he used condoms on a regular basis, and he said no. I just can’t reconcile those two things in my mind.”</li> <li> <strong>Stigma and expense.</strong> The stigma around HIV risk is still alive despite gains, Gordon said. And while insurance coverage is widespread, many patients associate PrEP with high cost.</li> </ul> <p> Dr. Houlberg has introduced about 2,000 patients to PrEP at her Chicago clinic. Howard Brown Health Center initiated 1,137 PrEP treatments in 2015, about 5 percent of the national total, according to official clinic numbers. <a href="http://www.aidsmap.com/PrEP-use-is-rising-fast-in-US-but-large-racial-disparities-remain/page/3065545/" target="_blank" rel="nofollow">NAM</a>, a UK-based charity that tracks HIV/AIDS issues<em>,</em> reports that more than 49,000 patients in the U.S. have so far filled prescriptions for PrEP.</p> <p> Panelists named groups they believed were most at risk of HIV and could benefit most from PrEP:</p> <ul> <li> Men who have sex with men</li> <li> Transgender women</li> <li> Intravenous drug users and their partners.</li> <li> Heterosexuals who have many sex partners</li> </ul> <p> Gordon said those four populations remain largely unaware of HIV risks, despite efforts to educate them.</p> <p> <strong>Moving it into primary care</strong></p> <p> Dr. Houlberg said that in many cases PrEP treatment has served a wider purpose by providing patients with a door into the world of medical care.</p> <p> “A lot of it is more like health counseling,” she said. “We’ve gotten a lot of people into preventive care overall. We see them and we can say, ‘Wow, you have high blood pressure.’ We never would have gotten that opportunity otherwise.”</p> <p> Dr. Houlberg said primary care physicians often remain reluctant to adopt PrEP treatment, perhaps leery of treating a disease that has not appeared or fearful that treating PrEP patients would open the floodgates to endless monitoring, follow-ups and tests.</p> <p> But she said PrEP treatment is far more trouble-free than many physicians believe, and she would like to see primary care embrace it.</p> <p> “I want people to be able to access care with someone they trust, someone they’re familiar with,” she said.</p> <p> Consult the Centers for Disease Control and Prevention’s <a href="http://www.cdc.gov/hiv/pdf/prepprovidersupplement2014.pdf" target="_blank" rel="nofollow">guidelines for using PReP</a> to learn more.</p> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ad458c7a-6728-4cb1-86e8-6dbbd81a3239 Later start date could ease transition to new Medicare system http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_later-start-date-could-ease-transition-new-medicare-system Mon, 18 Jul 2016 20:26:00 GMT <p> Testifying before the U.S. Committee on Finance, Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt made known concerns about physician readiness for implementation of the new Medicare payment system. Physicians already know the answer to that problem—a later start date and transition period.</p> <p> “We need to launch this program so that it begins on the right foot, and that means that every physician in the country needs to feel like they’re set up for success,” Slavitt said. “We remain open to multiple approaches. Some of the things … that we’re considering include alternative start dates, looking at whether shorter periods could be used and finding other ways for physicians to get experience with the program before the impact of it really hits them.”</p> <p> CMS issued the Medicare Access and CHIP Reauthorization Act (MACRA) <a href="http://www.ama-assn.org/ama/ama-wire/post/draft-regulations-outline-next-phase-of-medicare" target="_self">proposed rule</a> earlier this year. The current start date for the new program is Jan. 1, 2017. In <a href="http://www.ama-assn.org/ama/ama-wire/post/key-changes-new-medicare-payment-system-needs" target="_self">comments</a> sent to CMS on the MACRA proposed rule, the AMA recommended starting the program on July 1, 2017, to provide additional time between the issuance of the MACRA final rule and the start of the reporting period.</p> <p> The final rule is due in November, leaving physicians with just two months to prepare for and implement the most significant change to the Medicare payment system in more than two decades if the current implementation date stays in place. That’s clearly an inadequate amount of time for such major changes.</p> <p> <strong>Why a later date and transition period would help</strong></p> <p> The proposed start date is too early and will create significant problems for the launch of the MACRA programs, the AMA said in its comments on the draft rule. CMS needs to recognize the fundamental changes enacted as part of MACRA and treat the first year as a transitional period that allows physicians to move away from the existing Medicare reporting requirements, learn about MIPS and alternative payment models (APM) and implement work flow and system changes to become successful MACRA participants.</p> <p> The comments cite several reasons that physicians require a later start date and transitional period, including:</p> <ul> <li> <strong>Time to prepare the tools.</strong> Setting the performance year too soon will compromise the ability for vendors, registries, electronic health record vendors (EHR) and others to update their systems to meet program requirements.<br /> <br /> The MIPS program asks that these entities incorporate a significant number of new measures, and physicians have serious concerns that there will be inadequate time to not only include new measures but also to test and ensure the data submitted is accurate and reliable.<br /> <br /> Starting too soon could worsen usability and add to the existing problems with technology.</li> </ul> <ul> <li> <strong>Readying APMs.</strong> Physicians are also concerned that an early start date will limit the number of available APMs. A July 1 start date would provide time to modify CMS’ existing APMs so they can qualify under the MIPS or as Advanced APMs.<br /> <br /> The Physician-Focused Payment Model Technical Advisory Committee (PTAC) is still in the process of developing the framework for reviewing APMs and has not had sufficient time to review or even recommend new models. A later start date gives the PTAC more time to conduct its work identifying physician-focused payment models.</li> </ul> <ul> <li> <strong>More time to address physician concerns.</strong> Starting implementation at a later date would also provide more time for CMS to address several issues that were not in the proposed rule.<br /> <br /> These unaddressed issues include the development of virtual groups, improved risk-adjustment and attribution methods, further refinement of episode-based resource measures and measurement tools, and more actionable feedback reports.</li> </ul> <ul> <li> <strong>Physicians can’t report without the correct information.</strong> MACRA requires CMS to give timely feedback—such as quarterly reports—to physicians. By selecting Jan. 1 as the first performance period, physicians will not have received their first feedback reports. This would leave physicians without the information needed to successfully start the MIPS program, leaving them in the dark for over half of the first performance period.<br /> <br /> MACRA also requires a quality development plan with annual progress reports, and the first report progress is supposed to be issued by May 1. By starting the program on Jan. 1, before the quality progress reports are finalized, CMS is skipping ahead and not finalizing key program requirements before it begins MIPS.</li> </ul> <p> <strong>Learn more about the new Medicare payment system:</strong></p> <ul> <li> At the 2016 AMA Annual Meeting, Slavitt discussed <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-guiding-new-payment-system-cms-chief-says" target="_self">how physicians are guiding the new payment system</a></li> <li> Learn about <a href="http://www.ama-assn.org/ama/ama-wire/post/key-changes-new-medicare-payment-system-needs" target="_self">key changes the new Medicare payment system needs</a></li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/new-medicare-payment-system-intends-small-practices" target="_self">how the new Medicare payment system intends to help small practices</a></li> <li> Take a walk through the <a href="http://www.ama-assn.org/ama/ama-wire/post/4-steps-prepare-medicares-new-payment-systems" target="_self">4 steps to prepare for MACRA implementation</a></li> <li> Learn the <a href="http://www.ama-assn.org/ama/ama-wire/post/3-principles-driving-new-medicare-payment-systems" target="_self">three principles driving the new Medicare payment system</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e2c91e17-af82-4060-bf21-56fd68d00b85 Social media: How to reap the benefits while avoiding the hazards http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_social-media-reap-benefits-avoiding-hazards Mon, 18 Jul 2016 19:00:00 GMT <p> A tweet said the small-town hospital was deluged with suicidal patients that day, and the person who posted it appeared to show frustration with the endless hassle. The post could be seen as whiny, disrespectful and invasive of patient privacy—or supportive and compassionate, depending on how it was read.</p> <p> <strong>Thinking ahead</strong></p> <p> This tweet illustrates the two edges of the social media sword—an opportunity to promote health care and a minefield that can scar a physician for years to come. How to navigate Facebook, Instagram, Twitter and other social media to help your patients and foster your online image as a positive one was the subject of a student education session at the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_self">2016 AMA Annual Meeting</a> in Chicago.</p> <p> “Avoid saying anything you would not say out loud at work to your boss,” said Tyeese Gaines, DO, Medical Director at Landmark Medical Center in Woonsocket, RI, and media strategist for Doctor Ty Media, LLC. At stake, she told trainees, is patient privacy, their reputation and their job—current and future.</p> <p> “There are a lot of things you can’t take back, so think about these things early,” Dr. Gaines said. “Are these the things you want potential employers and colleagues to see?”</p> <p> <strong>Posts live forever</strong></p> <p> Insider commentary, criticism and rants have led to reprimands and dismissal, said Dr. Gaines, who spent 15 years in journalism and today advises physicians on media relations. She listed some pitfalls to avoid:</p> <ul> <li> Post no information that would cause an individual patient to be recognized—especially in small communities.</li> <li> Avoid unflattering opinions and photos.</li> <li> Don’t assume a forum is private.</li> <li> Remember that online posts live forever, and potential employers will search them.</li> </ul> <p> All the more reason to limit posts, keep them professional, avoid friending co-workers and classmates, and clean up past posts that could be taken out of context, Dr. Gaines said.</p> <p> <strong>Context is everything</strong></p> <p> “This is your profession, this is what you chose, and you can’t just post anything anymore,” she told students. They seemed to take her counsel to heart.</p> <p> “A good rule to live by is, if there’s any doubt in your mind that it could be misconstrued, just don’t post it,” said Nicole Paprocki, a rising second-year student at Midwestern University College of Osteopathic Medicine.</p> <p> The session inspired some students to look for more information and guidance.</p> <p> “Our training should be a lot more reflective about things like this,” said Nousha Hefzi, a rising second-year student at Wayne State University School of Medicine. “It’s mostly about how to protect your password, things like that.”</p> <p> That training could benefit both students and seasoned physicians who did not grow up with social media, she said.</p> <p> At its very best, social media offers a chance to advocate for patients and provide better care, Hefzi said: “Any sort of media can be turned into an educational message, depending on how you use it.”</p> <p> <strong>Read more about making social media work for you and your patients:</strong></p> <ul> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/physician-behind-kevinmd-reveals-leverage-social-media" target="_self">KevinMD founder’s guidance</a> for making a difference with social media and protecting your reputation.</li> <li> See expert <a href="http://www.ama-assn.org/ama/ama-wire/post/kevinmd-answers-doctors-top-social-media-questions" target="_self">answers to physicians’ top social media questions</a>.</li> <li> Learn how social media can <a href="http://www.ama-assn.org/ama/ama-wire/post/will-social-media-impact-residency-fellowship-application" target="_self">impact your residency or fellowship applications</a>.</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:647c14f7-2a68-45f7-8119-806fe8141351 5 Nutrition Facts misconceptions that sabotage patient health http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_5-nutrition-misconceptions-sabotage-patient-health Fri, 15 Jul 2016 20:27:00 GMT <p> The fight against diabetes and heart disease also means fighting nutritional misunderstandings and offering sound advice to patients. A new video helps dispel common misconceptions about the Nutrition Facts label found on food packages and offers physicians guidance on how to educate their patients.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/9/0726ea77-3064-4f07-99b1-f7aec5f0d00f.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/9/0726ea77-3064-4f07-99b1-f7aec5f0d00f.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Designed to help patients better understand what they are consuming and make more informed decisions about their daily diet, the Nutrition Facts label can be a powerful tool when used correctly.</p> <p> A <a href="https://www.youtube.com/watch?v=LUpN2zsj53A&feature=youtu.be" target="_blank" rel="nofollow">new video</a> from the AMA and the U.S. Food and Drug Administration (FDA) offers tips to get started using the label and describes some of the most common misunderstandings:  </p> <p style="margin-left:49.5pt;"> <strong>1.   </strong><strong>The % Daily Values do not add up vertically to 100 percent</strong>. Many patients are confused by the % Daily Value on the Nutrition Facts label. The video illustrates how physicians can discuss with patients the % Daily Value and clarify that it indicates how much of the daily recommended amount of a nutrient is found in one serving of that food.</p> <p style="margin-left:49.5pt;"> <strong>2.   </strong><strong> A 2,000 calorie daily diet should be used for general nutrition advice</strong>. Patients often overlook the fact that some of the daily values on the Nutrition Facts label are based on a 2,000 calorie daily diet, which is not necessarily how many calories each person should consume on a daily basis. Patients need to understand that the Daily Values may be higher or lower, depending on their calorie needs, which vary according to age, gender, height, weight and physical activity level.</p> <p style="margin-left:49.5pt;"> <strong>3.   </strong><strong>Small packaged foods aren’t necessarily a single serving</strong>. Many patients assume that small packages of foods—such as chips or bottled beverages—are a single serving. However, all of the nutrition information listed on the Nutrition Facts label is based on one serving of the food, even if a package contains more than one serving. Patients should always check the serving size and servings per container on the Nutrition Facts label to determine how many calories and nutrients they are consuming if they eat the entire package.</p> <p style="margin-left:49.5pt;"> <strong>4.   </strong><strong>All calories count.</strong> As a general rule, 400 calories per serving is high and 100 calories is moderate. Patients need to understand that “fat-free” doesn’t mean “calorie-free.” Some lower fat foods may have as many calories as the full-fat versions.</p> <p style="margin-left:49.5pt;"> <strong>5.   </strong><strong>Most dietary sodium doesn’t come from table salt.</strong> More than 75 percent of dietary sodium comes from packaged and restaurant foods, and many patients unwittingly eat far more than the recommended daily amount. Much of this comes from 10 common types of foods, including bread, cheese, deli foods, pizza, soup, savory snacks, and mixed pasta and meat dishes.<br /> <br /> In addition to sodium chloride (salt), sodium can come from ingredients such as saline, sodium benzoate, sodium bicarbonate (baking soda), sodium nitrite and monosodium glutamate (MSG). Physicians can illustrate for patients that the daily recommended amount for sodium amounts to less than a teaspoon of salt.<br />  </p> <p> <strong>New resources</strong></p> <p> The video is 30 minutes long and offers continuing medical education credit through the <a href="https://cme.ama-assn.org/Activity/4252182/Detail.aspx" target="_self">AMA Education Center</a>. It shows how physicians can turn office visits into teachable moments—helping patients track individual nutrients, compare foods and make choices armed with a stronger understanding of the Nutrition Facts label.</p> <p> “One of the simplest ways patients can make healthier food choices is referencing the Nutrition Facts label,” AMA President Andrew W. Gurman, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-22-cme-video-nutrition-facts-label.page" target="_self">news release</a>. “This new video showcases different strategies that physicians can easily incorporate into their work flow to help guide patients on making better food choices that will have a lasting, positive impact on their health outcomes.”</p> <p> In addition to the video, the AMA and FDA teamed up to offer <a href="http://www.fda.gov/Food/ResourcesForYou/HealthCareProfessionals/default.htm" target="_blank" rel="nofollow">patient handouts</a> on understanding the Nutrition Facts label and key nutrients for health.</p> <p> The AMA has made the fight against chronic disease a priority through its <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_self">Improving Health Outcomes</a> initiative, which seeks to prevent heart disease and type 2 diabetes. These two diseases affect millions of Americans and cost the economy hundreds of billions of dollars. The AMA works with allied organizations to reduce risk factors and improve treatment. The new Nutrition Facts label is one element of the campaign to reduce risk factors by improving patients’ diets.</p> <p> <strong>Continuing a collaboration</strong></p> <p> The <a href="http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm" target="_blank" rel="nofollow">new version of the Nutrition Facts label</a>, announced in May, will reflect the latest scientific research to help consumers maintain healthy diets. The AMA and the FDA will continue working together to provide education for physicians on all aspects of the Nutrition Facts label, emphasizing the changes and improvements that will come in the years ahead.</p> <p> <strong>Learn more about how you can prevent type 2 diabetes and heart disease:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/groundbreaking-effort-prevent-diabetes-announced" target="_self">“Groundbreaking effort” to prevent diabetes announced</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/diagnose-prediabetes" target="_self">How to diagnose prediabetes</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/should-use-self-measured-blood-pressure-monitoring" target="_self">Why you should use self-measured blood pressure monitoring</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/successful-self-measured-bp-looks-like-practice" target="_self">What successful self-measured BP looks like in practice</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e7e2b668-8127-4067-a499-7c773a4bc5e5 Easing the burden: An end-of-life decision tool to help patients http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_easing-burden-end-of-life-decision-tool-patients Fri, 15 Jul 2016 20:22:00 GMT <p> Talking about and planning for end-of-life care can be difficult for patients and their families. Often these conversations occur too late or even not at all. Recently, Stanford University Department of Medicine developed a project that empowers patients to take the initiative to talk to their physician about what matters most to them at the end of their lives.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/15/86f982a7-107b-4ed7-afe0-b5effd92792f.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/15/86f982a7-107b-4ed7-afe0-b5effd92792f.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Without end-of life decisions on file, a patient’s care decisions may be made by family members and the care team and not reflect what the patient actually wants. A new <a href="https://www.stepsforward.org/modules/end-of-life-planning" target="_self" rel="nofollow">module</a> from the AMA’s STEPS Forward™ collection of practice improvement initiatives can help physicians facilitate a conversation with a patient about end-of-life decisions before an emergency situation arises and those desires are left unknown.</p> <p> Stanford, which contributed this STEPS Forward module after <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-teach-their-secrets-success" target="_self">winning</a> the AMA-MGMA Practice Innovation Challenge, conducted research and enlisted the help of multi-ethnic, multi-lingual patients and their families to create a letter template that guides patients through the process of making important advanced planning decisions they might otherwise have put off.</p> <p> <strong>The Letter Project</strong></p> <p> The template, called “the Letter Project,” allows patients to talk about what matters to them most on a personal level unrelated to medical care. Patients also use the template to document how they like to handle bad news, describe their medical decision preferences, give input on the treatment interventions they want and don’t want at the end of life, and document their preference for palliative sedation.</p> <p> The letter format is personalized and accessible, written in straightforward language that is easily understood and free of medical and legal jargon that can be confusing to patients.</p> <p> After successful testing with hundreds of patients and families from various ethnic and racial backgrounds and in many languages, Stanford began spreading the Letter Project to different venues. Participants have included high school students who made their preferences known to their families, older adults who filled out the letter at local community centers and patients at Stanford. And so far, the response has been very positive, Stanford reports.</p> <p> Many of the participants said they appreciated the opportunity to discuss their decisions and that they and their families developed a greater understanding of what end-of-life care entails. They also said the process resulted in deeper connections with each other as they talked through the decisions.</p> <p> Physicians also gained much from the process, learning that when patients are given the opportunity to talk about what is important and share information in a letter format, they feel more confident that their care team will adhere to the decisions that they made.</p> <p> Now, at Stanford, a large multi-disciplinary committee is working to implement the letter both in the in-patient and out-patient settings. The letter template is now available in all hospital units at Stanford and through the STEPS Forward module. Each printed letter has a unique barcode that can be scanned into the electronic health record (EHR).</p> <p> There is a free <a href="https://itunes.apple.com/us/app/advance-directives/id1036320440?mt=8" target="_blank" rel="nofollow">Letter Project app</a> available and Stanford hopes to create a secure, HIPAA-compliant repository of 100,000 letters that can serve as examples for patients interested in writing their own.</p> <p> <strong>More practice resources</strong></p> <p> The module on <a href="https://www.stepsforward.org/modules/end-of-life-planning" target="_self" rel="nofollow">planning for end-of-life decisions with your patients</a> is one of eight new modules recently added to the AMA’s <a href="https://www.stepsforward.org/modules" target="_self" rel="nofollow">STEPS Forward</a> collection of practice improvement strategies to help physicians make transformative changes to their practices. Thirty-five modules now are available, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</p> <p> <em>AMA Wire</em> explores many of the other <a href="http://www.ama-assn.org/ama/ama-wire/blog/STEPS_Forward/1" target="_self">modules</a>, including why your practice needs a health coach and four questions to ask to find out if your patients have unmet needs.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a1f9ecc4-42a1-4bf0-b4b4-e9aca31f32bb Keys to cultivating empathy in residency http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_keys-cultivating-empathy-residency Thu, 14 Jul 2016 20:27:00 GMT <p> With burnout on the rise and so many competing demands, cultivating a healthy sense of empathy can be a struggle. Dhruv Khullar, MD, a resident physician at Massachusetts General Hospital in Boston and contributor to the <em>New York Times Well</em> blog, shared insights following a special <a href="https://storify.com/AmerMedicalAssn/welcome-to-residency-tweet-chat" target="_blank" rel="nofollow">AMA tweet chat</a>.</p> <p> <strong><em>AMA Wire</em></strong><strong>: How can a resident work to maintain pragmatic empathy over the long term?</strong></p> <p> <strong>Dr. Khullar:</strong> We go into medicine to help others, and empathy is at the core of what we do as doctors. But as enriching and inspiring as medical training can be, it can also be demanding and overwhelming. Maintaining our empathy and compassion throughout it all can sometimes be challenging.</p> <p> Recent studies show that <a href="http://www.ama-assn.org/ama/ama-wire/post/resident-depression-endemic-solutions-underway" target="_self">one-third of residents experience depressive symptoms and burnout</a>. This can make it hard to care for patients in a way that’s good for them and good for us. When we’re not at our best, patient care isn’t at its best.</p> <p> There are tangible steps that trainees can take to maintain their sense of purpose during residency. The first is to recognize you’re never alone. If you’re struggling, if you’re feeling down, it’s likely that others are too. Opening up to colleagues, family members and significant others is critical. I’ve found that when one person discusses what they’re going through, others inevitably do as well. This creates a supportive environment for everyone.</p> <p> Another important step is to carve out time to reflect. This can be done alone, with friends or through facilitated discussions within training programs.</p> <p> It’s important that medical schools and residencies have appropriate support systems in place to help trainees transition from one step to the next. We should invest in wellness programs like mindful medication, narrative medicine and facilitated group discussions. Research shows that these programs work—they can improve well-being, job satisfaction and professionalism, while reducing burnout and exhaustion.</p> <p> <strong><em>AMA Wire</em></strong><strong>: How can value be put into quality, when so much effort has gone into reducing and managing quantity for residents?</strong></p> <p> <strong>Dr. Khullar:</strong> So far in residency reform, the focus has been on reducing the number of hours worked, rather than improving the quality of hours worked. There’s a perception that resident and student wellness depends on separating work and life—that well-being will grow out of limiting duty hours. This may be partially true, but there’s much that needs to be done to improve the quality of time trainees spend in the hospital.</p> <p> We should reduce the time residents spend on administrative tasks and non-clinical activities to allow them to focus on direct patient care and education. First-year residents spend just eight minutes with each patient per day—about a quarter as long as they do <a href="http://www.ama-assn.org/ama/ama-wire/post/documentation-woes-study-tracks-residents-time-spent-ehrs" target="_self">behind a computer screen</a>. That’s unacceptable. We need to find ways to ensure residents spend more time with patients and families and less time with phones and computers.</p> <p> Some initial steps include improving the ease of communication with nurses and consulting medical services; enlisting medical scribes to assist with documentation; and employing administrative assistants on medical wards to help with paperwork, obtaining medical records, and coordinating discharge appointments. Small changes would go a long way. Most importantly, I think better supported residents will lead to better cared for patients.</p> <p> <strong><em>AMA Wire</em>: What should spouses, family and friends expect as new residents adjust to the emotional strain and requirements of work?</strong></p> <p> <strong>Dr. Khullar:</strong> We all adjust to new situations differently, so there’s a lot of variability in how residency training affects relationships with friends and family. Some people compartmentalize their home and work life; for others, it’s helpful to talk about work at home. Ideally, over time, there’s a synergistic relationship between the two—so that one makes you better at the other.</p> <p> But everyone approaches these things differently. Loved ones should recognize that residency can be a uniquely stressful experience, even if it’s an extremely rewarding one. It’s important to be understanding and supportive in ways and at times you may not have anticipated.</p> <p> <strong><em>AMA Wire</em></strong><strong>: How does a more analytical person learn to practice compassion—and how does a more empathetic person curb their emotional side as needed?</strong></p> <p> <strong>Dr. Khullar:</strong> We all exist on a continuum of rationality and emotionality at various times. The most important thing is being aware of where you are—and where you need to be. Just monitoring and understanding what’s going on inside you can help you more effectively manage and express it. These skills are honed over time, but not naturally or effortlessly. They require dedicated practice and constant evaluation. </p> <p> <strong>Explore the concepts of personal and professional wellness during residency:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/residency-training-environments-primed-transformation" target="_self">Residency training environments primed for transformation</a></li> <li> <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_preventing-resident-burnout-mayo-clinic-takes-unique-approach" target="_self">Preventing resident burnout: Mayo Clinic takes unique approach</a></li> <li> <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ward-off-burnout-peer-network-may-impact-think" target="_self">Ward off burnout: Your peer network may impact more than you think</a></li> <li> <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_6-key-aspects-residents-need-well-being" target="_self">6 key aspects residents need for well-being</a></li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:158a1a17-be7c-40fb-9b00-cd8c5e8380de HHS begins second phase of HIPAA audits http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_hhs-begins-second-phase-of-hipaa-audits Wed, 13 Jul 2016 21:16:00 GMT <p> The second phase of audits for compliance with the Health Insurance Portability and Accountability Act (HIPAA) regulations is underway. These audits provide an opportunity to get out ahead of problems that may exist before they result in breaches. Learn what you need to know about the process and the specific HIPAA provisions being reviewed.</p> <p> The 2016 phase 2 HIPAA audit program, conducted by the Department of Health and Human Services Office for Civil Rights (OCR), is a key part of OCR’s health information privacy, security and breach notification compliance activities. The audit program allows OCR to assess covered entity compliance with the HIPAA regulations.</p> <p> The AMA recently met with OCR about the audits to inform the agency of their concerns, noting that physicians are already attempting to successfully comply with the new Medicare payment system, the most significant change to that system in the last 25 years.</p> <p> OCR underscored that the audit results are a tool to identify best practices and discover risks and vulnerabilities that OCR may not be aware of through their normal enforcement mechanisms and will be used for educational purposes, not enforcement.</p> <p> The agency noted that if it uncovers a serious compliance issue through the audit process, it may initiate a compliance review to further investigate. The ultimate goal of the audits, however, is to help OCR provide better guidance to the health care community.</p> <p> <strong>What to watch for and how to prepare</strong></p> <p> Earlier this year, OCR asked for contact information from a number of entities, though not all physicians contacted were selected to be audited. OCR selected a total of 167 health plans, health care providers and health care clearinghouses to be audited. Selected physician practices would have received an email from OCR on July 11. The email may be incorrectly classified as spam, so check your spam and junk folders to make sure you didn't miss it.</p> <p> To determine auditees, OCR looked at a broad group of candidates to assess HIPAA compliance across the industry by factoring in size, affiliation with other health care organizations, the type of entity and its relationship to individuals.</p> <p> If your practice is selected for an audit, you will need to submit the requested documentation and any written comments demonstrating your compliance with the following HIPAA requirements to OCR by July 22:</p> <ul> <li> <strong>Privacy rule: </strong>Notice of Privacy Practices and Content Requirements, Privacy—Specific Requirements for Electronic Notice and Privacy—Right to Access.</li> <li> <strong>Breach notification rule: </strong>Breach Notification—Timeliness and Breach Notification—Content.</li> <li> <strong>Security rule: </strong>Security Risk Analysis and Security Risk Management.</li> </ul> <p> Physicians can look up the specific information OCR will look for within the documentation for each of the above standards by searching for the standard on OCR’s <a href="http://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/audit/protocol/index.html" target="_blank" rel="nofollow">audit protocol website</a>.  Note that OCR is <strong>not</strong> collecting information on all of the provisions in the audit protocol; rather, it is only collecting documentation on the above provisions. </p> <p> OCR also told the AMA that it plans to offer a webinar to auditees with specific expectations about timeliness including instructions on how to upload the documents to its web portal.</p> <p> The final audit report will be completed within 30 days of your response and OCR will share a copy of the final report with you.</p> <p> The AMA has a number of resources available on its <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act.page?" target="_self">website</a> to assist physicians with HIPAA compliance, including a sample Notice of Privacy Practices, privacy and security toolkit, and a podcast on security risk assessments.</p> <p> For more information on phase 2 of the OCR’s HIPAA compliance audit program, check out the <a href="http://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/audit" target="_blank" rel="nofollow">audit phase 2 program objectives and frequently asked questions</a>. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:df31c3ab-5011-427a-831a-b22e5dbad6c2 Online database simplifies residency, fellowship search http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_online-database-simplifies-residency-fellowship-search Wed, 13 Jul 2016 18:00:00 GMT <p> The go-to online resource for finding residencies and fellowships is turning 20. Learn what users have to say about <a href="http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.page" target="_self">FREIDA Online</a>®, the AMA Residency & Fellowship Database™, and how students can use it to make informed decisions about the next big step in their careers.</p> <p> <strong>Customizing the search</strong></p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/6/6cb4a222-603b-4bf5-a66b-3d0c79c418e6.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/6/6cb4a222-603b-4bf5-a66b-3d0c79c418e6.Large.jpg?1" style="margin:15px;float:right;" /></a>FREIDA—Fellowship and Residency Electronic Interactive Database Access—provides custom searches of more than 10,000 residency and fellowship programs to help students and residents find a match. Users can search by geographic areas, specialties and keywords. They can review basic program data and training statistics, find maps and websites, and determine key application deadlines.</p> <p> Since its launch, FREIDA has become indispensable.</p> <p> “I think it’s an essential tool for any medical student,” said Jerry Abraham, MD, “but especially for third- and fourth-year students as they conduct their residency search and determine which programs to apply to and interview with.”</p> <p> Dr. Abraham, chief resident physician in family and community medicine at the University of Southern California Keck School of Medicine, interviewed with 30 programs and made ample use of FREIDA. It helped him compare programs and keep the information in one place.</p> <p> At the University of Cincinnati College of Medicine, Director of Career Development Alice Mills, MD, specializes in helping students apply for residencies.</p> <p> “We introduce FREIDA to our rising fourth-year medical students at a class meeting, then regularly recommend it during their individual advising appointments,” Dr. Mills said. “Students have found FREIDA useful as they start exploring programs in their specialty. Students like being able to search for residency programs by state and by keywords.”</p> <p> <strong>The need for more information</strong></p> <p> FREIDA began to take shape in the late 1980s. The AMA House of Delegates endorsed the creation of a one-of-a-kind computerized reference tool at the urging of the AMA Resident and Fellows Section, after reports from residents that they lacked enough information to make sound choices on programs when they had conducted their residency searches.</p> <p> FREIDA was launched in 1991 as an electronic diskette format for medical schools and libraries, and the service went fully online five years later. Since then, the AMA has introduced a number of innovations and upgrades:</p> <ul> <li> Optimization for tablets and phones</li> <li> Maps that display program and training institutions</li> <li> Comparison tables to organize and save searches</li> <li> Sophisticated keyword searches that go beyond the basics to help students identify programs that include a hospitalist track, require a USMLE or COMLEX score for interview consideration, provide child care, offer free parking, and meet a range of other needs</li> </ul> <p> <strong>Organizing the options</strong></p> <p> Poornima Oruganti is in the midst of her residency application process. The rising fourth-year medical student at Northeast Ohio Medical University credited FREIDA with reducing stress and helping organize all her program options.</p> <p> “I have used it throughout medical school, starting my first year,” said Oruganti, an at-large officer with the AMA Medical Student Section. “I find it extremely useful to organize programs and get a sense of what residencies I’m interested in. It also allows me to create a list and compare programs.”</p> <p> <strong>Spreading the word</strong></p> <p> Christopher Libby, a rising fourth-year student at the University of Massachusetts Medical School, has encouraged other students to use FREIDA and to join the AMA to take advantage of premium FREIDA features.</p> <p> “I used it several times a week when developing a list of away rotations to apply to,” said Libby, the chair of the governing council for the AMA Medical Student Section. “I like being able to search by specialty and geographic area.”</p> <p> All the residency and fellowship programs listed on FREIDA are accredited by the Accreditation Council for Graduate Medical Education, or are board-approved combined programs. Information for the listings comes from the National GME Census conducted by the AMA and the Association of American Medical Colleges. Hospital data come from Health Forum, part of the American Hospital Association.