Even one voice: Teaching legislative advocacy as a core competency in family medicine.

Credentialing bodies increasingly focus on advocacy as a competency to be developed by physicians during residency. The skills of advocacy are especially important with the increased attention on social determinants of health and as restrictive state and federal health policy decisions gain widespread attention in the national news media. This movement is reflected in the ACGME's recently revised statement on the training mission of family medicine residencies and with their most recent update of the Milestones which identifies advocacy as a core competency. Additionally, the major family medicine organizations and governing bodies all similarly identify advocacy as an important professional responsibility for family physicians. Advocacy is a broad term that can be applied across a range of settings and scenarios. For the purposes of this paper we focus primarily on legislative advocacy as a specific area for growing curricular experiences in family medicine residency programs.

A silver lining playbook? My mom's death.

Was this a silver-lining playbook-my mother's death? We had planned for this moment, talked together about her wishes, filled out the paperwork: We were that kind of family-the one that talked and debated about life and death. And my mother, in her true tenacious fashion, rehearsed with us her dying wishes. The papers were filed with her primary care physician, scanned into the Electronic Medical Record (EMR), and a copy placed in their freezer-a clever way to find it in a crisis. The playbook was in place. The rest of the story is on replay in my mind. I remember asking to speak to the physician in a demanding tone and wanting to know why my mom was intubated . . . "Didn't any one look at the paper work?" The Emergency Department (ED) physician explained, "Your mom's blood pressure is dropping. She doesn't have a complicated medical condition so we want to give her pressors so that we can keep her alive." I replied that neither my mom nor the family wanted any intervention. This experience pulled us into the power of the protocols that make it possible to keep hearts beating and lungs breathing. In my mother's case, her uncomplicated medical history in the EMR triggered those standing lifesaving orders. But no one assessed her personhood. No one asked about her level of functioning, her pain, her memory loss, her desires. No one took a minute to ask about this mother of five children who sang her way through life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Review of Helping couples and families navigate illness and disability: An integrated approach.

Reviews the book, Helping Couples and Families Navigate Illness and Disability: An Integrated Approach by John S. Rolland (see record 2018-14404-000). Many health care providers have traveled with their patients and families on the journey of disease, disability, and death. This journey is often filled with unanticipated twists and turns: changes in physical functioning, intense emotional experiences, and demands on intimate relationships. In Helping Couples and Families Navigate Illness and Disability: An Integrated Approach, John Rolland has provided clinicians with a map of the territory, guiding them through the challenges of intersecting systems of family relationships, cultural values, and health care practices. This book is a culmination of John Rolland's expertise and writing over his 40-year career. The book expands on his work in theory development while adding an expansive repertoire of practical questions, suggestions, and interventions. His personal experience coping with the illness and death of his young spouse and his parents' health infuses a tender and personal tone to this academic work. In the context of his own journey, he wondered: "What would have been useful information or support for me and my family members at different phases of the illness that could have made a difference in our ability to cope and adapt?" (pp. viii). This question is at the heart of the book. His clinical expertise, theoretical acumen, and personal experiences comprise this comprehensive and readable book. The book is organized into four sections: (a) a conceptual overview of the Family Systems Illness Model (FSI); (b) the application of the model for families, couples and multigenerations, and family/cultural health beliefs; (c) health-related phases and transitions with specific populations (e.g., terminally ill, chronic conditions, aging individuals, and couples); and (d) the clinician's personal-professional dynamic emotional experience. This book will be an important resource for the growing workforce of behavioral health providers. It provides physicians with a family-oriented transition of care model and is applicable for nurses, nurse practitioners, and mental health professionals who coach families through many phases of care-inpatient, rehabilitation, or hospice. It does not include critical analysis of the research on family-oriented care. There are references to studies, but it is not a systematic review or meta-analysis of best practices for family-oriented health care. For family systems novices, this book will be conceptually dense. It is not entry-level reading but will be accessible if incorporated into a seminar by seasoned faculty. Clinicians will find that the FSI model is a necessary GPS for guiding families through their health care and journey of illness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Turning the tables: Using resident physicians' experiences as patients for leveraging patient-centered care.

Training physicians to become person-centered is a primary goal of behavioral health curriculum. We have curriculum on doctor-patient communication skills and patient narratives to help physicians relate to the patient's experiences. However, there is nothing more effective than actually being the patient that gives providers an "aha" experience of the patient's perspective. In this article, we will share personal resident physician-patient stories based on their experiences within acute urgent care, chronic disease management, and routine well health care. In each narrative, the physician-patient will describe how their experiences had an impact in three areas: (1) their professional identity, (2) their connection with patients, and (3) their experience of the health-care system and teams. Drawing from the key emotional and cognitive experiences from these stories, we will identify training strategies that can bridge the personal to professional experiences as a way to enhance person-centered care. Our goal is to use the physician's insider perspective on the patient experience as a means to augment the awareness of professional physician role, team-based care, and navigating the health-care system.

Don Bloch Award acceptance speech: 2017.

Provides Dr. Mary Talen's acceptance speech for the 2017 CFHA Don Bloch Award. (PsycINFO Database Record

Integrative Medicine and Mood, Emotions and Mental Health.

