Tag Archives: Family Medicine

I’m Not Just a Doctor, I’m Also a Candidate

 

Nothing is more American than winning. It’s so central to the American ethos that the Founding Fathers didn’t even bother to scribble it into the Bill of Rights. An amendment enshrining our right to strive for victory likely would’ve elicited a collective “Well, duh” by our bewigged forefathers. You might as well have guaranteed 18th-century citizens the right to breathe air or to wear jaunty tricornered hats. Thomas Jefferson didn’t begin the Declaration of Independence by announcing to King George III that “We hold this truth to be self-evident: Just win, baby.” He didn’t need to – Lexington, Concord, and Bunker Hill had demonstrated that the ancestors of future Boston Red Sox fans were in it to win it.

photo courtesy of Terry Rudd

Despite our national addiction to sports, it’s victory within the arena of politics – those recurring, well-funded bar brawls to decide who’s in charge – that most enthralls, unifies, and divides the nation. And even the shrine to the faith of apolitical science, the House of Medicine, enjoys intramural bouts of political pugilism.

Case in point: the campaign for leadership posts – particularly the job of president ‑ during last week’s American Academy of Family Physicians’ Congress of Delegates in Denver.

All the signs and symptoms of the American obsession with political victory were there – the ardent campaign supporters, the Technicolor campaign buttons, the sea of slick, sophisticated campaign brochures and origami-esque candidate cards that likely denuded many an Oregon hillside. The three-way race to be AAFP President-Elect even spawned a cliffhanger runoff election that ended in victory for a family physician from the state of Washington. And the aftermath of the presidential election featured the requisite shock, disappointment, and grumbling failure analysis within the ranks of the politically defeated.

But what came next were phenomena all too rare in America’s favorite blood sport: graciousness and a unifying patriotism.

 The magnanimous winners were almost literally overcome with emotion. They offered up acceptance speeches seasoned with the type of teary-eyed anecdotes usually served up by scenery-chewing Oscar winners right before the music cuts short their pathos and cues a commercial. The losers were no less generous and prone to edge-of-weepy acknowledgements during an open-mic session. And each and every one professed a shared love of their career country: family medicine.

 In victory and defeat, the AAFP political competitors’ push for victory was tempered by Abraham Lincoln’s “better angels of our nature.” At that moment, those better angels of American medicine, family physicians, embodied Abe’s selfless ideal of political healing.

At least at that moment.

During a postelection stroll through a chic Denver dining district, one family physician was overheard declaring to his dinner companions, “They kicked him to the curb in favor of some slacker from Washington.”

 Apparently, even America’s better angels prefer winning.

 –Terry Rudd (on twitter @FamilyPracNews)

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Filed under Family Medicine, Health Policy, health reform, IMNG

Healing and Reconciliation

Photo by P. Wendling

From the annual meeting of the American College of Psychiatrists, Ft. Lauderdale, Fla.

Getting Archbishop Desmond Tutu as your headline speaker is a coup for any medical society, but it also turned into an incredibly powerful pep talk.

The Arch, as he was introduced, recalled some of the personal stories he heard presiding over South Africa’s Truth and Reconciliation Commission. It was 20 years ago this month that the world was rocked when then-South Africa State President F.W. de Klerk announced the demise of apartheid and nine days later, Nelson Mandela was freed after 27 years of incarceration.

Archbishop Tutu told of Fulbright scholar Amy Biehl who was killed by a crowd of angry young black men and of white soldiers who casually sat down to a BBQ after setting a black man on fire.

The details from these traumatic events were so difficult to hear that it was hard “not to break down” for the self-described “cry baby.”

Although the commission did not require perpetrators to express regret or remorse, almost all did, he said.

When a trio of white soldiers asked an angry courtroom crowd to forgive them for shooting on a group of black protesters, Archbishop Tutu said the crowd broke out in deafening applause. And when the applause finally died down, he asked the room for silence because “we are standing on holy ground…we can not explain the alchemy that has happened here.”

