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Medical Student Anna Askari Tells Her Family Medicine Story

According to her facebook page, Anna Askari is a "second year medical student at The Ohio State University College of Medicine interested in pursuing a career in Family Medicine." As reported by the Ohio Academy of Family Physicians, Anna has been selected by the American Academy of Family Physicians (AAFP) to receive scholarship to attend the Family Medicine Congressional Conference (FMCC) from April 18-19, 2016 in Washington, DC.

I was curious about and I wanted to gain insight on Family Medicine's future leaders. I was honored that Anna accepted my invitation for the following interview below. My questions are in the bold print. I've talked a lot about the Family Medicine Revolution before. This medical student articulately paints the picture of Family Medicine advocacy. Here is Anna Askari, in her own words...

1) Why Is Family Medicine your speciality, and why should every medical student consider Family Medicine? Family Medicine is my specialty, because it is really the reason that I went to medical school. The career that I envisioned as a physician was specifically that of a family physician. My mentor, Dr. Maria Riza Conroy, who is a family physician at OSU Family Medicine at Carepoint Gahanna as well as a Clinical Assistant Professor of Family Medicine at OSUCOM, has inspired me from the beginning of my undergraduate career. She established the Helping Hands Free Medical Clinic in Columbus and another free clinic in her home country of the Philippines. She is dedicated to caring for the medically underserved. Shadowing her at Helping Hands during my undergraduate career made me realize that family medicine is the best area within medicine for me. I love the diversity of patients, and that unlike other specialties; I am afforded the opportunity to really get to know my patients and their families.

Every medical student should consider a career in family medicine not only because of the rewarding longitudinal relationship that you get to have with your patients, but also because of the vast number of different opportunities you get to practice medicine and be involved in your community. Not only do family physicians get to see and experience a number of different diagnoses and procedures through their practice, but they also get to do things such as policy and advocacy work from a local and national level. The sky is the limit with this specialty, and I love that I will never be bored while serving my patients doing such rewarding and important work. 

2) You are a member of the Family Medicine Interest Group (FMIG) at The Ohio State University. Highlight one of the awesome programs that the organization does during the year for medical students, and how does this help share the Family Medicine story to medical students?

I actually just passed on my duties as President of the FMIG at The Ohio State University School of Medicine (OSUCOM) recently. One of the programs that we had this year was during National Primary Care week last October. Our Vice President was in charge of planning the week, and she partnered with other primary care interest groups at OSUCOM (internal medicine, pediatrics, OB/Gyn, physical medicine and rehabilitation, and internal medicine/pediatrics).

At many schools, National Primary Care Week is primarily and executed by the American Medical Student (AMSA); however, this was not the case at OSUCOM. The Family Medicine department plans the entire week from beginning to end, and this year it became one of the primary responsibilities of our Vice President. Each group hosted a themed lunch panel to expose the first and second year medical students to the specialty.

Our FMIG lunch talk featured Dr. Ryan Kauffman from Hickory Medical DPC, to discuss the concept of Direct Primary Care with our students. Dr. Kauffman spent about two hours with students discussing DPC in an informal question-and-answer format. DPC is a type of primary care billing and and payment arrangement between patients and providers, without sending claims to insurance providers. It has recently became very popular with medical students and residents going into primary care specialties, such as family medicine. It was a successful way for us to introduce the diversity of family medicine to medical students who may not realize that the specialty is more than just an outpatient experience that they are used to seeing growing up with their own primary care provider. 

3) Congratulations on receiving one of the scholarships to attend FMCC! For those Family Physicians who are not familiar with the conference, how would you describe the meeting, and why did you apply for a scholarship to attend the meeting?

Thank you so much! I am really excited and honored to have the opportunity. AAFP together with the Council of Academic Family Medicine hosts FMCC each year. It will be held on April 18-19, 2016 in Washington, DC with the goal of educating participants on family medicine's legislative priority issues, train attendees on how to lobby on Capitol Hill, and allows participants to put these skills to use with federal legislators and their staff.