</p> <p> New information is uploaded each August, October and February.</p> <p> <strong>Premium features</strong></p> <p> Anyone can access FREIDA’s basic functions. With an AMA account, students can perform searches and save them to a comparison table. AMA members enjoy even more features, including the ability to save program searches into the comparison table across sessions. Members can rate, notate and sort programs into a custom dashboard, then return to searches with one easy click.</p> <p> If you’re not an <a href="https://commerce.ama-assn.org/membership/" target="_self">AMA member</a>, <a href="https://commerce.ama-assn.org/membership/" target="_self">join today</a> for access to these features and other resources. For more information, complete the <a href="http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.page" target="_self">free registration</a> for FREIDA Online and <a href="http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online/about-freida-online/frequently-asked-questions.page" target="_self">review the database’s FAQs</a>.</p> <p> <strong>Learn more about conducting a successful residency search:</strong></p> <ul> <li> Review the student’s <a href="http://www.ama-assn.org/ama/ama-wire/post/applying-residency-fourth-year-students-essential-checklist" target="_self">fourth-year essential checklist</a>.</li> <li> See <a href="http://www.ama-assn.org/ama/ama-wire/post/4-tricks-successful-residency-program-search" target="_self">4 tricks to a successful residency program search</a>.</li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-many-residency-programs-students-really-apply" target="_self">How many residency programs</a> do students really apply for?</li> <li> Read about the <a href="http://www.ama-assn.org/ama/ama-wire/post/2016-match-numbers" target="_self">record Match rate</a> for 2016.</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4bced26c-4f1f-4670-a092-cc06fc95cfc3 How faculty, students can improve care while saving money http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_faculty-students-can-improve-care-saving-money Tue, 12 Jul 2016 22:05:00 GMT <p> Medical school faculty could do more to cultivate a new generation of physicians focused on containing health care costs, a new research report finds. It outlines the opportunities and obstacles on the road to greater cost consciousness.</p> <p> <strong>The ethical imperative</strong></p> <p> Nine out of 10 students agree that physicians have a role in containing costs as well as limiting unnecessary tests and treatments for the sake of patients and society, according to <a href="http://journals.lww.com/academicmedicine/Abstract/publishahead/Role_Modeling_and_Regional_Health_Care_Intensity__.98498.aspx" target="_blank" rel="nofollow">a report in <em>Academic Medicine</em></a>. But it found that faculty and physicians must lead the way, modeling cost-conscious behavior and making clear it has a place in clinical practice.</p> <p> “[Students] recognize that excess testing and unnecessary procedures threaten patient safety and that spending more money on health care does not necessarily lead to better health outcomes,” the report’s authors said.</p> <p> The findings are based on a survey of 3,395 students at 10 medical schools, all of them members of the <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">AMA Accelerating Change in Medical Education Consortium</a>.</p> <p> The authors outlined the severity of the cost-control challenge. Up to 30 percent of health care spending is wasted, largely because of unnecessary services, they said. Wasted care exposes patients to added risk, burdens them with more out-of-pocket costs and displaces the care they actually need. Medical education must enlist faculty and future physicians in the campaign to control costs, the authors found.</p> <p> <strong>The need to role model cost consciousness</strong></p> <p> However, most students reported seeing role models that displayed “wasteful” behaviors, such as ordering numerous tests all at once rather than waiting for the results of initial tests or repeating tests rather than trying to get the results of recently performed tests.</p> <p> Students who took the survey identified other barriers to cost consciousness:</p> <ul> <li> More than one-half of students thought ordering fewer tests would raise the risk of medical liability litigation.</li> <li> One-half of students said that ordering a test is easier than explaining to a patient why it is unnecessary.</li> <li> Only 11 percent of students said it is easy to determine how much tests and procedures cost.</li> <li> Many students said the organizational culture makes it hard to address the cost of care.</li> </ul> <p> The authors suggested students training in institutions that provide few cost-conscious role models could be “imprinted” with a culture of higher spending. To prevent that they said educators must both teach and model cost consciousness. They called on medical schools to:</p> <ul> <li> Encourage faculty to understand that any action observed by learners is role modeling.</li> <li> Strategically expose students to physicians who are known to model high-value, cost-conscious care.</li> <li> Pursue cost savings in ways that are visible to students, praise them for proposing cost-effective plans of care and encourage them to include value in their case presentations.</li> <li> Encourage cost-conscious role modeling in high-spending environments.</li> <li> Introduce concepts of stewardship and systems thinking early, equip student with strategies to overcome barriers to cost-conscious care, and encourage discussion about whether the overall learning environment reinforces what is taught in the formal curricula.</li> </ul> <p> The campaign for cost-conscious care could well pay off in the long run for patients, medical systems and society, the report’s authors concluded: “Efforts to enhance physician role modeling in undergraduate medical education may play an important role in preparing the next generation of physicians to address health care costs.”</p> <p> <strong>Learn more about changes underway in medical education:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/teaching-students-part-of-system-should-enhance-care" target="_self">Teaching students how to be part of a system should enhance care</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/new-science-prepares-students-care-delivery-beyond-exam-room" target="_self">New science prepares students for care delivery beyond exam room</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/4-ways-schools-paving-new-path-residency" target="_self">4 ways schools are paving a new path to residency</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/students-forefront-of-transforming-med-ed" target="_self">Students at the forefront of changing medical education</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5ad73e4f-27e0-4b9a-983b-dc9b6f1f3c34 Court case examines telemedicine safety regulations http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_court-case-examines-telemedicine-safety-regulations Tue, 12 Jul 2016 22:02:00 GMT <p> A case before a United States Court of Appeals could restrict a state medical board from protecting patient safety through the regulation of telemedicine in that state.</p> <p> At stake in <em>Teladoc, Inc. v. Texas Medical Board</em> is whether the Texas Medical Board has demonstrated immunity from federal antitrust laws. <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/11/9f4f8618-df25-4e67-bba6-6f93e79ba1d4.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/11/9f4f8618-df25-4e67-bba6-6f93e79ba1d4.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> The Court of Appeals is being asked to determine whether the Board may be held liable under the antitrust laws for its rule requiring a “defined physician-patient relationship to exist before a physician may prescribe dangerous or addictive medications. The necessary relationship is defined as established through either an in-person examination or an examination by electronic means with a health care professional present with the patient.</p> <p> Teladoc, which uses telecommunications to connect patients and physicians, provides services in a way that would allow physicians to prescribe medications without the establishment of the required patient-physician relationship. Teladoc alleges that if the Board’s rule is valid, Teladoc would be limited in the way it could carry on business in Texas. It contends that this rule is anticompetitive and seeks to hold the Board liable under federal antitrust laws.</p> <p> Telemedicine is advancing rapidly as a tool to improve access to care and reduce the growth in health care spending. Last month the AMA House of Delegates <a href="http://www.ama-assn.org/ama/ama-wire/post/ethical-considerations-prompt-new-telemedicine-ground-rules" target="_self">adopted new ethical ground rules</a> for telemedicine. But the telemedicine standards of care and practice guidelines are constantly evolving and vary based on specialty and the services provided. It is important that state medical boards remain free to regulate the practice of medicine to ensure patient safety and appropriate prescribing.</p> <p> “Telemedicine offers significant potential benefits to patients, including expanded access to medical care,” the <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page" target="_self">Litigation Center of the AMA and State Medical Societies</a> said in an <a href="file:///C:/Users/trparks/Downloads/teladoc-v-tmb.pdf" rel="nofollow" target="_blank">amicus brief</a> (log in). “At the same time, telemedicine is inappropriate for certain medical conditions, and it carries risks. Because a physician treating a patient remotely may be called upon to act with limited information, the quality of care may suffer, and a potential exists for fraud and abuse.”</p> <p> “Given the complex and evolving state of telemedicine,” the brief said, “Texas’ balance of reliance on the expert board to act in the first instance, with state supervision as needed, is entirely appropriate—and should not be subject to second-guessing under the federal antitrust laws.”</p> <p> <strong>Why telemedicine regulation matters</strong></p> <p> Patient safety is the guiding force behind the Texas Board’s rule. With telephonic consultations, there may be no observation or physical examination of the patient, and there may be no laboratory or other diagnostic work that the physician can use to determine a diagnosis and course of treatment.</p> <p> One patient case detailed in the brief offers an example of how telephonic consultation, without an in-person examination to establish a patient-physician relationship, led to treatment errors.</p> <p> “There can be real, material risk of harm from treatment without any physical examination,” the brief said. “That risk is amplified where, as in this complaint, treatment is provided to a patient who cannot even communicate his or her own condition but must rely solely on characterizations by a layperson.”</p> <p> <strong>More court cases in which the Litigation Center is involved:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/confidential-patient-safety-information-threatened-court-case" target="_self">Confidential patient safety information threatened in Florida</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/court-decides-medical-liability-protections" target="_self">Court decides on medical liability protections under MICRA in California</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/freedom-of-patient-physician-conversations-hinges-court-case" target="_self">Federal court to hear case on freedom of patient-physician conversation</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/supreme-court-case-could-major-health-implications" target="_self">Supreme Court case could limit the authority of the EPA to restrict carbon emissions</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:eb3c3946-4a3b-4913-84b7-db8ec0ed856b The physician’s essential art of balancing emotion and logic http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-essential-art-of-balancing-emotion-logic Tue, 12 Jul 2016 19:45:00 GMT <p> From patient to patient and from hospital to home, physicians have to toggle back and forth between the emotional and rational parts of their minds to be effective in both establishing a therapeutic relationship and logically determining the best course of treatment. But how do you find the appropriate balance?</p> <p> In a piece for the <em>New York Times Well</em> blog titled, “<a href="http://well.blogs.nytimes.com/2015/12/10/death-and-sandwiches/?_r=0" rel="nofollow" target="_blank">Death and sandwiches</a>,” Dhruv Khullar, MD, a resident physician at Massachusetts General Hospital in Boston, investigated a skill that physicians develop over the course of their training—toggling between the rational and emotional sides of their minds.</p> <p> This dichotomy allows physicians to be empathic and compassionate with a patient, which helps them understand their concerns and condition, and at the same time gives them the ability to switch to a more rational, logical side to determine the best course of treatment to help that patient. <em>AMA Wire</em>® spoke to Dr. Khullar about the essence of this tension and the need to perfect the art of balance.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/11/73687d60-8e53-4890-bb61-062c765e5d18.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/11/73687d60-8e53-4890-bb61-062c765e5d18.Large.jpg?1" style="margin:15px;float:right;height:365px;width:243px;" /></a></p> <p> <strong>What it means to “toggle”</strong></p> <p> “I think it’s hard, and it’s something that you hone over time,” he said. “The first few times you see someone or something, you approach it in a very emotional way because many of these situations are difficult and trying. Patients are really going through a lot, so it really strikes you.”</p> <p> “Over time you learn to toggle back and forth a little better or start to blunt this emotional response, and so the visceral feelings that you have become less at the forefront and the more rational side takes over,” he said, “which I think has both its pros and cons.”</p> <p> “Now, after two or three years of being in residency, I’m starting to evolve to that side of things,” Dr. Khullar said. “The tension now is to try to bring a perfect balance and come back to the middle, where you’re able to explore both sides of yourself when you’re meeting a new patient and you’re in difficult situations.”</p> <p> “The danger sometimes becomes that we shut one part of ourselves down,” Dr. Khullar said. “Usually that’s the empathic part, the emotional part, because it is less visible.” Part of the therapeutic relationship is trying to understand how an illness is affecting a patient’s life and what they’re missing out on because they’re sick, he said. Yet, it’s important to focus on the rational as well in order to help the patient.</p> <p> For example, “after the first few codes you’ve been to, you know the drill and automatically flip into this rational, algorithm kind of person,” he said. “It’s not until afterward that you realize this has been a really traumatic experience for yourself, your colleagues and the patient.”</p> <p> “It’s something that most doctors have to contend with, and there are innumerable ups and downs,” he said. “There are some really trying situations that you’re witnessing with patients and their families and what they’re going through. … At the same time, you have to think, and you have to apply, and you have to operate, and you have to learn to distance yourself emotionally in order to be an effective clinician.”</p> <p> “There’s this pretty profound tension that occurs in the hospital, ED or the clinic between getting wrapped up in the emotions and the trauma of your patients’ lives and at the same time trying to create enough distance to think clearly about what the most effective next diagnostic step would be,” he said.</p> <p> “We often hear that we need to merge the art and science of medicine,” he said, “that we need to bring both of these rational and empathic aspects to bear when we’re caring for patients.”</p> <p> <strong>Training the physician brain</strong></p> <p> One <a href="http://www.sciencedirect.com/science/article/pii/S0960982207019793" rel="nofollow" target="_blank">study</a> that looked closely at physicians’ brains while they watched someone experience pain shows “that it’s very difficult—if not impossible—to merge those things in the same moment,” Dr. Khullar said. “When you’re thinking in a very rational way, you’re probably not feeling as much, and when you’re feeling and you’re expressing that part of yourself, you’re not thinking as well.”</p> <p> That skill over time becomes “recognizing, being self-aware of which mode of thinking you’re employing right now and is that the appropriate one?” he said. “It’s a pretty personal process, and at the end of the day, it’s a balance, a spectrum that we exist on from rationality to emotionality … and most people find themselves closer to one end of the spectrum.”</p> <p> Dr. Khullar offered three tips that have helped him understand the importance of toggling back and forth between emotion and logic:</p> <ul> <li> <strong>Find the balance</strong>. Many people start out naturally on one side or the other—emotional or rational, Dr. Khullar said. “The work that people have to do is try to come back to the center, or try to know when to employ one aspect or the other aspect.”<br /> <br /> “People have natural tendencies toward one,” he said, “but everyone needs to work on exploring that other realm as well.”</li> </ul> <ul> <li> <strong>Reflect on what you experience.</strong> For Dr. Khullar, writing has been an outlet to reflect and express the emotions of the day. “I write … to understand what’s going on not only around me but also what’s going on inside of me,” he said.<br /> <br /> “It doesn’t necessarily have to be something like writing or another creative outlet,” he said. “During medical school I wasn’t writing as much, but every Sunday we’d have a group of four guys who would sit around for one hour, put our smartphones away and … we’d talk about what went well that week, what didn’t go well, difficult patient experiences, good patient experiences and that hour, to me, was tremendously enriching.<br /> <br /> “It’s important for everyone to know they’re not alone,” he said. “When you start opening up to your colleagues, other residents, other medical students, you’ll find that most people are going through similar feelings and sensations to a lesser or greater extent.”</li> </ul> <ul> <li> <strong>It’s OK to take time for yourself.</strong> The issue of balance exists not only within the hospital between the emotional and rational modes of thinking but also between personal and professional life.<br /> <br /> “You’re pronouncing someone dead in the afternoon, and then you’re leaving and going to have dinner with your friends in the evening,” he said. “It’s very strange.”<br /> <br /> “Having the space and creating the time and having people with whom you can discuss what’s really a strange experience for everyone is important,” he said. “Only by engaging that dialogue by journaling or writing, having small groups, or talking to your family about it—only then can you observe these small changes that are occurring in ourselves every day, every month of training.”<br /> <br /> At the end of the day, taking this time to cultivate your own well-being makes you a better physician and caregiver, he said. If you take the time for yourself, when you go back into the hospital the next time your patients will be better off because of it.</li> </ul> <p> As part of the AMA’s annual <a href="https://www.facebook.com/amaresidentsandfellows" rel="nofollow" target="_blank">residents and fellows Facebook</a> “Welcome to residency” campaign, Dr. Khullar participated Tuesday in a <a href="https://storify.com/AmerMedicalAssn/welcome-to-residency-tweet-chat#publicize" target="_blank" rel="nofollow">tweet chat</a>, where he discussed with participants how residency changes you as caregiver and a person. </p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8817ed06-e76f-4477-9c21-dbb023c4d2d8 How much do you know about carrier screening? http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_much-carrier-screening Mon, 11 Jul 2016 23:10:00 GMT <p> As prenatal genetic screening options expand, physicians face questions about which screening is best for individual patients. Test your knowledge about new expanded carrier screening and what role it can play in clinical practice.</p> <p> <strong>Casting a wider net</strong></p> <p> Genomics is part of precision medicine, the science of crafting treatments to fit a patient’s particular genes, environment and lifestyle. Unlike traditional one-size-fits-all treatments, precision medicine tools enable clinicians to better understand a patient’s health and conditions, and better determine what treatments will be most effective for that particular person.</p> <p> Carrier screening provides information about reproductive risks by identifying genetic variations in parents that usually do not affect their own health but could result in diseases in their children. Results allow patients to consider their reproductive options.</p> <p> Traditional prenatal screening detects about a dozen conditions that are more prevalent in certain ethnicities. In contrast, new expanded carrier screening can test for more than 100 genetic conditions and isn’t limited to only certain ethnicities.</p> <p> As screening becomes available to more patients, physicians should consider additional factors and discuss them with patients before and after screening. For example, testing for more diseases, especially those that are less common, can lead to uncertainty about residual risks and clinical outcomes when data on those diseases is limited.</p> <p> <strong>Learn more about carrier screening </strong></p> <p> Extensive information on working with expanded screening can be found in a <a href="https://cme.ama-assn.org/Activity/4320591/Detail.aspx" target="_self">new continuing medical education (CME) module</a>. It is the first of 12 modules the AMA is creating in partnership with Scripps Translational Science Institute and The Jackson Laboratory on the benefits and limitations of genetic testing and how and when it is appropriate to incorporate it into patient care.</p> <p> In this first module, clinicians learn more about how to determine who is a good candidate for expanded carrier screening. The module includes patient scenarios illustrating issues that clinicians face as they weigh the merits of expanded carrier screening.</p> <p> <strong>Test your knowledge</strong></p> <p> Test your understanding of expanded carrier screening issues in clinical practice by considering three patient scenarios:</p> <p> <strong>Scenario 1: </strong>Sasha and Eli are planning to start a family soon and have been advised by their rabbi to consider preconception screening for “Jewish diseases.” They want to rule out as many serious disorders as possible before pregnancy.</p> <p> <strong>Scenario 2: </strong>Shonda is in her first pregnancy. She doesn’t know her family medical history or ethnicity but wants to know if her baby might have a treatable condition.</p> <p> <strong>Scenario 3: </strong>Martha is of Southeast Asian descent and is 16 weeks pregnant. The father of the baby is not involved. She is highly anxious about her ability to raise a child with special needs as a single mother.</p> <p> How would you answer questions for each of the three scenarios? They include:</p> <ul> <li> Is the patient more suited to expanded carrier screening or ethnicity-based screening?</li> <li> What is the impact if just one parent is a genetic carrier?</li> <li> What steps should be taken if screening reveals that one or both prospective parents are carriers or have disease risk themselves?</li> <li> What information is important to discuss with the patient before carrier screening?</li> <li> What is the best option if the father of the pregnancy is not available for testing?</li> </ul> <p> The <a href="https://cme.ama-assn.org/Activity/4320591/Detail.aspx" target="_self">CME module</a> offers answers to these questions and more. The module breaks down into three parts: A video overview of the topic, an opportunity to practice applying key points to real-world patient cases and referral to additional information for those who want to dig deeper into expanded carrier screening.</p> <p> Additional CME genomics modules will follow. Module 2, expected to launch later this summer, addresses prenatal cell-free DNA screening, sometimes referred to as non-invasive prenatal screening. Other topics will include precision medicine and its applications in oncology, neurology and cardiology.</p> <p> Find out more about precision medicine:</p> <ul> <li> <a href="https://download.ama-assn.org/resources/doc/csaph/x-pub/a16-csaph3.pdf" target="_self">The Precision Medicine Initiative: Report of the AMA Council on Science and Public Health</a></li> <li> <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/precision-medicine.page" target="_self">What is precision medicine?</a></li> <li> <a href="http://www.ama-assn.org/ama/pub/physician-resources/medical-science/genetics-molecular-medicine/education-research.page" target="_self">Personalized medicine resources for physicians</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7a658f97-b9fe-40c3-b9d1-53f6fa349355 Inside peek: Test-driving clinical skills before rotations http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_inside-peak-test-driving-clinical-skills-before-rotations Mon, 11 Jul 2016 23:08:00 GMT <p> The rising third-year student, tongue between his teeth, slowly drove his needle into a silicone pad meant to mimic human skin, then pulled his thread tight and started in again.</p> <table align="right" border="0" cellpadding="0" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/1/261f3c50-c529-4465-9185-eacb356a77d0.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/1/261f3c50-c529-4465-9185-eacb356a77d0.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <p> <em><span style="font-size:10px;">Steady hands and keen focus meant clean stitches at the suturing table, one of seven skills stations at the clinical skills workshop.</span></em></p> </td> </tr> </tbody> </table> <p> Theodore Zaki sealed up the gash with a classic horizontal mattress suture, not unlike the stitches in a baseball, then straightened up and took a satisfied breath.</p> <p> “You want to do anything you can to avoid looking like an idiot on the first day,” said Zaki, a medical student at Yale School of Medicine, who is just two days from the start of his surgical rotation. “When the doctor hands me a needle and asks me to suture something up, I’ll definitely be prepared.”</p> <p> <strong>Learning from mistakes and successes</strong></p> <p> It was that motivation to get ready that brought hundreds of students to a workshop on clinical skills during the <a href="http://www.ama-assn.org/ama/ama-wire.page" target="_self">2016 AMA Annual Meeting</a>. There they found a safe setting to make their mistakes and learn what they will need to know when they first treat patients. With guidance from experienced specialists, they tried their hands at not only suturing but airway management, radiology, hematology, orthopedics, prediabetes screening and blood pressure care.</p> <p> Clinicians urged students to dive in with and sample every specialty they could. The workshops mean more comfort and confidence for students in their transition to caring for patients, Paul Glat, MD, said. He walked students through the finer points of suturing while others waited for their chance.</p> <p> “Most have never held an instrument before,” said the plastic surgeon and professor of surgery at Drexel University College of Medicine in Philadelphia. “Surgery is a tough specialty—it’s sort of militaristic in a way. This is all about how not to stick themselves or another member of the team. It’s sort of self-preservation.”</p> <p> <strong>Carrots and splints</strong></p> <p> Bales of carrots surrounded Jessica Brozek, MD, an orthopedic resident at the University of Kansas School of Medicine. But she wasn’t offering nutritional tips.</p> <p> “I can’t really break your arm to show you, but we can break some carrots,” Dr. Brozek told a student. “Carrots break in the same way as arm bones.”</p> <p> Fascinated students bunched around the carrots, then picked one. Some inflicted a transverse break, others a spiral or oblique. Then, with Dr. Brozek’s tutoring, they began mending.</p> <table align="right" border="0" cellpadding="0" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/3/ccc75503-c454-441f-b39b-2824f6b7ba19.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/3/ccc75503-c454-441f-b39b-2824f6b7ba19.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <p> <em><span style="font-size:10px;">Jessica Brozek, MD, right, an orthopedic resident at the University of Kansas School of Medicine, uses carrots to show a student the fundamentals of mending a broken bone. Orthopedics was one of seven skills stations at the AMA Medical Specialty Showcase and Clinical Skills Workshop.</span></em></p> </td> </tr> </tbody> </table> <p> Collin Shumate, who just finished his first year at Morehouse School of Medicine, rolled his fiberglass wrap too tightly at first. With a second effort and some coaching, he crafted a workable cast.</p> <p> “You get to do something hands on and learn how to use the tools in the real world,” Shumate said.</p> <p> Nearby, students did their best to intubate a mannequin and build airway management skills. Stephanie Winslow felt a particular motivation to “save” the mannequin known as Bob. A University of Florida College of Medicine student, Winslow will help conduct research during the summer before her second year on post-intubation morbidity and mortality. Her earlier work in an emergency room helped spark her passion for emergency medicine.</p> <p> “I found myself in an ER as a scribe, and I fell in love with it,” she said. “I’ve always wanted to come back for more.”</p> <p> <strong>Getting acquainted with specialties</strong></p> <p> Between hands-on workshops, students at the event also had the chance to pore over information on nearly 50 medical specialties and talk with physicians and residents in the field. Steven Hao, MD, helped acquaint students with cardiology.</p> <p> “I remember vividly as a student, you had wide-open eyes, looking for opportunities, very idealistic,” said Dr. Hao. “These sessions are an opportunity to work with someone out in the real world and get an idea where your passions will take you.”</p> <p> Student Gina Jamal took her turn with radiology, finding how tough it can be to route a catheter through a model torso. She started in a femoral artery and worked the tiny tube toward the neck and head. Turning and pulling, she found a sharp angle too hard to navigate.</p> <p> “When I thought I had it, I didn’t,” said the rising second-year student at the University of Texas School of Medicine in San Antonio. “Honestly I think it was the user.”</p> <p> Nevertheless, Jamal was among the countless students who cherished the chance to step out of the classroom and test-drive a variety of skills in something close to a real-care setting.</p> <p> “I’m trying to get exposure to all I can,” she said. “This is the most fun event—all these specialties all in one place.”</p> <p> The next AMA Clinical Skills Workshop will be offered Nov. 12 in Orlando as part of the 2016 AMA Interim Meeting.</p> <p> <strong>Explore more practical tips for students:</strong></p> <ul> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/7-clinical-rotation-tips-experienced-physicians" target="_self">7 clinical rotation tips</a> from experienced physicians.</li> <li> Consult <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-must-checklist-med-school-success" target="_self">this must-have checklist</a> of tasks to prioritize during your first and second years of training. This will help you begin preparing a strong application for residency.</li> <li> Review a second checklist <a href="http://www.ama-assn.org/ama/ama-wire/post/checklist-success-third-year-of-med-school" target="_self">for success during your third year</a> of med school.</li> <li> Prepare for entering your fourth year with this <a href="http://www.ama-assn.org/ama/ama-wire/post/applying-residency-fourth-year-students-essential-checklist" target="_self">roadmap to graduation and residency</a>.</li> <li> Master these <a href="http://www.ama-assn.org/ama/ama-wire/post/4-tricks-successful-residency-program-search" target="_self">4 tricks to a successful residency program search</a>.</li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-many-residency-programs-students-really-apply" target="_self">how many residency programs students really apply to</a> each year.</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:68d14558-38eb-4d1c-ae81-b1cd1d2cd29a How one physician uses his PDMP to help patients http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_one-physician-uses-his-pdmp-patients Sun, 10 Jul 2016 22:00:00 GMT <p> Prescription drug monitoring programs (PDMP) can be an effective clinical tool to assist physicians in making prescribing decisions. Effective PDMPs can help identify red flags in prescription use, and provide information when assessing and making treatment decisions. Learn how one physician in New York uses his PDMP to inform treatment options and discuss safety issues with patients.</p> <p> <strong>What a PDMP can do for patients and physicians</strong></p> <p> “The bottom line is that New York’s PDMP is a good tool to use to get some information for your assessment and discussion with your patient,” said Frank Dowling, MD, clinical associate professor of psychiatry at SUNY at Stony Brook and medical director at Long Island Behavioral Medicine. “It’s like blood sugar or hemoglobin A1c [data]. They give you certain information about your diabetic patient—how they’re doing over time and what’s going on and the PDMP can be used similarly regarding controlled medications.”</p> <p> The New York PDMP is fully funded, can be integrated into practice work flow and contains the relevant and timely information that physicians need. It is a tool to see exactly what prescriptions for controlled substances are being filled for individual patients, Dr. Dowling said. “So many patients in pain management are afraid to tell me as their psychiatrist that they’re taking [opioid analgesics]. And then if I’m giving an anxiety drug, for example, they’re afraid to tell the pain specialist that they’re on a tranquilizer because … they know there’s a stigma, and they feel kind of like they’re stuck between a rock and a hard place.”</p> <p> When a patient is being treated with controlled medications, it’s important to be careful about quantity and interactions with other medications, he said. Medications aside, the medical conditions themselves may increasse risk for smoe patients, so the information from the PDMP can be useful during the discussion with a patient.</p> <p> “I actually print up the PDMP report,” Dr. Dowling said. “We could just pull it up on the screen and eyeball it, but we print it up. And if there’s no major discussion, I write a line in the chart, and we shred it. But if there’s a [need for] discussion, I show the patient.”</p> <p> When the PDMP report shows, for example, that the patient has been prescribed controlled medications from two different physicians, it provides an opportunity for physicians to have a conversation about how to better coordinate that patient’s care.</p> <p> In New York, the PDMP report identifies all prescribers, prescriptions and amounts that were dispensed. It also shows which pharmacy the patient used and how the prescription was paid for. “[Payment information] comes up either public, private, self-pay or cash because those are additional red flags that can help you to intentify a possible problem,” Dr. Dowling said.</p> <p> “It’s a conversation and further assessment,” Dr. Dowling said. “I love to show them what the PDMP shows. Just like if I do a toxicology screen, and it shows something aberrant or something different than what I expect or hope to see.”</p> <p> “I try to be open and come across as nonjudgmental as I can,” he said. “If it’s high doses of a few different [drugs], I have to say I’m a little worried. Sometimes this is appropriate, but sometimes it could be a risky situation, and we need to talk and work it out together. It’s still about the patient and about the situation that’s unsafe, not that the patient did a bad thing—this is for their own safety.”</p> <p> In Dr. Dowling’s practice, every patient’s PDMP report is examined, whether or not he is prescribing a medication because it’s useful information for assessment and decision-making, he said.</p> <p> “When we first started using the PDMP, we looked up about 400 people over the first few months,” Dr. Dowling said. “It stirred up about 40 or 50 conversations,” some of which were about how a pain medication could interact with a psychiatric medication and required his practice to follow more closely, “due to the risk of sedation and accidental overdose,” he said.</p> <p> “Sometimes they’re just people who get in over their head with pain medications, and they’re just looking for some help,” he said. “And you can talk with them. You can give them a pathway … prescribe buprenorphine … connect them to therapy and meetings, detox or rehab if needed.”</p> <p> Speaking on a panel at the 2016 AMA Annual Meeting last month, Dr. Dowling offered one of <a href="http://www.ama-assn.org/ama/ama-wire/post/3-things-physician-should-treating-pain" target="_self">three things every physician should do when treating pain</a>, including information on how to use a PDMP.</p> <p> <strong>Focusing on the individual patient</strong></p> <p> Dr. Dowling detailed one case in which the PDMP helped him identify a patient who was in need of help. The PDMP report showed that the patient was receiving multiple prescriptions from multiple physicians, and he was using different pharmacies as well.</p> <p> The patient was prescribed buprenorphine for opioid use disorder. “He’d had a problem with heroin in his teens,” Dr. Dowling said. But the patient had been off of opioids for several decades and was a high-level executive. But then he experienced a physical injury to his shoulder, for which an opioid medication was prescribed.</p> <p> There were 23 scripts in a short period of time, and the patient was taking about 12 tablets a day when three or four is usually the daily maximum, Dr. Dowling said.</p> <p> “I was very worried about him, and I called him,” Dr. Dowling said. “I started to talk with him on the phone, and I said, ‘Is there anyone in your family with the same name?’”</p> <p> The patient sounded nervous but relieved, Dr. Dowling said. The patient then said, “Why do you ask?”</p> <p> Dr. Dowling told him that the PDMP report showed that he was receiving more than one medication from more than one prescriber and that he was worried. The patient replied that he was glad that Dr. Dowling called because he had gotten himself in troubleand he didn't know how to deal with it.</p> <p> “He told me everything,” Dr. Dowling said. “He said, ‘I’m seeing these two other docs, and I got myself in over my head. I’m terrified that none of you will work with me, and I don’t know what to do.’”</p> <p> Dr. Dowling then told him, “That’s why I’m calling, so come on in.”</p> <p> “I set up a visit the next day, and we talked and cleared the air,” Dr. Dowling said. “I told him that what’s important here is you have an addiction problem and we’ve got to get a handle on it. [You need] one prescriber, and you should let me talk to the other docs. If you’re comfortable with one of the other docs, that’s fine, and we’ll do a smooth handoff. If you’re comfortable with me, that’s fine too; you can let them know, and we’ll consolidate with me.”</p> <p> “He decided to stick with me,” Dr. Dowling said. “This particular patient, to his credit, is active in 12-step meetings, and he said, ‘You know, doc, I owe these other two doctors an amends. Can you give me a couple of days to call them so they hear it from me first?’”