Storylines of family medicine IV: perspectives on practice-lenses of appreciation.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'IV: perspectives on practice-lenses of appreciation', authors address the following themes: 'Relational connections in the doctor-patient partnership', 'Feminism and family medicine', 'Positive family medicine', 'Mindful practice', 'The new, old ethics of family medicine', 'Public health, prevention and populations', 'Information mastery in family medicine' and 'Clinical courage.' May readers nurture their curiosity through these essays.

Effective Communication with Refugees and Immigrants.

Immigrant and refugee patients may have limited English proficiency. Effective use of professional interpreter services reduces clinically significant errors and increases the quality of care. A multitude of professional interpreter services are available, and clinicians should carefully select the preferred modality of interpretation based on the type of encounter. Ad hoc interpreters, such as family members, are least preferred because of concerns of privacy and evidence of poorer outcomes. Children less than 18 years of age should only be used as interpreters in emergency situations. Professional telephonic, video, or in-person interpreters each have distinct advantages in specific clinical situations.

Health Care for Refugee and Immigrant Adolescents.

This article describes the current scope of immigration to the United States, defines the different categories of immigrants, and describes the Centers for Disease Control and Prevention-mandated overseas and postarrival medical assessment of adolescent refugees. Guidelines for primary care physicians who care for refugee youth are provided, including diagnosis and treatment of common medical and mental health conditions. Special considerations in caring for this vulnerable population include acknowledging prior traumas, acculturation and challenges to education such as bullying, and adjustment to a new health care system that emphasizes preventive care in addition to curative medical care.

Neonatal hyperbilirubinemia: An evidence-based approach.

This review provides the latest advice on the screening and management of hyperbilirubinemia in term infants.

Oh rats! Fever, rash and arthritis in a young woman.

A 17-year-old girl presented with worsening right-sided hip and low back pain for 2 days. She had also experienced intermittent fevers and a recurring maculopapular rash over the past 2 weeks. Social history revealed the presence of three domestic rats living in the girl's home. Blood cultures returned positive for Streptobacillus moniliformis, the causative agent of rat-bite fever. Rat-bite fever often goes undiagnosed, as the clinical presentation is non-specific. Untreated, the infection can result in death due to sepsis or endocarditis. The bacterium is generally susceptible to penicillin antibiotics with full clinical recovery when treated in a timely and appropriate manner. After 4 weeks of intravenous antibiotics, our patient fully recovered without long-term sequelae.

A collaborative approach to achieving NCQA PCMH recognition within family medicine residency practices.

BACKGROUND AND OBJECTIVES: The Pennsylvania Academy of Family Physicians (PAFP) developed a statewide Residency Program Collaborative (RPC) to facilitate family medicine residency practices in Pennsylvania becoming recognized patient-centered medical homes (PCMHs). This report outlines the methods and a brief evaluation of the RPC, which included 20 residency practices. Participants attended tri-annual learning sessions and monthly conference calls, received physician faculty mentorship, and reported clinical quality data monthly on diabetes and ischemic vascular disease. METHODS: Two years after the start of the RPC, surveys were sent to residents, staff, providers, and administrators at participating practices to measure attendance and usefulness of collaborative sessions, mentors, and monthly reports. Evaluators also mapped the RPC curriculum to the Accreditation Council of Graduate Medical Education (ACGME) Core Competencies. RESULTS: All 20 participating practices achieved National Committee for Quality Assurance (NCQA) PCMH recognition, with 17 attaining Level 3 recognition. A total of 295 surveys were collected (92 residents, 71 faculty, and 132 office staff/administrators). Survey data showed higher collaborative attendance for residents and faculty compared to office staff/administrators (~84% versus 45%). No differences were noted between resident and faculty respondents regarding perceived helpfulness of collaborative sessions (6.3 and 6.5, respectively), mentors (6.6 and 6.2) and monthly reports (6.4 and 6.5), with both groups rating these components more highly than staff/administrators (5.3, 5.3, and 5.4 for each category). CONCLUSIONS: Learning collaboratives can assist residency practices in achieving PCMH recognition while concurrently providing an educational framework aligned with residency program Core Competencies. The RPC intervention, including learning sessions, monthly conference calls, data reporting, and faculty mentors, also can effectively guide residency practices in the PCMH transformation process and can serve as a means to experientially imbue future family physicians with the attitudes and skills to create and effectively operate their practices under PCMH principles.