Advocating for Family Medicine

I recently had the opportunity to join a group of California-based family physicians for the annual AAFP National Conference of Special Constituencies, or “NCSC” in Kansas City, Missouri. This meeting takes place once yearly in early May, and is designed as an opportunity for members of the American Academy of Family Physicians (AAFP) from underrepresented constituencies to meet, network and integrate their perspectives into the national organization. The meeting was first held in 1990 as the National Conference of Women, Minority, and New Physicians. There are now five Special Constituencies; in addition to the three listed above, International Medical Graduates and Gay, Lesbian, Bisexual and Transgender Physicians are now represented. Over time, NCSC has become one of the best opportunities for leadership training and policy development on the annual AAFP events calendar.

I wasn’t sure quite what to expect as a resident, but was delighted to be asked to go along with the California Delegation. I was sure the conference would be both interesting and educational, but I was not nearly prepared for the amount of energy and work that we managed to pack into the three day event.

We began our official first day of the NCSC with a keynote speech from Dr. David Satcher, former U.S. Surgeon General and now head of the Satcher Health Leadership Institute at the Morehouse School of Medicine in Atlanta, Georgia. What a way to begin! Dr. Satcher focused on the theme of leadership, remarking that he thinks of himself not as an expert, but rather a perpetual student of leadership technique. He described some of his opportunities to serve, and the experiences he encountered as both Surgeon General and in his current position. “How do we work towards our goals? How do we begin to address health disparities?” he mused. “We need comprehensive health systems, policy development, and leadership." He also noted "it's not the position you hold that makes you a leader, [but] it's taking advantage of every opportunity where you are." Well, that was all the delegates needed to hear. What followed was nothing short of a frenzy of activity motivated by the care and experience of a group of people who identify themselves, first and foremost, as Family Physicians.

Twitter messages began flying back and forth during Dr. Satcher’s speech, as people became more involved in high-tech communication, aided by the ever-popular smart phones and our own growing sense of interconnectedness. In addition to Twitter, Facebook was a popular mechanism to connect delegates from all states with one another. The Facebook site for the NCSC kept up a running commentary of events and daily images of the activities both at the Conference of Special Constituencies and the Annual Leadership Forum, the conference taking place simultaneously alongside the NCSC.

Following the keynote, we then moved into breakout sessions, discussing topics pertinent to each of the five special constituencies. Discussion could be heard even in the hallways outside the sessions, as people debated which issues were pertinent to the AAFP and what position the AAFP should take on a particular subject. Resolution writing on these topics was quick and efficient, and everyone was encouraged to get involved in developing, researching, and writing these policy resolutions. I had the opportunity to participate in the Women’s Constituency discussion, which turned into a really stimulating session, where we took real-world examples of challenges we encounter in the office and created resolutions directing the AAFP to address these issues at the national level. Each constituency had the opportunity to review the others resolutions and ask questions about the origin or intent of the statements. Leaders, or “conveners” of each constituency spoke in support for or against specific resolutions, and there were some impassioned discussions on many topics from debating AAFP’s place on the Relative Value Scale Update Committee (RUC) to improving continuity of care for migrant workers.

In addition to debate, attendees were asked to volunteer to review the resolutions in five Reference Committees. I had the privilege of serving on the Reference Committee on Advocacy, which reviewed eleven different resolutions developed over the course of the day. We met for the duration of one afternoon, reviewing and researching the suggested resolutions, which culminated in a committee report presented to the entire group of delegates on the last day of the conference. It was incredible to see so many people involved in developing the policy agenda, and the AAFP staff were incredibly knowledgeable and generous with their time as we worked to develop our final report.

Our last day represented the culmination of our previous two-day experience; from discussion sessions, resolution writing, to preparing reports and researching AAFP policy. All the official state delegates from each of the Special Constituencies had the opportunity to hear the Reference Committee reports and vote on each resolution. I was particularly impressed with the general discussion and considered opinions on all sides of the resolution debate. It was very rewarding to both participate in development of the resolutions and to see action taken on some of the issues at the close of the conference.

One of the best aspects of the NCSC that I didn’t anticipate was the fact that the entire AAFP leadership, including AAFP President-elect Dr. Glen Stream, current AAFP President Dr. Roland Goertz, and Board Chair Dr. Lori Heim, were all present at the conference, attending the simultaneous Annual Leadership Forum. Every AAFP Board member was also in attendance. There was a genuine sense of camaraderie at the conference, and everyone had an opportunity to interact, connect, and engage with every other attendee whether a first time attendee (like me), a seasoned member of a state delegation, or a member of the national leadership team. It made for a very special sense of engagement and contributed to my sense of team responsibility for our work during the conference. That's really what this conference is about - making yourself available and open to new ideas, new information and new opportunities. I was inspired by this incredible group of leaders and truly impressed by the amount of energy all the attendees gave to the conference from beginning to end. Given my experience this year at NCSC, I can’t wait until 2012.

In California, Facing Down a Family Physician Shortage

A little inspiration

After spending the last four weeks in the hospital, I confess that I returned to my office this week a bit disilusioned, wondering whether the current health reform will actually create real change in the system to support people's healthier choices. The level of illness and care needs in the hospital is so severe, it can be a bit overwhelming. It's difficult to contemplate a healthier community within the four walls of an acute care facility like a hospital. Needless to say, I missed being an active member of my community, and I have to admit I was feeling rather un-inspired.

So I flew to Denver, Colorado this week to attend the American Academy of Family Physicians' annual Scientific Assembly, and opportunity to do continued medical learning and to network with family docs across the country regarding best practices, quality improvement, and community health work. Dr. Regina Benjamin, "America's Doctor" as the current US Surgeon General, gave our keynote speech. She herself is a family physician, and her speech got me right back where I needed to be: inspired about change, and excited to work towards that change. How many times in the last 5 years have we heard a cabinet member speak the phrases "social determinants of health," "poverty as a health indicator" and "food desert"? I am particularly excited to hear what my colleagues are doing in their own medical offices to address these issues during this conference, and Dr. Benjamin got us off to a great start.