</p> <p> “That was great—that’s the perfect, ideal thing,” Dr. Dowling said. “We tapered him down by one dose every two days in the outpatient setting without a problem. And since then there’s been no aberration with the PDMP or toxicology screens.”  The patient only takes buprenorphine as prescribed and has been functioning well for several years.</p> <p> One of the recommendations of the AMA <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page?" target="_self">Task Force to Reduce Prescription Opioid Abuse</a> is to register for and use your state PDMP to check prescription history. Check out all <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse.page?" target="_self">five recommendations</a> for physicians to take action and prevent opioid abuse.</p> <p> <strong>For more on physician efforts to end the opioid overdose epidemic:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/talk-substance-use-disorders-patients" target="_self">How to talk about substance use disorders with your patients</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-team-up-treat-addiction-rural-areas" target="_self">Physicians team up to treat addiction in rural areas</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-steps-talking-patients-substance-use-disorder" target="_self">3 steps for talking with patients about substance use disorder</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/entire-state-gets-one-naloxone-prescription" target="_self">Entire state gets one naloxone prescription</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/antidote-3-things-consider-co-prescribing-naloxone" target="_self">How naloxone can be a way to start the broader conversation about risk</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:020a0649-b3c9-4316-9ff1-cefd234eb7c7 Senior physicians recognized for caring for the underserved http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_senior-physicians-recognized-caring-underserved-1 Fri, 08 Jul 2016 21:36:00 GMT <p> Four physicians are being recognized by the AMA Foundation for showing an extraordinary commitment to leadership, community service and care for those in need—each with decades of service that run the gamut from Ebola research to primary care. Find out who has been awarded this year’s honors.</p> <p> <strong>Serving underserved international populations</strong></p> <p> The AMA Foundation presented this year’s <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/excellence-medicine-awards.page" target="_self">Excellence in Medicine Awards</a> to  physicians June 10 at the 2016 AMA Annual Meeting in Chicago.</p> <p> <strong>Jennifer A. Downs, MD, PhD,</strong> assistant professor of medicine and assistant professor of microbiology and immunology at the Center for Global Health at Weill Cornell Medical College, is equally comfortable in Ithaca as in her small concrete home in Tanzania.</p> <p> When she went to that country years ago as a rotating resident, she didn’t suspect she would develop a heartfelt commitment to caring for its people.</p> <p> “But now I love this country,” said Dr. Downs, “and it is difficult to imagine not working here.”</p> <p> She is the recipient of this year’s Dr. Debasish Mridha Spirit of Medicine Award, which recognizes a U.S. physician who has demonstrated altruism, compassion, integrity, leadership and personal sacrifice while providing care to marginalized populations.</p> <p> Dr. Downs’ first days working with the underserved population of Africa led to an epiphany: “I took care of women younger than I was who were dying of AIDS,” she recalled. “It was haunting. And I knew then that I wanted to come back and work to address the problem.”</p> <p> Dr. Downs, who has learned the local language and become enmeshed in the culture of Tanzania, teaches, mentors and carries out clinical care. She makes the care and education of women a priority.. A $2,500 grant will be given to the Center for Global Health in her name.</p> <p> <strong>Adam Levine, MD</strong>, an associate professor of emergency medicine at the Warren Alpert Medical School of Brown University, is the recipient of the Dr. Nathan Davis International Award in Medicine. It comes with a grant of $2,500 to the International Medical Corps.</p> <p> The award recognizes Dr. Levine for outstanding international service. He has responded to humanitarian emergencies in Haiti, Libya, South Sudan and Liberia, and has led research and training initiatives in Zambia, Bangladesh, Rwanda, Liberia and Sierra Leone.</p> <p> He currently serves as the emergency medicine coordinator for the USAID-funded Human Resources for Health Program, helping to develop the first emergency medicine training program in Rwanda. He serves as the primary investigator for the Ebola research team of the International Medical Corps, a disaster and humanitarian relief organization, and as director for the Humanitarian Innovation Initiative at Brown University.</p> <p> Dr. Levine also is editor-in-chief of Academic Emergency Medicine's annual Global Emergency Medicine Literature Review. His research focuses on improving the delivery of emergency care in resource-limited settings and during humanitarian emergencies.</p> <p> <strong>Providing care for U.S. patients without access</strong></p> <p> This year the AMA Foundation recognizes two recipients of the Jack B. McConnell, MD, Award for Excellence in Volunteerism, honoring senior physicians who provide treatment to U.S. patients who lack access to health care.</p> <p> <strong>Charles Clements, MD</strong>, a family medicine specialist in Huntington, W.V., helped found the Marshall Medical Outreach, a medical screening and treatment program for the local homeless community. The program provides an average of 35 patients a day with family medicine, internal medicine, ophthalmology and dermatology treatment. Many patients are referred to Recovery Point, an addiction treatment facility.</p> <p> Dr. Clements plans to spend his summer with a group of medical students on his seventh trip to treat underserved villages in Honduras. He and his students will examine and treat more than 1,500 people, providing perhaps the only medical attention they receive this year.</p> <p> His award comes with a grant of $2,500 to Marshall Medical Outreach.</p> <p> The second McConnell recipient, <strong>Rafael A. Zaragoza, MD</strong>, is a urologist who lives in Delaware. His award comes with a $2,500 grant to the Delaware Prostate Cancer Coalition.</p> <p> Dr. Zaragoza formed the Volunteer Ambulatory Surgical Access Program to provide free low-risk outpatient surgery to the uninsured in Kent County, Del., who cannot afford private pay and are not eligible for Medicaid.</p> <p> Participating surgeons and nurses volunteer their time, and use of operating rooms is free to patients. He also launched the Hope Clinic, which provides non-emergency medical care to the uninsured.</p> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7c6f4ebc-ac74-43f2-a0ab-5baeeafe9db5 How med schools are training tomorrow’s physician leaders http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_med-schools-training-tomorrows-physician-leaders Thu, 07 Jul 2016 20:55:00 GMT <p> Medical school faculty members recognize that, as the health care delivery system changes, curricula must incorporate new classes and hands-on experiences to create future leaders in medicine. Find out what several schools are doing to better prepare the next generation of physician leaders.</p> <p> These leadership curriculum changes are part of the schools’ work with the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education Consortium</a>. The consortium is working to modernize and reshape the way physicians are trained. It brings schools together to share ideas and experiences with new programs designed to improve competency, leadership and patient care.</p> <p> <strong>Building leaders in Chicago</strong></p> <p> The University of Chicago Pritzker School of Medicine will teach students about the value of care, improvement science, safety of patients and team training (a program they abbreviate as “VISTA”) to help shape physician leaders. It also is implementing a four-step strategy to create a learning environment that transforms medical students into frontline advocates for a better health care system, including creating a sense of urgency and building a guiding coalition.</p> <p> VISTA students will be able to actively participate and lead patient safety and quality activities rather than just observe them, said Vineet Arora, MD, assistant dean for Scholarship and Discovery at Pritzker School of Medicine. Also, she said “we need to have graduating students who are equipped to not only provide the best care but also the highest value care. This is a critical skill we hope VISTA students will carry with them to residency.”</p> <p> Jeanne Farnan, MD, assistant dean for Curricular Development and Evaluation at Pritzker, said it also will be critical for physician leaders to function as part of a team because health care delivery is now more than ever a “team sport.”</p> <p> “VISTA prepares students for that through earlier immersive exposure to health care team members in the health care delivery system as well as through a greater emphasis on team communication and function and vulnerable points in a patient’s passage through the health care system, such as care transitions,” Dr. Farnan said.</p> <p> <strong>Individual leadership paths in Texas</strong></p> <p> At Dell Medical School at the University of Texas at Austin, all students will go through a core leadership curriculum but will have the opportunity to pursue an individual leadership path that allows them to explore areas that they are interested in during medical school.</p> <p> “The competencies needed now for physicians are different than when we went to medical school. It is more about leading a team and working on a team, advocacy and person-centered care,” said Susan “Sue” Cox, MD, executive vice dean for Academics and chair of Medical Education for Dell Medical School.</p> <p> In their third year, students will be able to pursue distinctions in health care redesign, population health and basic science/translational research and dual degrees with a focus on leading change in an area in which they are interested. For example, a student or team of students can carry out a population health study on diabetes in a particular zip code or help improve health care in a clinic setting.</p> <p> “Physicians will not just be leaders in coordinating health care in the clinical setting, but they will be leaders in the community in general,” said executive coach and leadership expert Eddie Erlandson, MD, leadership advisor for Dell Medical School. </p> <p> <strong>Community leaders in Atlanta</strong></p> <p> Morehouse School of Medicine in Atlanta is increasing its ongoing efforts to recruit medical students from underserved urban and rural populations and will provide those students with learning communities that begin on the first day of medical school. Students will take an interactive, learner-centered approach to engage in building teamwork, communication and professionalism skills.</p> <p> For the past 20 years, Morehouse medical students have been part of a yearlong service learning course in which they work with a community site to assess needs and develop, implement and evaluate an intervention. Morehouse in its application to the consortium said the school is expanding this effort and creating a program that keeps students “longitudinally linked to their communities for ongoing collaboration in addressing the health and well-being of these communities.”</p> <p> “The goals of our revised curriculum support our mission of helping lessen the physician shortage that exists, especially in the area of primary care, and to help train physicians, especially physicians of color, who will choose to serve in medically underserved urban and rural communities,” said associate professor of clinical obstetrics and gynecology Ngozi F. Anachebe, Pharm.D, MD, Morehouse’s associate dean of undergraduate medical education and associate dean of admissions and student affairs.</p> <p> A major focus of the revised curriculum is enhanced self-directed learning, Dr. Anachebe said. The goal is for students to take ownership of their learning with academic portfolios and personal development planning.</p> <p> “Our hope is for students to continue regular self-assessment and to continually seek out resources for this continuous self-improvement and learning,” she said. “The doctors of tomorrow must take advantage of the information explosion that is occurring to stay in the forefront of medicine.”</p> <p> <strong>Patient safety leaders in Michigan</strong></p> <p> The goal of curriculum changes at Michigan State University College of Osteopathic Medicine is to give medical students the skills they need to become leaders in patient safety by being able to identify safety concerns and find solutions to make the situation better.</p> <p> Students need a specific curriculum that gives them the opportunity to practice the skills associated with patient safety in clinical settings where they learn, said Saroj Misra, DO, associate professor of family and community medicine at Michigan State University College of Osteopathic Medicine.</p> <p> “It is our belief that our approach to this curriculum will create a student who is better versed in the basic tenets of patient safety so that they can make meaningful contributions to the systems they learn in and feel confident that they are giving back to those systems that train them,” Dr. Misra said.</p> <p> Consortium schools are also changing other ways medical school students learn, including <a href="http://www.ama-assn.org/ama/ama-wire/post/4-ways-schools-paving-new-path-residency" target="_self">paving new paths to residency</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/michigan-relaying-student-competency-residency-programs" target="_self">relaying student competency to residency programs</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/one-school-training-students-rural-medicine" target="_self">training students for rural medicine</a>. You also can read about what <a href="http://www.ama-assn.org/ama/ama-wire/post/students-forefront-of-transforming-med-ed" target="_self">students at the forefront of transforming med ed</a> have to say about their experiences.</p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:6bee62a9-5592-4a19-9cbb-0e5b6ff92a23 Resident burnout: Unearthing the bigger picture http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_resident-burnout-unearthing-bigger-picture Wed, 06 Jul 2016 21:40:00 GMT <p> To fortify our understanding of burnout among residents, we have to widen the list of themes we consider, a leading scholar told a gathering of physicians from across the medical continuum. Learn what guidance he had to offer.</p> <p> <strong>A broader conversation</strong></p> <p> The conventional focus on the work and learning environments, though important, is not enough to address burnout in residents, said DeWitt Baldwin, MD, senior scholar in residence at the Accreditation Council for Graduate Medical Education (ACGME).</p> <p> In his remarks to the council’s first <a href="https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/ACGME-Symposium-on-Physician-Well-Being" rel="nofollow" target="_blank">Symposium on Physician Well-being</a>—part of the ACGME’s larger effort to <a href="http://www.ama-assn.org/ama/ama-wire/post/acgme-seeks-transform-residency-foster-wellness" target="_self">transform residency to foster wellness</a>—Dr. Baldwin encouraged consideration of the socio-economic setting in which residents work, the moral-ethical environment and the personal characteristics that individuals bring to the job.</p> <p> Standing in the way of the search for solutions is a culture that holds onto the stigma that surrounds mental and emotional health issues, he said.</p> <p> “The culture of medicine still entertains the view that persons who cannot cope or err or fail or are weak have violated the traditional norms of the physician as a strong, independent, self-sufficient perfectionist who does not and should not need help,” he said.</p> <p> “Absurdly, seeking therapy or even help from a wellness program may be seen [as] a weakness or failure,” he said, and it is sometimes looked on as something that could interfere with licensure and employment opportunities.</p> <p> <strong>Casting the net</strong></p> <p> While the profession works to shed outdated attitudes, Dr. Baldwin said, it must cast a wider net to weigh more facets of resident well-being, including:</p> <ul> <li> <strong>Moral-ethical factors:</strong> Toxic and unprofessional learning environments prevent engagement and quash the youthful idealism and enthusiasm that students often bring to the table.</li> </ul> <ul> <li> <strong>Individual</strong> <strong>factors:</strong> Examination of burnout must take into account the motivations, temperament, capability, education and health of individual trainees. This can include considering childhood maltreatment trainees may have suffered, and how it can give rise to such conditions as depression and post-traumatic stress disorder.</li> </ul> <ul> <li> <strong>Social-economic setting:</strong> Residents work in conditions that differ widely in terms of the medical needs of the community and patient safety, factors that can influence burnout.</li> </ul> <p> <strong>Changing the fundamentals </strong></p> <p> The call to renew and refocus efforts to prevent burnout is loud and strong. Thomas Nasca, MD, CEO of the ACGME, opened the symposium with some sobering statistics. Close to 400 physicians take their own lives each year, he said, while other suicides most likely go unreported.</p> <p> “The pain that this scourge is heaping on our profession … is unbearable at times,” he said, and suicide only represents “the tip of the iceberg,” with other forms of distress below the surface. Dr. Nasca called on physicians as a whole to reimagine the campaign against burnout.</p> <p> “We can’t just stand by and wring our hands and then walk out the door and go back to doing what we usually do,” he said.</p> <p> As urgent as the call for action may be, Dr. Baldwin said, there are miles to go in the fight to overturn fundamental factors in medical education that stand in the way. One obstacle is the low priority burnout sometimes holds.</p> <p> “Wellness and well-being just don’t pay,” he said. “It takes too long. It’s neither glamorous nor dramatic, and there’s little sense of slaying the dragon.”</p> <p> Change means confronting what he called an antiquated, assembly-line education model that dehumanizes trainees and undercuts their well-being.</p> <p> “We need to take from them the task of having to gain their well-being,” Dr. Baldwin said. “We should be providing it for them.”</p> <p> <strong>Continuing the conversation</strong></p> <p> The ACGME will host a webinar, “Combating burnout, promoting physician well-being: Building blocks for a healthy learning environment in GME,” with speakers Lyuba Konopasel, MD, and Carol Bernstein, MD, from 2 to 3 p.m. Eastern time July 13. <a href="https://event.onlineseminarsolutions.com/eventRegistration/EventLobbyServlet?target=registration.jsp&eventid=1214177&sessionid=1&key=E80DE06B547452A6253BE206A2A6FBE1&sourcepage=register" rel="nofollow" target="_blank">Register to participate</a>.</p> <p> The ACGME also will be holding its next Symposium on Physician Well-Being this fall. Learn more: Access <a href="http://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/ACGME-Symposium-on-Physician-Well-Being" rel="nofollow" target="_blank">resources and videos</a> from the 2015 symposium.</p> <p> <strong>Learn how physician groups are addressing burnout:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/student-wellness-blueprints-curriculum-of-future" target="_self">Student wellness: Blueprints for the curriculum of the future</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/one-program-achieved-resident-wellness-work-life-balance" target="_self">How Stanford achieved resident wellness, work-life balance</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/preventing-resident-burnout-mayo-clinic-takes-unique-approach" target="_self">Mayo Clinic takes unique approach to battling resident burnout</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/double-edged-sword-doctors-great-also-drives-burnout" target="_self">A double-edged sword: What makes doctors great also drives burnout</a></li> <li> The <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page" target="_self">International Conference on Physician Health</a>™ will take place Sept. 18-20 in Boston</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:3d6d4ca9-6cb6-4b2c-8225-ff5132222e3b Inside look: A physician’s success story as a prediabetic patient http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_inside-look-physicians-success-story-prediabetic-patient Wed, 06 Jul 2016 21:37:00 GMT <p> As a patient enrollee in her local diabetes prevention program, Nancy Nielsen, MD, PhD, didn’t want anyone to know she was a physician. But now she’s sharing her experience far and wide because it quite possibly changed her life.</p> <p> <strong>Altering her family history</strong></p> <p> “My father had his first heart attack when I was in ninth grade, and he died at 62—a diabetic,” Dr. Nielsen, an internal medicine physician, told physicians last month. “So were both his parents and seven of his eight siblings. And so I knew: With a sedentary lifestyle, I was a prime candidate.”</p> <p> Dr. Nielsen last month spoke to two groups of physician leaders at the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_self">2016 AMA Annual Meeting</a> and a special meeting of the AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" target="_self">Accelerating Change in Medical Education Consortium</a> and <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_self">Improving Health Outcomes</a> initiative, which focused on preparing students how to best care for patients with chronic diseases. Dr. Nielsen is a past president of the AMA and senior associate dean for health policy at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York.</p> <p> “It was at an AMA meeting that I got my hemoglobin A1c,” Dr. Nielsen said. “It was creeping up. Isn’t denial so interesting in all of us? I thought I was eating healthy, but I never had time to measure or count or really worry about all this stuff. I really thought I was eating healthy.”</p> <p> That’s when Dr. Nielsen got a referral from her primary care physician to participate in the YMCA’s Diabetes Prevention Program, which had become available for the first time at her neighborhood Y.</p> <p> Dr. Nielsen isn’t in an uncommon situation when it comes to type 2 diabetes risk. In fact, 86 million U.S. adults—one in three—have prediabetes, according to estimates by the Centers for Disease Control and Prevention (CDC). What is far less common is that Dr. Nielsen knows her risk and is taking action to reduce it. The CDC estimates that only 90 percent of adults with prediabetes are even aware they have it.</p> <p> <strong>Why the prevention program works</strong></p> <p> The YMCA’s Diabetes Prevention Program is based on the <a href="https://www.cdc.gov/diabetes/prevention/index.html" target="_blank" rel="nofollow">National Diabetes Prevention Program</a>, which is offered by a variety of community organizations and even is available from some providers online. It’s an evidence-based program that helps patients with elevated blood sugar levels make the necessary lifestyle changes to prevent the onset of type 2 diabetes, one of the most disabling and expensive chronic diseases.</p> <p> In the YMCA’s yearlong program, participants meet once a week for 16 weeks and then once a month for the remainder of the year. Participants meet as a group with an experienced life coach and learn the knowledge and skills to adopt healthy behaviors that lower their risk of developing type 2 diabetes. Two of the primary goals for participants are 5-7 percent weight loss during the course of the year and 150 minutes of weekly exercise, changes that can cut a patient’s diabetes risk by more than half.</p> <p> “If you looked at the curriculum, you as physicians would be bored,” Dr. Nielsen said. “It’s very simple.”</p> <p> “[But] that is not the power,” she said. “The power is being together, having a life coach. The dynamics of changing human behavior are not just knowledge.”</p> <p> Dr. Nielsen admitted that she isn’t one who enjoys working on her individual goals as part of a group, but being part of a group and working together toward common goals was very motivating.</p> <p> “One night just for fun, [our group’s life coach] brought in a bunch of foods and put them on the table, and we had to guess” how many calories and grams of fat were in them, Dr. Nielsen said. “And, boy, were we off. And I wasn’t better than anyone else.”</p> <p> Dr. Nielsen explained that the program included such practical activities as counting fat grams and recording everything they ate. There were weekly weigh-ins, and the Y provided access to its facilities and a session with a fitness trainer.</p> <p> Out of the 35 people in her group, every single one of them met their 7 percent weight loss goal.</p> <p> <strong>What physicians can do</strong></p> <p> Dr. Nielsen encourages all physicians to refer their patients with prediabetes to a diabetes prevention program.</p> <p> “In our curriculum, how do we teach nutrition?” Dr. Nielsen said. “When I took it, it was biochemistry … [and offered] very little practical advice. As a busy internist, I didn’t have time to sit and talk about nutrition with people. And frankly from a practical standpoint, I wouldn’t have known what to tell people.”</p> <p> Referring patients to a diabetes prevention program gives patients access to the information and support that they need to make important lifestyle changes without placing the resource burden entirely on busy physician practices.</p> <p> In partnership with the CDC, the AMA offers the <a href="http://www.ama-assn.org/sub/prevent-diabetes-stat/for-health-care-professionals.html" target="_self">Prevent Diabetes STAT: Screen, Test, Act–Today™</a> toolkit, which makes it simple for physicians and their care teams to screen, test and refer patients to diabetes prevention programs.</p> <p> Participation in the programs is covered by some insurers, which soon will <a href="http://www.ama-assn.org/ama/ama-wire/post/groundbreaking-effort-prevent-diabetes-announced" target="_self">include Medicare</a>.</p> <p> “[The program] was only $320, which is only $20 per night,” Dr. Nielsen said. “But for many patients, that would be a barrier. We as physicians need to advocate for insurers to cover it. I really think that’s part of our role.”</p> <p> For educators who are training the next generation of physicians, Dr. Nielsen said this program offers important lessons in chronic disease care and prevention. “Students need to understand that they don’t have to know everything,” she said. “What they do need to do is partner with the resources in their community like the AMA and the CDC have done with the Y. This has been around for a while, is evidence-based, and the results are stunning.”</p> <p> Dr. Nielsen left physicians with an important thought: “I think it’s time that we learn from other disciplines outside of medicine to help our patients become as healthy as they possibly can. This may allow me and others to outlive our family history.”</p> <p align="right"> <em>By AMA Wire editor</em> <a href="https://twitter.com/amy_amawire" target="_blank" rel="nofollow"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9b5dea5c-ed18-430b-9cf6-5444d49d2748 What Supreme Court ruling on admissions means for med schools http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_supreme-court-ruling-admissions-means-med-schools Tue, 05 Jul 2016 21:00:00 GMT <p> The Supreme Court of the United States has made a ruling in a case considering race as one factor in academic admission, which allows medical schools to create a more racially and ethnically diverse physician workforce that more closely reflects the patient population and can combat racial disparities in health outcomes.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/7/c2d7e219-dc9a-4fd5-8722-c6529df805cc.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/7/c2d7e219-dc9a-4fd5-8722-c6529df805cc.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>Where the case began and its result</strong></p> <p> In <em>Fisher v. University of Texas at Austin</em>, Abigail Fisher, a white applicant, was rejected from the University of Texas undergraduate college and sued the university, asserting that the school preferred African-American students over whites and that she would have been accepted if racial preferences were not in place.</p> <p> In 2013, the Supreme Court held that the University of Texas could potentially use racial preferences in its admission decisions under limited circumstances, known as “strict scrutiny.” The Supreme Court remanded the case to the court of appeals for determination of whether the University’s racial preferences met the strict scrutiny standard.</p> <p> On remand, the court of appeals confirmed its earlier ruling, which had approved the racial preferences. The latest Supreme Court ruling affirmed the court of appeals application of the strict scrutiny standard to the University of Texas admission policies.</p> <p> “The goal of increasing medical career opportunities for minorities is an important step in developing a diverse physician workforce that will help bridge the gap in racial health disparities,” said Andrew W. Gurman, MD, AMA president. “The AMA supports efforts to bring an end to any inequalities in health care.”</p> <p> <strong>Why this matters</strong></p> <p> Beyond this obligation to their individual students, medical schools in the U.S. have obligations to society at large. This includes redressing current disparities in health care, where minority patients often receive less and lower quality health care.</p> <p> The schools in this country are charged with ensuring that future physicians will be able to practice medicine at the highest levels and that competent medical care in different practice areas will be available to all who need it.</p> <p> “The current picture of health in America is simultaneously bright and bleak,” the AMA said in an <a href="https://download.ama-assn.org/resources/doc/legal-issues/x-pub/fisher-v-univ-tx-austin2.pdf" target="_self">amicus brief</a> (log in). “While we are better equipped than ever with biomedical knowledge and technology to both avoid disease and prevent early death, certain segments of the population have been slow to benefit from these advancements.”</p> <p> While the country continues to grow more diverse, minority populations still lag behind on nearly every health indicator, including health care coverage, life expectancy and disease rates. Several studies show that patients who share racial or gender characteristics with their treating physicians report greater satisfaction and higher rates of medication compliance.</p> <p> “Unlike most undergraduate institutions, medical and other health professional schools have always considered and highly value personal interviews in order to learn what the applicant’s background would contribute to a culturally competent workforce,” the brief said. “Removing the ability of medical schools to consider applicants’ race and ethnicity as one of many personal attributes would undermine their ability to assess the entirety of each individual’s background, thus frustrating the goal of best serving the public’s health.”</p> <p> The AMA is dedicating resources to numerous efforts aimed at addressing health care disparities, including developing and implementing an initiative focused on <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_self">reducing inequalities in hypertension control and diabetes prevention</a>. The AMA also has funded several medical school members of the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education Consortium</a> to implement projects intended to increase diversity among physicians and reduce disparities in health care.</p> <p> <strong>Other cases in which the AMA is involved include:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/confidential-patient-safety-information-threatened-court-case" target="_self">Confidential patient safety information threatened in court case</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/freedom-of-patient-physician-conversations-hinges-court-case" target="_self">Freedom of patient-physician conversations hinges on court case</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-lead-unlimited-awards-of-punitive-damages" target="_self">Court case could lead to unlimited awards of punitive damages</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0b0dcf16-5db3-4bae-ba2e-8d2aaf63205a Lessons from Rwanda: The intersection of care abroad and at home http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_lessons-rwanda-intersection-of-care-abroad-home Tue, 05 Jul 2016 20:57:00 GMT <p> When it comes time to build or reinforce health care infrastructure in resource-poor areas of the world, what role should aiding physicians play—and what can they learn in the process?</p> <p> “Global is all the world, not only Africa or … foreign countries,” said Agnes Binagwaho, MD, PhD, the minister of health in Rwanda, in a <a href="http://journalofethics.ama-assn.org/podcast/ethics-talk-jul-2016.mp3" target="_blank">podcast interview</a> featured in the <a href="http://journalofethics.ama-assn.org/site/current.html" target="_blank">July issue</a> of the <em>AMA Journal of Ethics®.</em></p> <p> <strong>Similar disparities at home and abroad</strong></p> <p> An article featured in this month’s issue, “<a href="http://journalofethics.ama-assn.org/2016/07/msoc1-1607.html" target="_blank">Why U.S. health care should think globally</a>,” suggests that learning from practitioners in resource-poor settings can help allopathic physicians connect with local and global populations and motivate reciprocity.</p> <p> “Successful health care systems in low-resource settings are designed to target and serve the poor in ways that are contextually appropriate, addressing social, cultural and economic barriers to care,” the authors said. “These systems have already learned how to make efficient use of limited resources.”</p> <p> Methods developed for or in low-resource settings abroad also can be used in the U.S. to address inequalities in health status and health care, access and quality.</p> <p> Two tools developed abroad, a low-cost ventilator and a mobile-based flow cytometer used to diagnose some infections and cancers, are already being used in the U.S.</p> <p> <strong>What we learned from Rwanda</strong></p> <p> In her podcast interview, Dr. Binagwaho detailed how further development of the health care system in Rwanda improved access and quality.</p> <p> “Before 1994, we were producing around 20 doctors a year,” she said. “Now we produce hundreds.” The most important lesson learned in the development of the Rwandan health care system, according to Dr. Binagwaho, was to understand the needs of the people of her country and develop a system that met those needs.</p> <p> “First of all, [we needed] to understand our city,” she said, “What are our needs? So that means propose decisions that are evidence-based, that you can explain to others and also proceed by creating your own plan. And after that, agree altogether how we’d implement it so that we create the trust in the system and the people can use the system … because they know that the system is there and responding to their needs.”</p> <p> “You put everybody around the table from communities, from civil societies, from government, and leaving nobody out,” she said. “A plan done by the people who will live with that plan is always better than any plan done elsewhere.”</p> <p> Mortality rates on several fronts have improved since the implementation of new strategies in Rwanda. “The mortality rate for HIV/AIDS has decreased by 78.4 percent,” Dr. Binagwaho said. For tuberculosis, the mortality rate decreased by 77 percent and for malaria by 85 percent.</p> <p> <strong>How to offer input in international contexts</strong></p> <p> When physicians travel to other countries offering their expertise to local populations, it is important to remember a few things:</p> <ul> <li> Help countries know their cities and understand the needs of the people in those cities, Dr. Binagwaho said. When traveling to another country, “understand the right to health and ethics … [and] go with humility and say ‘I have always something else to learn; I have always something to share.’ … And then go and listen.”</li> </ul> <ul> <li> “Don’t act like a teacher; act like a student,” she said. “Learn the culture—how to do, how to say, how to express. Because the most important [aspect of] the conversation is not to say what you want; it’s to make sure that the person you talk to has understood.”</li> </ul> <ul> <li> “You have to be like a chameleon: ready to change [to] the local color and bring the shining color from your country in addition,” Dr. Binagwaho said. “You always have to say what you believe—say it loudly—but with a lot of humility.”</li> </ul> <p> Carolyn Sargent, PhD, professor of anthropology at Washington University in St. Louis and co-author of “<a href="http://journalofethics.ama-assn.org/2016/07/ecas4-1607.html" target="_blank">Blending western biomedicine with local healing practices</a>,” an article featured in this month’s issue, shared a story of her experience abroad.</p> <p> While conducting fieldwork in a rural West African village as a scholar of reproductive health, she found that after deliveries, birth attendants would place dung on the newborn’s umbilical cord stump to dry it out. Knowing this practice is considered dangerous in Western medicine, she felt conflicted. As an allopathic practitioner she had to decide whether or not to say something to the midwives regarding what she knew without sounding disrespectful.</p> <p> When she described her dilemma to an elder woman and respected community leader, the elder said, “Your duty is to convey what you know. And the family’s duty is to decide what they think is best.”</p> <p> “The elder’s statement encapsulates the heart of the challenge posed by the concept of autonomy,” Sargent said in the article. “Sometimes we must respect—at least in the short term—decisions that we might not fully support.” But, as Dr. Binagwaho said, it is important for medical professionals to share what they know because that is one important reason why they are there.</p> <p> The July issue of the <em>AMA Journal of Ethics</em> is available now and features articles on several other issues in global health, including “<a href="http://journalofethics.ama-assn.org/2016/07/mhst1-1607.html" target="_blank">Medicine, empires and ethics in colonial Africa</a>,” and, “<a href="http://journalofethics.ama-assn.org/2016/07/ecas3-1607.html" target="_blank">Changing donor funding and the challenges of integrated HIV treatment</a>.”</p> <p> <strong>Take the ethics poll</strong></p> <p> <a href="http://journalofethics.ama-assn.org/site/poll.html" target="_blank">Give your answer</a> to this month’s poll: What should practitioners of modern medicine do when wondering about the safety or efficacy of traditional therapies from an allopathic perspective?</p> <p> <strong>Submit an article</strong></p> <p> The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. <a href="https://amajournalofethics.msubmit.net/" rel="nofollow" target="_blank">Submit your work</a> for publication.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:743f785a-4807-4625-87fb-3c2aaa149a31 Overcoming barriers, physicians use EHRs in innovative ways http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_overcoming-barriers-physicians-use-ehrs-innovative-ways Mon, 04 Jul 2016 22:00:00 GMT <p> Even with the current limitations of electronic health records (EHR), Vanderbilt University School of Medicine has tapped into physician ingenuity to overcome problems with the technology and access the wide range of data available to improve patient care.</p> <p> When he got to Vanderbilt several years ago, Jesse Ehrenfeld, MD, an anesthesiologist and AMA board member, created a team that was focused on helping physicians better use technology that was already at their fingertips.