I first heard about this scholarship from one of my mentors, Dr. Sarah Sams, who is currently Chair of the AAFP Commission on Governmental Advocacy this year. She is attending the conference as well, and thought it would be a great experience for me as a medical student. Another mentor, Dr. Allison Macerollo, who is the advisor of our FMIG at OSUCOM also encouraged me to apply. I applied for this scholarship, because I wanted to explore the policy and advocacy side of medicine. I graduated from The Ohio State University with a degree in political science before I started medical school here. The conference is the perfect opportunity to combine my interest in medicine and politics and explore this area of family medicine.

4) As a medical student, what are 1-2 of the issues that concern students whether it be from a personal standpoint, legislative standpoint, or health policy standpoint? What skills do you hope to learn when you attend FMCC to address these medical student concerns?

Based on my experience as a medical student, the one issue that should concern students the most is the shortage of graduate medical education training spots. Our country is continuing to face a nationwide shortage of physicians for a growing older and sicker population. There are more and more medical students graduating from medical school, but there are not enough residency spots to meet the national demand for physicians and these students graduating from medical school. Funding for graduate medical education comes from the US government, and unfortunately there are proposed cuts to the already inadequate budget. This means that each year more medical students are not matching into a residency program, which translates into having fewer physicians meeting the increased demand for physicians. This is not only an issue now, but will continue to be an issue in the next 10-20 years.

5) Finally, why do you think Family Medicine is the group to lead the change locally, at the state level, and nationally?

Family Medicine is the group to lead change, because it is the medical specialty that always puts the patients' needs before the physicians' needs. One of my mentors is a past OAFP President and family physician who has attended FMCC for several years. She tells me that members of Congress would always tell her that they are so impressed with the family physicians that they see lobbying on Capitol Hill. Other physician specialties are more concerned about issues that affect the physician directly, and put the needs of their patients second to that. Family Physicians, however, lead the discussion by advocating for their patients. It is one of the reasons why I Love Family Medicine.

Honoring Our Heroes

As I write this, I'm on a bus heading home from another trip to our Nation's Capitol wth my parents. I remember when I was in grade school, spending Easter vacation walking all round the city learning everything from American History, to civics and government, and much more. 

On this occasion, the most valuable lesson I learned was not from a museum, but was from acts of honor, kindness, and reverence. The photo above was takes at the Air Force Memorial. What appears to be happening is that an active duty serviceman is giving a tour to a veteran. The emotions I observed included smiles and laughter to seriousness and somberness.

This encounter triggered many questions having to do with my profession. Why aren't older physicians, more veteran physicians, and retired physicians treated with more respect by our own? I have heard newly minted physicians say that they cannot wait until Dr. X finally retires so that they can increase their own clientele. 

What would happen if an image like the above happened? A sort of mutual mentorship experience occurred between less experienced physicians and veteran physicians. A two way interaction where the veteran physician can pass along the wisdom of their experience, while the less experienced physician brings their enthusiasm and reminds the veteran physician of the idealism they used to have.

Don't get me wrong, many organizations have been talking about programs like this for years, and some successful programs have actually been implemented. But, for the most part, in medicine, youth is celebrated, and increasing age is not. But, just like the military, I believe that medical profession needs to celebrate our own veteran heroes.

For those long time practicing physicians and retired physicians, thank you for your service to medicine, and for service to your patients. You have not been recognized enough for the difference you have made to your local community. I challenge anyone who reads this to just say "Thank You" to our veteran heroes!

(This essay is dedicated to my father, who is my hero, and who retired in 2011 following 33 years in solo private practice as an otolaryngologist [surgeon & ear, nose, and throat specialist]. He continues to teach me, even today, and I appreciate his wisdom every day.)

First Uterus Transplant in US: Be Careful What You Wish For

Today, the Cleveland Clinic announced that they performed the first uterus transplant in the United States. According to the New York Times, the operation, took nine hours, and used a uterus from a deceased organ donor. Here is more information from that article.