I hope to share some of my experiences at the AAFP conference on this blog in the next few entries. In the meantime, for more information about Dr. Benjamin's Vision for a Healthy and Fit Nation, visit the website of the Office of the Surgeon General, or read the report.

You are what you eat

This past week, I was listening to National Public Radio during a rare lunch break. I was pleasantly surprised to catch a 20 minute segment discussing child nutrition and the fact that nearly 17 million children struggle with hunger on a daily basis.

Several guests were invited to offer their perspective about hunger, nutrition and healthy eating during the NPR program. What interested me most, however, was the discussion about food deserts. This phrase was coined to describe a community or district with little or no access to foods needed to maintain a healthy diet. Often, these areas are served by plenty of fast food restaurants, but offer little to no access to fresh fruits, vegetables, or healthy grains. This concept has been gaining ground and is becoming more familiar in daily vocabulary. It has also become a real issue during my daily work as a doctor.

That same afternoon I listened to the NPR program, a woman came into my office for a follow-up visit about her diabetes. Although she is currently on medication to help control her blood sugar, part of our plan to help improve her long term health has been to begin weekly exercise, and to eat a healthier diet. As we discussed her current weight loss plans, she told me how she struggled to prepare healthy meals each day. She described making the difficult choice between buying more expensive fresh spinach compared to the frozen variety, and how she alternated weeks driving to the farmer's market across town to buy fruits, vegetables and whole grains. The rest of the month she would save gas and money buying the cheaper microwave meals in order to meet her budget. It seems that despite her best efforts, she was constantly struggling to make the healthy choice which could improve her health.

This story is a familiar one, to health professionals, teachers and social service workers nationwide. As a doctor, a lot of my work is focused on helping my patients manage their own expectations and their activities where healthy living is concerned. As the medical community continues to develop treatments for chronic diseases like diabetes and heart disease, I am finding that access to healthy foods is a necessary complement to the care I give my patients.

Several efforts are in progress to address this issue, but in my opinion, the most important and real change is within local communities. Eliminating food deserts can be a struggle for inner city communities, or in districts where local public transportation is sparse. However, knowing where the healthy food is sold is a good first step. If you are interested in finding local farmer's markets, or alternative sites to buying healthy foods, check out Local Harvest, a site that enables you to locate fresh food in your community. Sites like this one also offer recipes, meal plan suggestions, and additional links to help you take advantage of local farmer's offerings.

You can catch the NPR program mentioned above, or read the transcript yourself, at NPR's website (click on this link: http://www.npr.org/templates/story/story.php?storyId=128671673).

Prevention, smart growth and walkability

I recently returned from a very interesting few months working in the hospital, and traveling to various conferences around the country. The topic at many of these meetings was, of course, health reform. It is no secret that I am a big fan of much of what is in the legislation, especially the emphasis on preventive health care, and funding for primary care to assist patient in the treatment of chronic disease.

Part of the reason I am so excited about the national push for prevention is because our country continues to move slowly towards becoming the most overweight nation in the world. Our rates of heart disease and diabetes are sky rocketing. It is my hope that funding for preventive care can help get our health back on track.

However, it is going to take more than national legislation to reduce our collective body mass index. This was never so apparent to me as when I recently attended a two-day conference in Washington DC. I began my trip reading more about the Let's Move Campaign, an ambitious federal program aimed to reduce childhood obesity by promoting physical activity and healthful eating in schools. Motivated by the opportunity to meet some of the people behind the creation of the program, I eagerly reviewed the action plan. Seeing the words "food desert" and "complete street" in a national policy brief was exciting - especially since many dedicated community members, academic researchers and patient advocates have been using this terminology for decades without much national attention.

I was properly motivated as I deplaned in DC, and being a fan of public transportation, I decided to do as much walking as possible in our nation's capitol and really embrace the spirit of Let's Move. I decided to keep track of my efforts and see just how easy it was to stay physically active while on a highly scheduled two-day business trip.

I had no trouble walking through National Airport, and made it to the METRO train (conveniently located across the street from the airport) without incident. One fifteen minute ride later and I had arrived in Alexandria, Virginia. I had just a short 10 minute walk to the place I would be staying, but this walk proved rather difficult in a business suit and suitcase. A sidewalk was available for the first three minutes of my walk, but then ended abruptly at the busiest intersection in town, without a cross walk in sight. Undeterred, I continued along the safest side of the street, half in grass and half in dirt. I eventually made it to another section of sidewalk, which then took me to the driveway of my destination.

The remainder of my trip was spent mostly in the downtown areas of DC near the Capitol, where the METRO stops regularly and sidewalks are plentiful. However, my return to the airport again involved a walk along a rather dismal stretch of road that only the bravest of souls would consider traveling with a suitcase. Needless to say, a street complete with sidewalk and bike lane is always welcome.

As the country continues to focus on prevention as a key part of our improved health, many local groups are starting to discuss complete streets, and smarter growth development policies, to make communities safe for outside activity that is not dependent on the automobile. For health professionals like me, who tend to recommend walking as a key activity to promote weight loss and healthy lifestyles, the importance of campaigns like Let's Move and community coalitions supporting smart growth cannot be overstated. If you are curious, you can test the "walkability" of your city or town and find handy routes to exercise or explore. Consider supporting local community efforts; many cities are developing tools for smart growth advocacy to support such change. You can also visit the Let's Move website (see link above) to see how you and your community can get involved! Or, do your own walkability test and see for yourself!