</p> <p> <strong>Two ways Vanderbilt is using EHR data</strong></p> <p> “We have all of this data, we click buttons and check off boxes, and we enter in fields, but we never get anything back in return,” Dr. Ehrenfeld said. “The data lives somewhere, but nobody knows where it is, and nobody can get to it in a way that helps me take care of patients—that was the No. 1 complaint that I heard from my clinician colleagues.”<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/4/6855db1c-3630-4232-841b-88d690bc2a59.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/4/6855db1c-3630-4232-841b-88d690bc2a59.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> As a result, Dr. Ehrenfeld’s team has been focused on developing approaches and infrastructure to “bring that data alive,” he said, “to make it actionable and allow our clinicians to use it to work more efficiently and effectively.”</p> <p> Here are two solutions he and his colleague Johnathan Wanderer, MD, have developed to assist in clinical decision-making:</p> <ul> <li> <strong>Tracking outcomes.</strong> “There is no shortage of quality reporting that happens at hospitals around the country,” Dr. Ehrenfeld said. “We, in fact, are drowning in metrics. There are CMS metrics … payer metrics, Joint Commission metrics—all these things that we have to report out.”<br /> <br /> “But what comes back to the clinicians is rarely meaningful,” he said. “It’s typically stale data that’s six months to a year old that doesn’t have the capability to really help me understand what I can do to make the experience better for a patient or to improve my practice.”<br /> <br /> Drs. Ehrenfeld and Wanderer's team at Vanderbilt created an infrastructure that pushes actionable information back to the clinical faculty on a weekly basis so that they can see how the patients are doing. “Were there adverse events, were there good outcomes?” he said. “And then we can use that information to feed things back into the system.”<br /> <br /> “It comes out as a simple email that has a list of the patients, a little description of who they were so you can remember who you saw and then the outcomes of interest,” he said. “If you want to dive in, it’s one click that takes you to a secure website, where you can get detailed information about exactly what happened.”<br /> <br /> “I took care of a patient who had a hernia surgery and saw in my weekly outcomes email that she’d been readmitted,” Dr. Ehrenfeld said. He wouldn’t have otherwise known because she was doing fine after he did his post-op check. “But there was a complication that happened a few days later.”<br /> <br /> The next day, Dr. Ehrenfeld went to the surgeon he had been working with and it led to a conversation about what was going on. “It brought the surgical team back together with me so we could brainstorm about how we ended up with this readmission,” he said, “and how we could improve.”<br /> <br /> “This technology helps physicians see what they need to see to make better decisions,” he said. “It closes the loop in a way that brings information that’s timely back to the physicians and lets us really leverage the information that we are already collecting.”<br /> <br /> “The data is all there,” he said. “It’s not like there’s a tech or a research assistant or a clerk who’s looking through charts and calling patients. We’re automatically extracting data out of the EHR. It’s lab data, encounter data, quality data—we’re just bringing it together in a format that’s useful to clinicians so that we can use that to improve our practice.”</li> </ul> <ul> <li> <strong>Preparing for tomorrow’s patients.</strong> Similar to the above example, physicians who are preparing for the next day’s patients generally have to cross-reference scheduling information with EHR information and clinic information to be able to identify information the patients they’ll be taking care of, how they need to prepare and whether they need additional data.<br /> <br /> At Vanderbilt, they’ve developed a way to do that for the clinician by cross-referencing all of the data sources and bringing them together. “[We] send every clinician an email with the patients they’re seeing the next day that has information that will be useful to them,” Dr. Ehrenfeld said. “Types of cases, who they’re working with, the surgical staff and issues that are unique to those patients—that way you can then focus on what’s most important.”<br /> <br /> “Every day in every hospital EHRs feed data into data warehouses,” he said. “The opportunity here is to pull together informatino from across multiple sources, in ways that make it useful and save people time. We’ve developed a team of programmers and data analysts that have built an environment that automatically brings that data together in a way that allows the system to then generate these kinds of reports.”</li> </ul> <p> <strong>Making health IT SMART</strong></p> <p> Beyond Vanderbilt, Dr. Ehrenfeld is involved in expanding the possibilities of EHRs to physicians across the country. SMART Health IT, an open, standards-based technology platform enables innovators to create apps that seamlessly and securely run across the health care system. Using an EHR system or data warehouse, patients, physicians and other health care professionals can draw on a library of apps to improve care, research and public health.</p> <p> Dr. Ehrenfeld sits on the advisory board and provides input and guidance about how the technologies can be further developed and how the concepts can be brought forward to enable broader audiences to use them.</p> <p> “The genomics of cancer are very complicated,” he said, pointing to an example project as part of SMART health IT. “A colleague of mine at Vanderbilt has developed an app to help physicians have the conversation in a less complicated way with patients.”</p> <p> Jeremy Warner, MD, an oncologist at Vanderbilt, built an app, <a href="https://gallery.smarthealthit.org/vanderbilt-university-medical-center/smart-precision-cancer-medicine" rel="nofollow" target="_blank">SMART Precision Cancer Medicine</a>, which compares a patient’s diagnosis-specific somatic gene mutation to a population-level set of comparable data. Specific links within the app connect to Gene Wiki, My Cancer Genome and HemOnc.org to allow the physician to talk with the patient in a way that helps them understand their risk and treatment options.</p> <p> <strong>More on how physicians are expanding their use of technology:</strong></p> <ul> <li> Experts at Health Datapalooza in May explained <a href="http://www.ama-assn.org/ama/ama-wire/post/medicine-needs-cloud" target="_self">why medicine needs a cloud</a>.</li> <li> Learn how one practice in Minnesota <a href="http://www.ama-assn.org/ama/ama-wire/post/minnesota-practice-preventing-diabetes-can" target="_self">used their EHR to enroll patients in a diabetes prevention program</a>.</li> <li> At the 2016 AMA Annual Meeting, Dr. Ehrenfeld detailed another technology solution from Vanderbilt that <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-making-ehrs-interoperable" target="_self">streamlines the surgical timeout</a> that is directly tied to their EHR, and learn how Kansas developed an interoperable EHR system statewide.</li> <li> Vanderbilt has also established a <a href="http://www.ama-assn.org/ama/ama-wire/post/med-school-explores-new-way-assess-millennial-learners" target="_self">competency-based education program</a> within their medical school. Using open-source software, they created a complex e-portfolio system that charts students’ performance across a core set of competencies based on the Accreditation Council for Graduate Medical Education’s graduate medical education  milestones.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8eae3f55-7c10-4a58-866c-9fee22591ab1 The road less traveled: Non-traditional careers for physicians http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_road-less-traveled-non-traditional-careers-physicians Fri, 01 Jul 2016 20:00:00 GMT <p> Not every young physician plans to pursue the conventional course to a clinical career in medicine. Learn more about other options and what inspired physicians to follow them.</p> <p> Researcher, political adviser, medical director for a jail—these and other options were on the table during a workshop titled “Shaping unique careers in medicine,” part of the 2016 AMA Annual Meeting in Chicago.</p> <p> <strong>Inspiration in surprising places</strong></p> <p> Outside-the-box choices can excite the imagination and bring a satisfying and inspiring career in sometimes unexpected places.</p> <p> “We had an appetite for doing something other than clinical practice,” said Erick Eiting, MD, referring to himself and the other panelists. He told students in the standing-room-only session that he had never thought of a career in medical care for inmates until his dean called him into his office one day and pitched the idea.</p> <p> Today he is medical director for USC Correctional Health, a collaboration of the Los Angeles County Sheriff’s Department, the county health department and Keck School of Medicine at the University of Southern California.</p> <p> Dr. Eiting has since found his sense of mission serving some of the most medically and socially disenfranchised in society: those behind bars.</p> <p> “I think you’ll realize along the way that there will be opportunities that present themselves to you, things you never considered before,” Dr. Eiting told students. “Half the skill is recognizing when you have a good opportunity—and how you can chase that.”</p> <p> Heather Smith, MD, spends 25 percent of her time treating patients in the Bronx. The rest of the time she is a researcher and academic generalist at the Department of Obstetrics and Gynecology and Women’s Health Center at Montefiore Medical Center.</p> <p> Her master’s degree in public health, which she earned before her MD, gave her a perspective on health policies and disparities, she said. “I realized I really wanted to impact patients, but inside the clinical wall was just not enough.”</p> <p> She encouraged students to explore their options: “There really are no mistakes; there are decisions that may not be right you in the moment, but down the road it will put you in the right place.”</p> <p> For Josh Lumbley, MD, his career path was very focused. Dr. Lumbley is chief medical officer for the Midwest division of NorthStar Anesthesia and a former legislative aide to Sen. Ed Markey, D-Mass. “I wanted to be in the maelstrom … of policymaking,” he said. “I want to be a leader in health care; I want to be where it’s hottest.</p> <p> “I’m very happy with the choices I’ve made,” Dr. Lumbley said.</p> <p> Medical student Kevin Mensah-Biney, a second-year student at Virginia Tech Carilion School of Medicine, came to the session to hear just such testimony—to learn what options are out there and how the decision-making process unfolds.</p> <p> “It’s about how your decisions are not necessarily something you are predisposed to do,” he said, “but how different options come your way unexpectedly.”</p> <p> Dr. Smith urged students to forge a balanced life, based on a sense of mission within medicine and outside it. Students also should be confident that life will take shape over the long term, she said.</p> <p> “You may find your niche, or you may create your own niche,” Dr. Smith said. “Feel free to make all the mistakes you want to make, then I’ll see you in 10 years.”</p> <p> Learn more about nontraditional careers in which physicians are shaping health care outside the exam room. <em>AMA Wire</em>® recently profiled <a href="http://www.ama-assn.org/ama/ama-wire/post/nonclinical-careers-insights-rep-tom-price-md" target="_self">Rep. Tom Price, MD, R-GA</a>, and <a href="http://www.ama-assn.org/ama/ama-wire/post/nonclinical-careers-its-like-working-fda" target="_self">John Whyte, MD</a>, an official at the U.S. Food and Drug Administration.</p> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:12c93e61-5d6a-48ce-b9d2-ae746824b91f Become a part of the AMA-WPS policymaking process http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_become-part-of-ama-wps-policymaking-process-3 Fri, 01 Jul 2016 14:03:00 GMT <p> Consider joining one of the AMA Women Physicians Section (WPS) committees that contribute to the section’s policymaking process:</p> <ul> <li> The AMA-WPS Policy Committee is a new group that will be responsible for generating resolution ideas and working with the section’s delegate and alternate delegate to vet potential resolutions for the AMA House of Delegates meetings. Individuals joining the committee are requested to make a one-year commitment. <a href="mailto:wps@ama-assn.org" rel="nofollow">Email the AMA-WPS</a> to join this committee or obtain more information. In preparation for the upcoming 2016 AMA Interim Meeting, the AMA-WPS Policy Committee will convene electronically Aug. 15.<br />  </li> <li> The AMA-WPS Handbook Review Committee will convene prior to each business meeting of the section to review items of business that are referred to each AMA House of Delegates reference committee. Interested individuals should <a href="mailto:wps@ama-assn.org" rel="nofollow">email the AMA-WPS</a> by Sept. 30 to review items for the 2016 AMA Interim Meeting.</li> </ul> <p> The deadline to submit resolutions for consideration at the 2016 AMA-WPS Interim Meeting is Aug. 30. <a href="mailto:wps@ama-assn.org" rel="nofollow">Email the section</a> to submit a resolution or ask a question. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c61621cd-3555-441d-9adf-a348f060b927 Show appreciation to someone who’s made a difference in your professional life http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_show-appreciation-someone-whos-made-difference-professional-life Fri, 01 Jul 2016 14:02:00 GMT <p> Acknowledge the people who have made a difference in your professional life by nominating them to be a part of the AMA Women Physicians Section (WPS) <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/women-physicians-section/physician-mentor-recognition-form.page" target="_self">Inspirational Physician Recognition Program</a>.</p> <p> As a member of the AMA-WPS, you are invited to tell us about a professional colleague or teacher who has served a special role in your life and career. The individual may have inspired you to greater heights, steered you into a specialty you love, helped you find balance in life and work, guided you through your professional society, challenged you to surprise yourself, or unknowingly served as a role model for you and others.</p> <p> All nominees will be issued a special certificate and recognized during Women in Medicine Month this September. Nominations forms are due July 31.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:337c2df0-65bd-4d70-8020-bbc50324cd12 Apply by July 31: Joan F. Giambalvo Fund for the Advancement of Women http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_apply-july-31-joan-f-giambalvo-fund-advancement-of-women Fri, 01 Jul 2016 14:01:00 GMT <p> The <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/joan-f-giambalvo.page" target="_self">Joan F. Giambalvo Fund for the Advancement of Women</a> was established by the AMA Women Physicians Section and the AMA Foundation with the goal of promoting women in the medical profession and strengthening the ability of the AMA to identify and address the needs of women physicians and medical students.</p> <p> Recent topics have included empathy and burnout among emergency medicine residents; reproductive barriers and outcomes among female medical students and trainees; flexible work options; and promotion and retention of diversity in medical education. Applications for the 2016 program are due July 31 at 6 p.m. Eastern time.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:bb6fc909-3d06-4a34-8cc4-da10341e4581 Showcase your research: Abstracts due Aug. 17 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_showcase-research-abstracts-due-aug-17 Fri, 01 Jul 2016 14:00:00 GMT <p> Medical students, residents and international medical graduates (IMG) who are ECFMG-certified awaiting residency have the opportunity to showcase their research at the 14th annual AMA Research Symposium Nov. 11 in Orlando.</p> <p> If you are an ECFMG-certified candidate awaiting residency, you are invited to submit your research in one of the following categories:</p> <ul> <li> Clinical vignette</li> <li> Clinical medicine</li> <li> Improving health outcomes (cardiovascular disease and/or diabetes)</li> </ul> <p> Visit the <a href="http://www.ama-assn.org/go/researchsymposium" target="_self">Research Symposium web page</a> to review the Symposium guidelines.</p> <p> Don’t lose the opportunity to win a prize or be featured in this national research event. <a href="https://apps.ama-assn.org/mtgregcvent/register/search?ECODE=%20564630ed-e807-4ec4-b1ca-2132e052fd7e" target="_self">Register and submit your abstract</a> by Aug. 17. View the symposium guidelines on the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/news-events/research-symposium.page" target="_self">event web page</a>.</p> <p> <strong>Are you interested in judging?</strong> <a href="mailto:researchsymposium@ama-assn.org" rel="nofollow">Send us an email</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:bcaad22f-637d-48b1-a66f-28d915ff9100 Don’t miss the CPT® and RBRVS 2017 Annual Symposium http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_dont-miss-cpt-rbrvs-2017-annual-symposium Fri, 01 Jul 2016 14:00:00 GMT <p> 2017 brings changes to the CPT® code set and Medicare’s Resource-Based Relative Value Scale (RBRVS). Face these changes head on by attending the CPT and RBRVS 2017 Annual Symposium, Nov. 16-18 in Chicago.</p> <p> The <a href="https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod1290056&navAction=push" target="_blank">2017 CPT® and RBRVS Annual Symposium</a> will feature discussions of the many significant changes to CPT® 2017 codes and descriptors, as well as payment policy and RBRVS changes to the Medicare physician fee schedule.</p> <ul> <li> Experts on CPT®, RBRVS and Medicare payment policy will present. They include representatives from:</li> <li> CPT® Advisory Committee</li> <li> CPT® Editorial Panel</li> <li> AMA/Specialty Society Relative Value Scale Update Committee (RUC)</li> <li> Centers for Medicare & Medicaid Services (CMS)</li> <li> Medicare contractors</li> </ul> <p> <a href="http://www.cvent.com/events/cpt-and-rbrvs-2017-annual-symposium/event-summary-6cc1b6d63d0b45e69ee435185d31d051.aspx" target="_blank" rel="nofollow">Register now</a> to attend in November. A special $150 discount is available until Sept. 30 for AMA members, CPT® and RUC advisers or staff, past AMA symposia attendees, CPT® licensees, and AAPC, AHIMA and PAHCOM members.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e7984932-f897-4aff-892b-8f188eb76b7b Becoming a master in med school takes on new meaning http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_becoming-master-med-school-takes-new-meaning Thu, 30 Jun 2016 19:00:00 GMT <p> Tackling a master’s degree during medical school—usually in public health or business—has become increasingly popular among students as they prepare for the rigors of the profession. Many schools now are focused on developing a mastery of learning that is essential for physicians’ entire careers—but it doesn’t involve an additional degree.</p> <p> The AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page"><u>Accelerating Change in Medical Education Consortium</u></a>—working to modernize and reshape the way physicians are trained—brings schools together to share ideas and experiences with new programs designed to improve competency, leadership and patient care through innovations that prepare students to thrive in an evolving care delivery system. A priority area for many of the schools is training students to become lifelong learners, also known as “master adaptive learners.”</p> <p> <strong>Pathways at Harvard</strong></p> <p> Harvard Medical School, which joined the consortium this year, created the Pathways Curriculum and implemented it in August 2015. The program aims to create master adaptive leaners who are self-directed, reflective, curious, cognitively flexible, and capable of embracing uncertainty and dealing with complexity.</p> <p> To foster that, the school has moved to a 14-month pre-clerkship curriculum and then returns students to integrated classroom/clinical experiences after their core clerkships. Among other changes, three Professional Development Weeks provide students with feedback about their evolving skills, and students meet regularly with their advisers to work on individualized plans to guide their development.</p> <p> “There is a great emphasis on self-directed learning … we want people to be motived by learning and growing, not just studying for what they are being tested on,” said Edward Krupat, PhD, director of Harvard Medical School’s Center for Evaluation and an associate professor of psychology in the Department of Psychiatry at the Beth Israel Deaconess Medical Center.</p> <p> Harvard Medical School leaders also are trying to change the culture so students understand that there are shades of gray in medicine and will be willing to say that they don’t know something, Krupat said.</p> <p> <strong>Translational learning in North Carolina</strong></p> <p> The University of North Carolina School of Medicine, which also joined the consortium this year, is in its second year of Translational Education at Carolina (TEC), a change that has the school expanding the ways in which it develops students’ physician leadership skills. As part of the changes, UNC will now tap into the university’s public health and population science and business school talents.</p> <p> The TEC program is built on three threads: the translation of medical science to the care of people, patients and populations. It also now will include a professional development thread that will be woven throughout the four years of medical school. Students will become more familiar with the health care system and how it is financed and become familiar with business terms, such as value-based purchasing.</p> <p> Physicians will need to focus on populations instead of just the patients, said Julie Byerley, MD, vice dean for education at the University of North Carolina School of Medicine. It also demands that physicians work in teams and recognize their unique role on the team.</p> <p> “Medicine is always changing, but the pace of change in health care right now is incredibly rapid,” Dr. Byerley said. “We want our graduates to take care of the patients in front of them with the goal in mind of taking care of the entire population.”</p> <p> <strong>Technology in Texas</strong></p> <p> The University of Texas Rio Grande Valley School of Medicine (UTRGV SOM) in Edinburg, Texas, another school that joined the consortium in 2016, will use technology to support communication and empathetic interactions with patients in diverse groups and in multiple settings for numerous preventive health, health maintenance and health care delivery purposes.</p> <p> “The aspects of the UTRGV SOM curriculum that we are most excited about in terms of facilitating the students to becoming master adaptive learners are the structured and guided opportunities threaded throughout the curriculum for reflection and self-directed, independent learning so that the students become competent, self-aware lifelong learners with an interest in and skills to work with underserved populations,” said Arden D. Dingle, MD, psychiatry professor and UTRGV SOM’s chief of child and adolescent psychiatry, and Valerie Terry, PhD, instructional development designer and communication discipline coordinator at UTRGV SOM.</p> <p> The school, which matriculated its inaugural class of 55 students in June 2016, is in the Lower Rio Grande Valley. The region shares its southern border with Mexico, and much of the population lacks access to quality, affordable health care. The medical school’s curriculum features problem/case-based learning and hands-on experiences that incorporate information and approaches that are relevant to working with underserved populations.</p> <p> “Due to the different cultural background of this large population, we are engaging students with family ties and similar socioeconomic backgrounds as well as cultural traditions who  would want to stay long term in the Rio Grande Valley,” Francisco Fernandez, MD, the school of medicine’s dean wrote in a letter to the consortium.</p> <p> <strong>Curriculum 2.0 at Vanderbilt</strong></p> <p> Leaders at Vanderbilt University School of Medicine, one of the 11 founding members of the consortium in 2013, said they have benefited from participating in the consortium. Among the changes they have accomplished:</p> <ul> <li> Attention to all domains from the first day</li> <li> Standardized milestones across settings</li> <li> A portfolio coach for each student</li> <li> Systems-oriented activities in clerkships</li> <li> Population health and advocacy</li> </ul> <p> Improving student perceptions of competency-based assessment, practical applications of the master adaptive learner construct and connecting personalized learning goals to daily work are among the areas Vanderbilt medical school leaders are now working to change.</p> <p> <strong>Other consortium projects</strong></p> <p> The 32 consortium schools are also changing other ways medical students study, including <a href="http://www.ama-assn.org/ama/ama-wire/post/4-ways-schools-paving-new-path-residency" target="_self">paving a new path to residency</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/michigan-relaying-student-competency-residency-programs" target="_self">relaying student competency to residency programs</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/one-school-training-students-rural-medicine" target="_self">training students for rural medicine</a>. You also can read about what <a href="http://www.ama-assn.org/ama/ama-wire/post/students-forefront-of-transforming-med-ed" target="_self">students at the forefront of transforming med ed</a> have to say about their experiences.</p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8e959e28-3984-4146-8593-439e2590b168 Nonclinical careers: Insights from Rep. Tom Price, MD http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_nonclinical-careers-insights-rep-tom-price-md Wed, 29 Jun 2016 22:13:00 GMT <p> As you complete your medical training and advance in your career as a physician, do you ever wonder where your career might take you beyond the exam room? In this new mini-series, we’re getting a glimpse of the jobs some physicians take on to support health care in the United States through nonclinical means.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/0/b8d2efb6-c0ec-4d57-90c3-e40428ba22d0.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/0/b8d2efb6-c0ec-4d57-90c3-e40428ba22d0.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Rep. Tom Price, MD, was first elected to represent Georgia’s 6th district in November 2004. Prior to going to Washington, Dr. Price served four terms in the Georgia State Senate, including two terms as minority whip and one term as majority leader. Dr. Price worked in private practice as an orthopaedic surgeon for nearly 20 years. </p> <p style="margin-left:40px;"> <strong>1.   </strong><strong>What led you to run for public office?</strong><br /> This was never my grand plan. However, at some point early in my career, I recognized that there were a whole lot of people in our state capitol and in Washington who were making decisions about what I could do for and with my patients who never practiced medicine or took care of a patient. That knowledge, and the concerns of my patients, led me into public service. These were non-medical people making medical decisions, and I thought that was not appropriate or needed. </p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>How did your clinical background equip you to take on your role as a member of Congress?</strong><br /> The expertise and training we undergo as physicians, I believe, is ideally suited to public service. In the political arena, folks are most interested in someone who listens and appreciates the big picture. If that doesn’t describe doctors, I don’t know what does. Our challenge is to bring the scientific method of problem solving to the public service arena. We’d all be better off.</p> <p style="margin-left:40px;"> <strong>3.   </strong><strong>What do you find the most rewarding about being a member of Congress? What have you found the most challenging or surprising?</strong><br /> Being able to participate in solving, and have an opportunity to help move, big problems is a remarkable privilege. There are so many challenges confronting us as a nation. Working with colleagues from different parts of the country with unique and diverse points of view is tremendously rewarding. One of the more challenging aspects of this job is the patience that’s required when it comes to getting real solutions enacted. The legislative process, by design, can be laboriously extended, even when folks are in general agreement on how to proceed. That took some getting used to after coming from a profession where quite often, by necessity, decisions are made quickly and a treatment plan is put into action shortly after the patient comes through the door.</p> <p style="margin-left:40px;"> <strong>4.   </strong><strong>What advice would you give medical residents and young physicians who are interested in running for public office in the future?</strong><br /> Find your passion in medicine and pursue it. There is no greater honor or joy that one could ever gain in life than in caring for one's fellow man. If public service calls you, plant yourself firmly in a community and pour yourself into the issues that confront folks locally every day. Then, and only then, will you be able to feel the personal concerns and frustrations of your fellow citizens—and then, and only then, will you be able to gain their trust to have them consider you as a person who might possibly be able to represent their interests at any level. I’d be more than pleased to discuss any one individual’s personal goals with them as we move forward.  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ac681391-0447-47c5-90ff-b133ad29f2b2 36 med students, young physicians recognized as future leaders http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_36-med-students-young-physicians-recognized-future-leaders Wed, 29 Jun 2016 22:10:00 GMT <p> Three dozen students, residents and early career physicians from around the country are being recognized for their commitment to reducing health care disparities and their non-clinical leadership in advocacy, community service and education. Find out who has been awarded this year’s honors.</p> <p> <strong>Minority med students receive equity honors</strong></p> <p> Growing up, Aaron Doctor had a front-row view of the barriers to health care.</p> <p> The Gullah Sea Islands off the coast of South Carolina are among the nation’s most remote and insular communities. Daily life offered Doctor a range of lessons on coping with a lack of care.</p> <p> “Often people who are from communities like mine are mistrusting of people that they deem as outsiders, and that’s where I come in,” said Doctor, a student at Morehouse School of Medicine. “A familiar face goes a long way to creating the comfort necessary to build a successful relationship.”</p> <p> “I’m motivated because I’m a product of a community where social inequality and health disparities are a very real concern,” he said.</p> <p> That motivation makes Doctor one of this year’s recipients of the <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/medical-education/minority-scholars-award.page" target="_self">Minority Scholars Award</a>, part of the AMA Foundation’s <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/excellence-medicine-awards.page" target="_self">Excellence in Medicine</a> program. The award provides $10,000 scholarships to first- and second-year students who show academic achievement and a commitment to reducing health care disparities.</p> <p> Scholarship recipients were honored June 10 in Chicago at the 2016 AMA Annual Meeting.</p> <p> The 21 recipients this year come from groups historically underrepresented in the medical profession, including African-American, American Indian, Native Hawaiian, Alaska Native and Latino. Less than 9 percent of U.S. physicians come from these groups.</p> <p> Since 2014, one student also has been honored by a scholarship to promote diversity specifically in cardiology. The Dr. Richard Allen Williams and Genita Evangelista Johnson /Association of Black Cardiologists Scholarship recognizes a first- or second-year African-American student with an expressed interest in cardiology.</p> <p> This year’s Minority Scholars Award list includes students from schools throughout the nation, with a range of cultural experiences:</p> <ul> <li> Jemma Alarcon, University of California, Irvine School of Medicine</li> <li> Anya Bazzell, Morehouse School of Medicine</li> <li> Shakira Burton, Drexel University College of Medicine</li> <li> Amanda Compadre, the University of Arkansas for Medical Sciences</li> <li> Elizabeth Dalchand, Stony Brook University School of Medicine</li> <li> Aaron Doctor, Morehouse School of Medicine</li> <li> Mariana Gomez, University of California, Irvine School of Medicine</li> <li> Gerard Holder, Alabama College of Osteopathic Medicine</li> <li> Maseray Kamara, Michigan State College of Human Medicine</li> <li> Bianca Lizarraga, David Geffen School of Medicine at UCLA</li> <li> Joana Loeza, University of California, San Francisco</li> <li> Mariela Martinez, Ponce Health Sciences University</li> <li> Ana Ortiz Ilizaliturri, University of California, San Diego School of Medicine</li> <li> Maricruz Rivera, Case Western Reserve University School of Medicine</li> <li> Nancy Rodriguez, University of California, Davis School of Medicine</li> <li> Zena Salim, Michigan State College of Human Medicine</li> <li> Javier Sotelo, Jr., Keck School of Medicine of University of Southern California</li> <li> Ashley White-Stern, Columbia College of Physicians and Surgeons</li> <li> Kelsey Williams, University of South Carolina School of Medicine, Greenville</li> <li> Shannon Zullo, University of Arizona, College of Medicine</li> <li> Paris Austell, Rush Medical College (recipient of the Dr. Richard Allen Williams and Genita Evangelista Johnson /Association of Black Cardiologists Scholarship)</li> </ul> <p> <strong>Future community and medical leaders selected</strong></p> <p> Also honored this year were 15 medical students, residents, fellows and early career physicians who received the AMA Foundation’s Leadership Award.</p> <p> Recipients are recognized for outstanding non-clinical leadership in advocacy, community service and education. The award provides recipients from around the country with training to develop their skills as future leaders in medicine and community affairs.</p> <p> The winners are:</p> <ul> <li> Annalise O. Abiodun, MD, Greater Baltimore Medical Center</li> <li> Rohit Abraham, Michigan State University College of Medicine</li> <li> Eric James Chow, MD, Brown University</li> <li> Anupriya Dayal, Medical College of Wisconsin-Milwaukee</li> <li> Olatokunbo Famakinwa, MD, Yale-New Haven Hospital</li> <li> Cherie Fathy, Vanderbilt University School of Medicine</li> <li> Oswaldo Hasbún Avalos, Columbia University College of Physicians and Surgeons</li> <li> Leedor Lieberman, Wayne State University School of Medicine</li> <li> David A. Nissan, MD, New York-Presbyterian Hospital/Weill Cornell Medical Center</li> <li> Ravi Bharat Parikh, MD, Brigham and Women’s Hospital</li> <li> Hunter Pattison, University of Florida College of Medicine</li> <li> Christa Pulvino, Tulane University School of Medicine</li> <li> Nikita Saxena, Boston University School of Medicine</li> <li> Aleesha Shaik, Drexel University College of Medicine</li> <li> Christiana Shoushtari, University of Illinois-Chicago, College of Medicine</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9c61f143-6434-4b1b-928f-aa0c75c418db Nonclinical careers: What it’s like working at the FDA http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_nonclinical-careers-its-like-working-fda Wed, 29 Jun 2016 22:04:00 GMT <p> As you complete your medical training and advance in your career as a physician, do you ever wonder about career options outside the exam room? In this new mini-series, we’re getting a glimpse of the jobs some physicians take on to support health care in the United States through nonclinical means.</p> <p> Here’s a look into the work of John Whyte, MD, director of professional affairs and stakeholder engagement at the U.S. Food and Drug Administration (FDA). Dr. Whyte completed his medical training in internal medicine and also holds a Master of Public Health.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/0/da46c298-1d87-4cc7-90fa-b805d244bd39.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/0/da46c298-1d87-4cc7-90fa-b805d244bd39.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>What are your main responsibilities in your current role?</strong></p> <p> My main responsibilities include improving our stakeholders’ drug regulatory insight and understanding to:</p> <ul> <li> Enrich the experience of patients, advocacy groups, health care professionals and agencies in engaging with the FDA</li> <li> Provide a focal point for advocacy and two-way engagement on drug development, review and safety</li> <li> Enhance safe use of medications and reduce preventable harm from medication misuse, abuse and errors</li> </ul> <p> <strong>How did you get into this position?</strong></p> <p> I actually was recruited to the position. It’s a new office at FDA, and they knew of my work communicating health messages at the Discovery Channel.</p> <p> At the Discovery Channel, I was responsible for health documentaries and medical education programs, both on television and online. This experience made me learn how to distill complicated information into a few salient points. I also appreciated how critical it is to engage and even entertain an audience—after all, there’s a reason why Shark Week is so popular!</p> <p> <strong>How did your clinical background equip you to take on this role?</strong></p> <p> Clinical medicine definitely taught me how to multitask. Just like on the wards and in the emergency room, you need to manage multiple issues contemporaneously.</p> <p> <strong>What do you find the most rewarding about your current job?</strong> <strong>What do you find the most challenging or surprising?</strong></p> <p> The ability to change a culture by creating more transparency at a regulatory agency is exciting. The government moves much more slowly, though, than the private sector. And sometimes there are rules and policies that don’t quite seem to make sense.</p> <p> <strong>What advice would you give medical residents who are interested in pursuing a career in your current field?</strong></p> <p> Spend time learning what physicians in government (or in media) really do day-to-day. Search for and ask about participating in four-week internships.</p> <p> <strong>Are there any resources, organizations or networking events you’d suggest for medical residents who are interested in your field?</strong></p> <p> I have found organized medicine (like the AMA) to be one of the most valuable resources. I have been interested in health policy issues since college. Medical school and residency don’t provide you the opportunity to learn about broader policy issues. But being involved with the AMA, state medical societies and specialty groups provides an unparalleled opportunity to learn a whole new discipline separate from clinical medicine.</p> <p> <strong>What advice would you offer to medical residents on how to find a mentor in your profession?</strong></p> <p> Be creative. If the job you want doesn’t exist, think of ways you can create it. Several of my jobs were ones for which I created the role. Reach out and talk to people. Most leaders are interested in talking to residents and students. But be prepared: Come with questions and do some homework on the person from whom you want advice.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:65368e19-5e34-4e42-9b0e-99163d910b9a Take the challenge: Answer this USMLE Step 1 question http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_challenge-answer-this-usmle-step-1-question Tue, 28 Jun 2016 22:02:00 GMT <div> When it comes to taking exams, not all questions are created equal. If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 1 exam, you need this exclusive scoop on one of the most commonly missed USMLE test prep questions. Find out what this month’s challenging question is, and view an expert video explanation of the answer from Kaplan Medical.