What he did not understand, Archbishop Tutu admitted, was that “telling one’s story could be so potent, could be so therapeutic, so healing.”

There wasn’t a sound among the 500 or so psychiatrists packing the hotel auditorium, but you knew they understood that power.

– Patrice Wendling (on Twitter @pwendl)
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Filed under Family Medicine, IMNG, Internal Medicine, Psychiatry

The Kisses Are at the Front Desk

Photo courtesy of Wikimedia Commons

Kid-friendly stickers and suckers have been mainstays in pediatric offices for years, but now obstetricians can offer their patients something even better – dark chocolate.

At the annual meeting of the Society for Maternal-Fetal Medicine, Italian investigators presented the first report showing that a “daily appropriate amount” of dark chocolate in pregnancy improves pregnancy metabolism and decreases the risk of anemia.

They defined “appropriate” as 30 grams per day of chocolate with 70% cocoa content. While this definition wouldn’t fly with most chocolate lovers I know given that nine Hershey’s Kisses equal 41 grams,  it seemed to do the trick.

Blood tests showed that women fed dark chocolate beginning at 9-12 weeks gestation had a signficantly lower increase in blood cholesterol concentrations during pregnancy at 35.5% , compared with 56.5% for controls who were free to increase their diet with other preferential foods up to 300 Kcal/day.

Oral glucose tolerance testing revealed no alterations in the 40 women in the chocolate group, while gestational diabetes was detected in 2 of the 40 controls.

No women fed chocolate developed anemia in pregnancy, while roughly 65% of controls needed iron supplementation from 24 weeks onwards.

“It is an appealing idea that a food commonly consumed for pure pleasure could also bring tangible benefits for health,” wrote lead author Dr. Gian Carlo di Renzo and his colleagues at the University of Perugia.

The authors note that it’s been more than 10 years since the first mention in a medical journal about cocoa and chocolate as potential sources of antioxidants for health. Chocolate contains more than 600 chemicals including flavanoids, which are known for their potent antioxidant and anti-inflammatory effects.

Recent randomized studies have shown clinically important cardiovascular effects of dark chocolate including correction of endothelial dysfunction and reduction of blood pressure. A recent study from Yale University showed that pregnant women who ate five or more servings of chocolate per week had a lower risk of preeclampsia than those eating less than one serving per week.

In the current analysis, blood pressure values were lower at all time points among women eating chocolate when compared with controls. At the final check up, systolic BP and diastolic BP in controls were increased in controls by a mean of 8.32 mmHg and 3.76 mmHg, respectively.

Importantly, the 160-calorie dark chocolate treat did not affect weight gain during pregnancy. Cesarean section rates were also equivalent at 32% in both groups.

The authors conclude that “dark chocolate is a well accepted and valuable supplemental food in pregnancy, delivering adequate intake of antioxidants.”

Not surprising, patient compliance was nearly 100%.

– Patrice Wendling (on Twitter @pwendl)

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Filed under Alternative and Complementary Medicine, Cardiovascular Medicine, Endocrinology, Diabetes, and Metabolism, IMNG, Obstetrics and Gynecology, Pediatrics, Primary care

Perfect Harmony: AAFP and Coca-Cola Get Cozy

From the annual American Academy of Family Physicians Congress of Delegates, Boston

Under fiscal pressure to make ends meet without raising its dues, the American Academy of Family Physicians has inked a consumer alliance with the Coca-Cola Company. At a town hall meeting held the opening evening of the Congress of Delegates, AAFP President-Elect Dr. Lori J. Heim unveiled the deal to angry members: Under a 1-year contract, the beverage company will pay AAFP a “strong six-figure sum” (around $600,000, rumor has it) to provide consumer education materials on, you guessed it, beverage choices for the academy’s Web site. The aim is to provide evidence-based, health-related information about sweetened, unsweetened, and artificially sweetened beverages. No specific brand names are supposed to appear, and the AAFP will maintain 100% editorial control, Dr. Heim stressed.