An integrative approach to individuals with mood, emotional or mental health concerns involves a comprehensive model of care that is person-centered. Integrative medicine builds on a patient's personal meaning and goals (spiritual aspects) and includes herbal therapies, nutritional support, movement and physical manipulative therapies, mindfulness, relaxation strategies, and psychotherapies.

Psychiatric Emergencies.

Psychiatric emergencies are acute disturbances in thought, behavior, mood, or social relationship that require immediate intervention as defined by the patient, family, or social unit to save the patient and/or others from imminent danger. Ensuring the safety of the patient, surrounding persons, and the medical team is the first step of evaluation. Treatment focuses on stabilization of the patient, then on specific symptoms and ultimately the cause of symptoms. There are important legal considerations, particularly regarding involuntary admissions. It is important to debrief with the patient, surrounding family, and the health care team to ensure a continued therapeutic alliance and the emotional health of all involved.

Evaluation of an electronic health record-supported obesity management protocol implemented in a community health center: a cautionary note.

OBJECTIVE: Primary care clinicians are well-positioned to intervene in the obesity epidemic. We studied whether implementation of an obesity intake protocol and electronic health record (EHR) form to guide behavior modification would facilitate identification and management of adult obesity in a Federally Qualified Health Center serving low-income, Hispanic patients. MATERIALS AND METHODS: In three studies, we examined clinician and patient outcomes before and after the addition of the weight management protocol and form. In the Clinician Study, 12 clinicians self-reported obesity management practices. In the Population Study, BMI and order data from 5000 patients and all 40 clinicians in the practice were extracted from the EHR preintervention and postintervention. In the Exposure Study, EHR-documented outcomes for a sub-sample of 46 patients actually exposed to the obesity management form were compared to matched controls. RESULTS: Clinicians reported that the intake protocol and form increased their performance of obesity-related assessments and their confidence in managing obesity. However, no improvement in obesity management practices or patient weight-loss was evident in EHR records for the overall clinic population. Further analysis revealed that only 55 patients were exposed to the form. Exposed patients were twice as likely to receive weight-loss counseling following the intervention, as compared to before, and more likely than matched controls. However, their obesity outcomes did not differ. CONCLUSION: Results suggest that an obesity intake protocol and EHR-based weight management form may facilitate clinician weight-loss counseling among those exposed to the form. Significant implementation barriers can limit exposure, however, and need to be addressed.

Patients' communication with doctors: a randomized control study of a brief patient communication intervention.

In research on doctor-patient communication, the patient role in the communication process has received little attention. The dynamic interactions of shared decision making and partnership styles which involve active patient communication are becoming a growing area of focus in doctor-patient communication. However, patients rarely know what makes "good communication" with medical providers and even fewer have received coaching in this type of communication. In this study, 180 patients were randomly assigned to either an intervention group using a written communication tool to facilitate doctor-patient communication or to standard care. The goal of this intervention was to assist patients in becoming more effective communicators with their physicians. The physicians and patients both rated the quality of the communication after the office visit based on the patients' knowledge of their health concerns, organizational skills and questions, and attitudes of ownership and partnership. The results supported that patients in the intervention group had significantly better communication with their doctors than patients in the standard care condition. Physicians also rated patients who were in the intervention group as having better overall communication and organizational skills, and a more positive attitude during the office visit. This study supports that helping patients structure their communication using a written format can facilitate doctor-patient communication. Patients can become more adept at describing their health concerns, organizing their needs and questions, and being proactive, which can have a positive effect on the quality of the doctor-patient communication during outpatient office visits. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Obesity and mental health.

Mental health factors contribute to the onset and maintenance of overweight and obese status in children, adolescents, and adults. Binge eating disorder (BED), body image, self-esteem, mood disorders, and social and family factors affect individuals in different ways and contribute to weight gain and failure in weight loss management. Assessment of these mental health factors and treatment by 1 of several mental health treatment models may not only improve self-worth but also weight loss and maintenance.

Residents' perspective on the impact of the 80-hour workweek policy.

BACKGROUND: The 80-hour workweek was initiated in 2003 to reduce the resident workweek and subsequently improve the safety and quality of patient care. PURPOSE: The purpose is to assess the impact of the 80-hr workweek from a resident's perspective. METHOD: We surveyed residents with experience before and after the 80-hr workweek policy. The survey assessed residents' perspective on the impact of the 80-hr workweek on 4 areas: patient care/safety, training experience, resident team functioning, and personal life. RESULTS: There were 111 respondents (57% female, 65% married, average age = 32 years, 66% primary care residents). We found the 80-hr workweek had the greatest impact in personal self-care and sleep hygiene. Primary care residents reported a significantly more positive impact of the 80-hr workweek on quality of the training compared to specialty residents. There was no difference between the primary care residents and specialty residents for patient care/safety, resident team functioning, and personal life. Gender, marital status, and having children did not impact how residents' evaluated the 80-hr workweek. CONCLUSION: Residents, with pre- and post-80-hr workweek experience, reported the policy change as having the greatest benefit on their self-care and personal life significantly more than any other area.