Reflections on Family Medicine

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Reflections on Family Medicine

• -John Grauch

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Primary Care

• Primary Care-based health care system has the
  potential to reduce costs while maintaining
  quality.
• The majority of patients with diabetes,
  hypertension, and other chronic conditions do not
  receive adequate care.
• Estimated
• Providing chronic care need 10.6 hrs/d
• Preventative care additional 7.4 hrs/d

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Primary Care Will it Survive? The Best Job
in Medicine-NEJM August 2006

• Primary Care Specialties
• Family Medicine
• Internal Medicine
• Pediatrics
• Dropped from choice of 50 of Medical Students in
  1998 to 38 in 2006

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Primary Care The Best Job in Medicine-NEJM 2006

• Medical Students and residents are no less
  idealistic or dedicated today than they have been
  in the past...

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Primary Care The Best Job in Medicine-NEJM 2006

• Patients want a continuing relationship with a
  doctor whom they trust

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Family Care Medical CenterDenver, Colorado

• National Statistics
• Well-person exams- 11
• Cough- 5
• High BP- 4.6
• Sore Throat- 3.8
• URI- 3.3
• Back Pain- 2.8
• Skin Rash- 2.2
• Abdominal Pain- 1.9
• Med monitoring/Refill- 1.8
• Ear Pain- 1.7

• FCMC, Denver
• Abortion/TAB recheck- 20
• URI/cough/sinusitis- 20
• High BP- 15
• Musculoskeletal/LBP- 15
• Physical Exam- 10
• Cholesterol- 5
• Depression- 5
• Travel Preparation- 1
• Diabetes- 1
• UTI/STD- 10

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Family Care Medical CenterDenver, Colorado
Colfax and Leyden

• One Physician
• Two Medical Assistants/Office Staff
• Four Exam Rooms
• X-Ray
• Procedure Space
• Ultrasound Space
• Lab Space

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Family Care Medical CenterDenver, Colorado
Colfax and Leyden

• Significant Hispanic and Ethiopian demographic
• Majority Insured
• Small percentage Medicare and uninsured

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Patient S.S.

• CC Peeling and cracked/chapped lips x 5d
• HPI 8d ago flu-like syndrome
• 5d ago, blisters on lips and inside mouth
• 3d ago, blisters on hands
• 1d ago, isolated blister on penis
• CAME IN TO THE DOCTOR!

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Patient S.S.
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Patient S.S.
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Patient S.S.
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Patient S.S.
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Patient S.S.

• Meds none
• PHM/PSH none
• FH/SH recently Quit Smoking, no IVDA, works as a
  technician for Pepsi, heterosexual monogamous.
• Lab Rapid Strept. Negative
• Hx of oral mucosa lesions 1 year ago!

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Stevens-Johnson syndrome

• Usually preceded by a respiratory illness (1-14d
  prior)
• Mucosal Erosions Skin lesions
• Ocular symptoms!
• Precipitants
• NSAIDs, penicillins, antiepileptics
• also infectious agents (mycoplasma, yersinia or
  other viruses and bacteria.)

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Chronic Disease Management and Community
Resources

• Success
• Diabetic Foot Care
• Cholesterol
• BP follow-up
• Immunizations
• A1C, microalbumin
• Diabetes Educators
• basically
• EBM guidelines

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Chronic illness is often a poorly connected
string of episodes initiated by patients.

• Improvement
• Chart Summaries
• Baseline Labs
• Pre-Planning
• Patient Education
• Community Resources
• ASA for diabetics
• Acute Care Diagnoses

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Reflections on Family Medicine

• at times the GP may have to bypass confident
  biomechanical diagnosis, and adopt a decision
  pathway which approximates more to symptomatic
  treatmentdealing with non-disease and
  non-diagnosis is a routine part of a GPs work.