  • The recipient, 26, is not being identified to protect her privacy
  • The patient will have to wait one year before trying to become pregnant, letting her heal and giving doctors time to adjust anti-rejection medications
  • The transplant is only Temporary: The uterus will be removed after the recipient has had one or two babies
  • The ethics committee at Cleveland Clinic has given it permission to perform the procedure 10 times, as an experiment. Then, it will evaluate whether it will offer this as a "standard procedure"

I first wrote about the possibility of the uterus transplants almost 10 years ago on the old Doctor Anonymous blog, and it was by far one of the most popular posts on the DA blog.  I still have many of the same questions 10 years later. I'll quote from that blog piece below, and I also invite you to read the comments from back then, which I think still apply today.

  • Medical Questions: Anti-rejection transplant drugs are powerful stuff. Yes, we have some data which states that the pregnancy rate for transplant patients are "not much worse than for the general population. Can this data be correlated to uterine transplant patients? How much do anti-rejection drugs cross the placenta barrier? What would be the effects to the fetus/baby? What about the 3D Printing of a uterus? Can/should this be done?
  • Moral Questions: You have to know that this will be another platform for the abortion debate to take place (especially so in this US Presidential election cycle). Presuming the transplant goes ok, what if the pregnancy goes awry? What if the life of the mother is at risk and/or the life of the fetus/baby is at risk? Both sides of this debate will definitely make their points of view known.
  • Legal Questions: The malpractice attorneys are preying, er, praying that this procedure becomes a "standard procedure" as outlined above. The liability here is huge. The potential for medical problems are everywhere starting wtih the transplant itself, then the pregnancy, then the potential complications of anti-rejection drugs.
  • Not to mention the Financial Questions: Who is going to pay for all of this? I know I'm going to get hate mail saying, "Hey Jerk, isn't life priceless to you?" There are some estimates that one fertility treatment alone can cost $25,000 dollars. But, then there's the first surgery of the transplant. At least two fertility treatments, removal of the uterus (according to the Cleveland Clinic protocol above), the anti-rejection medication, and a lot more. I forsee more feedback for me, "You don't know what it's like to be told that from a medical standpoint, you can NEVER have the possibility of the pregnancy and childbirth experience."

As I said 10 years ago, I'll say again. I'm pessimistic that the uterus transplant will become a "standard procedure" for a number of reasons. Just because it looks like it can be technically done, I don't think they should be done. I think there are still too many unanswered questions to proceed further...

Zika Virus In Stark County, Ohio

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For weeks now, the national and international news has been scattered with stories about what is called "Zika Virus." But, for me, the story has increased relevance for me, as it was announced by the Ohio Department of Health, that Ohio has its first two cases of Zika Virus, one in the Cleveland area, and the second case in Stark County, close to where I live.

My fear is that there may be some kind of panic that may start to set in as news of the Stark County case starts to make the rounds locally. I remember when the Ebola story really started rolling in the fall of 2014. And, then there was a local connection in close-by Akron, the story really took off around here. But, alas, Ebola is not Zika. However, do local people know that yet?

Why my local peeps SHOULD NOT panic about Zika Virus (yet):

  • It's Still Winter, Dude: Even though it's been milder than last year (what an understatement that is), Zika is spread my mosquitoes and they need a warmer climate. Now as spring gets closer, this story becomes more interesting.
  • People Rarely Die of Zika: This is not Ebola, and don't let people make you think differently
  • Zika is not airborne and is not spread by casual contact

Why people SHOULD be concerned about Zika Virus:

  • There is no test for Zika Virus: Well, that's not very accurate. There is no local testing for Zika. The only way to get testing done is through the CDC.
  • There is no Zika vaccine: Politicians like President Obama are pushing for quick development of a Zika vaccine. But, in reality, we probably won't see one for at least 2 years.
  • Possible association with Guillan-Barre syndrome (GBS) which is a rare disorder where a person's own immune system damages nerve cells, causing muscle weakness, and sometimes paralysis (CDC). It not has been proven if Zika causes GBS, but officials in Brazil are investigating.

So, I'll be watching closely as this news cycle continues, especially for more Ohio cases. But, for more information, I recommend these links: CDC has an entire section of their website devoted to Zika, an article from Lifehacker, article from Columbus Dispatch, article from WKBN-TV, article from Canton Repository.

