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Medicine, Media and the Need for a Physician’s Perspective

“I don’t like taking medicine unless I really have to.”

That is the most common complaint I hear from my patient Sandra whenever I talk with her about why she should be taking a statin or why it’s important to get an annual flu vaccination. Unfortunately, she bristles at discussions about quality of life and mortality.

But a conversation I had with her at this time last year was different. Sandra was eager to learn more about an immunization and medication she thought she really needed. This patient, who had rejected recommended preventive care that could protect her from far more prevalent diseases, was worried about Ebola.

My visit with Sandra was during the peak of the Ebola scare. After the first case was reported in the United States last fall,parents pulled their children from schools, politicians called for a ban on travelersfrom West African nations, and health experts had to put down fears that Ebola would become airborne.

Although more than 28,000 cases resulting in more than 11,000 deaths have been reported in Guinea, Liberia and Sierra Leone, Ebola has not made much of an impact on public health in the United States. According to the CDCthere were four cases and one death in this country last year.

In stark comparison, heart disease is the No. 1 cause of death in the United States, claiming more than 600,000 lives each year. But, no, Sandra won’t take a statin. And although more than one-third of Americans are obese, many patients don’t want to talk about diet and exercise. Diabetes, by the way, kills more than 75,000 Americans per year.

Influenza and pneumonia (nearly 57,000 annual deaths) pose much bigger, immediate threats to U.S. public health than Ebola, yet some Americans were panicked by the incessant news coverage generated by a handful of Ebola cases being treated in the United States. Sandra had heard about an experimental Ebola vaccine on the news, but she didn’t understand its indications or the fact that it was still in trials.

The intersection of medicine and the media is a peculiar place. What the media considers newsworthy — interesting, impactful, timely or novel — often has little or nothing to do with scientific validity and reliability.

Mainstream news outlets frequently tout new treatment modalities and new drugs long before we know their true potential. News outlets also love stories (and ratings) related to “looming” health threats, even if the threat isn’t particularly great. The urgency of Ebola was easier to convey than the long-term, more significant threat of heart disease. And news about a pill being developed to prevent Alzheimer’s (someday) or a cutting-edge therapy for cancer will always beat out common-sense recommendations about exercising to prevent obesity.

In reality, newer medical treatments and technologies do not necessarily translate to better medical care or health outcomes. In fact, they are often ineffective or come with higher costs. What is new should not trump what is true. Yet the health information disseminated to the public isn’t always helpful.

Medical statistics and information can easily be misunderstood by the average person. Ideally, health care news should be dominated by systematic reviews of multiple high-quality randomized controlled trials; however, this is limited by a number of factors, including a paucity of resources to execute these trials. Consequently, media outlets often cover the results of observational studies or presentations from academic meetings, although many of these abstracts will never be published in a peer-reviewed medical journal. It’s no surprise such cursory information can be misinterpreted.

The good news is more media outlets are starting to rely on physicians to convey health news. Physicians are consistently rated favorably by the public in surveys regarding honesty and ethical standards. As members of a profession that has earned the public trust, physicians can work with the media to deliver important health messages. Family physicians, in particular, are in a unique position: We have both the most intimate and the most global perspectives when it comes to the health of our patients. We are able to interpret research without distorting its impact and articulate this information to the general public. Finally, given the broad scope of our capabilities, we can comment on topics ranging from antibiotic overuse to sleep hygiene.

Social media is another venue that allows physicians to potentially reach an audience that extends far beyond the exam room. Physicians can recommend evidence-based guidelines, provide commentary on journal articles and dispel misinformation.

Of course, the best way to combat medical misinformation is to have a trusting relationship with your patients. I explained to Sandra what I knew about Ebola and eased her fears about transmission. I also engaged her in a goal-oriented discussion about statins and the influenza vaccine. Although she didn’t change her mind that time, I took comfort in the fact that she always comes back to see me. And she’s no longer worried about Ebola.

Natasha Bhuyan, M.D., is a family physician in Phoenix. You can follow her on Twitter @NatashaBhuyan.

Vaccine Provider Updates:

To continue providing VFC vaccines to eligible patients VFC providers must re-enroll each year in the VFC program. The re-enrollment process for the 2016 VFC program year begins on November 13, 2015 and re-enrollment forms will be due to the Arizona Vaccine Center no later than December 18, 2015. 

