Departments Of Family Practice Research Articles

Why Washington University Doesn't Need/Can't Afford Family Practice-Reply

ABSTRACT In Reply. —The October 9,1991, issue of JAMA was devoted to the centennial of the Washington University School of Medicine. I appreciated the invitation from JAMA to include an Editorial in which I reviewed the successes of our institution.Dr Paul M. Fischer responded to the Editorial, criticizing the absence of a department of family practice at Washington University. I elected not to reply to Fischer's letter because it did not seem to call for a response, and because the Editorial that concerned Fischer was not meant to a position paper on the hard choices the school's leadership have made over the years. Now comes Dr Dell who suggests that I should not be reasonably excused from that responsibility (responding to reasonable, thoughtful, bona fide letters) even though JAMA does not mandate responses.In order to defray the issue of responsibility, let me answer Fischer's letter. Above all, let

RJR Nabisco's cartoon camel promotes Camel cigarettes to children : DiFranza JR, Richards JW Jr, Paulman PM, Wolf-Gillespie N, Fletcher C, Jaffe RD et al. Department of Family Practice, University of Massachusetts Medical School, 47 Ashby State Rd, Fitchburg, MA 01420. J Am Med Assoc 1991;266:3149-53

RJR Nabisco's cartoon camel promotes Camel cigarettes to children : DiFranza JR, Richards JW Jr, Paulman PM, Wolf-Gillespie N, Fletcher C, Jaffe RD et al. Department of Family Practice, University of Massachusetts Medical School, 47 Ashby State Rd, Fitchburg, MA 01420. J Am Med Assoc 1991;266:3149-53

Play Healthy, Stay Healthy

Primary Care Sports Medicine, Department of Family Practice, Hennepin County Medical Center, Minneapolis, Minnesota.

Observational data in faculty development: An underused method

Direct observation in clinical settings ("in the field") as a method of evaluation has been mentioned infrequently in the medical education literature. This article presents a case study of the use of qualitative field observations for the purposes of both needs assessment and formative evaluation in the implementation of a Faculty Development Program in a Department of Family Practice. The observations were repeated after a 2‐year period, permitting comparison. The results of the observations, and how they were used in the evolution of the Faculty Development Program, are discussed, as are the value and cost of this form of data collection.

The Financial Impact of a Nursing Home Practice on an Academic Medical Center

This study reports the economic contributions of nursing home practice to an academic department of family practice as well as the fiscal impact of referrals from nursing home practice on an academic medical center. Payment to primary physician faculty for nursing home service did not fully compensate for faculty effort. Nevertheless, these services did result in significant revenues to consulting physicians and the University Hospital. In aggregate, an average nursing home visit was associated with $33 in charges for the visit by the primary physician, $15 for additional primary care services in the clinic and hospital, $72 for services by consulting physicians, and $307 in charges by the University Hospital. The average nursing home patient provided $3,744 in charges and $2,403 in income to the academic medical center per year, with $1,813 going to the hospital and $331 to consulting physicians. Even though primary care is not well reimbursed, a relatively small number of patients have the capacity to create substantial income for consulting physicians and the hospital. The study does not address whether these nursing home referrals to the hospital utilized disproportionately high hospital resources.

The do-not-resuscitate order: A comparison of physician and patient preferences and decision-making

purpose: The purpose of this study was to compare the decision-making and preferences regarding do-not-resuscitate (DNR) orders of a group of family physicians with a group of outpatients from a family practice center. Complete results of the outpatient questionnaire were published in a previous study by the authors. subjects and methods: A random sample of 202 members of the Michigan Academy of Family Practice and all 32 members of the University of Michigan Department of Family Practice were surveyed by a mailed questionnaire. The questionnaire was divided into five parts: demographics, past experiences with DNR orders, who should be involved in DNR decision-making, values clarification, and a series of scenarios matched by a variety of biomedical and non-biomedical factors. results: After eliminating physicians who had left no forwarding address or who had retired or died, the overall response rate was 61.8%. Most physicians (97%) had at some time written a DNR order for one of their patients; discussions most commonly took place in the hospital room. Physicians, like patients, thought that in addition to the patient, DNR decisions should involve the spouse, the physician, and the patient's children, respectively. Value clarification revealed that both groups most highly value “being able to think clearly” and “being treated with dignity.” The presence of a number of quality-of-life issues (age, drug or alcohol use, wheelchair use, dementia, and severe pain) in a series of scenarios negatively affected the decision of both family physicians and patients to resuscitate. conclusion: There are significant similarities and differences in the way physicians and patients make DNR decisions. It is important that physicians and their patients communicate in a timely manner about prognosis, values, and quality-of-life issues in order to make effective DNR decisions.