Cold Weather Actually Causes Colds

Every time the weather gets cooler, a common question that I receive is this, "Does cold weather cause colds?" In the past, I have always said, No. However, there has been some new research by Yale University scientists published in the Proceedings of the National Academy of Sciences. (Reuters, NBC). 

There were two interesting findings from this research. First, the common cold virus replicates quicker in colder air that is surrounded by warmer air, like in the nose. Secondly, in cooler temperatures, this can lower the immune system, and increase your chance to catch a cold. Now, this research was done in mice. So, it can be difficult to make the leap to humans. Yet, it's still interesting research.

I was interviewed by WKBN television in Youngstown, Ohio on January 14, 2016 and asked the question, "Can The Cold Give You A Cold?" I encourage you to read their report at this link, and to check out my TV interview below and at this link. Enjoy!

2016 Influenza Season: Slow So Far

Since it is the end of January, we're right in the middle of Influenza season. Fortunately, the Centers for Disease Control report that Influenza activity has been for the most part "minimal" (as of January 16, 2016). Our local community has matched national trends in that our community has not seen a lot of Influenza cases this season. However, the peak of flu season is right now for another 4-6 weeks. So, a flu epidemic could still potentially happen.

I was interviewed by WKBN television in Youngstown, Ohio on January 29, 2016. During my chat with the news reporter, I emphasized that it's not too late to get your flu shot. At our office, we have been seeing a lot of "flu-like" symptoms including cough, congestion, sinus pressure/congestion, and other symptoms. However, there have been few positive tests for Influenza. Why is that important? That is important because the treatment is different, and it is very important to make an accurate diagnosis so that appropriate treatment can be made.

So, in addition to getting your flu shot, there are some other steps that you can take to help spreading illness, according to the Ohio Department of Health: Wash your hands with soap and water; Covering your cough; Avoid touching your eyes, nose, and mouth; Staying hydrated; and Exercising regularly. And, don't forget: Get Your Flu Shot!

American Family Physician Podcast: Check It Out

For the past couple of months, I've been watching a podcast roll out talking about the American Family Physician journal. The podcast is written, recorded, and produced by the residents and faculty of the University of Arizona College of Medicine, Phoenix Family Medicine Residency. Check out their page at this link, and subscribe on iTunes at this link. Also follow @AFPPodcast on twitter!

In addition to great discussion about articles in the journal, the podcast also features a cool musical theme and also an opportunity for medical students and residents to participate in the podcast by reading their closing credits. In these early episodes, they have interviewed a couple of our friends including Dr. Jay Lee and Dr. Jennifer Middleton. 

I thought it would be fun to try to read the credits myself and to try to get an interview on their wonderful program. In the video clip below, I discuss this with our friends Dr. Gerry Tolbert and Dr. Kim Yu. An audio clip is also included for your reference. Let's Do This America!

New Blog Look

Happy New Year 2016! With a new year comes a new start. I have really enjoyed this Squarespace platform in that there are some new templates every few months to check out. For those who are curious, this one is called, "Momentum."

It's no secret that I've been in a social media creation "block" for the past few months. But with January 2nd, comes new chances to start again. I've been doing a lot of thinking lately about how to make 2016 the best year ever. Writing will hopefully be part of the solution. What will this year bring? Who knows? But, I know I will make every effort to make this the best year ever. Happy New Year!

2015 Texas Academy of Family Physicians Meeting

As I usually do, I'm sitting in the airport, on my way home from another meeting. I always enjoy collecting my thoughts and processing what has happened at a conference. My thanks to the Texas Academy of Family Physicians (TAFP) for the opportunity to speak on Family Medicine Advocacy using Social Media. I was honored to be a part of a Family Medicine Leadership course that has been "reimagined" from one about a decade ago. TAFP also announced a year long leadership course named the "TAFP Family Medicine Leadership Experience."