</div> <div>  </div> <div> Welcome to this month’s installment of the <em>AMA Wire</em>® series, Tutor talk: Tips from Kaplan Medical on the most missed USMLE test prep questions from Kaplan’s Qbank: Step 1. Each month, we’re revealing the top questions physicians in training miss on the USMLE, a helpful analysis of answers and videos featuring tips on how to advance your test-taking strategies. See <a href="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" target="_self">all posts in this series</a>.</div> <div>  </div> <div> Think you have what it takes to rise above your peers? Test your USMLE knowledge below.</div> <div>  </div> <div> Ready. Set. Go.</div> <p style="margin:0in 0in 0.0001pt;background-image:initial;background-attachment:initial;background-size:initial;background-origin:initial;background-clip:initial;background-position:initial;background-repeat:initial;">  </p> <p style="margin:0in 0in 0.0001pt;background-image:initial;background-attachment:initial;background-size:initial;background-origin:initial;background-clip:initial;background-position:initial;background-repeat:initial;"> <strong>This month’s question that stumped most students:</strong></p> <p> A 66-year-old man is brought to the emergency department after recent discharge following a Whipple’s procedure for pancreatic cancer performed seven days prior. He has a six-hour history of worsening shortness of breath and sudden onset chest pain. He is given oxygen supplementation, which moderately improves his saturation. A contrast-enhanced CT scan of the chest is shown. Which of the following is the most likely origin of the abnormality seen on CT?</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/1/3fe51c18-d4aa-4b1e-8125-d3ae4f5cb507.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/1/3fe51c18-d4aa-4b1e-8125-d3ae4f5cb507.Large.jpg?1" style="margin:15px;height:251px;width:350px;" /></a></p> <p> A. Basilic vein<br /> B. Brachial vein<br /> C. Cephalic vein<br /> D. Femoral vein<br /> E. Great saphenous vein<br /> F. Lesser saphenous vein</p> <p> <object data="http://www.youtube.com/v/ENwpm8GRrn0" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/ENwpm8GRrn0" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/ENwpm8GRrn0" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object></p> <p> <strong>The correct answer is D.</strong></p> <p> <strong>Kaplan says, here’s why: </strong></p> <p> The patient most likely has a pulmonary embolism (PE). The large filling defect in the right pulmonary artery and in the superior branch of the left pulmonary artery (see circles in the left image below) in the CT scan support the diagnosis. For comparison, a normal image through the same region is shown on the right.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/9/dd3278ee-2cdf-476e-899e-d67e6bb85f19.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/9/dd3278ee-2cdf-476e-899e-d67e6bb85f19.Full.jpg?1" style="margin:15px;" /></a></p> <p> More than 90 percent of pulmonary emboli originate from the deep veins of the lower limbs. The only deep vein of the lower limb listed in the answer choices is the femoral vein. Venous thromboses can also form more distally in the popliteal vein. The risk of embolism increases as the clot extends proximally.</p> <p> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer.</em></p> <p> <strong>Choices A and C:</strong> The basilic and cephalic veins are two superficial veins of the upper limbs and are the ones most frequently accessed with IV catheters. Virtually the only time you see major clots in the upper extremities is when they contain some sort of catheter.</p> <p> <strong>Choice B:</strong> The brachial vein is the major deep vein of the upper extremities. Venous thromboses can form in the deep veins of the upper extremities but venous thromboembolism much more commonly arises from DVTs in the lower extremities.</p> <p> <strong>Choices E and F:</strong> The great saphenous and lesser saphenous veins are the superficial veins of the lower limbs and do not commonly result in pulmonary embolism. The great saphenous vein is commonly harvested for bypass procedures.</p> <p> <strong>Key tips to remember:</strong></p> <ul> <li> More than 90 percent of pulmonary emboli begin in the deep veins of the lower limbs.</li> <li> Deep vein thromboses of the lower extremities generally form in the popliteal veins and extend proximally.</li> <li> The more proximal the clot, the more likely it is to embolize to the lungs. </li> </ul> <p style="margin:0in 0in 0.0001pt;background-image:initial;background-attachment:initial;background-size:initial;background-origin:initial;background-clip:initial;background-position:initial;background-repeat:initial;">  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1ae75718-87c0-488d-bf34-2c09efad9593 Pain expert: Judge the opioid treatment, not the patient http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_pain-expert-judge-opioid-treatment-not-patient Tue, 28 Jun 2016 21:05:00 GMT <p> With medications that carry significant risks, such as opioids, appropriate prescribing practices are critical to patient safety. One physician in Boston lives by a mantra that puts patients first: Judge the treatment, not the patient.</p> <p> We need to start re-conceptualizing chronic pain as a chronic disease, said Daniel P. Alford, MD, associate professor of medicine at the Boston University School of Medicine and director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program.</p> <p> “Acute pain is a symptom, and it’s life-sustaining—and you need to feel acute pain in order to survive,” Dr. Alford said. But “there is no advantage to chronic pain. Chronic pain really is a malfunctioning of the nervous system and requires, like other chronic diseases, a multimodal approach.”</p> <p> <strong>Assessing whether opioids are the appropriate course of treatment</strong></p> <p> Many potential physical, psycho-behavioral, procedural and pharmacologic options exist for managing chronic pain. Dr. Alford follows a process that helps him to make the appropriate clinical judgment regarding whether or not opioids are an appropriate course of treatment for each individual patient:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Determine whether the patient has a pain process that is likely to respond to opioid therapy. </strong>For a lot of chronic pain disorders, opioids are probably not the answer, Dr. Alford said. “For example, chronic migraine headaches, fibromyalgia and back pain … tend to be less opioid responsive, and so I’d be reluctant to start them.”<br /> <br /> For non-cancer chronic pain, opioids are indicated when pain is severe, has significant impact on function and quality of life and other treatments have been inadequate. “When you’ve tried other things and they haven’t been successful,” he said, “a trial with an opioid is appropriate.”</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Prior to prescribing opioids, do a risk assessment. </strong>Attempt to evaluate how risky it might be to prescribe opioids to the individual patient, Dr. Alford said. “There are opioid misuse risk stratification tools … including the opioid risk tool (ORT),” which are intended to classify patients as low, moderate and high risk for opioid misuse.  But you cannot rely on these tools alone because they have not been rigorously tested<br /> <br /> They can help start the  conversation about other known risk factors and predictors for problematic prescription opioids with the patient so that they’re informed about their risk, Dr. Alford said. “[This conversation] also helps you determine how to structure therapy and monitor them for safety—that is, if they’re at higher risk or misusing their opioids, then they need to be monitored more closely.”</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Use universal precautions.</strong> Because no one can predict problematic behavior with absolute certainty, you have to “assume that every single person who’s prescribed opioids carries some risk for misusing that opioid,” Dr. Alford said. “Every one of my patients on chronic opioid therapy gets that initial risk assessment but also needs to be monitored for adherence and misuse.”<br /> <br /> “The frequency of doing all those things,” he said, “is going to be based on your initial and ongoing assessment of their response to therapy, particular risks and behavior.”</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Structuring care and monitoring the patient for safety.</strong> Over time, monitor the patient for adherence using objective information including checking the prescription drug monitoring program (PDMP), urine testing, pill counts and making sure the interval between visits is appropriate. “If the patient is doing well based on pain relief, function and daily activities,” he said, “then I’m going to be less worried about their potential misuse of opioids.”<br /> <br /> At least a 30 percent improvement in pain and function is a reasonable goal.<br /> <br /> “Even if the person appears to be benefitting,” he said, “if you start to get a sense that they are misusing the opioid—that is, loss of control, compulsive use, continued use despite harm, they keep running out early, showing up in the emergency room, calling the on-call service, or they become so focused on the drug they can’t even imagine doing anything else for their pain, or they’re having some negative consequences from the opioid but still want more—I would probably end up tapering that opioid because I just feel that it’s too unsafe.”<br /> <br /> “These are all very difficult decisions to be made,” he said. </p> <p style="margin-left:40px;"> <strong>5.  </strong><strong>Prescribing opioids for chronic pain at the lowest dose possible. </strong>Dr. Alford said you should initiate therapy in a way that the patient understands that it is a test or a trial to see whether or not they will benefit from the treatment.<br /> <br /> “If they’re not benefitting, then they may be in the portion of patients who are never going to benefit from an opioid because their pain is just not responsive to opioids” and the risks are too high, he said. “If they are responding, that’s encouraging—but I’m going to be very reluctant to increase the dose.”<br /> <br /> As you increase the dose, the risk for overdose and other complications increases, Dr. Alford said. “If the patient is benefitting on the opioid, I want to try to maintain them on the lowest dose possible … keeping in mind that [with chronic pain] like other chronic diseases, I want to try to [use] other therapies concurrent to it, whether it be other medications, using rational polypharmacy or other non-pharmacological treatments like acupuncture, behavioral and physical treatments.”</p> <p> <strong>Judge the treatment not the patient</strong></p> <p> Conceptually, treating chronic pain with opioids has to be viewed through the same lens as treating any other chronic disease with any other medication, Dr. Alford said. “That is, when I put someone on an antihypertensive for their blood pressure, I’m judging whether or not the treatment is working by measuring the person’s blood pressure and checking for adverse effects.”</p> <p> “If it isn’t working, I’m not blaming the patient, saying this medication should work, but that patient is a bad person; they can’t take it right,” he said. “I’m judging the treatment both from a benefit and risk perspective.”</p> <p> “Apply the same thing to opioids for pain,” he recommends. “Are the opioids helping the patient more than they’re hurting the patient? If that’s not the case, if I can’t be satisfied that the person is benefitting more than being harmed, then the treatment has failed—not the patient. … And it’s time to consider something else.”</p> <p> “We need to put our clinician cap on and avoid becoming a police officer, or a DEA agent or a judge when it comes to opioids and chronic pain,” Dr. Alford said. “Chronic pain is a chronic disease, and opioids are one tool that benefits some patients but carries a whole lot of risk. And we should just treat it that way.”</p> <p> Naloxone also can be a way to <a href="http://www.ama-assn.org/ama/ama-wire/post/antidote-3-things-consider-co-prescribing-naloxone" target="_self">start the broader conversation about the risks</a> that opioid medications carry without contributing to the stigma that surrounds overdose and substance use disorders.</p> <p> <strong>For more on treating patients with chronic pain using opioid therapy treatment:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/talk-substance-use-disorders-patients" target="_self">How to talk about substance use disorders with your patients</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-steps-talking-patients-substance-use-disorder" target="_self">3 steps for talking with patients about substance use disorder</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-team-up-treat-addiction-rural-areas" target="_self">Physicians team up to treat addiction in rural areas</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-things-physician-should-treating-pain" target="_self">3 things every physician should do when treating pain</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d910d54c-3620-4468-a53b-d9bed051a003 This month’s toughest USMLE Step 2 question to master http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_this-months-toughest-usmle-step-2-question-master Tue, 28 Jun 2016 20:59:00 GMT <p> Getting ready for the United States Medical Licensing Examination® (USMLE®) Step 2 is no easy feat, but we’re sharing expert insights to help give you a leg up. Take a look at the exclusive scoop on this month’s most-missed USMLE Step 2 test prep question. Think you have what it takes to rise above your peers? Test your USMLE knowledge, and view an expert video explanation of the answer from Kaplan Medical.</p> <p> Once you’ve got this question under your belt, be sure to test your knowledge with <a href="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" target="_self">other posts in this series</a>.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong></p> <p> A 70-year-old woman presents to her primary care physician with diarrhea. She describes watery stools associated with abdominal cramping for the last week. There has been no fever, nausea, or vomiting. She was hospitalized 1 month ago for community-acquired pneumonia, which was treated with ceftriaxone and azithromycin. She also has a history of watery diarrhea with abdominal cramps when she consumes milk products. Physical examination reveals lower abdominal tenderness. The initial laboratory evaluation of stool is significant for the presence of fecal leukocytes. Which of the following is the most useful step in diagnosing this patient?</p> <p style="margin-left:40px;"> <strong>A. </strong> Avoiding milk products</p> <p style="margin-left:40px;"> <strong>B.  </strong>Colonoscopy with biopsy</p> <p style="margin-left:40px;"> <strong>C.  </strong>Stool <em>C. difficile</em> cytotoxic assay</p> <p style="margin-left:40px;"> <strong>D. </strong> Trial of loperamide</p> <p style="margin-left:40px;"> <strong>E.  </strong>Trial of metronidazole</p> <p>  </p> <p> <object data="http://www.youtube.com/v/gH9qgijQclU?list=PL5PtfrifXVhS2U6BflV9KKmfolL1x_qEc" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/gH9qgijQclU?list=PL5PtfrifXVhS2U6BflV9KKmfolL1x_qEc" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/gH9qgijQclU?list=PL5PtfrifXVhS2U6BflV9KKmfolL1x_qEc" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowFullScreen" value="true" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object></p> <p>  </p> <p>  </p> <p> <strong>The correct answer is C.</strong></p> <p> <strong>Kaplan says, here’s why: </strong><br /> This patient has findings suggestive of <em>C. difficile</em>-associated diarrhea, which is characterized by loose, watery stools plus fecal leukocytosis and abdominal cramping several weeks after treatment with antibiotics. A cytotoxin tissue culture assay is used to show the presence of the toxin and is the most useful test in establishing the diagnosis of <em>C. difficile</em> colitis. Enzyme-linked immunoassays can also be done.</p> <p> Treatment includes stopping the offending antibiotic and initiating metronidazole. Vancomycin is indicated in severe disease or after more than two treatment courses with metronidazole (i.e., on the third recurrent episode of <em>C. difficile</em> colitis).</p> <p> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer.</em></p> <p> <strong>Choice A:</strong> Avoiding milk products is useful in diagnosing lactose intolerance. This patient’s history suggests that she has suffered from lactose intolerance in the past (which presents in a similar fashion), but the recent use of antibiotics and the fecal leukocytosis suggest that the cause of this patient’s watery diarrhea is <em>C. difficile</em> infection rather than lactose intolerance, which is simply an osmotic diarrhea.</p> <p> <strong>Choice B:</strong> Colonoscopy with biopsy may show pseudomembranes, which, combined with the history of diarrhea after recent antibiotic use, is virtually pathognomonic for <em>C. difficile</em> infection. However, sigmoidoscopy and colonoscopy are not generally recommended in patients with classic clinical findings and a positive stool toxin assay. In some patients, when there is a doubt about diagnosis or when it is crucial that a diagnosis be established quickly (the results of toxin assays take a longer time), colonoscopy with biopsy proves extremely useful.</p> <p> <strong>Choice E:</strong> A trial of metronidazole is not the correct option. Metronidazole is the first-line therapy for <em>C. difficile </em>colitis after the diagnosis is established with positive stool assay for cytotoxins. Empiric therapy with metronidazole is indicated if the initial diagnostic assay is negative and clinical suspicion is high.</p> <p> <strong>Choice D:</strong> Antimotility agents such as loperamide are contraindicated because they may predispose the development of toxic megacolon in patients with pseudomembranous colitis.</p> <p> <strong>One tip to remember:</strong></p> <p> When <em>C. difficile </em>colitis (watery diarrhea, abdominal cramps, recent antibiotic use, fecal leukocytosis) is suspected, the first step in management is stool assay for cytotoxins. With a positive assay, metronidazole is the initial treatment of choice.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ec9b72a2-d04d-4831-973a-40ff098d5dd9 Key changes the new Medicare payment system needs http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_key-changes-new-medicare-payment-system-needs Mon, 27 Jun 2016 20:22:00 GMT <p> Physicians have submitted <a href="https://download.ama-assn.org/resources/doc/washington/ama-macra-comments-27june2016.pdf" target="_self">comments</a> to the Centers for Medicare & Medicaid Services (CMS), detailing the changes that need to be made to the <a href="http://www.ama-assn.org/ama/ama-wire/post/draft-regulations-outline-next-phase-of-medicare" target="_self">draft rule</a> for the new Medicare payment system so it works for physicians and their patients.</p> <p> The AMA is urging changes across the reformed program as well as revisions that are specific to the Merit-based Incentive Payment System (MIPS) and the alternative payment model (APM) option.</p> <p> Three of the overarching program recommendations call on CMS to:</p> <ul> <li> Create a transitional reporting period in the first year, beginning July 1, to allow sufficient time to prepare physicians and have a successful launch of the new payment system.</li> <li> Provide more flexibility for solo physicians and small group practices, such as modifying the low volume threshold, lowering reporting burdens, comparing practices to their peers, and providing education, training and technical assistance to these practices.</li> <li> Provide physicians with more timely and actionable feedback in a more usable and clear format.</li> </ul> <p> <strong>Changes needed to improve the MIPS</strong></p> <p> The comments outline several key recommendations regarding the MIPS, which currently is separated into four components. The comments ask CMS to:</p> <ul> <li> Align the different components so the MIPS operates as a single program, rather than four separate parts.</li> <li> Further simplify reporting burdens by creating more opportunities for partial credit and reducing the number of required measures.</li> <li> Maintain the thresholds for reporting on quality measures at 50 percent.</li> <li> Replace current cost-of-care measures that were developed for hospital-level measurement and refine new episode-of-care measures prior to widespread adoption.</li> <li> Remove the pass-fail component of the Advancing Care Information score and restructure the electronic health record performance measures rather than folding the current Meaningful Use Stage 3 requirements into the MIPS.</li> <li> Improve risk adjustment and attribution methods before moving forward with the resource use category, and reduce the number of required Clinical Practice Improvement Activities.</li> </ul> <p> <strong>Changes needed to improve the advanced APMs option</strong></p> <p> The MIPS is a revised fee-for-service model that most physicians will participate in initially. But the program allows for an alternative course through APMs that may work better for some practice types.</p> <p> Physicians detailed several ways the APM option could be improved, including:</p> <ul> <li> Simplify and lower financial risk standards for advanced APMs, and base the risk requirements on physicians’ Medicare revenues instead of total Medicare expenditures.</li> <li> Provide more opportunities for APM participation.</li> </ul> <p> <strong>Physician organizations submit collective recommendations</strong></p> <p> More than 110 state medical associations and national medical specialty societies joined the AMA in a <a href="https://download.ama-assn.org/resources/doc/washington/macra-state-speciality-sign-on-letter.pdf">sign-on letter</a> to CMS that called for simplification, an easier APM pathway, and accommodations for physicians in small and rural practices.</p> <p> “The overall goal in MIPS should be to create a more unified reporting program with greater choice and fewer requirements,” the letter said. “While we see several positive changes in the proposed rule, our main concern is that CMS continues to view the four components as separate programs, each with distinct measures, scoring methodologies and requirements.”</p> <p> Physicians identified in the letter several of the positive MIPS proposals that should be finalized, including reporting quality information through a variety of methods, such as electronic health records (EHR), clinical registry, qualified clinical data registry (QCDR) and group practice reporting.</p> <p> <strong>Resources to prepare for the new Medicare payment systems</strong></p> <p> The AMA offers an <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-physician-payment-reform.page" target="_self">action kit and other resources</a> to help your practice get ready for the upcoming transition and learn more about the new Medicare payment system.</p> <p> The AMA’s STEPS Forward™ collection of practice improvement initiatives provides a step-by-step process to help you <a href="https://www.stepsforward.org/modules/value-based-care" rel="nofollow" target="_blank">prepare your practice for value-based care</a>. </p> <p> Also, <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-guiding-new-payment-system-cms-chief-says" target="_self">read what CMS Acting Administrator Andy Slavitt</a> had to say in his address at the 2016 AMA Annual Meeting, and <a href="https://reachmd.com/programs/focus-on-public-health-policy/future-medicare-payment-reform-perspectives-macra-cmss-andy-slavitt/8179/" rel="nofollow" target="_blank">listen to a ReachMD podcast interview</a> with Slavitt on how physician input is driving the new Medicare payment system.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:6a0111a5-d8f6-4bed-9fd1-b322b438be31 How to talk to Congress about the issues http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_talk-congress-issues Fri, 24 Jun 2016 20:34:00 GMT <p> Members of Congress will be heading home in a few weeks for summer recess to meet with their constituents—now’s the time to make sure you get a seat at the table to make sure your legislators are well-informed on the issues that you care about. Learn from an expert how to conduct in-person visits with legislators and how to keep that relationship going.</p> <p> Jim Wilson, PhD, manager of the AMA’s political education programs including the popular <a href="http://www.ampaconline.org/" target="_blank" rel="nofollow">AMPAC</a> Candidate Workshop and AMPAC Campaign School, recently spoke about advocating for health care issues during a session at the 2016 AMA Annual Meeting.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/6/8dcdde29-11e9-4e24-a61c-5969af1014ef.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/6/8dcdde29-11e9-4e24-a61c-5969af1014ef.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>You are the best advocate for your patients—and yourself</strong></p> <p> “There are a whole lot of people who don’t have anywhere near the training you [do],” Wilson said. “Yet they help drive decisions that determine how you do” your work.</p> <p> “No one else is going to be able to do this for you,” he said. “You’re the best possible advocate that you can have.” So what do you do when you want a member of Congress or a state legislator to vote for or against a bill that you feel strongly about?</p> <p> Figure out a way to engage legislators on a year-round basis, Wilson said. “It’s important that when you want them to do something, you’re not only there when <em>you</em> need something. Because then they say, ‘Well, they only call me when they want me to do something, but I had a question about loan policy three months ago, and I emailed them and I never heard back.’”</p> <p> “It’s easy to get cynical about politics,” Wilson said. “Think about it in a different way.” Try to have a symbiotic relationship with them: They need information on health care policy, and you need help with legislation.</p> <p> “Keep in mind that your elected representatives expect this of different groups,” Wilson said. “If you’re not in the office, the drug company will be, the insurance company will be …. It’s a representative democracy; you have a right to petition the government for grievances, and if you’re not petitioning for grievances, somebody else will be.”</p> <p> In a survey conducted by the <a href="http://www.congressfoundation.org/" target="_blank" rel="nofollow">Congressional Management Foundation</a>, senators’ and representatives’ offices were asked how much influence certain activities have on their decision making. The No. 1 influence was in-person visits from constituents.</p> <p> “They expect you to be there,” Wilson said. “They expect to hear from you …. When you’re personally taking the time to visit your representative, you’re making a difference.”</p> <p> <strong>How to be better at advocacy “asks”</strong></p> <p> When you prepare for a meeting—whether it’s in Washington or your state capitol or even the county commissioner’s office—take time to better understand who your lawmaker is, Wilson said.</p> <p> To better understand your legislator, pay attention to these four things:</p> <ul> <li> <strong>Interests. </strong>They might be a business professional, a physician, a nurse, a software engineer or a farmer, Wilson said. “Is there any way you can find an intersection between what they know and care about as a legislator and what you know and care about in terms of health care policy?”<br /> <br /> “What are they doing in their regular life?” he said. “What are they interested in, or what are they working on? Can you make your ask relevant to them?</li> </ul> <ul> <li> <strong>Leadership.</strong> “Keep in mind if they’re in leadership, whatever party … if they’re the minority leader or the majority leader or a whip, their interests are a little different,” he said. “If there’s legislation out there, they have an interest in either getting it passed or holding it up. Can you get on the right side of that?”<br /> <br /> “If they’re in leadership, they know the issues,” he said. “You have to give them a reason why to vote yes and not hold up the bill or vote no.”</li> </ul> <ul> <li> <strong>Committees.</strong> “What committees are they on?” Wilson said. “Are they on an education committee? You might have to educate them a little bit more about health care policy. If they’re on a health committee, they’re probably going to be pretty conversant with the issues already, and you might take a different tactic with them.”</li> </ul> <ul> <li> <strong>Positions taken.</strong> “Sometimes people go into a meeting to lobby somebody, and they don’t realize that [they] have already taken a position on the bill,” Wilson said. Don’t waste your time if they’ve already made up their mind and stated it publicly. Do your research.</li> </ul> <p> <strong>The visit</strong></p> <p> Once you have done your research and are prepared, it’s time for the visit. But how do you conduct yourself from the moment you enter the office?</p> <ul> <li> <strong>Identify yourself.</strong> “When you go in, quickly introduce yourself,” Wilson said. “Say who you are and where you’re from. Establish that connection right away. Make sure they realize that you are in fact a constituent.”</li> </ul> <ul> <li> <strong>Get right to the point.</strong> “‘I want you to vote this way on this bill,’” Wilson said. “Make it clear, make it simple.” If they have an interest in that issue, explain why it is important to you.</li> </ul> <ul> <li> <strong>Focus on the patient impact.</strong> “When you make that ask,” he said, don’t talk about yourself. Rather, talk about the people who are going to be your patients. “[Legislators] understand what being a patient is because they’ve been a patient.”<br /> <br /> “Make them understand how a particular policy is going to affect the people that you are trying to take care of,” he said. As healers, physicians have an incredible amount of credibility.<br /> <br /> “Once you talk to them in terms of the people you want to take care of,” Wilson said, “They’re going to see your request in a whole different way.” Tell a story about a particular patient or situation that will help them understand the impact on the community.</li> </ul> <ul> <li> <strong>Ask for an answer.</strong> “Get a commitment if you can,” he said. “If they say no, that’s fine … stay in touch.” Leave behind one or two pages on the issue—something you can get from the AMA—that will summarize what your case is and what you want them to do.</li> </ul> <ul> <li> <strong>Express your thanks</strong>. “Don’t forget to say thank you afterwards,” Wilson said. “A written note in this day and age is great, an email is still fine, but make sure that they know that you appreciate that they took time out of their schedules.”</li> </ul> <p> In August, Congress will head home for the annual month-long summer recess during which time lawmakers will be back in their districts holding constituent meetings, listening sessions and town halls. Take the time to learn the issues that you care about and set up a meeting to make those concerns known. Check out AMA resources to learn about <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-physician-payment-reform.page" target="_self">Medicare payment reform</a> or visit <a href="https://savegme.org/" target="_blank" rel="nofollow">SaveGME.org</a> to learn about advocacy efforts regarding student loan debt.</p> <p align="right"> <em>By AMA </em><em>staff writer</em> <a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a9467c29-46de-4d14-b820-549c3edd7b78 Confidential patient safety information threatened in court case http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_confidential-patient-safety-information-threatened-court-case Fri, 24 Jun 2016 20:30:00 GMT <p> An intermediate level appellate court in Florida last year held that patient safety information can be shielded from disclosure in a medical liability case. Now, that same case is on appeal—this time, in the Supreme Court of Florida.</p> <p> <strong>What happened last year</strong></p> <p> In <em>Southern Baptist Hospital of Florida, Inc. v. Charles</em>, a trial court had ordered the release of medical documents used for patient safety and quality improvement efforts as part of litigation discovery. Then, in October of last year, a Florida district court of appeal overturned the trial court’s decision and found that health care information, which was being used for patient safety improvement efforts, was privileged from discovery.</p> <p> The district court of appeal held that the Patient Safety and Quality Improvement Act of 2005 (PSQIA) preempted a provision in the Florida constitution.</p> <p> The PSQIA enables physicians and hospitals to share medical information used for quality improvement through a patient safety organization (PSO). The data within these systems is deemed privileged under the PSQIA, with the exception of requests that state administrative agencies might make for the information. If this information is not protected from litigation discovery, it could stifle the sharing of information and impeded upon quality and patient safety improvements.</p> <p> PSOs were established to gather and analyze information critical to the improvement of patient safety and quality of care. The information is submitted to PSOs in accordance with the PSQIA and is protected from disclosure as a patient safety work product (PSWP).</p> <p> The district court of appeal’s decision allowed for continued confidential sharing of patient safety information without fear of disclosure in medical liability litigation.</p> <p> <strong>Protected patient safety information again under threat</strong></p> <p> Now on appeal in the Supreme Court of Florida, the case is focused on documents prepared as the result of a state legal requirement.</p> <p> Both sides are in agreement on one thing: Physicians and hospitals must under some circumstances submit patient safety information upon request from a state agency—even with the protections afforded to PSWPs.</p> <p> The  twist in this particular case is that the PSWP information, although prepared as the result of a state agency requirement, was never submitted to the state agency because the agency did not request it.</p> <p>  The question before the Florida Supreme Court is whether, under the PSQIA, if the state agency does not request the PSWP documents from a physician or hospital, those documents will be protected from disclosure in medical liability litigation.</p> <p> A reversal of the First District Court of Appeal holding would “effectively nullify the PSQIA in the state of Florida,” the <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page" target="_self">Litigation Center of the AMA and State Medical Societies</a> said in an amicus brief.</p> <p> “This court’s reversal of the First District’s ruling in this case,” the brief said, “would undo the progress made to date and undermine the valuable work that has been done by PSOs and their member health care providers. Patients, who are the ultimate beneficiaries of the PSQIA, would suffer.”</p> <p> <strong>Other medical liability cases in which the Litigation Center is involved include:</strong></p> <ul> <li> Learn how a case <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-lead-unlimited-awards-of-punitive-damages" target="_self">could lead to unlimited awards of punitive damages</a>.</li> <li> Get the details on a <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-extend-medical-liability" target="_self">case that could extend medical liability</a>.</li> <li> Find out how one <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-increase-liability-exposure-redefine-injury" target="_self">case could increase liability exposure and redefine injury</a>.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:27a98727-eab3-4516-ac6d-bb49957c3705 Resolutions for the AMA Senior Physicians Section due Sept. 9 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_resolutions-ama-senior-physicians-section-due-sept-9 Fri, 24 Jun 2016 14:00:00 GMT <p> With the 2016 AMA Interim Meeting taking place Nov. 12-15 in Orlando, the AMA Senior Physicians Section (SPS) Governing Council would like to encourage participation of its members. As a member of the AMA, you have the opportunity to influence policies within the organization. The section leadership welcomes proposals from members to identify the needs of senior physicians (i.e., doctors age 65 and above, both active and retired).</p> <p> Although proposed resolutions on any topic will be given consideration, the following are broad topics affecting senior physicians that are more likely to be accepted for transmittal to the AMA House of Delegates for adoption.</p> <ol> <li> <strong>Practice patterns and transitioning out of practice</strong>. Senior physicians should stay in practice as long as they have the desire and competency to do so, in order to care for an expanding patient population. How can senior physicians be an ongoing resource, thereby using their talents and experience?<br />  </li> <li> <strong>Senior physicians’ roles in supplementing or filling gaps in community health needs. </strong>How can senior physicians impact health concerns or the delivery of health services for the medically underserved or those suffering from chronic diseases?<br />  </li> <li> <strong>Overcoming barriers to adopting and implementing technology.</strong> What kind of improvements can be made to address recordkeeping, administrative processes or care coordination to help physicians as they age?<br />  </li> <li> <strong>Roles in medical education. </strong>How can senior physicians play a greater role in the medical education process? Are there volunteer opportunities, such as preceptors or medical student or undergraduate advisers?<br />  </li> <li> <strong>Licensure for “partial” or reduced scope of practice</strong>. How can limited license status be developed for senior physicians when they are not in full-time practice?</li> </ol> <p> A template is available for your use on the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/senior-physicians-section/meetings/meeting-timeline.page" target="_self">section web page</a>. The deadline for submission is Sept. 9 for the 2016 AMA Interim Meeting.   </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8d82476a-434b-44ff-8c98-47c167d0e73e 3 things every physician should do when treating pain http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_3-things-physician-should-treating-pain Wed, 22 Jun 2016 23:00:00 GMT <p> A panel of physician experts offered three actions every physician can take to appropriately treat patients with acute or chronic pain. Presenting at the 2016 AMA Annual Meeting, they also discussed tools that can help keep patients safe from overdose and improve their quality of life.</p> <p> The panel was comprised of physician representatives from the AMA <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page" target="_blank">Task Force to Reduce Prescription Opioid Abuse</a> and one of the nation’s leading health policy experts.</p> <p> In light of the opioid epidemic, the task force has put forth recommendations for physicians. “These recommendations come from our colleagues,” Patrice A. Harris, MD, psychiatrist and chair of the AMA Board of Trustees, said. “We are better physicians when we learn from one another.”</p> <p> Dr. Harris said the task force is encouraging physicians to support comprehensive pain care and reduce the stigma associated with pain, reduce the stigma of substance use disorders, increase access to treatment and naloxone, and to use state PDMPs to make more informed prescribing decisions.</p> <p> <strong>Using PDMPs to improve care</strong></p> <p> “[Guidelines] are useful to inform clinical judgement,” said Cynthia Reilly, director of the prescription drug abuse project at Pew Charitable Trusts, “but they alone will not reduce the harm that we see from opioids. Really, one of the challenges here is unless you are aware of medications that your patients may be receiving from other prescribers—even if you follow those guidelines to a ‘T’—the patient may still be at risk from harm.”