Three years of a required geriatrics module for third-year medical students

The Parker Jewish Geriatric Institute, a teaching nursing home at which an accredited internal medicine geriatrics fellowship is based, co-developed with the Department of Family Practice of the medical school at the State University of New York at Stony Brook a mandatory geriatrics module for third-year medical students. The module's implementation over a three-year period (1985-1987) with 278 medical students is described. The authors conclude that if time and effort are given to the development of a geriatrics curriculum, and if appropriate instructors are chosen, then learning geriatrics in long-term-care settings can be as rewarding and exciting an experience for medical students as their experiences in other clinical settings, even when that learning is required.

Care Management

Journal of the American Geriatrics SocietyVolume 39, Issue 4 p. 431-437 Care Management Dr James E. Fanale MD, Corresponding Author Dr James E. Fanale MD Medical Center of Massachusetts, Worcester, MassachusettsMedical Center of Central Massachusetts, 119 Belmont St., Worcester, MA 01605–2982.Search for more papers by this authorJoseph M. Keenan MD, Joseph M. Keenan MD Department of Family Practice and Community Health, Minneapolis, MinnesotaSearch for more papers by this authorKenneth W. Hepburn PhD, Kenneth W. Hepburn PhD Department of Family Practice and Community Health, Minneapolis, MinnesotaSearch for more papers by this authorThomas Von Sternberg MD, Thomas Von Sternberg MD Department of Family Practice and Community Health, Minneapolis, Minnesota Group Health, Inc., Minneapolis, MinnesotaSearch for more papers by this author Dr James E. Fanale MD, Corresponding Author Dr James E. Fanale MD Medical Center of Massachusetts, Worcester, MassachusettsMedical Center of Central Massachusetts, 119 Belmont St., Worcester, MA 01605–2982.Search for more papers by this authorJoseph M. Keenan MD, Joseph M. Keenan MD Department of Family Practice and Community Health, Minneapolis, MinnesotaSearch for more papers by this authorKenneth W. Hepburn PhD, Kenneth W. Hepburn PhD Department of Family Practice and Community Health, Minneapolis, MinnesotaSearch for more papers by this authorThomas Von Sternberg MD, Thomas Von Sternberg MD Department of Family Practice and Community Health, Minneapolis, Minnesota Group Health, Inc., Minneapolis, MinnesotaSearch for more papers by this author First published: April 1991 https://doi.org/10.1111/j.1532-5415.1991.tb02915.xCitations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume39, Issue4April 1991Pages 431-437 RelatedInformation

Cholesterol Screening in a Black Inner-City Pediatric Population

A screening for total blood cholesterol levels was conducted by the University of Louisville Department of Family Practice in association with the National Youth Sports Program in Louisville, Kentucky. On May 30, 1987, 224 inner-city children between 10 and 16 years of age were tested; 109 (49%) were girls and 115 (51%) were boys. All participants were black. Of the entire population, the girls had a slightly lower mean level of cholesterol than the boys (160 mg/dL vs 165 mg/dL, respectively). Because of the large number of participants aged 10 to 14 years (211), this subset of children was studied more closely. In this age group, 47 (22%) of the children were at moderate risk for future cardiovascular disease and 48 (23%) were at high risk. The serum cholesterol levels were relatively constant in all children until age 12, after which a slight reduction occurred. This decrease is more evident in boys. Our study also showed a correlation between increased blood cholesterol and above normal weight/height indices (ie, Quetelet scores), with nearly 70% of all children having elevated cholesterol levels also exhibiting above normal Quetelet scores. We observed no correlation between high cholesterol levels and high blood pressure in this study population. Dietary intervention is recommended as the initial treatment for elevated cholesterol levels in children.

MARRIAGE COUNSELING: A CHRISTIAN APPROACH TO COUNSELING COUPLES

Counseling and ValuesVolume 35, Issue 1 p. 18-21 MARRIAGE COUNSELING: A CHRISTIAN APPROACH TO COUNSELING COUPLES Everett L. Worthington Jr., Everett L. Worthington Jr. Coordinator, Marital & Sex Therapy Program Department of Family Practice and Community Health University of Minnesota Medical School, MinneapolisSearch for more papers by this authorMichael E. Metz, Michael E. Metz Assistant Professor Coordinator, Marital & Sex Therapy Program Department of Family Practice and Community Health University of Minnesota Medical School, MinneapolisSearch for more papers by this author Everett L. Worthington Jr., Everett L. Worthington Jr. Coordinator, Marital & Sex Therapy Program Department of Family Practice and Community Health University of Minnesota Medical School, MinneapolisSearch for more papers by this authorMichael E. Metz, Michael E. Metz Assistant Professor Coordinator, Marital & Sex Therapy Program Department of Family Practice and Community Health University of Minnesota Medical School, MinneapolisSearch for more papers by this author First published: October 1990 https://doi.org/10.1002/j.2161-007X.1990.tb00353.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume35, Issue1October 1990Pages 18-21 RelatedInformation

