Blogs

Changing Social Norms

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November 27 2015 Kris Oaks, D.O. All of us have heard complaints about the increasing costs of healthcare. The out of pocket expenses for most consumers of health care have risen and the expenses have climbed for employers and public agencies as well. Statistics show our nation’s health expenditures are on such a breathtakingly unsustainable trajectory that one day in the next few decades costs will exceed our GDP. The causes are multifactorial, but a large component is the continuing decline in overall health due to poor lifestyle habits or choices. Emphasis on the social determinants of our declining ...
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Teams

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December 5, 2015 | John Brady, M.D. I always get the current medical buzz phrase from the local hospital system when I listen to the radio. Gone is “patient-centered, doctor-directed” care. We have moved on to “expert, team-based care.” And why not? Proponents argue that doctors cannot possibly do everything themselves, so a team is necessary. As one physician described it to me, he likes to think of himself as the conductor of a medical symphony—the lead person organizing and orchestrating many talented individuals to ...
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December 14, 2015 | Lynn Ho, M.D. In Rhode Island, health care comprises a small fiefdom. Reasonable population levels of income and education, a small geographic footprint, two out of three of the major insurers under ‘local’ control, and a relatively ‘beneficent’ attitude towards primary care from the state health department and the Office of the Health Insurance Commissioner (OHIC) are the factors that have allowed a variety of primary care delivery systems to coexist. Micropractices have ...
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The Ghosts of IMP

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December 2015 Jean Antonucci, M.D. Sometimes I go back to the earlier days of IMP and the lessons I learned, as I find that helps keep me focused. Here are a collection of some random nuggets delivered in a kind of hodgepodge fashion. Though some are nearly a decade old, they are just as apropos today. If you’re working toward the goal of delivering superb care and have data to guide you, and you’re structured to deliver on the fundamental attributes of effective primary with great access, huge continuity, and work and expansive scope of services & work at least on the foothills ...
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January 2016 Melissa Weakland MD IMP Board President We keep a detailed messy old fashioned paper calendar tracking the events and activities of me, my husband and our two boys. I threw it out today and hung our new “Beautiful Places in the World” 2016 still blank replacement. I do this each year with mixed emotions as it feels odd to say goodbye to such an eventful year. And the blank slate for the year to come is both exciting and scary. I became board President of IMP this past fall. For the last three months I’ve been learning IMP past and working to help create IMP future. Our organization ...
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Just Whining

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January 12, 2016 | John Brady, M.D. Whining is complaining without offering any solutions. It tends to be overly emotional, not thoughtful, and not very helpful. Whining is frequently discarded as useless and those who whine regularly are often viewed as “part of the problem.” But what if the solution is too complex to understand or it is too overwhelming to implement? At that point, is it whining to point out obvious failures without offering tangible solutions? Such is the dilemma in medicine. So much to complain about and so few good solutions. More ...
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Measuring Quality

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March 19, 2016 | John Brady, M.D. Over the years, I have been told by many quality directors that we need to measure stuff. “If you can’t measure it, then you can’t improve it.” I would ask how knowing the average HGBA1C of the population translates into the overall health of the population (particularly keeping in mind the results of the ACCORD Trial). I would ask if anyone truly believes that measuring the number of diabetics with a HGBA1C over 9 who are on insulin (assuming it should be 100%) would make a difference. I would ask over and ...
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Let's Have Another

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April 30 2016 Jean Antonucci, MD There was a recent story in JAMA about an incorrigible patient. Palliative care was called in to set goals. They sat and listened to the patient, and he went home calm and comforted. Funny how this used to be the family doctor's job. A recent story in the popular press said that we don’t have enough geriatricians. The elderly are complex and need time to prevent readmits, reconcile meds, keep them safe from falls and grieve over losses. Not enough board-certified, trained geriatricians. Funny, family docs used to do this. Even the family medicine residencies support the idea of specialization. ...
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