Arizona VFC enrollment forms can be found on the AZ VFC website

The forms are electronically fillable, and, once completed, should be emailed to: ArizonaVFC@azdhs.gov. In the subject line of your email include your VFC PIN and the phrase “VFC Re-enrollment.” The following forms are required: 

✓ 2016 Arizona VFC Provider Enrollment Agreement 
✓ 2016 ASIIS HIPAA Pledge to Protect Confidential Information 
✓ 2016 VFC ASIIS User Agreement Form 
✓ 2016 VFC Provider Profile Form 
✓ 2016 VFC Refrigerator-Freezer Verification Statement 

Your site’s VFC Coordinator and Backup VFC Coordinator are required to complete annual training such as the CDC webinar “You Call the Shots.” The instructions and link for the webinar can also be found on the AZ VFC website

 

Valley Fever stakeholder meeting attended by the AzAFP Staff

Your AzAFP Staff attended the stakeholder meeting on November 17th as part of the Valley Fever Awareness Week proceedings. The stakeholder meeting offered an opportunity for members of the clinician community to gather, learn and collaborate. The agenda provided an overview of the current Valley Fever data in Arizona by Ken Komatsu, MPH, State Epidemiologist, Arizona Department of Health Services (ADHS), patient experience and perspective by Mr. Daniel Leis, presentations from industry representatives working on diagnostics and treatment aspects of Valley Fever, and a community action discussion. Dr. Tom Chiller, Deputy Chief, Mycotic Diseases Branch at the Centers for Disease Control and Prevention (CDC) presented a concise national perspective on the State of Valley Fever. ArMA thanks our meeting organizers, Drs. John Galgiani, Peter Kelly, and Michael Grossman, for their invaluable leadership and coordination in bringing together the individuals who contributed to the agenda. We are grateful for the support of our meeting sponsors; The University of Arizona College of Medicine – Phoenix, who hosted the meeting on their campus, and to our industry sponsors DxNA, HealthTell,IMMY, and Nielsen Biosciences.  We urge you to take advantage of FREE Valley Fever online CME offered by the VFCE here or just learn more about Valley Fever here

 

USPSTF: Screen Overweight, Obese Adults for Abnormal Blood Glucose

November 02, 2015 01:53 pm News Staff – On Oct. 27, the U.S. Preventive Services Task Force (USPSTF) released a final recommendation statement (www.uspreventiveservicestaskforce.org) that calls for adults at increased risk for type 2 diabetes to be screened to detect abnormal blood glucose levels or diabetes. This is a grade B recommendation.

Specifically, the task force recommends screening for abnormal blood glucose in adults 40-70 who are overweight or obese. Furthermore, said the group, physicians should offer patients in whom abnormal blood glucose levels are detected intensive behavioral counseling interventions or refer them, if necessary, to promote a healthful diet and physical activity.

“Diabetes is a leading cause of heart attacks and strokes,” said USPSTF member Michael Pignone, M.D., M.P.H., in a news release.(www.uspreventiveservicestaskforce.org) “The good news is, we can identify people at risk and help them make lifestyle changes that may ultimately prevent or delay complications associated with this serious illness.”

Risk factors for diabetes include being age 45 or older, being overweight or obese, and having a first-degree relative with diabetes. Women with a history of gestational diabetes or polycystic ovarian syndrome are also at increased risk, as are certain racial and ethnic minorities (i.e., African Americans, American Indians or Alaska Natives, Asian Americans, Hispanics or Latinos, and Native Hawaiians or Pacific Islanders).

This final statement updates a 2008 USPSTF recommendation (www.uspreventiveservicestaskforce.org) calling for diabetes screening in asymptomatic adults with hypertension (sustained blood pressure of greater than 135/80 mm Hg), which also was a B recommendation. In addition, the USPSTF found insufficient evidence to assess the balance of benefits and harms of screening in asymptomatic adults without hypertension.

At the time, the AAFP’s recommendations on screening for diabetes mirrored those of the task force.

Since the previous recommendation statement was issued, six new intervention studies have shown consistent benefit from lifestyle modifications intended to prevent or delay progression to diabetes in those who have impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). The groups also found limited evidence from longer-term studies that suggested such interventions may actually improve outcomes.

Lifestyle modifications such as improved nutrition, healthy eating behaviors and increased physical activity are, in fact, considered first-line therapy for preventing IFG, IGT and diabetes. The USPSTF found adequate evidence that intensive lifestyle modifications result in a lower incidence of diabetes, cardiovascular mortality and all-cause mortality.