During the leadership track yesterday, many questions came to my mind. Can you really teach leadership? Can people learn leadership, or is it something that you're born with? I guess what it really comes down to is that, yes, there are some leadership skills that can be taught. We talked about this during the sessions, but here what I think are some essential elements to a successful leadership course:

  • Basic Leadership Literature: We talked about a variety of books that people recommended including Good To Great by Jim Collins, books by John Maxwell, books by Malcolm Gladwell, books by John Maxwell, Emotional Intelligence by Daniel Goleman, books on American history, Physicians as Leaders by Perry Pugno & Mindi McKenna, and many more.
  • Access To Leadership Stories from People In Your Industry: In this case, it was fascinating hearing stories from three TAFP past presidents, two of whom were also the president of the national academy. Not only did I get a sense of leadership history in our speciality, they also talked about missed opportunities, and what they learned from them. For me, not only do I learn from the successes of others, but also I learn from their mis-steps.
  • Leadership Is Learning By Doing: In medical school, when it comes to performing procedures, the saying goes: "Learn One, Do One, and Teach One." All day, you can sit in a classroom and talk about tips and tricks, and you can hear stories from others. But, when it comes down to it, leadership comes down to practical application. 

All that being said, here is the number one litmus test to know if you're a great leader: The Dance Floor Test. If you're at a party with fun music, can you get your non-dancing friends and colleagues out to the dance floor? If you can, then you're a great leader. How about that? LOL

It has been so much fun for me to visit different state chapters and see how they organize and conduct their meetings. TAFP reported that they had record attendance this year, of which I fully take credit for (hehe). This fabulous meeting is a credit to the awesome TAFP staff along with the Family Physician leaders. Check out the pics below...

Physicians Forgotten from Health Is Primary & CVS Collaboration

At the National Press Club this morning, the Health Is Primary campaign (also knows as Family Medicine for America's Health) announced a "collaboration" with CVS Pharmacy and Minute Clinics. In their press release, they state "This initiative will advocate for patient access to coordinated, continuous care and help to ensure that all consumers will have access to a primary care provider."

Initial reaction among some of my social media contacts has been negative. Some stated that it's a "money grab" by CVS under the guise of promoting "America's Health." Organizations like the American Academy of Family Physicians (AAFP) have been watching retail clinics closely. AAFP even says this in their Retail Clinics policy statement: "While retail clinics may provide a limited scope of health care services for patients, this can ultimately lead to fragmentation of the patient's health care, unless it is coordinated with the patient's primary care physician."

And, I think that this is where the Health Is Primary campaign is going with this. I mean, retail clinics are not going away, it would be foolish to try to combat them, because the American public finds value in these clinics, and partnering with them is not a bad thing. You'll see the relevant tweets below from the National Press Club event.

However, there are three initial key questions that I'd like to ask as I was thinking about this morning:

  • What happened to Physicians in this Health Is Primary, CVS, and Minute Clinic collaboration? In the entire 400 word press release, guess how many times the word "Physician" was used: Just once in the title. Meanwhile, the word "provider" was used six times. According to published reports, $20 million dollars have been committed for the promotion of Primary Care, Family Medicine, and (what I thought was) Family Physicians. Even on the FMAHealth website, it states, "A New Initiative Sponsored by Family Medicine." Are the eight Family Medicine organizations feel like they're getting their money's worth when they read this press release?
  • What about the Independent Practice Nurse Practitioner? Now, don't get me wrong, I'm not anti-Nurse Practitioner. We have a nurse practitioner and a physicians assistant who work in our office. However, I believe that the physician is the leader of the health care team, and the NP/PA providers should have a collaborative agreement. Now, current status of collaborative agreements are not perfect, and needs reform. However, in reading this press release, it seems like Health Is Primary is ok with any primary care provider, including the independent practice nurse practitioner. I would ask clarification on this.
  • What about future CVS Health & Minute Clinics future collaborations? Did you know it's National Nurse Practitioner Week? And, our friends at the American Association of Nurse Practitioners are promoting their advocacy points like the aforementioned independent practice nurse practitioner. Why do I forsee a press event next week with the AANP, CVS, and MinuteClinics? What would be the response of the Health Is Primary campaign?

Now, I haven't talked with anyone from Family Medicine for America's Health. These thoughts are just from their press release today and the tweets below from their National Press Club event this morning. Their challenge now is to their marketing, messaging, and communication of this collaboration.