</p> <p> “PDMPs are one strategy to help with that,” Reilly said. “In an ideal world, a PDMP would be connected to … electronic health records (EHR) and other states. While efforts are underway to address that, we don’t have that yet.”</p> <table align="right" border="0" cellpadding="0" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/2/45371ac1-e124-47db-b279-6a82efb86f30.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/2/45371ac1-e124-47db-b279-6a82efb86f30.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <span style="font-size:10px;"><em>Frank Dowling, MD</em></span></td> </tr> </tbody> </table> <p> Frank Dowling, MD, clinical associate professor of psychiatry at SUNY at Stony Brook and medical director at Long Island Behavioral Medicine, said his state recently mandated PDMP use. The reason doctors are using the tool in New York is because the PDMP—called I-STOP—has the funding and technological support to make it useful. There were more than 18 million queries of I-STOP in 2015, according to the New York Department of Health.</p> <p> This valuable tool is not just for when a physician plans to prescribe but can also aid in treatment. “Any time I’m assessing and making a treatment decision, I can look up that information that may be useful, even if I’m not going to prescribe,” Dr. Dowling said. “Some docs will look up all patients in their practice who may be on the schedule … others may look up only when they feel it’s clinically indicated because of a suspicion or a worry or they’re considering a prescription.”</p> <p> “When using the PDMP in clinical care,” Dr. Dowling said, keep a couple of things in mind:</p> <ul> <li> “Stigma is high for people with pain and with a substance use disorder,” he said. “It’s even worse when they’re co-occurring. The info [from the PDMP] is a clinical tool; it’s an assist. It’s not a mandate that you must prescribe or not prescribe.”<br /> <br /> “Even with [patients] without a substance use disorder, aberrant behaviors are common,” he said. Patients may get scripts from other physicians or take more than they’re supposed to. They may need education on the matter or have “the reigns pulled in a little,” he said.</li> </ul> <ul> <li> Remember that the PDMP is a tool to use, “and it starts a conversation,” Dr. Dowling said. “In every unique patient that we all have, 80 percent of the time it’s very simple, 20 percent of the time it’s complex …. The information from your PDMP can be very useful.”</li> </ul> <p> <strong>Managing chronic pain—focus on the patient’s goals</strong></p> <p> Treating patients with chronic, non-cancer pain comes down to the individual clinic visits and facing problems one-on-one with patients, said Erin Krebs, MD, medical director at the Women Veterans Comprehensive Health Center in Minneapolis. “What do we need to do that well?”</p> <table align="left" border="0" cellpadding="0" cellspacing="15" style="width:365px;"> <tbody> <tr> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/3/bc787873-8976-41cd-93d3-9d66e51283f6.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/3/bc787873-8976-41cd-93d3-9d66e51283f6.Large.jpg?1" /></a></td> <td>  </td> </tr> <tr> <td> <span style="font-size:10px;"><em>Erin Krebs, MD</em></span></td> <td>  </td> </tr> </tbody> </table> <p> Dr. Krebs highlighted one of her patients, a woman with chronic back pain and multiple co-morbidities, including insomnia, fatigue, obesity, nausea and depression.</p> <p> The patient’s prescription drug monitoring results showed that her use of the medications was appropriate. “There was no concern that this woman was misusing her medications,” she said. “But how is she doing?”</p> <p> “Her pain and depression scores are persistently high,” Dr. Krebs said. “You can look at scores all day long, but ask her ‘how is pain affecting your life, or how is your day-to-day life going?’”</p> <p> “She says, ‘I can’t leave the house very much; I can barely walk more than a block,’” Dr. Krebs said. “’My house is a mess; I’m not really cooking dinner anymore because I can’t stand at the stove long enough … I’m not even going to my kid’s activities anymore …. If I can do just one thing, I want to be a good mom.’”</p> <p> “So what are the tools you need to help this woman?” Dr. Krebs asked. “Technology helps, but it comes down to a lot of other things. From my perspective, I need time with this woman. I need visits that are more than twice a year …. I need a team that’s going to help me.”</p> <p> “This is really what it comes down to on a one-to-one basis,” she said. “We’re going to have to turn this around one patient at a time and help each patient manage their pain—get their life back and avoid avoidable risk.”</p> <p> Dr. Krebs offered some advice for dealing with patients whose pain seems to persist. “I think the key thing is to keep focusing and refocusing on what the patient’s goals are, not [just] the pain intensity,” she said. “What does she care about and how can I get her closer to achieving what she cares about, because that’s a positive conversation that you can have at every visit.”</p> <p> “This is my line,” she said, “‘I’m your cheerleader and your coach. I’m not going to promise a cure for this problem, but I’m going to be here every time you come in, and I’m going to talk to you about this and try to help you figure out how you can change your life to get closer to where you want to be.’”</p> <table align="right" border="0" cellpadding="0" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/6/ba530a53-3fc0-4b1d-b6df-6b339dfd57fb.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/6/ba530a53-3fc0-4b1d-b6df-6b339dfd57fb.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <span style="font-size:10px;"><em>Robert Rich, MD</em></span></td> </tr> </tbody> </table> <p> <strong>Naloxone as a conversation starter</strong></p> <p> Robert Rich, MD, a family medicine specialist in North Carolina, offered advice on the use of naloxone and detailed the role he plays as a family physician.</p> <p> In 2008, <a href="http://projectlazarus.org/" rel="nofollow" target="_blank">Project Lazarus</a> was started in Wilkes County, N.C., which is a rural county that was dealing with one of the highest per capita overdose rates in the country. Project Lazarus developed a take-home naloxone overdose kit that contains two needle-free syringes of naloxone, two nasal adapters, a DVD instructional video and guides for patients on how to talk to their families about overdose.</p> <p> “I use the Project Lazarus discussion as a way to introduce my concern to the patient that they may have a lot of medical problems, which may increase their risk of overdose,” Dr. Rich said. “I’m trying to say, ‘Let’s do something to help manage your risk; here’s another tool to help you do that.’”</p> <p> “I’m saying, ‘I’m concerned about your overall health and well-being,’” he said, “‘not being judgmental at all …. I want to do something to help you.’”</p> <p> Naloxone also can be a way to <a href="http://www.ama-assn.org/ama/ama-wire/post/antidote-3-things-consider-co-prescribing-naloxone" target="_self">start the broader conversation about the risks</a> that opioid medications carry without contributing to the stigma that surrounds overdose and substance use disorders.</p> <p> <strong>For more on physician efforts to end the opioid overdose epidemic:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/obamas-opioid-initiatives-align-physician-recommendations" target="_self">How Obama’s opioid initiatives align with physician recommendations</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/talk-substance-use-disorders-patients" target="_self">How to talk about substance use disorders with your patients</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-team-up-treat-addiction-rural-areas" target="_self">Physicians team up to treat addiction in rural areas</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-steps-talking-patients-substance-use-disorder" target="_self">3 steps for talking with patients about substance use disorder</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/entire-state-gets-one-naloxone-prescription" target="_self">Entire state gets one naloxone prescription</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d3f71d36-7f56-4d3e-af13-ce60cc9514c9 New benefit: Get evidence-based information at the point of care http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-benefit-evidence-based-information-point-of-care Wed, 22 Jun 2016 22:11:00 GMT <p> Make sure you’re equipped with all the information you need to deliver the best care for your patients, whatever their condition. <em>DynaMed Plus®</em>, a next-generation information resource, provides the most up-to-date, evidence-based information on any digital device. And now AMA members get free access.</p> <p> <strong>Content and features you don’t want to miss</strong></p> <p> A trusted resource by physicians around the world, <em>DynaMed Plus</em> was designed from the ground up last year. It offers an optimal blend of evidence and expertise as a real-time clinical reference, and is updated daily.</p> <p> Enhance your clinical decision-making. This resource offers:</p> <ul> <li> Concise, accurate overviews for the most common conditions and evidence-based recommendations for action—all developed by physicians</li> <li> More than 10,000 images from The JAMA Network and other valuable content providers</li> <li> Specialty content, covering thousands of topics in emergency medicine, cardiology, oncology, infectious diseases, pediatrics, obstetrics and gynecology, and many other specialties</li> <li> Links to 2,500 full-text journals (with <em>MEDLINE Complete</em>)</li> </ul> <p> In addition to traveling with you on any device, <em>DynaMed Plus </em>integrates with your electronic health record (EHR) system. A real-time web service API enables customized and contextually based searches of clinical content directly from your EHR.</p> <p> <strong>How to access this resource</strong></p> <p> AMA members get a free 18-month trial of <em>DynaMed Plus</em>. <a href="https://offers.jamanetwork.com/" rel="nofollow" target="_self">Sign up for your free trial today</a>.</p> <p> Once the free trial ends, AMA members get a special discounted rate to continue the subscription. The annual subscription fee is $199 for individual physician members (a $395 value), $75 for resident and fellow members (a $150 value), and $50 for student members (a $100 value).</p> <p> If you’re not yet an AMA member, <a href="https://commerce.ama-assn.org/membership/" target="_self">join or renew your membership</a> today.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:90b4a2b7-4e12-430e-8ef9-e891048a1e15 Ink on the page: Get your quality improvement project published http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ink-quality-improvement-project-published Wed, 22 Jun 2016 20:24:00 GMT <p> Medical journals welcome research papers from trainees on quality improvement (QI), but those papers are often faulted for inconsistent approaches and formats. Two editors at the <em>Journal of Graduate Medical Education</em> offer some <a href="http://www.jgme.org/doi/full/10.4300/JGME-D-16-00086.1" target="_blank" rel="nofollow">guidelines</a> on how to construct your paper and what to emphasize most in order to get your research published and enhance your CV.</p> <p> <strong>How to construct a compelling paper</strong></p> <p> The editors discuss what you should explicitly emphasize within each section of your manuscript as it pertains to your QI project. If you haven’t yet begun your QI project, these suggestions also should help you with planning and implementing your project with publication in mind.</p> <ul> <li> <strong>The introduction</strong> should consist of a clear, concise statement of the primary aim of your QI project and how the problem is relevant beyond your institution. It should describe the gap between current practice and the proposed practice.<br /> <br /> “The introduction section must be brief,” the editors said. “This is not the time to provide an in-depth review of the literature on your quality problem of interest—which could be an important but separate paper.”</li> </ul> <ul> <li> <strong>A methods section</strong> should help readers understand how they can translate the proposal into their own setting. It should contain a rationale for why the intervention was chosen and link it to the specific problem it will solve.<br /> <br /> “The truth is that if authors do not articulate a theory or rationale for why their proposed intervention should fix the quality problem of interest,” the editors said, “they run the risk of designing a suboptimal intervention or choosing the wrong approach altogether.”<br /> <br /> You should outline how the intervention was tested, refined and implemented.</li> </ul> <ul> <li> <strong>A discussion section</strong> “should concisely summarize the main findings of the QI project, relate the key finding to what is already known in the published literature, reflect on the broader implications of the findings, discuss how important limitations could have affected the findings, and briefly introduce next steps to further understand the field,” the editors said.</li> </ul> <ul> <li> <strong>The conclusion</strong> should simply serve as a summary. “This short paragraph succinctly summarizes the most important findings from the study, without speculating beyond the results,” the authors said. “Conclusions should be appropriately conservative in relation to the study findings.”</li> </ul> <ul> <li> <strong>Figures and tables</strong> can be used, “which will avoid excess word length while still providing a concise summary of what was actually done,” the editors said. “Another option for providing more details is to include additional supplemental information for publication online.”</li> </ul> <p> <strong>Don’t fear the dark side</strong></p> <p> The editors urge authors to consider including negative outcomes in their papers, including failures of the proposed intervention. Measures of unintended consequences also should be reported to ensure that the intervention does not create new problems.</p> <p> Projects that fail to achieve the intended results are still important because they can help others who might consider similar projects and allow them to build on the author’s work.</p> <p> Residents have a unique chance to showcase their QI projects at the 2016 AMA Research Symposium. The symposium features hundreds of poster and oral presentations, and takes place this year on Nov. 11 at the 2016 AMA Interim Meeting in Orlando, Fla.</p> <p> The event is hosted annually by the AMA Medical Student Section, the AMA Resident and Fellow Section and the AMA International Medical Graduates Section. Each section holds a separate competition within the event. Abstracts will be accepted beginning in July and are due by Aug. 17.</p> <p> <strong>Learn more about getting your project onto the page:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-like-pro-5-expert-strategies-innovative-research" target="_self">5 steps to getting your research published</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-top-journals-physicians-training" target="_self">Top journals for physicians in training</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/9-top-tips-getting-published-medical-journal" target="_self">9 tips for getting published from fellows, residents</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/research-paper-got-rejected-heres-handle" target="_self">How to handle it when the editor rejects your paper</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/future-physicians-honored-top-research-ama-symposium" target="_self">Winners of the 2015 AMA Research Symposium</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:74ac5505-d78e-47b2-9477-6e25bc3b9ddb A double-edged sword: What makes doctors great also drives burnout http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_double-edged-sword-doctors-great-also-drives-burnout Wed, 22 Jun 2016 03:00:00 GMT <p> A physician burnout expert from the Mayo Clinic explained earlier this month at the 2016 AMA Annual Meeting how physicians in the current health care system often have an intrinsic risk of burnout. Learn about the role that the “physician personality” can play in burnout and ways Mayo has found to help address burnout as a system-wide issue.</p> <p> <strong>What’s happening to physicians?</strong></p> <p> “If I told you we had a system issue that affected quality of care, limited access to care, and eroded patient satisfaction, that affected up to half of patient encounters,” said Tait Shanafelt, MD, a hematologist and physician burnout researcher at the Mayo Clinic, “you would immediately assign a team of systems engineers, physicians, administrators at your center to fix that problem rapidly.”</p> <table align="right" border="0" cellpadding="0" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/14/ba0792a6-f25c-4828-8e1a-6c2cec982e88.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/14/ba0792a6-f25c-4828-8e1a-6c2cec982e88.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <em>Tait Shanafelt, MD, hematologist and physician burnout researcher at the Mayo Clinic</em></td> </tr> </tbody> </table> <p> That’s what burnout is, he said. It’s a system issue. “And we have not mobilized the way we would to address other factors affecting quality access and patient satisfaction,” Dr. Shanafelt said.</p> <p> “On a societal level folks would look at us and think we have a recipe for great personal and professional satisfaction,” he said. “We engage in work that society values and thinks is meaningful work. And yet our own literature has been telling a different story about the experience of being a physician.”</p> <p> A recent study published in <em>Mayo Clinic Proceedings</em> took a look at <a href="http://www.ama-assn.org/ama/ama-wire/post/physician-burnout-compares-general-working-population" target="_self">how physician burnout compares to the general population</a> and found that physicians displayed almost double the rate of emotional exhaustion as the general working population and reported lower satisfaction with work-life balance (36.0 percent for physicians, versus 61.3 percent of the general working population).</p> <p> Dr. Shanafelt said that burnout is often the result of three components:</p> <ul> <li> Depersonalization: Treating people as though they’re objects rather than human beings</li> <li> Emotional exhaustion: Losing enthusiasm for your work</li> <li> Low personal accomplishment: Feeling you’re ineffective in your work, whether or not that is an accurate perception</li> </ul> <p> “All of us have those feelings to some frequency and some severity,” he said. “But when they come too often and to too severe an extent, they can begin to undermine your effectiveness in your work.”</p> <p> “This syndrome differs from the global impairment of depression,” he said. “It primarily relates to your professional spirit of life, and it primarily affects individuals whose work involves an intense interaction with people—so professions such as teachers, social workers, police officers, nurses and physicians.”</p> <p> <strong>The survival mentality and the physician personality</strong></p> <p> “I think we all remember that survival mentality of residency,” Dr. Shanafelt said. “‘I’ve just got to make it through; things will get better when I’m done with residency.’ But what we find is that physicians perpetuate that framework throughout their whole career.”</p> <p> Dr. Shanafelt said that in one study, 37 percent of physicians reported looking forward to retirement as an effective wellness strategy. “This is the same thing as the survival mentality … and what was notable was that it was equally common to report that strategy for those under the age of 40 as those who were older,” he said. “It’s not just those who were actually getting closer to retirement.”</p> <p> It’s a mentality of “work now, when I retire I’ll get to personal life,” he said.</p> <p> Dr. Shanafelt said that one suggestion many researchers have found to be a possible cause of physician burnout is “that we are also at inherently higher risk due to what they’ve coined the ‘physician personality,’” he said. “Now, this is where if I wasn’t a physician myself you would start throwing rotten fruit.”</p> <p> “They say … that the characteristics that define many doctors are doubt, guilt and an exaggerated sense of personal responsibility,” he said. “But these are the qualities that make you a good physician. They lead you to be thorough, committed, leaving no stone unturned, to always be thinking about Mrs. Jones and what else I could do, what am I missing? How could we do a better job taking care of her?”</p> <p> “The qualities that make people good physicians are a double-edged sword,” he said. “It’s those who are most dedicated to their work who are at greatest risk to be most consumed by it.”</p> <p> <strong>A strategy to examine work-life balance</strong></p> <p> If you’re experiencing burnout, identifying values—both personally and professionally—is an important factor in addressing what causes burnout, Dr. Shanafelt said. One way to do that is to engage in a series of questions to examine the two sides.</p> <p> The first set of questions:</p> <ul> <li> What are the things you care about in your personal life?</li> <li> What does it look like for you to live in a way that demonstrates those are the things you care about?</li> </ul> <p> The second set of questions:</p> <ul> <li> What are the things you care about in your professional life?</li> <li> How are you devoting and spending your time to align with those things?</li> </ul> <p> “Physicians usually are relying on things around being a healer, teacher, making discoveries or operating a successful practice,” Dr. Shanafelt said. “The thing I can guarantee you is that your two lists are incompatible and that you cannot achieve everything on those lists.”</p> <p> “If I think that I’m going to be a world expert in my field,” he said, “but never miss a soccer game to be away at study section, presenting at a meeting, to be writing a grant or manuscript, that’s an unrealistic expectation. I will miss soccer games to make a difference for the patients with this disease that I care about.”</p> <p> “The question is,” he said, “how many soccer games is it OK to miss to still have the relationship with my kids that I want and the impact professionally that I aspire to? It’s this integration of these two spheres that’s really where the rubber meets the road.”</p> <p> <strong>Addressing isolation</strong></p> <p> Due to some of the changes to the medical profession over the past few decades that have resulted in busier schedules, higher productivity expectations and more time spent documenting, physicians have less time to interact with each other.</p> <p> “That interaction has always been part of the fabric of the profession,” Dr. Shanafelt said. “We have amazing colleagues, and getting to work with those people is what makes this profession great. But we have less of that interaction now than we did in the past.”</p> <p> In a study at the Mayo Clinic, Dr. Shanafelt and colleagues randomized 75 physicians and “bought” an hour of their time. One-half of them used the hour every other week however they wanted for nine months—for instance, to catch up on administrative tasks or get home early. The other one-half used it to meet with a group of colleagues to engage a curriculum largely around sharing their experience of the challenges and virtues of being a physician.</p> <p> “We measured a variety of personal and professional characteristics,” he said. Both groups saw a reduction in physician-reported burnout symptoms, but the group who met with their colleagues also had an improvement in meaning of work, “and we came back a year after the intervention ended.”</p> <p> “The group who had that hour to catch up on admin went immediately back to baseline with respect to burnout as soon as they stopped getting an hour,” he said, “but those who had met with their colleagues every other week for nine months, the burnout and meaning in work remained improved a year after the intervention ended.”</p> <p> As a result, Mayo conducted a second study during which physicians met for happy hour, breakfast, lunch or dinner. Mayo would buy the meal and send five questions the physicians could choose from to talk about as a group. The study saw the same outcomes as the previous study in improvement in burnout and meaning in work just from that interaction.</p> <p> The Mayo Clinic’s board approved the program, which they now offer to all physicians. As a standard practice, Mayo pays for groups of colleagues every two weeks to go out to a restaurant in town with their colleagues. Dr. Shanafelt said about 1,000 physicians have signed up.</p> <p> One physician in the audience who teaches in a residency program noted, “One of the questions that I got once—that I still don’t know how to answer—is: ‘Aren’t you just teaching us how to trick ourselves into being happier when we really are in this horrible situation?’”</p> <p> “I look at it just like clinical skills,” Dr. Shanafelt answered. “You as an individual want to do your [continuing medical education] and keep yourself current and refine your art as best you can. And the system in which you plug into is also going to make you a better or less effective physician.”</p> <p> “The answer is: ‘Yeah, I get it, this isn’t all yours and the organization has to do its part,’” he said. “But you want to be as good as you can at navigating the choppy water and knowing it’s going to come. And we’re trying to give you that skill set.”</p> <p> <strong>More resources to help combat burnout</strong></p> <p> The AMA’s <a href="https://www.stepsforward.org/modules/physician-burnout" rel="nofollow" target="_self">STEPS Forward™</a> collection of practice improvement strategies helps physicians make transformative changes to their practices. It offers modules on <a href="https://www.stepsforward.org/modules/physician-burnout" rel="nofollow" target="_self">preventing physician burnout in practice</a>, <a href="https://www.stepsforward.org/modules/physician-wellness" rel="nofollow" target="_self">preventing resident and fellow burnout</a> and <a href="https://www.stepsforward.org/modules/improving-physician-resilience" rel="nofollow" target="_self">improving physician resiliency</a>.</p> <p> Physicians and experts from around the world will gather Sept. 18-20 in Boston for the <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page" target="_self">International Conference on Physician Health™</a>. This collaborative conference of the AMA, the Canadian Medical Association and the British Medical Association will showcases research and perspectives into physicians’ health and offer practical, evidence-based skills and strategies to promote a healthier medical culture for physicians. <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page?" target="_self">Learn more and register</a>.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:cdc782e6-0b79-469b-b8e7-bec87e0391b8 VA invites physicians to join as agency recovers from scandal http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_va-invites-physicians-join-agency-recovers-scandal Tue, 21 Jun 2016 22:31:00 GMT <p> The <a href="http://www.va.gov/health/" target="_blank" rel="nofollow">U.S. Department of Veterans Affairs</a> (VA) is in the midst of fundamental changes after a period of struggle and public criticism—and some of those changes could make it an appealing place for physicians to work.</p> <p> <strong>Appeal for help</strong></p> <p> David Shulkin, MD, undersecretary of health at the VA, delivered that message of hope for his once-beleaguered organization during a presentation at the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_self">2016 AMA Annual Meeting</a> in Chicago. He issued a passionate appeal for physicians to contribute to the VA’s colossal rebuilding effort.</p> <p> “We desperately need physicians and have to make it an attractive place to work,” Dr. Shulkin, a primary care physician, said. “I think we’re working on that.”</p> <p> The VA has openings for 1,800 physicians and 44,000 employees of all kinds as it accommodates a growing patient population, Dr. Shulkin said.</p> <p> <strong>An agency in crisis</strong></p> <p> The VA hit a low point in 2014 when it drew criticism over excessive patient wait times and allegations of deceptive record-keeping at its Phoenix medical center. President Obama called for an investigation after it was discovered that 40 veterans had died in Phoenix while awaiting treatment.</p> <p> The scandal soon spread as shoddy practices were discovered at centers around the nation. In May 2014 President Obama accepted VA Director Eric Shinseki’s resignation.</p> <p> The crisis has spurred the VA to respond with five key efforts, Dr. Shulkin said:</p> <ul> <li> Reducing wait times for patients</li> <li> Engaging employees once again in their sense of mission</li> <li> Adopting best practices consistently across all VA facilities</li> <li> Partnering with the private sector to expand access to care</li> <li> Restoring the confidence of veterans and the public in the VA</li> </ul> <p> Dr. Shulkin said the VA has already reduced wait times, and this year has set a goal of same-day access to care for veterans. As conditions improve, the VA is becoming a more satisfying place for physicians to work, he said.</p> <p> <strong>Fewer contributors to burnout</strong></p> <p> For example, VA physicians don’t have to deal with insurance companies and medical liability issues, he said.</p> <p> “You don’t have to deal with a lot of the things that create burnout in the private sector,” he told physicians.</p> <p> He said physicians who go to work for the VA will discover many reasons to be proud of its historic mission. For instance, in partnership with 1,800 other institutions, the VA is the largest trainer of physicians in the nation. It is a leader in reducing hepatitis C, addressing the opioids crisis and preventing suicide, he said.</p> <p> Dr. Shulkin also touted the long and distinguished history of VA research that has paved the way for solutions in prosthetics, cancer, liver transplant, CAT scans and dialysis.</p> <p> “The discoveries that have come out the VA are important to all of us in American medicine,” he said.</p> <p> <strong>New AMA policy</strong></p> <p> Also at the 2016 AMA Annual Meeting, physicians adopted new policy that directs the AMA to work with the VA to enhance its loan forgiveness efforts to help with physician recruitment and retention and to improve patient access in VA facilities. That includes a call for the Public Service Loan Forgiveness Program to allow physicians to receive immediate loan forgiveness when they practice in a VA facility.</p> <p> The AMA also will be working with the VA to minimize the administrative burdens that can prevent physicians who are not employed by the VA from volunteering their time to care for veterans.</p> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ce0e8013-33e8-4e4d-ad8c-e3c2f1090b41 How students can thrive in the wards, from one who knows http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_students-can-thrive-wards-one-knows Mon, 20 Jun 2016 21:30:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/1/d4ce35a5-4cfb-4863-b14f-64aac692bba1.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/1/d4ce35a5-4cfb-4863-b14f-64aac692bba1.Large.jpg?1" style="margin:15px;float:right;" /></a>Always be nice to the nurses. Mark Nolan Hill, MD, professor of surgery at Chicago Medical School at Rosalind Franklin University, had that and more advice for students as they prepare for their third year and the start of caring for patients.</p> <p> “The nurses will save your butt,” Dr. Hill assured students at the 2016 AMA Annual Meeting earlier this month. “They can teach you—always be nice to the nurses.”</p> <p> <strong>All about attitude</strong></p> <p> Nurses, along with residents, attending physicians and others, will loom large on the wards. But Dr. Hill spent much of his animated hourlong address focused on the crucial physician-patient relationship and how to shape it in the cause of good medicine.</p> <p> He had no secret formulas to offer.</p> <p> “The most important thing is attitude, attitude, attitude,” Dr. Hill said. “When you’re dealing with patients, listen to them. Sit down, touch them, be warm to patients.”</p> <p> That approach goes hand-in-hand with clear, respectful language, free of jargon. He favors using “Mr.” and “Mrs.” when addressing patients, and he advises that you avoid making value judgments.</p> <p> <strong>Roles and routines</strong></p> <p> Students have to not only treat patients but navigate the routines and roles of the wards, and Dr. Hill offered a few basics to keep in mind:</p> <ul> <li> Don’t arrive late, so you can avoid getting behind.</li> <li> Look neat and clean—it’s part of your image on the wards.</li> <li> Ask questions of your professors and attendings, and don’t let the fear of looking stupid hold you back. “The only stupid thing is not asking the question,” he reminded students.</li> <li> Seek out mentors and make ample use of them. “Always hang around people who will teach you and guide you.”</li> </ul> <p> <strong>The payoff</strong></p> <p> Perhaps most challenging of all Dr. Hill’s counsel is staying optimistic and not lamenting the sacrifices you have to make as a medical student with growing obligations. Take heart when your friends head out for a tropical vacation, and you have to stay at home and study. The payoff will come.</p> <p> “You are in the absolute greatest profession there is,” he said. “When you get out [there], it’s a lot of work, but I’m telling you, it’s all worth it.”</p> <p align="right"> <em>By contributing writer Michael Winters</em></p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:76c7cebc-dcb3-4490-b5af-f58c2e3e300d Why criminal justice should be part of fostering public health http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_criminal-justice-should-part-of-fostering-public-health Mon, 20 Jun 2016 21:27:00 GMT <p> Mass incarceration poses a threat to public health, fueling chronic disease and mental illness that physicians must address, according to a recent panel discussion.</p> <p> <strong>A physician’s duty</strong></p> <p> Physicians have a duty to work for health justice for inmates, especially minors, said Nzinga Harrison, MD, a founder of <a href="http://www.pfcjreform.org/" target="_blank" rel="nofollow">Physicians for Criminal Justice Reform</a>, an activist organization made up of academics, government officials, psychiatrists, neurologists and others.</p> <p> Dr. Harrison and other panelists explained their efforts on behalf of health justice at a discussion held by the AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section.page" target="_self">Minority Affairs Section</a> during the 2016 AMA Annual Meeting in Chicago.</p> <p> <strong>Primary goals for justice reform</strong></p> <p> Dr. Harrison said Physicians for Criminal Justice Reform invites physicians, medical students and the lay public to join in working for its primary objectives:</p> <ul> <li> <strong>Decriminalizing mental health and addictive disorders</strong>. Across the nation, people with severe mental illness are three times more likely to be in jail or prison than a mental health facility. Twenty percent of prison inmates have serious mental illness, and up to 60 percent have serious addictive problems, Dr. Harrison said.<br />  </li> <li> <strong>Diverting at-risk youths from adult jails and prisons</strong>. Youths in adult jails are 36 times more likely to take their own lives than youths housed in juvenile facilities, Dr. Harrison said, and minors are far more likely to be victims of sexual assault in jails.<br />  </li> <li> <strong>Providing adequate physical and mental health care for inmates</strong>. Inmates are far more likely to enter prison without a history of primary care and to suffer from addictive disorders. Prison inmates suffer a higher incidence of chronic and infectious diseases such as AIDS and hepatitis C than the general population, Dr. Harrison said.</li> </ul> <p> The United States incarcerates far more of its residents than any other industrialized nation, Dr. Harrison said, so improving care for that population improves the health of the community as a whole. Diversion from the criminal justice system not only saves lives but saves money in the long run, she said.</p> <p> <strong>Three foundations of health</strong></p> <p> Spiritual, physical and mental health care are intimately linked, both in prisons and the community at large, the Rev. Carmin Frederick told attendees at the session.</p> <p> “We are all connected,” said Rev. Frederick, a panelist. She is associate pastor to teens and families at <a href="https://trinitychicago.org/social-justice/" target="_blank" rel="nofollow">Trinity United Church of Christ</a>. The Chicago church works for social justice, an end to mass incarceration, access to health care and a living wage.</p> <p> Poverty itself undermines well-being and plays a role as an early and powerful social determinant of health, according to panelist Carl Bell, MD, a psychiatry professor at the University of Illinois College of Medicine in Chicago.</p> <p> “Being poor is a problem,” Dr. Bell said. “Because if you’re poor, you’re going to be living in a community where the only business that is thriving is the liquor store.” His work at the Jackson Park Hospital’s Family Medical Clinic highlights the long-term impact of fetal alcohol syndrome on youths.</p> <p> “They’re slow in school. They’ve got bad tempers. They have poor social skills,” he said.</p> <p> <strong>Tools for achieving justice reform</strong></p> <p> Physicians for Criminal Justice Reform named strategies to advocate for changes in health care and the criminal justice system:</p> <ul> <li> The organization increases awareness of the ties between health and the justice system by educating the public with consulting services, webinars and keynote speakers.<br />  </li> <li> It maintains a social media presence, circulates petitions and fosters a relationship with the media to expand awareness of its issues.<br />  </li> <li> It partners with allied organizations to leverage distribution of its message.</li> </ul> <p> Dr. Harrison issued an appeal to action for physicians to recognize the relationship between the justice system and health.</p> <p> “We can make a change,” she said. “I hope I have compelled you to joins us and raise your voice so we can minimalize the impact of the criminal justice system on our patients.”</p> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1ef4d8e5-c2dd-42c2-ad9c-7a7a4518d7ac 40 years of shaping medical education http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_40-years-of-shaping-medical-education Mon, 20 Jun 2016 18:00:00 GMT <p> In 1976, the average cost of a new home was $43,400, Apple Computer Inc. was established, and an important group in medical education was just getting started.</p> <p> <strong>A notable history</strong></p> <p> The <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/academic-physicians-section.page" target="_self">AMA Academic Physicians Section</a> (APS) is celebrating its 40th anniversary this month, and physicians who were a part of the group in its early years can tell of its strong history in shaping medical education and the practice of medicine.</p> <p> From its beginning as the AMA Section on Medical Schools, this group of physician educators had high aspirations.</p> <p> Within a few years of its founding, the section had played an important role in contributing to the “Future directions of medical education” report adopted by the AMA in 1982 and began a series of medical education conferences with the AMA Council on Medical Education, the Association of American Medical Colleges (AAMC) and the American Hospital Association.</p> <p> Myron Genel, MD, professor emeritus of pediatrics and senior research scientist at Yale Child Health Research Center and Yale School of Medicine and a clinical professor of nursing at the Yale School of Nursing, recounts that the work of the section and the AMA Council on Scientific Affairs in the mid-1980s led to a joint effort with the AAMC that culminated in the Graylyn Clinical Research Summit.