However, although this new body of evidence led the USPSTF to conclude there is an overall moderate net benefit to measuring blood glucose levels in adults at increased risk for diabetes, the task force found inadequate direct evidence to show that measuring blood glucose leads to improvements in mortality or cardiovascular morbidity.

“Losing weight reduces the chances of developing diabetes, which is why our recommendation focuses on diet and exercise,” said task force member William Phillips, M.D., M.P.H., in the release. “Patients who have abnormal blood sugar levels can be referred to programs that help them eat a more healthful diet and exercise more often.”

 

Primary Care Caucus Grows

Also on Capitol Hill, Board members met with two House members who last month inaugurated the Primary Care Caucus. Academy leaders thanked Reps. David Rouzer, R-N.C., and Joe Courtney, D-Conn., for their efforts and discussed next steps for the caucus. 

The caucus now has 14 members, and Courtney sent a letter to his colleagues in Congress this week asking them to join. He explained that the caucus will educate legislators and the public about the importance of primary care to the health system. 

“Our hope is that the Primary Care Caucus will transcend politics to focus on a positive path forward for patients, providers and our health care system that will finally achieve the triple aim of higher quality, lower cost and better outcomes,” Courtney wrote. 

He told AAFP leaders that he plans to help organize several events each year to explain the value of primary care. AAFP members can help, he said, by contacting their representatives in Congress and encouraging them to join the caucus. The Academy has created a tool to help members do just that.

Courtney also thanked AAFP leaders for engaging students and residents in advocacy efforts, saying they have an important role to play in shaping the future of public health policy.

“He told us that there are a lot of caucuses that are just ‘window dressing,’ so he wants this one to have a real impact,” Filer said.

AzAFP awards an FMCC scholarship to Medical Student:

May 2016

During my third-year family medicine clerkship, I loved watching residents and faculty members advocate for their patients.  They juggled notes and phone calls to other members of the healthcare team, explained test results and addressed patient concerns, and helped patients find health solutions that would fit into their daily lives.  I valued the way they approached each patient as a whole person, advocating daily for their health and well being.  Their efforts inspired me to join their ranks as a family physician.

 

Since then, I have learned that advocating for patients, both on an individual and collective basis, is a true a hallmark of family medicine.  That’s why I was thrilled when, last month, AzAFP provided me with an incredible opportunity to attend the Family Medicine Congressional Conference in Washington, DC. 

 

The energy in the room was palpable as family physicians from across the country discussed pressing issues, from prescription drug abuse to funding for Teaching Health Centers.  We also heard a fascinating analysis of the presidential election, learned about new payment models under MACRA, and more.

 

The following day, we set out to meet with our Congressional representatives.  For me, this meant meeting with representatives from the offices of Senator McCain and Senator Flake.  It was exhilarating to walk into the Senate office buildings and discuss specific actions Congress could take to help curb prescription drug abuse and to ensure the sustainability of Teaching Health Centers.  I came away with an added appreciation of the political process and with professional relationships that I hope to continue into the future.

 

I learned so much from this experience: always stand on the right on the DC Metro escalators, Washington is beautiful in the spring, and quiet reflection in front of the monuments never gets old.  Most importantly, though, I learned that it’s never too early in your career to speak up and be involved.  No matter who you are, you have valuable knowledge and experiences that can benefit your patients and your community as a whole.  This was never more true than for family physicians.

 

 

Mandy Boltz, MD, MPH

 

Mandy graduated from the University of Arizona College of Medicine – Phoenix in May 2016 and will be begin as a resident in the University of Arizona College of Medicine – Phoenix (formerly Banner University Medical Center – Phoenix) Family Medicine Residency this June.

NEW YEAR, NEW GOALS! Are You Ready To GET INVOLVED IN YOUR ACADEMY?

Please read this attachment which outlines ways in which YOU can get involved in your AzAFP!  We want YOUR help to make the Arizona Academy of Family Physicians the best it’s ever been in 2016!  After reviewing this document called “Getting Involved in Your Academy,” please email Christy with any questions christy@azafp.org!  Happy Holidays!

AAFP Congress of Delegates in Denver a Huge Success

Although the AAFP President-Elect Election did not go the way we had hoped it would, it was a successful trip for the AzAFP.  The AzAFP enjoyed learning more about and promoting our wonderful member Carlos Gonzales and his family!  He has made an enormous contribution to family medicine in Arizona.  We were so proud to have him as our candidate and to represent the State of Arizona.  For more information on the COD and the election, please visit www.aafp.org.