from flickr user Old Shoe Woman, under Creative Commons

from flickr user Old Shoe Woman, under Creative Commons

“I have had patients who’ve gotten better when they quit drinking Dr Pepper.… The evidence on this is clear and consistent. The single biggest contributor to the obesity epidemic is sugar-sweetened beverages,” said Dr. Robert Rauner, president of the Nebraska Academy of Family Physicians. The AAFP’s “guilt by association could be a problem here,” he said adding that the tobacco companies have waged similar consumer education campaigns as a means of a makeover.

Several clearly frustrated members took to the mic on the congress floor to express their concern about the AAFP tarnishing its image, especially while the stakes are so high and given the academy’s strong push for a health care reform bill acceptable to family physicians and their patients.

Dr. Heim urged members to take a wait and see approach and reserve judgment until the materials are up on the site. “It may be something that you actually don’t find to be appalling,” she said to a room of collective laughter.

As Dr. Richard Cirello, a delegate from New Jersey said,  “I have no objection to pursing this business approach; however, at a time when credibility is very important, let’s be honest. We’re not doing this to educate anybody. We’re doing this to create a revenue stream and apparently we need this revenue stream. If this is what we have to do to keep us whole and to keep the dues where they should be, well, we could put some lipstick on this pig and sell it.”

—Kathryn DeMott
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Filed under Endocrinology, Diabetes, and Metabolism, Family Medicine, Practice Trends, Primary care

Surgeon General Nominee Informed by Storms

I met President Obama’s surgeon general nominee Regina M. Benjamin in 2005 in Washington at an AMA  conference for science reporters.

Dr. Regina Benjamin

 

I recall other speakers, but I vividly remember Dr. Benjamin’s words, which I summarized in a page 1 story for the Dec. 15, 2005, issue of Family Practice News. Her story provides the strongest endorsement I can imagine for the use of electronic medical records.

The AMA conference took place just after Hurricane Katrina. Dr. Benjamin recounted the pain of her patients, many of whom were poor, who had lost even more in the storm. She stopped billing them because, “There’s no point when they don’t have an address.”

As the founder of Bayou La Batre (Ala.) Rural Health Clinic, Dr. Benjamin was used to treating patients too poor to afford medical care but who earned too much to qualify for Medicaid. When she wrote replacement prescriptions for patients who had lost them in the water, “I simply asked for the pharmacist to bill me. I had no idea how I was ever going to pay for this, but … you just do what you need to do.”

In fact, Katrina was not Dr. Benjamin’s first major storm. In 1998, her clinic was destroyed by Hurricane Georges. She had been renting space in a low-lying area when Georges hit and she lost everything. After that, she rebuilt her clinic on higher ground—and on 4-foot stilts. That worked well until Katrina’s 25-foot surge. From her previous experience with Georges, she knew that she needed to empty the office in 48 hours to prevent serious mold. She and her staff removed it everything, leaving nothing but the wooden beams, roof, and ceiling. Paper records were put outside to dry in the sun.

That’s when she knew that electronic medical records were not a luxury but a necessity. “After Hurricane Georges, I knew I wanted to get an electronic health record, but I couldn’t afford it. This time, I can’t afford not to. Even if we have to go into debt, we have to get one because it’s essential for our patients’ quality of care,” she said in 2005.

In Obama’s introduction of Dr. Benjamin as his surgeon general nominee today, he recited her impressive achievements: the first black woman to be named to the AMA’s board of trustees, president of Alabama’s State Medical Association, and a recipient of the MacArthur Genius Award. But, he added, “Of all these achievements and experience, none has been more pertinent to today’s challenges or closer to Regina’s heart than the rural health clinic that she has built and rebuilt in Bayou La Batre.” Indeed.

—Miriam E. Tucker (on Twitter: @MiriamETucker)
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