</p> <p> The summit in turn led directly to the formation of the Clinical Research Roundtable at the Institute of Medicine and enhancement of the National Institutes of Health’s clinical research program.</p> <p> In the early 1990s, the section began participating in a series of conferences with the Society of Directors of Research in Medical Education and produced a report on the potential impact health system reform would have on medical education.</p> <p> Moving into the 2000s, the section was instrumental in the AMA’s collaboration with the AAMC on the Initiative to Transform Medical Education, which included the 2010 New Horizons in Medical Education conference.</p> <p> More recently, the section has been involved in the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education initiative</a>, which awarded $11 million in grants to 11 leading medical schools for major medical education innovations in 2013. These schools have made tremendous progress in creating the medical school of the future and transforming physician training.</p> <p> This year, 21 additional medical schools joined these 11 founding members of the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" target="_self">Accelerating Change in Medical Education Consortium</a> to continue spreading innovative medical education ideas. An estimated 19,000 medical students—18 percent of all U.S. allopathic and osteopathic students—study at a consortium school.</p> <p> <strong>Representing the continuum of medical education</strong></p> <p> While the section is very active in undergraduate medical education, its work isn’t limited to what takes place in medical school. The section instituted a new membership category back in 1996 to ensure the section encompassed graduate medical education (GME) and continuing medical education as well.</p> <p> Just last year, the section officially changed its name to the AMA Academic Physicians Section to better reflect this commitment to shaping the full continuum of medical education.</p> <p> “The transition from the AMA Section on Medical Schools to the AMA Academic Physicians Section symbolizes and codifies our commitment to inclusiveness for all those who educate our students and house staff,” said Kenneth Simons, MD, senior associate dean for GME and accreditation at the Medical College of Wisconsin.</p> <p> Throughout its four decades, the section has introduced and influenced AMA policy.</p> <p> “This section is a strong advocate of medical education at undergraduate, graduate and postgraduate levels,” said Surendra Varma, MD, executive associate dean for GME and resident affairs and the Ted Hartman Endowed Chair in Medical Education, university distinguished professor and vice-chair of Pediatrics at Texas Tech University Health Sciences Center School of Medicine.</p> <p> Members of the AMA Academic Physicians Section also view their work as a service to the full medical education community. The section “influence[s] policy in order to help faculty in our academic institutions do their jobs with more efficiency and satisfaction,” said George Mejicano, MD, professor of medicine and senior associate dean for education at Oregon Health and Sciences University. The school is one of the founding members of the Accelerating Change in Medical Education Consortium, and Dr. Mejicano is the principal investigator of the school’s consortium project.  </p> <p> Cynda Ann Johnson, MD, president and founding dean of Virginia Tech Carilion School of Medicine, encourages all academic physicians to get involved in the section. “It matters,” Dr. Johnson said. “The AMA takes its role in shaping medical education seriously, and it has political clout.”</p> <p> Over the years, the section has introduced 173 resolutions on important matters, including expansion of medical schools, faculty development, physician workforce, duty hours, maintenance of certification, resident and student rotations and challenges of primary care.</p> <p> “There has been a tremendous wealth in important topics that we address in our individual institutions and in our daily work,” M. Dewayne Andrews, MD, executive dean of the University of Oklahoma College of Medicine, told physicians during a special lecture in honor of the section’s anniversary, named after its founder John Chapman, MD.</p> <p> “Physicians need a strong voice to advocate for our patients and our profession. The AMA Academic Physicians Section can and should be that voice,” said Maria C. Savoia, MD, dean for medical education and professor of medicine at the University of California–San Diego School of Medicine.</p> <p> The section also gives members key roles to play beyond the AMA.</p> <p> “Membership in the AMA Academic Physicians Section is an avenue toward nomination for important national committees in education and practice, such as the LCME, ACGME and RRCs,” said Betty Drees, MD, professor and dean emerita at the University of Missouri–Kansas City School of Medicine. “This is a way for faculty from all institutions to get involved at a national level to have input and also to provide avenues for career advancement. This type of service counts toward promotion guidelines in most institutions, but also gives participants the opportunity to build networks of colleagues.” </p> <p> If you’re not yet a member of the AMA Academic Physicians Section, now is an exciting time to <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/academic-physicians-section/members.page" target="_self">join your colleagues</a> in this important work. The next meeting of the section will take place Nov. 11 in Seattle.</p> <p style="text-align:right;"> <em>By AMA Wire editor <a href="https://twitter.com/amy_amawire" target="_blank" rel="nofollow">Amy Farouk</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b707a4f0-4cd9-420f-a57f-cb381c7b247e Senior physicians recognized for caring for the underserved http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_senior-physicians-recognized-caring-underserved Mon, 20 Jun 2016 01:16:00 GMT <p class="p1"> Four physicians are being recognized by the <span class="s1">AMA</span> Foundation for showing an extraordinary commitment to leadership, community service and care for those in need—each with decades of service that run the gamut from Ebola research to primary care.<b> </b>Find out who has been awarded this year’s honors.</p> <p class="p1"> <b>Serving underserved international populations</b></p> <p class="p1"> The AMA Foundation presented this year’s <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/excellence-medicine-awards.page"><span class="s1">Excellence in Medicine Awards</span></a> to  physicians June 10 at the 2016 AMA Annual Meeting in Chicago.</p> <p class="p1"> <b>Jennifer A. Downs, MD, PhD,</b> assistant professor of medicine and assistant professor of microbiology and immunology at the Center for Global Health at Weill Cornell Medical College, is equally comfortable in Ithaca as in her small concrete home in Tanzania.</p> <p class="p1"> When she went to that country years ago as a rotating resident, she didn’t suspect she would develop a heartfelt commitment to caring for its people. </p> <p class="p1"> “But now I love this country,” said Dr. Downs, “and it is difficult to imagine not working here.”</p> <p class="p1"> She<b> </b>is the recipient of this year’s Dr. Debasish Mridha Spirit of Medicine Award, which recognizes a U.S. physician who has demonstrated altruism, compassion, integrity, leadership and personal sacrifice while providing care to marginalized populations. </p> <p class="p1"> Dr. Downs’ first days working with the underserved population of Africa led to an epiphany: “I took care of women younger than I was who were dying of AIDS,” she recalled. “It was haunting. And I knew then that I wanted to come back and work to address the problem.”</p> <p class="p1"> Dr. Downs, who has learned the local language and become enmeshed in the culture of Tanzania, teaches, mentors and carries out clinical care. She makes the care and education of women a priority.. A $2,500 grant will be given to the Center for Global Health in her name.</p> <p class="p1"> <b>Adam Levine, MD</b>,<b> </b>an associate professor of emergency medicine at the Warren Alpert Medical School of Brown University, is the recipient of the Dr. Nathan Davis International Award in Medicine. It comes with a grant of $2,500 to the International Medical Corps. </p> <p class="p1"> The award recognizes Dr. Levine for outstanding international service. He has responded to humanitarian emergencies in Haiti, Libya, South Sudan and Liberia, and has led research and training initiatives in Zambia, Bangladesh, Rwanda, Liberia and Sierra Leone. </p> <p class="p1"> He currently serves as the emergency medicine coordinator for the USAID-funded Human Resources for Health Program, helping to develop the first emergency medicine training program in Rwanda. He serves as the primary investigator for the Ebola research team of the International Medical Corps, a disaster and humanitarian relief organization, and as director for the Humanitarian Innovation Initiative at Brown University. </p> <p class="p1"> Dr. Levine also is editor-in-chief of Academic Emergency Medicine's annual Global Emergency Medicine Literature Review. His research focuses on improving the delivery of emergency care in resource-limited settings and during humanitarian emergencies.</p> <p class="p1"> <b>Providing care for U.S. patients without access</b></p> <p class="p1"> This year the AMA Foundation recognizes two recipients<b> </b>of the<b> </b>Jack B. McConnell, MD, Award for Excellence in Volunteerism, honoring senior physicians who provide treatment to U.S. patients who lack access to health care. </p> <p class="p1"> <b>Charles Clements, MD</b>, a family medicine specialist in Huntington, W.V., helped found the Marshall Medical Outreach, a medical screening and treatment program for the local homeless community. The program provides an average of 35 patients a day with family medicine, internal medicine, ophthalmology and dermatology treatment. Many patients are referred to Recovery Point, an addiction treatment facility. </p> <p class="p1"> Dr. Clements plans to spend his summer with a group of medical students on his seventh trip to treat underserved villages in Honduras. He and his students will examine and treat more than 1,500 people, providing perhaps the only medical attention they receive this year.</p> <p class="p1"> His award comes with a grant of $2,500 to Marshall Medical Outreach.</p> <p class="p1"> The second McConnell recipient, <b>Rafael A. Zaragoza, MD</b>, is a urologist who lives in Delaware. His award comes with a $2,500 grant to the Delaware Prostate Cancer Coalition.</p> <p class="p1"> Dr. Zaragoza formed the Volunteer Ambulatory Surgical Access Program to provide free low-risk outpatient surgery to the uninsured in Kent County, Del., who cannot afford private pay and are not eligible for Medicaid. </p> <p class="p1"> Participating surgeons and nurses volunteer their time, and use of operating rooms is free to patients. He also launched the Hope Clinic, which provides non-emergency medical care to the uninsured.</p> <p class="p3"> <i>By contributing writer Michael Winters</i></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8115d0e1-da9f-4c1f-b75c-f9e40cb60aff California joins growing opposition to insurer mergers http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_california-joins-growing-opposition-insurer-mergers Fri, 17 Jun 2016 20:42:00 GMT <p> In a letter to the U.S. Department of Justice (DOJ), the California Department of Insurance (CDI) Thursday urged the DOJ to block the Anthem-Cigna merger in California on the grounds that the merger would substantially lessen competition.</p> <p> The call for a block is a major development given that California has the largest health insurance market in the nation and the CDI is nationally known for its expertise in health insurance regulation.</p> <p> <strong>Why California said no</strong></p> <p> The CDI based its conclusion on the information obtained in a March 29 public hearing that included testimony and written comments from the public, patient advocates, experts on health insurance mergers and both the AMA and California Medical Association (CMA).</p> <p> The AMA and CMA jointly filed a comprehensive, evidence-based <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/competition-anthem-cigna-merger-full.pdf" target="_self">analysis</a> (log in) explaining why the merger should be blocked. Both organizations also testified in person at the hearing before Insurance Commissioner David Jones, and worked hand-in-hand in developing a survey to determine the effect the merger would have on physician practices and patients.</p> <p> “Based on the merger guidelines and data from California alone,” Jones said in the <a href="https://www.insurance.ca.gov/0400-news/0100-press-releases/2016/upload/LetterUSDOJAnthem-Cigna06-16-16.pdf" rel="nofollow" target="_blank">letter</a>, “the proposed merger of Anthem and Cigna will substantially lessen competition in the most populous state containing four of the 20 largest MSAs [metropolitan statistical areas] in the country.”</p> <p> <strong>Premiums would increase</strong></p> <p> Citing the AMA analysis, the CDI found that the Anthem-Cigna merger would likely enhance market power or raise significant competitive concerns in most of California’s MSAs. The CDI also agreed with the AMA that lost competition through a merger would likely be permanent and acquired health insurer market power would be durable because of barriers to entry into the California health insurance markets.</p> <p> As a consequence, the CDI reasoned, quality adjusted premiums would increase notwithstanding new medical loss rating requirements that to some extent regulate unreasonable premium increases.</p> <p> <strong>Quality and consumer choice would suffer</strong></p> <p> The CDI recognized that the merger will harm patients because of its anticompetitive impact on physicians. In the letter, Jones stated that “… the merger would increase the monopsony power of the combined entities in purchasing the services of healthcare providers, thus likely decreasing the quality of services and increasing the price of health insurance.”</p> <p> Based in part on the AMA-CMA survey of physicians, the CDI letter also says that the physician surveys in other states in which Anthem has a substantial market share would likely “replicate the CMA survey results concerning physician vulnerability to Anthem-Cigna monopsony power. Allowing Anthem to increase its already enormous bargaining power will further limit network size and excessively squeeze reimbursement rates, thereby discouraging provider contracting and unacceptably reducing consumer choice and quality of care.”</p> <p> "The AMA commends the Commissioner for acknowledging the <a href="http://www.ama-assn.org/ama/pub/news/news/2015/2015-09-08-analysis-anthem-cigna-aetna-humana-mergers.page" target="_self">evidence</a> physicians and others presented,” said AMA President Andrew W. Gurman, MD, in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-16-california-commissioner-insurance-competition.page" target="_self">statement</a>, “demonstrating that the Anthem-Cigna merger would likely enhance market power or raise significant competitive concerns in most of California metropolitan areas.”</p> <p> The prospect of the other merger, Aetna’s acquisition of Humana, last month received a major blow when the Missouri Department of Insurance issued an <a href="http://insurance.mo.gov/documents/findings-fact-5-24-16.pdf" rel="nofollow" target="_blank">order</a> preventing the companies from doing any post-merger business in Missouri's Medicare Advantage markets and some commercial insurance markets—if the merger should be allowed.</p> <p> <strong>Price increases: An excerpt from the hearing</strong></p> <p> At the hearing in California on March 29, Jones directly questioned Jay Wagner, Anthem’s vice president and counsel, and Thomas Richards, Cigna’s global leader for strategy and business development, on the possibility of price increases and their claim that prices would actually decrease:</p> <p style="margin-left:40px;"> “ … cost will not go up? [On] any product?” Jones asked.</p> <p style="margin-left:40px;"> “No, I can’t commit to that,” Wagner said.</p> <p style="margin-left:40px;"> “We would need … a guaranteed commitment from our provider partners in order to do that,” Richards said. “I don’t know that we have those in terms of multi-year guarantees in the system to be able [to] do that this morning.”</p> <p style="margin-left:40px;"> “So none of you can provide any assurance that any of the health insurance products sold by any of the entities that will continue selling after the mergers will not increase in price, but at the same time, you’re both very confident that there’s going to be $2 billion in savings?” Jones asked.</p> <p style="margin-left:40px;"> “Correct,” Wagner replied.</p> <p> In the CDI letter to the DOJ, Jones said that he and his staff have been unable to find “reliable evidence in the public record that this merger will result in price decreases overall.”</p> <p> <strong>Learn more about the effects of proposed mergers:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/experts-stand-against-insurance-mergers" target="_self">Experts take a stand against insurance mergers</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-stand-up-against-mergers-of-powerful-insurers" target="_self">Physicians stand up against mergers of powerful insurers</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/states-health-insurers-squeezing-out-competition" target="_self">States where health insurers are squeezing out competition</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5f4d8d7b-c804-4398-abb8-e376490ac033 Deeper dive into digital snake oil: Q&A with Dr. Madara http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_deeper-dive-digital-snake-oil-qa-dr-madara Fri, 17 Jun 2016 18:00:00 GMT <p> In <a href="https://www.youtube.com/watch?v=RbWgJIOWQmQ" rel="nofollow" target="_blank">his address to the AMA’s House of Delegates</a> at the 2016 Annual Meeting last weekend, AMA CEO and Executive Vice President James L. Madara, MD, used the term “digital snake oil” to begin a critical conversation about emerging technologies in medicine. Following his remarks, he sat down with<em> AMA Wire®</em> for a conversation on what it means to separate the snake oil products from the products that improve patient care.</p> <p> The premise of Dr. Madara’s remarks was that innovations in medicine must be validated, evidence-based, actionable and connected. For new technologies to reach their potential, they must exhibit these primary features in order to bring patients and physicians closer together for the common purpose of improving health outcomes.  </p> <p> Since the speech, reporters, physicians and people from across the field of health IT have had questions for Dr. Madara. Here’s what he had to say on the AMA’s role in the ever-changing landscape of health care in the digital age.</p> <p> <strong><em>AMA Wire:</em></strong><strong> What has been the response to your remarks and your use of the term “digital snake oil”?</strong></p> <p> <strong>Dr. Madara:</strong> The early response has fallen into two general camps, which is exciting because it has initiated a healthy and much-needed discussion about this issue. The first camp is those who are generally comfortable with the pace of development of new technologies, the tsunami of digital tools and apps that I spoke of, and who perhaps aren’t concerned or don’t know enough about the potential health risks of what sometimes amounts to un-validated toys.</p> <p> The second camp sees this issue differently, and their response to me has been: “That’s right, we are moving toward a mess where the useful tools are not clearly differentiated from the toys. We had better get this right if we really believe in a digital health future.”</p> <p> Physicians recognize the tremendous potential in digital health and are looking to the AMA to help make sense of the changing landscape and incorporate new technologies into their practice—technologies that have been shown to improve patient care and outcomes.  </p> <p> But there is too much fantasy right now, blending what could and should be possible with what actually exists today. There are books, for example, that are still promoting use of un-validated approaches that are now under federal investigation—unhelpful and misleading to say the least. This makes a hash of our current digital health state and slows progress.</p> <p> <strong><em>AMA Wire:</em></strong><strong> Why did you choose this message for the House of Delegates?</strong></p> <p> <strong>Dr. Madara:</strong> The AMA has a long history of speaking out on issues important to physicians and patients. Our predecessors helped stamp out medical quackery in the 19<sup>th</sup> Century, as well as created the first code of clinical medical ethics, and crafted the nation’s first educational standards in medicine.</p> <p> Digital health, which spans the entire ecosystem of health IT, continues to play a greater role in the practice of medicine. The AMA is carefully examining the role health IT plays in providing high-quality care to patients and is helping physicians navigate and successfully use these technologies to improve health. We are identifying key challenges physicians face with health IT and focusing on improved usability and interoperability.</p> <p> At the core of the AMA’s mission—to promote the art and science of medicine and the betterment of public health—is the work to improve the health of the nation. With that in mind, we speak out when the all-important physician-patient relationship is threatened or a new health risk is identified.</p> <p> <strong><em>AMA Wire:</em></strong><strong> Which current digital technologies in medicine do you consider to be “snake oil”?</strong></p> <p> <strong>Dr. Madara:</strong> Right now we are often dealing with first-generation technology that has a remarkable potential to change medicine, health care delivery and even the doctor-patient relationship. The term digital snake oil isn’t meant to be a criticism of any one product, rather a critique of a direct-to-consumer industry that exists today with little oversight and often questionable scientific evidence to support the claims made.</p> <p> Though these products may be well-intended, far too many provide incomplete or inaccurate snapshots of a patient’s health and, ultimately, fail to deliver on their promises. Our challenge is finding, fostering and refining the real medical advancements—separating the medically useful from the merely entertaining. </p> <p> One can find products, for example, that claim to measure your blood pressure but in the fine print indicate the product is for entertainment only—that the readings are not to be trusted! I believe a digital environment is critical to enhancing medical practice. However, mixing the medically useful digital advances with what amounts to poorly-validated digital toys slows the advance of this promising field.</p> <p> <strong><em>AMA Wire:</em></strong><strong> Are you saying there is a deliberate attempt by these tech innovators to deceive the public?</strong></p> <p> <strong>Dr. Madara:</strong> The vast majority of these products are well intended, even if they fail to deliver true health benefits. Health is not just another field of entertainment. While some new technologies represent wonderful advances in medicine, hidden among them are countless other products that don’t have an appropriate evidence base and others that just don’t work well—elements that impede the care physicians provide and serve no purpose but to confuse patients and waste time.</p> <p> Another misguided direction in the digital health space stems from a failure to correctly understand the interconnected nature of health care. Health and health care are not monolithic, linear manufacturing processes. Rather, they are more akin to a systems engineering model with the added layer of considerable practice-to-practice, geographic and other variations. As such, interconnectedness and data liquidity are critical and, unfortunately, we have precious little of either today. Isolated tools, even when validated, do not fit this model.</p> <p> According to a Price Waterhouse study released just last month, 65 percent of adults who own and use a wearable device are “excited” by the opportunity to use a wearable to interact in a doctor’s office, which is also the site they identified at the highest level of trust level in interpreting the data collected by the device. At the same time, a recent Commonwealth Fund <a href="http://www.commonwealthfund.org/publications/issue-briefs/2016/feb/evaluating-mobile-health-apps" rel="nofollow" target="_blank">report</a> stated that while mobile applications are a “potentially promising tool for engaging patients in their health care …” only about 43 percent of iOS apps and 27 percent of Android apps appeared to be useful.</p> <p> <strong><em>AMA Wire:</em></strong><strong> Do you consider electronic health records (EHR) to be a form of digital snake oil?</strong></p> <p> <strong>Dr. Madara:</strong> No. But, EHRs are symbolic of a system that is not fully functional or living up to its potential. There are significant usability challenges when it comes to EHR implementation and the delivery of quality care. To resolve these challenges, the AMA put forth eight <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/digital-health.page" target="_self">EHR usability priorities</a> to be urgently addressed and we are partnering with multiple stakeholders to improve EHR usability for physicians.</p> <p> A detailed AMA Rand study revealed that, while physicians do not want to go back to paper and see the promise of EHRs, they are highly frustrated by the current form of these records.  They tend not to be interoperable, at least not with ease, and many argue that the copy-and-paste culture they induce actually deteriorate the quality of the medical record.  One day we will look back on the current 1.0 state of the electronic record the way we currently look back on typewriters.</p> <p> The AMA is taking a multi-pronged approach to helping to influence the improvement and evolution of EHRs and working to ensure physicians have high-performing EHRs that support a learning health system. We continue to consult with experts in the EHR and digital health fields, speak to vendors, advocate for changes to the Meaningful Use and EHR certification programs, and promote interoperability through participation in industry-led efforts.</p> <p> <strong><em>AMA Wire:</em></strong><strong> Is the AMA trying to slow the development of new products?</strong></p> <p> <strong>Dr. Madara:</strong> It’s the opposite actually. We want a more robust conversion to support a digital environment that consists of evidence-based tools that are validated, actionable, and interconnected. Taking such elements and intermixing them with toys that do not have these characteristics, slows progress.</p> <p> We need to get digital tools right. The AMA is taking a leadership role to support the development of new technologies by building a bridge to tech innovators and entrepreneurs so that physicians have a seat at the table when new technologies are being designed and created. This ensures that new innovations, once fully formed, have real-world applications in clinics and hospitals … that they work to reduce inefficiencies in health care delivery, improve patient access, lower costs and, ultimately, increase the quality of care.</p> <p> The AMA is committed to innovation and collaboration that will help advance our ongoing work on behalf of the nation’s physicians and patients to meet the needs of 21st Century health care. We call this the AMA’s health innovation ecosystem.</p> <p> For example, in Chicago we are partnering with the technology incubator <a href="http://matterchicago.com/" rel="nofollow" target="_blank">MATTER</a>, connecting entrepreneurs and physicians at the very point of the “idea conception” to develop new technologies, services and products to better serve physicians and patients. And earlier this year, we launched <a href="https://www.health2047.com/" rel="nofollow" target="_blank">Health2047</a> in San Francisco. Health2047 is an integrated innovation company, which takes on many of the problems sourced from AMA studies (as well as from others) and applies rapid prototyping and design to achieve tools based on physician need. Emerging prototypes will be iterated with physicians until the tool gets it right. Partnering with industry on the development of needed products is an additional possible pathway for Health 2047.</p> <p> <strong><em>AMA Wire:</em></strong><strong> Are consumers at risk by these so-called “defective” tech products? Do you have research that supports that claim?</strong></p> <p> <strong>Dr. Madara:</strong> Consumers can be at risk when new technologies make claims that cannot be supported by evidence and science—particularly if they are allowed to enter the marketplace unchecked.</p> <p> In calling attention to these emerging technologies, the AMA is trying to raise awareness about the risks and establish high industry standards so that consumers know what they’re getting and can trust the data as they track their general wellness and manage chronic diseases. The field of medicine deserves the same attention to validated interconnected digital quality as the field of aviation. Can you imagine digital instruments that are not validated, not evidence based, not actionable, and not connected being used in a cockpit?</p> <p> <strong><em>AMA Wire:</em></strong><strong> What’s next? How should the AMA carry this message forward?</strong></p> <p> <strong>Dr. Madara:</strong> By leading with action, such as our work at MATTER and our role as founding investor in the Health 2047 innovation studio, the AMA is not simply sitting on the sideline. The promise of a functional, supportive digital future is simply too important for that. We need to do all we can to ensure that digital medicine lives up to its promise, even if it means calling attention to so-called innovations that confuse, and therefore inhibit, the supportive digital future that physicians and patients want.</p> <p> We look forward to that day when a trustworthy, validated, interconnected digital environment both frees and support physicians to do what they value most—spend time with their patients.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8a4cc823-1fd7-4a9b-8827-5754756dc574 Physicians elect AMA trustees, council members http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-elect-ama-trustees-council-members Thu, 16 Jun 2016 22:54:00 GMT <p> In a daylong series of runoff and special elections, delegates at the 2016 AMA Annual Meeting Tuesday voted for officer positions—including president-elect, members for the AMA Board of Trustees, speaker and vice speaker of the AMA House of Delegates, and six seats on four councils.</p> <p> <strong>Results of officer elections</strong></p> <p> Following a compelling debate by both candidates, David O. Barbe, MD, was voted president-elect of the AMA. Dr. Barbe is a family physician from Mountain Grove, Mo., and previously served as the chair of the AMA Board of Trustees. Following a year-long term as president-elect, Dr. Barbe will assume the office of AMA president in June 2017.</p> <p> “It is a tremendous honor and privilege to be elected by my peers to be president-elect of an organization that is dedicated to improving the practice environment for physicians, the education of our medical students and the health of the patients we serve,” Dr. Barbe said. “I am eager to continue the strong work of the AMA in shaping America’s health care system to better meet the needs of patients and physicians both now and in the future.”</p> <p> Running unopposed for reelection to the offices of speaker and vice speaker of the AMA House of Delegates were Susan R. Bailey, MD, and Bruce A. Scott, MD, respectively. Both candidates were voted by acclamation to complete another term.</p> <p> Six qualified candidates ran for three seats on the AMA Board of Trustees. Delegates reelected William E. Kobler, MD, and elected two new members to the board: Willarda V. Edwards, MD, and William A. McDade, MD.</p> <p> Also appointed to the executive committee of the AMA Board of Trustees:</p> <ul> <li> Chair: Patrice A. Harris, MD</li> <li> Chair-elect: Gerald E. Harmon, MD</li> <li> Secretary: Jack Resneck, Jr., MD</li> </ul> <p> <strong>Council elections</strong></p> <p> In competitive elections for council seats, five delegates were selected by their peers to serve in open positions:</p> <ul> <li> AMA Council on Constitution and Bylaws: Pino Colone, MD</li> <li> AMA Council on Medical Service: Alan Harmon, MD, and Lynn Jeffers, MD</li> <li> AMA Council on Medical Service resident and fellow seat: Laura Faye Gephart, MD</li> <li> AMA Council on Science and Public Health: Alex Ding, MD, and David J. Welsh, MD</li> <li> AMA Council on Medical Education: Cynthia Jumper, MD</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ed9a4680-fa2f-42f1-9d94-8fc0f8593322 Preventing gun violence is all about saving lives http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_preventing-gun-violence-saving-lives Thu, 16 Jun 2016 21:41:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/4/b892f0b5-f0fe-4f84-a4b0-88862e8c8de0.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/4/b892f0b5-f0fe-4f84-a4b0-88862e8c8de0.Large.jpg?1" style="margin:10px;float:left;" /></a><em>An AMA Viewpoints post by AMA Immediate-Past President Steven J. Stack, MD</em></p> <p> When dozens of physicians lined up to testify at the 2016 <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_self">AMA Annual Meeting</a> this week, the remarks were impassioned and derived from lifetimes of treating victims of gun violence. While this topic has become highly politicized in our country, the passion in the room stemmed from the urgent need to take a stance on a vital public health issue—one that could help save thousands of lives and prevent needless tragedies that affect so many families in our nation.</p> <p> <strong>Agreement across regions, specialties and political leanings</strong></p> <p> One of the remarkable things about the AMA policymaking process is how truly democratic it is. The AMA House of Delegates includes representatives from every corner of the country, from 118 specialties and every kind of practice setting. Delegates range from young medical students to veterans of the profession. Every perspective is included, and everyone gets a voice.</p> <p> Hearing medical students and physicians from so many backgrounds and points of view share their perspectives spoke to the importance of intervening to stop gun-related violence and how it gets at the very heart of our calling as physicians.</p> <p> We heard from physicians who practice in places with high rates of violence—including a poverty-stricken neighborhood in Washington, D.C., inner city Wilmington, Del., and downtown Los Angeles. We heard from one physician who was among the medical responders for the Boston Marathon bombing and another from Orlando who was among the physicians who were paged regarding the mass casualties and injuries from the tragic shooting there last week.</p> <p> One physician testified that she had treated so many gunshot victims as a resident that she was told to stop tracking the head and neck surgeries she performed because she had more than enough to demonstrate her competency to complete her training.</p> <p> A young emergency physician shared that trying to revive gunshot victims and treat the wounded had become shockingly routine for him. What’s more, he noted that even as an academic physician treating such a high number of victims, he doesn’t have the ability to turn to data to examine how these injuries might be prevented.</p> <p> Many physicians from states that traditionally are highly supportive of gun ownership also expressed the need to get behind any evidence-based policy that would help prevent violence from befalling our patients.</p> <p> A senior delegate perhaps characterized the AMA policymaking discussion best when he testified that it wasn’t about questioning second amendment rights but about conducting research to better understand the issue because we currently suffer from a lack of data to look at gun violence from an epidemiological point of view.</p> <p> <strong>How the AMA is taking action</strong></p> <p> AMA policy guides our advocacy efforts for patients and physicians and at this meeting, we built on existing policy with several key developments:</p> <ul> <li> Officially calling gun violence in the United States a public health crisis that requires a comprehensive public health response and solution</li> <li> Directing the AMA to actively lobby Congress to overturn legislation that for 20 years has prevented the Centers for Disease Control and Prevention from researching gun violence</li> <li> Calling for background checks and a waiting period for all firearms purchasers, whereas previous policy only dealt with handguns</li> </ul> <p> These are very important steps to tackle a public health crisis. It truly is an issue that affects us all and demands our best efforts to address it.</p> <p> In addition to the expanded AMA policy, we’ve also been hard at work over the last few years in the nation’s courts to preserve freedom of speech in the exam room for physicians to talk to patients and family members about safety.</p> <p> A recent law in Florida would effectively put a gag on physicians, preventing them from discussing gun safety with their patients. This kind of counseling is especially important for families with young children because it can prevent accidental gun-related injuries and deaths. It seems like every time you see the news, another child is accidentally shot or accidentally shoots someone else because of unsafe gun storage practices.</p> <p> The AMA and several other medical associations have been <a href="http://www.ama-assn.org/ama/ama-wire/post/freedom-of-patient-physician-conversations-hinges-court-case" target="_self">fighting this law</a>, and the case is scheduled to be heard by a rare 11-judge panel beginning June 21 in Atlanta.</p> <p> It’s significant that so many physicians at the 2016 AMA Annual Meeting gave a standing ovation upon passage of our new policy: It represents our common, unwavering commitment to protect our patients and improve the health of the nation in the most meaningful ways possible.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4f8c340e-4587-437e-8395-38a94a7552cf From ethics to gun violence: Top stories from 2016 AMA Annual Meeting http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ethics-gun-violence-top-stories-2016-ama-annual-meeting Thu, 16 Jun 2016 19:00:00 GMT <p> The 2016 AMA Annual Meeting took place this week. Read these highlights from the meeting, and see <em>AMA Wire's</em><em>®</em> <a href="http://www.ama-assn.org/ama/ama-wire/blog/AMA_Meeting/1" target="_blank">full coverage</a> of the event to learn more.</p> <p> <strong>1.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/code-of-medical-ethics-modernized-first-time-50-years"><strong><em>Code of Medical Ethics </em>modernized for first time in 50 years</strong></a><a href="https://www.youtube.com/watch?v=39W1xhvUEbM" rel="nofollow" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/4/b6f94b37-24a2-4207-a400-f1b7b7e94853.Large.jpg?1" style="margin:5px;float:right;width:247px;height:150px;" /></a><br /> Physicians have just affirmed a comprehensive update of the nearly 170-year-old <em>AMA Code of Medical Ethics</em>, the conclusion of a meticulous project started eight years ago to ensure that this ethical guidance keeps pace with the demands of the changing world of medical practice.</p> <div> <p> <strong>2.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/bright-future-horizon-path-there"><strong>Bright future on the horizon—and we know the path to get there</strong></a> <br /> Physicians live in a world of contradictions, outgoing AMA President Steven J. Stack, MD, said in his address. It’s a profession of rewards and privilege amid the toll of frustration and burnout, borne of administrative hassles and bureaucratic overreach. The challenge is to persevere and lead the way for others.</p> <p> <strong>3.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/ama-calls-background-checks-wait-periods-prevent-gun-violence"><strong>AMA calls for gun research, background checks to prevent violence</strong></a><br /> <a href="https://www.youtube.com/watch?v=-yQQiTzuGQs" rel="nofollow" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/4/d053a23b-6900-409d-b42a-b568d1415396.Large.jpg?1" style="color:rgb(0, 0, 238);margin:5px;float:right;width:247px;height:150px;" /></a>Calling gun violence a “public health crisis,” the AMA is urging background checks and a waiting period for all firearms purchasers and will lobby Congress to overturn legislation that for 20 years has prevented the Centers for Disease Control and Prevention from researching gun violence.</p> <p> <strong>4.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/ethical-considerations-prompt-new-telemedicine-ground-rules"><strong>Ethical considerations prompt new telemedicine ground rules</strong></a><br /> With the increasing use of telemedicine and telehealth technologies, delegates adopted new policy that outlines ethical ground rules for physicians using these technologies to treat patients.</p> </div> <div> <p> <strong>5.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-guiding-new-payment-system-cms-chief-says"><strong>Physicians are guiding new payment system, CMS chief says</strong></a><br /> In the effort to design the new Medicare payment system, Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), said that the driving factor behind many of the changes was physician input. But the physician’s role does not stop there.</p> <p> <strong>6.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/new-ama-policies-patients-should"><strong>11 new AMA policies your patients should know</strong></a><br /> <a href="https://www.youtube.com/watch?v=yvsdz7O3m-c" rel="nofollow" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/9/aa3119b0-1782-4eb5-a9d2-74b679169ad9.Large.jpg?1" style="color:rgb(0, 0, 238);margin:5px;float:right;width:247px;height:150px;" /></a>At the heart of policymaking of the AMA is the mission to promote the betterment of public health. Physicians adopted policies that will help improve consumer safety and reduce harm—they range from preventing drug overdose to delaying school start times and supporting paid sick leave.</p> <p> <strong>7.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/sitting-sidelines-involved"><strong>If you’re sitting on the sidelines, get involved</strong></a><br /> Andrew W. Gurman, MD, in his inaugural speech as president of the AMA, issued a call to action for physicians to be leaders and advocates for their profession.</p> <p> <strong>8.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-making-ehrs-interoperable"><strong>How physicians are making EHRs interoperable</strong></a><br /> Electronic health records (EHR) have consistently caused problems for physicians due to a lack of interoperability. Physicians and health IT developers explained how physicians must lead—and are leading—the way forward.</p> <p> <strong>9.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/digital-dystopia-developing-tools-work-practice"><strong>Digital dystopia: Developing tools that work in practice</strong></a> <a href="https://www.youtube.com/watch?v=RbWgJIOWQmQ" rel="nofollow" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/13/ac884ee1-1399-4cae-8d92-c1d4d30e3b08.Large.jpg?1" style="margin:5px;float:right;width:247px;height:150px;" /></a><br /> Identifying the technology that makes care less efficient and building new tools that are based on physician perspectives from the start are critical to developing a digital practice environment that works for physicians and patients, AMA Executive Vice President and CEO James L. Madara, MD, said.</p> <p> <strong>10.  </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-steps-address-opioid-overdose-epidemic"><strong>Physicians take steps to address opioid overdose epidemic</strong></a><br /> The physician role in reducing opioid medication misuse, overdose and death is an important one. New policies address factors that are critical to reversing the epidemic, including prescription drug monitoring programs, access to naloxone and addiction medicine as a sub-specialty.</p> </div> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8008fa08-eebc-4af9-bb56-462d389c7c46 EHRs to MOC: Physicians tackle practice issues in new policy http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ehrs-moc-physicians-tackle-practice-issues-new-policy Wed, 15 Jun 2016 21:00:00 GMT <p> During the third day of policymaking at the 2016 AMA Annual Meeting, physicians discussed a range of topics that affect their practice of medicine. Among them were maintenance of certification (MOC) concerns, the desire to improve patient safety amid the difficulties of electronic health records (EHR) and the need to ensure coverage of telemedicine services.</p> <p> <strong>Minimizing EHR-related patient safety risks</strong></p> <p> EHRs vendors have been required to make changes to EHR products at such a rapid pace in order to comply with required meaningful use certification that there hasn’t been enough time to align new functionalities with efficient practice work flows.</p> <p> Poor usability and a lack of interoperability between EHR systems carry patient safety risks and efforts at the local and state levels have been ineffective to reduce these risks.</p> <p> In order to improve patient safety, physicians Tuesday adopted policy to support efforts of the Office of the National Coordinator for Health IT to implement a Health IT Safety Center to minimize EHR-related patient safety risks through collection, aggregation and analysis of data reported from EHR-related adverse patient-safety events.</p> <p> <strong>Ensuring payment parity for telemedicine services</strong></p> <p> Telemedicine and telehealth services offer an opportunity for physicians to improve health outcomes among their existing patients, particularly for those with chronic conditions or who need routine follow-up care but have mobility issues. For instance, when physicians conduct <a href="http://www.ama-assn.org/ama/ama-wire/post/tablet-can-treat-diabetes-watch-this-film-out" target="_self">home monitoring of chronic conditions</a>, such as diabetes, they are better able to keep their patients healthy and reduce hospital admissions and emergency department visits.</p> <p> Delegates voted to adopt policy that calls for private health insurers to cover telemedicine-provided services that are comparable to that of in-person services and not limit coverage to services provided by select corporate telemedicine providers.</p> <p> “The AMA has supported state medical societies in developing telemedicine policies, which have provided tremendous benefit to rural communities. But these benefits will continue to be limited if patients must pay out of pocket for the services that should be covered by insurance,” AMA Board Member Russell W. H. Kridel, MD, said in a news release.</p> <p> The AMA in 2014 released model legislation to support states’ efforts to achieve parity in telemedicine coverage policies, ensure telemedicine is appropriately defined in each state’s medical practice statutes and that its regulation falls under the jurisdiction of the state medical board. The resolution adopted today reflects the great interest in the safe and effective practice of telemedicine, and the AMA will continue to work with state medical societies to accomplish this goal.</p> <p> <strong>Improving MOC and OCC</strong></p> <p> A new report from the AMA Council on Medical Education examines the current state of maintenance of certification (MOC) and osteopathic continuous certification (OCC), noting both the physician concerns around such elements as cost effectiveness and relevance to practice and the professional imperative to ensure patients are receiving high-quality care.</p> <p> The report notes that the council will continue to work with the relevant associations and member boards to identify and suggest improvements to the MOC and OCC programs. Additionally, the council “is committed to ensuring that MOC and OCC support physicians’ ongoing learning and practice improvement.”</p> <p> “The AMA will continue to advocate for a certification process that is evidence based and relevant to clinical practice as well as cost effective and inclusive to reduce duplication of work,” the report said.</p> <p> Delegates adopted policy to further these efforts, including:</p> <ul> <li> Examining the activities that medical specialty organizations have underway to review alternative pathways for board recertification</li> <li> Determining whether there is a need to establish criteria and construct a tool to evaluate whether alternative methods for board recertification are equivalent to established pathways</li> <li> Asking the American Board of Medical Specialties to encourage its member boards to review their MOC policies regarding the requirements for maintaining underlying primary or initial specialty board certification in addition to subspecialty board certification to allow physicians the option to focus on MOC activities most relevant to their practices</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:12270819-6742-4425-80ec-bc93524df726 Physicians take steps to address opioid overdose epidemic http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-steps-address-opioid-overdose-epidemic Wed, 15 Jun 2016 20:25:00 GMT <p> The physician role in reducing opioid medication misuse, overdose and death is an important one. Several new policies were put into place by physician delegates at the 2016 AMA Annual Meeting addressing factors that are critical  to reversing the epidemic, including prescription drug monitoring programs (PDMP), access to naloxone and addiction medicine as a sub-specialty.</p> <p> <strong>The importance and effectiveness of PDMPs</strong></p> <p> The prevention and treatment of opioid use disorder has been a focus of the AMA’s <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page">Task Force to Reduce Prescription Opioid Abuse</a> since its inception. PDMPs are important tools that physicians have to help them in this effort.</p> <p> Not all states allow physicians to access their own prescription records, which would provide better control against fraudulent prescribing. Physicians adopted policy to promote the efforts for state-run electronic PDMPs that allow individual physicians to access their opioid prescribing records for their entire panel of patients, including patient names and prescription information.</p> <p> New policy also asks that the AMA study current pathways that may allow physicians to report possible fraudulent use of their prescriptions.</p> <p> <strong>Increasing access to naloxone </strong></p> <p> There has been a large increase in naloxone dispensed over the past 18 months, a report from the AMA Board of Trustees stated. From the fourth quarter of 2014 to the second quarter of 2015, there was a 1,170 percent increase. This life-saving opioid overdose antidote is an important tool for physicians to minimize harm when treating at-risk patients with opioid medications.</p> <p> In response to the report, delegates at the 2016 AMA Annual Meeting adopted policy to:</p> <ul> <li> Support legislative and regulatory efforts that increase access to naloxone, including collaborative practice agreements with pharmacists and standing orders for pharmacies as well as community-based organizations, law enforcement agencies, correctional settings, schools, and other locations that do not restrict the route or administration for naloxone delivery.</li> <li> Support efforts that enable law enforcement agencies to carry and administer naloxone.</li> <li> Encourage physicians to co-prescribe naloxone to patients at risk of overdose and, where permitted by law, to the friends and family members of such patients.</li> <li> Encourage private and public payers to include all forms of naloxone on their preferred drug lists and formularies with minimal or no cost sharing.</li> <li> Support liability protections for physicians and other health care professionals and others who are authorized to prescribe, dispense or administer naloxone pursuant to state law.</li> <li> Support efforts to encourage individuals who are authorized to administer naloxone to receive appropriate education to enable them to do so effectively.</li> </ul> <p> <strong>Breaking down barriers to pain management</strong></p> <p> Although intended to promote pain assessment and effective treatment, notion of “pain as the fifth vital sign” and the evolution of patient satisfaction surveys that include a focus on the extent to which a patient’s pain is relieved has created a practice environment that likely contributed to an increase in opioid prescriptions, according to a report from the AMA Board of Trustees.</p> <p> Despite the substantial burden of persistent pain in the U.S., access to multidisciplinary care and insurance coverage for non-pharmacologic approaches is woefully inadequate, according to the report. These factors also have contributed to the routine use of opioid analgesics.</p> <p> Measuring adequate pain control in acute and subacute care settings is complicated by the subjective nature of pain intensity reports by patients. Delegates adopted policies intended to promote access to high quality, comprehensive pain care, including:</p> <ul> <li> Work with The Joint Commission to promote evidence-based, functional and effective pain assessment and treatment measures for accreditation standards.</li> <li> Support timely and appropriate access to non-opioid and non-pharmacologic treatments for pain, including removing barriers to such treatments when they inhibit a patient’s access to care.</li> <li> Advocate for the removal of the pain management component of patient satisfaction surveys as it pertains to payment and quality metrics.</li> </ul> <p> <strong>Specialties and guidelines—more action from physicians</strong></p> <p> Delegates also adopted policy supporting the American Board of Preventive Medicine’s (ABPM) establishment of addiction medicine as a subspecialty for physicians. The new policy also encourages ABPM to offer its first American Board of Medical Specialties-approved certification examination in addiction medicine expeditiously in order to improve access to care to treat addiction.</p> <p> “We applaud the American Board of Preventive Medicine for making addiction medicine a new subspecialty,” AMA Board Member Patrice A. Harris, MD, said news release. “We believe that having more physicians specifically trained to treat addiction will help improve access to care and help combat the nation’s opioid epidemic.”</p> <p> Delegates also instructed the AMA to work with the Centers for Disease Control and Prevention (CDC) and other regulatory agencies to have long-term care facilities viewed as exempt from the  recommendations contained in <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-saying-new-cdc-opioid-guidelines" target="_self">new guidelines</a> from the CDC for the use of  opioid medications for chronic pain, in much the same way as is being done for hospice and palliative care.</p> <p> The AMA Task Force to Reduce Prescription Opioid Abuse has established five recommendations for physicians to combat the opioid overdose epidemic. These recommendations include: Register for and use your state <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/prescription-drug-monitoring-programs.page?" target="_self">PDMP</a> to check your patient’s prescription history; <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-resource-guide.page?" target="_self">educate yourself</a> on managing pain and promoting safe, responsible opioid prescribing; support overdose prevention measures, such as <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/increase-naloxone-access.page?" target="_self">increased access to naloxone</a>; reduce the stigma of <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/stigma-of-substance-use-disorder.page?" target="_self">substance use disorder</a> and enhance access to treatment; and ensure patients in pain aren’t stigmatized and can receive comprehensive treatment.</p> <p> <strong>For more on physician efforts to end the opioid overdose epidemic:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/obamas-opioid-initiatives-align-physician-recommendations">How Obama’s opioid initiatives align with physician recommendations</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/talk-substance-use-disorders-patients">How to talk about substance use disorders with your patients</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-team-up-treat-addiction-rural-areas">Physicians team up to treat addiction in rural areas</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-steps-talking-patients-substance-use-disorder">3 steps for talking with patients about substance use disorder</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/entire-state-gets-one-naloxone-prescription">Entire state gets one naloxone prescription</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/antidote-3-things-consider-co-prescribing-naloxone">The antidote: 3 things to consider when co-prescribing naloxone</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5cf89e38-42f3-4b81-a760-ed66da47c45e Physicians take on timely public health issues http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-timely-public-health-issues Wed, 15 Jun 2016 18:00:00 GMT <p> In Days 2 and 3 of policymaking at the 2016 AMA Annual Meeting, delegates adopted a variety of policies on important issues affecting the health of patients across the country. Issues range from controlled LED lighting to safe provision of dry needling procedures to better training for hemorrhage control.</p> <p> <strong>Attorney ads on drug side-effects</strong></p> <p> Late-night television is rampant with attorney ads that seek plaintiffs regarding complications from new medications. Potential complications are spoken about in an alarming way, and often, it is the first time the public learns about those potential complications and side effects.</p> <p> These ads describe only the lethal side effects and not the benefits of the medications that many patients have experienced—but this is not explained to the viewers.</p> <p> To protect the health of the public, physicians Tuesday adopted policy to advocate for a requirement that attorney commercials which may cause patients to stop using necessary medications to have appropriate and conspicuous warnings that patients should not discontinue medications without seeking the advice of their physician.</p> <p> “The onslaught of attorney ads has the potential to frighten patients and place fear between them and their doctor,” AMA Board Member Russell W. H. Kridel, MD, said in a news release. “By emphasizing side effects while ignoring the benefits or the fact that the medication is FDA approved, these ads jeopardize patient care. For many patients, stopping a prescribed medication is far more dangerous, and we need to be looking out for them.”</p> <p> <strong>Standards of practice for dry needling</strong></p> <p> Ensuring patient safety is paramount for physicians. To that end, delegates adopted new policy that recognizes the procedure of dry needling as invasive.</p> <p> Physical therapists are increasingly incorporating dry needling into their practice. Dry needling is indistinguishable from acupuncture, yet physical therapists are using this invasive procedure with as little as 12 hours of training, while the industry standard minimum for physicians to practice acupuncture is 300 hours of training.</p> <p> Delegates agreed that the practice of dry needling by physical therapists and other non-physician groups should include—at a minimum—the benchmarking of training and standards to already existing standards of training, certification and continuing education that exist for the practice of acupuncture.</p> <p> The policy also maintains that dry needling as an invasive procedure should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed medical physicians and licensed acupuncturists.</p> <p> “Lax regulation and nonexistent standards surround this invasive practice,” AMA Board Member Russel W.H. Kridel said in a news release. “For patients’ safety, practitioners should meet standards required for acupuncturists and physicians.”</p> <p> <strong>Physicians suggest controlled LED lighting</strong></p> <p> Strong arguments exist for overhauling the lighting systems on roadways with light emitting diode (LED), but conversions to improper LED technology can have adverse consequences.</p> <p> In response, physicians adopted guidance for communities on selecting LED lighting options to minimize potential harmful human and environmental effects. The guidance was based on a report from the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-science-public-health.page?" target="_self">AMA Council on Science and Public Health</a>.</p> <p> Converting conventional street light to energy-efficient LED lighting leads to cost and energy savings, and a lower reliance on fossil-based fuels. Approximately 10 percent of existing U.S. street lighting has been converted to solid state LED technology, with many efforts underway to accelerate this conversion.</p> <p> “Despite the energy efficiency benefits, some LED lights are harmful when used as street lighting,” AMA AMA Board Member Maya A. Babu, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-community-guidance-street-lighting.page" target="_self">news release</a>. “The new AMA guidance encourages proper attention to optimal design and engineering features that minimize detrimental health and environmental effects.”</p> <p> High-intensity LED lighting designs emit a large amount of blue light that appears white to the naked eye and create worse nighttime glare than conventional lighting. The intense, blue-rich LED lighting can decrease visual acuity, resulting in safety concerns and road hazards.</p> <p> The new policy encourages communities to:</p> <ul> <li> Minimize and control blue-rich environmental lighting by using the lowest emission of blue-light possible</li> <li> Properly shield all LED lighting to minimize glare and detrimental human health and environmental effects</li> <li> Consider using dimmers on LED lighting for off-peak times</li> </ul> <p> In addition to its impact on drivers, blue-rich LED streetlights operate at a wavelength that adversely suppresses melatonin during the night. It is estimated that white LED lamps have five times greater impact on the body’s natural sleep-wake cycle than conventional street lamps. Recent surveys found that brighter residential nighttime lighting is associated with reduced sleep times, dissatisfaction with sleep quality, excessive sleepiness, impaired daytime functioning and obesity.</p> <p> <strong>Action to address illegal methamphetamine production</strong></p> <p> Physicians adopted policy that supports the replacement of current pseudophoedrine-containing over-the-counter products with formulations that are resistant to methamphetamine production as well as initiatives that focus on prevention and treatment of methamphetamine abuse.</p> <p> Additionally, physicians encouraged the widespread and proper use of the national precursor log exchange (NPLEx), a real-time electronic logging system used to track over-the-counter medications that can be used to make methamphetamine.</p> <p> <strong>Increasing training for hemorrhage control</strong></p> <p> The AMA adopted policy calling for state medical and specialty societies to promote the training of first responders and the lay public in techniques of bleeding control. With increases in active shooter incidents, the need is greater than ever for training in hemorrhage control training, the AMA policy says.</p> <p> The AMA also called for providing hemorrhage control kits to law enforcement and other first responders. The U.S. military found that uncontrolled hemorrhage due to trauma was the most common cause of preventable death among more than 6,800 military casualties in Iraq and Afghanistan.</p> <p> “After implementing hemorrhage control training to help victims of trauma, the military saw a significant decrease in the number of deaths caused by uncontrolled bleeding in these patients,” AMA Board Member Jesse M. Ehrenfeld, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-public-health-policies.page" target="_self">news release</a>. “We believe that by equipping the public, police and others who are first on the scene of a traumatic event with training and supplies to control bleeding, we will also be able to help save more trauma patients.”</p> <p> <strong>Promoting long-term health and wellness in the juvenile justice system</strong></p> <p> The U.S. leads the industrialized world in the rate of confinement of young people. African-Americans and Latinos especially suffer from large-scale incarceration.</p> <p> The AMA adopted a policy calling for reforms of the nation’s juvenile justice system to help protect the long-term health and safety of adolescents during and after confinement. New policy also aims to help prevent youth incarceration when rehabilitation or community-based alternatives are most appropriate and no threat to public safety exists.</p> <p> The AMA called for other measures to reduce youth incarceration, including replacement of “zero-tolerance” school policies with other discipline policies, raising the upper age limit for juvenile court jurisdiction, research to identify programs that could reduce minority contact with the juvenile justice system and encouraging juvenile justice facilities to prohibit discrimination based on sexual orientation, gender identity and gender expression.</p> <p> “Most incarcerated youth today suffer from childhood trauma, mental health disorders or substance use disorders and require proper treatment,” Dr. Ehrenfeld said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-public-health-policies.page" target="_self">news release</a>. “While we have extensive scientific evidence showing significant differences in cognitive function and decision-making between adolescents and adults and the impact trauma has on adolescent brain development, the law has been slow to apply these scientific findings to the juvenile justice system.” </p> <p> “The AMA is calling on the federal government, states and schools to implement policies and programs that focus on rehabilitating and treating incarcerated youth to promote their long-term health and wellness, and help prevent unnecessary confinement when better alternatives exist,” Dr. Ehrenfeld said. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:3ad1f2ff-6b97-4004-b2ac-2fed7aca514a 11 new AMA policies patients should know http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-ama-policies-patients-should Wed, 15 Jun 2016 18:00:00 GMT <p> At the heart of all policymaking of the AMA is the mission to promote the betterment of public health. Physicians at the 2016 AMA Annual Meeting adopted a variety of policies that will help improve consumer safety and reduce harm—they range from preventing drug overdose to delaying school start times and supporting paid sick leave.</p> <p> <strong>1. Medication disposal programs could help prevent overdose, improve health</strong></p> <p> An unprecedented drug overdose epidemic in the United State could be addressed in part by stronger medication return programs that treat unused medications as hazardous waste. The AMA called for support of medication return programs, funded by pharmaceutical manufacturers, and called for federal laws that encourage medication recycling and disposal.</p> <p> Estimates indicate that 30-80 percent of patients do not finish prescriptions for common medications, including pain medications, and many patients discard these drugs at home. The U.S. Geological Survey sampled rivers and streams and found that up to 80 percent showed traces of drugs, hormones, steroids and personal care products.</p> <p> “Many of these unused medications, most notably opioids, are diverted and used by someone other than the targeted patient,” AMA President-Elect David O. Barbe, MD, said in a news release. “Manufacturers should be stewards of their products throughout their lifecycle and provide this critical service to patients and our environment.”</p> <p> <strong>2. Protecting children’s eyes through air gun safety</strong></p> <p> In response to soaring rates of eye injuries among minors as a result of air guns, delegates adopted policy to better protect children and teenagers from injuries that can inflict lasting damages, despite treatment.</p> <p> The new policy directs the AMA to encourage the use and provision of protective eyewear when using air guns as well as education on the proper use of protective eyewear to avoid ocular injuries.</p> <p> “The increase in air gun use has not been met with increased safety awareness,” Dr. Barbe said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-public-health-policies.page" target="_self">news release</a>. “Many of these injuries result in lasting changes in sight and can be avoided by wearing proper eye protection.”</p> <p> <strong>3. Ending sales tax on feminine hygiene products</strong></p> <p> The AMA adopted policy to support laws that strip taxes from the sale of feminine hygiene products. These essential products for women’s health are taxed, but delegates noted that many other far less necessary purchases—from cupcakes to circus performances—are exempt from sales taxes.</p> <p> Five states no longer charge a sales tax on these products and more are considering similar legislation. </p> <p> “Feminine hygiene products are essential for women’s health, and taxes on them are a regressive penalty,” Dr. Barbe said. “We applaud the states that have already eliminated sales taxes on these products, and we urge every state to follow suit.”</p> <p> <strong>4. The importance of radon testing in rentals</strong></p> <p> The AMA adopted policy that calls for renters to have similar protections as home buyers in terms testing for radon. Radon, a radioactive gas and known carcinogen, is the second leading cause of lung cancer and causes more than 20,000 deaths a year.</p> <p> Only two states mandate that new renters be informed of whether a radon test has been performed and the nature of its results. The new AMA policy calls for transparency and disclosure of prior radon tests and the most recent results of tests for renters entering into a lease.</p> <p> <strong>5. Dangers of detergent packets</strong></p> <p> Recognizing that concentrated detergent packets can compromise children’s health and safety, the AMA today adopted policy calling for the redesign of detergent product packages to make them less attractive to children to help prevent accidental exposure or ingestion.</p> <p> According to a <a href="http://pediatrics.aappublications.org/content/early/2014/11/05/peds.2014-0057" rel="nofollow" target="_blank">study</a> published in the <em>Journal of the American Academy of Pediatrics</em>, between 2012 and 2013 alone, more than 17,000 children under the age of six were exposed to highly-concentrated laundry detergent pods—resulting in hundreds of hospitalizations from ingestion and one confirmed death.</p> <p> “While liquid detergent pods were developed for the convenience for consumers, they have also have had unfortunate, unintended health consequences for children who ingested the colorful, candy-like packages,” AMA Board Member William E. Kobler, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-public-health-policies.page" target="_self">news release</a>.</p> <p> “We urge state and federal authorities to enact laws, including the Detergent Poisoning and Child Safety Act, to ensure that these packages are child-resistant, less attractive in color and design, and include clear and obvious warning labels to help deter further child exposure and the harmful health effects that could result,” Dr. Kobler said.</p> <p> <strong>6. Preventing hearing loss in children caused by noisy toys</strong></p> <p> From talking dolls to musical instruments, many children’s toys emit intense sound that could cause lasting hearing damage. To help prevent long-term hearing loss in children, the AMA today adopted policy in support of specific noise exposure standards for children's toys.</p> <p> “Parents need to know that their children’s toys could be producing dangerously high levels of sound that could seriously impair their hearing,” AMA Board Member Jesse M. Ehrenfeld, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-public-health-policies.page" target="_self">news release</a>. “We encourage manufacturers to ensure that the toys they produce adhere to pediatric noise exposure standards and include a warning label on any products that exceed safety standards so that parents can make an informed decision when buying sound-emitting toys.”</p> <p> <strong>7. Supporting a ban on powdered alcohol</strong></p> <p> With concerns mounting from physicians and public health advocates about the health dangers associated with powdered alcohol, the AMA adopted policy supporting federal and state laws banning this substance.</p> <p> Excessive alcohol use is the fourth leading preventable cause of death in the United States. Alcohol is responsible for the deaths of 4,300 youths each year, and current AMA policy supports efforts to reduce youth access and consumption. Powdered alcohol, which can be mixed with liquid, poses a particular hazard to youths.</p> <p> “Given the variety of flavors that could be enticing to youth and concerns that the final alcohol concentration could be much greater than intended by the manufacturer, we believe that powdered alcohol has the potential to cause serious harm to minors and should be banned,” Dr. Ehrenfeld said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-policy-ban-powdered-alcohol.page" target="_self">news release</a>. “We urge states and the federal government to prevent powdered alcohol from being manufactured, distributed, imported and sold in the U.S.”</p> <p> The AMA is a long-time advocate for reducing youth access to alcohol and is a strong supporter of banning the marketing of alcohol products that appeal to people under the age of 21.</p> <p> <strong>8. The case for delaying school start times</strong></p> <p> Given that AMA policy identifies insufficient sleep as a public health issue, and that sleep deprivation has particularly harmful health impacts in adolescents, the AMA adopted a resolution recommending that school districts start school no earlier than 8:30 a.m.</p> <p> According to recent studies, only 32 percent of American teenagers reported getting at least eight hours of sleep on an average school night. The American Academy of Pediatrics recommends that teenagers between 14 and 17 years of age should get 8.5-9.5 hours of sleep per night to achieve optimal health and learning.</p> <p> “Sleep deprivation is a growing public health issue affecting our nation’s adolescents, putting them at risk for mental, physical and emotional distress and disorders,” AMA Board Member William E. Kobler, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-supports-delayed-school-times.page" target="_self">news release</a>. “Evidence strongly suggests that allowing adolescents more time for sleep results in improvements in health, academic performance, behavior and general well-being.”</p> <p> “We believe delaying school start times will help ensure middle and high school students get enough sleep, and that it will improve the overall mental and physical health of our nation’s young people,” Dr. Kobler said.</p> <p> <strong>9. Paid sick leave can lead to better health</strong></p> <p> The AMA adopted new policy recognizing the public health benefits of paid sick leave and other discretionary time off. Citing a growing body of evidence that lack of access to paid sick leave results in the spread of infectious diseases, as well as delayed screenings, diagnoses and treatment, the new AMA policy supports paid sick leave as well as unpaid sick leave for employees to care for themselves or a family member.</p> <p> Workers without paid sick days are more likely to work sick and are more likely to delay needed medical care, which can lead to prolonged illness and worsen otherwise minor health issues, according to a report of the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-medical-service.page?" target="_self">AMA Council on Medical Service</a> that the policy is based upon. The AMA noted that the U.S. is the only industrialized nation without a federal law that guarantees paid sick leave. However, the AMA also weighed the impact of sick leave on businesses finances. The AMA pledged to continue monitoring different approaches to sick leave.</p> <p> “With both dual-earner and single-parent households on the rise in the United States, it is increasingly challenging for workers to juggle family and work,” former AMA Board Chair Barbara L. McAneny, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-15-benefits-paid-sick-leave.page" target="_self">news release</a>.</p> <p> “Lack of paid leave also has a ripple effect across a worker’s family,” Dr. McAneny said. “Paid sick leave has been shown to aid children’s health, shorten hospital stays and reduce the risk of disease transmission by allowing parents to stay home with sick children. Paid sick leave keeps our homes, offices and communities healthier while ensuring the family’s economic security.”</p> <p> <strong>10. Increasing the use of HIV preventive treatment</strong></p> <p> The AMA adopted policy to educate physicians and the public on the use of pre-exposure prophylaxis for HIV.</p> <p> Tenofovir/emtricitabine (also known as PrEP) is a once-a-day prevention option for HIV-negative men and women that reduces the risk of HIV acquisition. Although the U.S. Food and Drug Administration approved PrEP in July of 2012, a 2015 survey by the Centers for Disease Control and Prevention (CDC) found that 34 percent of primary care physicians and nurses had never heard of PrEP.</p> <p> “With more than 1.2 million people in the United States living with substantial risk of HIV infection but fewer than 5 percent of them taking PrEP, there is significant ground to gain in stemming the incidence of HIV,” Dr. Ehrenfeld said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-15-physician-education-hiv-prep.page" target="_self">news release</a>. “Educating physicians and the public about the effective use of PrEP and supporting insurers to cover the costs associated with its administration will make the transmission of HIV rarer and our nation healthier.”</p> <p> The AMA will support the coverage of the treatment—which on average costs more than $1,500 for a month’s supply</p> <p> The new policy builds on years of AMA efforts to bolster education and training to combat HIV/AIDS and to increase multi-layer collaboration to increase public awareness.</p> <p> <strong>11. Physicians call for insurance parity for eating disorders</strong></p> <p> The AMA adopted policy in support of health insurance coverage for eating disorders. Although current federal law mandates parity in benefit levels for eating disorders, many payers do not offer parity of services, effectively excluding eating disorders from mental health parity.</p> <p> “Eating disorders have the highest mortality rate of any mental illness, but too often a patient’s care is determined by their insurance company instead of their health needs,” Dr. McAneny said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-15-health-care-eating-disorders.page" target="_self">news release</a>. “With only one in 10 patients with an eating disorder receiving treatment and with psychological intervention widely accepted as a critical component of care, ensuring mental health parity in benefits will save lives.”</p> <p> The policy builds on existing AMA policy related to eating disorders, mental health parity and body image. The AMA already encourages payment for physical and behavioral health care services on the same day and for Medicaid to pay for those services in school settings. Additionally, the AMA supports increased funding for research on diagnosis, prevention and treatment of eating disorders, including research on the effectiveness of school-based primary prevention programs for pre-adolescent children and their parents.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:372f8bde-650b-4c40-9c1a-05a7964f0081 AMA calls for background checks, wait periods to prevent gun violence http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-calls-background-checks-wait-periods-prevent-gun-violence Wed, 15 Jun 2016 16:30:00 GMT <p> The AMA adopted policy calling for background checks and a waiting pe