Harvest of Hope

As busy practitioners we have to be selective in what we read because of the time limitations of our professional lives. Nevertheless, we require diversion, and some reading may help to replenish our batteries, especially after long hours of clinical, administrative, and teaching duties. This is a brief autobiography by Jorge Prieto, MD, former chairman of the Department of Family Practice at Cook County Hospital in Chicago, Ill, and briefly president of the Chicago Board of Health. The book is hard to put down and can be read in one sitting. It is the story of a young refugee from Mexico, a pilgrim who decided to become a physician to help his countrymen in this land. Proud of his heritage, religion, and vocation, he survived immigration, rose above his own infirmities (rheumatic heart disease), learned the system, and tried to improve conditions not only for his patients and community, but

A National Physician Service Corps?

This paper describes a program initiated in 1984 by the University of Minnesota Department of Family Practice and Community Health to train volunteer community preceptors for their instructional role in the Ambulatory Care Rotation (ACR), a six-week outpatient medicine offering for third- and fourth-year medical students. The preceptor training program consists of a full-day faculty development workshop for prospective community preceptors and periodic follow-up activities designed to reinforce workshop goals. Five workshops have been held from 1984 to 1987 and have provided a group of trained faculty preceptors for the ACR. The authors reviewed the methods and results of the workshops; self-ratings by participants demonstrated a significant gain in teaching skills and knowledge. Students' ratings of both the ACR course and the teaching by preceptors have been high and compare favorably with ratings of other preceptors and clinical rotations. There has been a 97% retention rate of the workshop-trained preceptors as active teachers in the ACR course, which suggests that the preceptors are satisfied with their role.

A Workshop Program to Train Volunteer Community Preceptors

This paper describes a program initiated in 1984 by the University of Minnesota Department of Family Practice and Community Health to train volunteer community preceptors for their instructional role in the Ambulatory Care Rotation (ACR), a six-week outpatient medicine offering for third- and fourth-year medical students. The preceptor training program consists of a full-day faculty development workshop for prospective community preceptors and periodic follow-up activities designed to reinforce workshop goals. Five workshops have been held from 1984 to 1987 and have provided a group of trained faculty preceptors for the ACR. The authors reviewed the methods and results of the workshops; self-ratings by participants demonstrated a significant gain in teaching skills and knowledge. Students' ratings of both the ACR course and the teaching by preceptors have been high and compare favorably with ratings of other preceptors and clinical rotations. There has been a 97% retention rate of the workshop-trained preceptors as active teachers in the ACR course, which suggests that the preceptors are satisfied with their role.

Behavioral Patterns and Personality Characteristics of 56 Sex Offenders

Researchers at the Program in Human Sexuality, Department of Family Practice and Community Health, University of Minnesota, have treated sex offenders for 10 years and believe they have identified 14 prevalent behavior patterns and personality characteristics. Descriptive statistics are used to analyze the patterns and characteristics of 56 male offenders before treatment. This preliminary report indicates that offenders do indeed have clusters of these characteristics. The data showed that 70% of the offenders have 11 of the patterns and characteristics, and 83% have eight.

Grants and Outcomes

Grants and Outcomes

Umbilical Cord Blood pH and Apgar Scores as an Index of Neonatal Health

Departments of Family Practice and Obstetrics and Gynecology, Malcolm Grow United States Air Force Medical Center, Andrews Air Force Base

The urban environment and its impact on primary care.

*From the Department of Family Practice, State University of New York, Health Sciences Center at Brooklyn, Brooklyn, New York †From the Graduate School of Education, Fordham University, New York, New York

Family Violence in Stable Middle-Class Homes

Journal Article Family Violence in Stable Middle-Class Homes Get access Cyrus Stewart, Cyrus Stewart Cyrus Stewart, PhD, is Professor of Social Science, Michigan State University, Vice President of Meridian Professional Psychological Consultants, 5031 Park Lake Drive, East Lansing, MI 48824. Mary Margaret Senger, PhD, is Director of Behavioral Medicine, Department of Family Practice, College of Human Medicine, Michigan State University. David Kallen, PhD, is Professor and Susan Scheurer, MD, is Assistant Professor, Department of Pediatrics, College of Human Medicine, Michigan State University. Search for other works by this author on: Oxford Academic PubMed Google Scholar Mary Margaret Senger, Mary Margaret Senger Cyrus Stewart, PhD, is Professor of Social Science, Michigan State University, Vice President of Meridian Professional Psychological Consultants, 5031 Park Lake Drive, East Lansing, MI 48824. Mary Margaret Senger, PhD, is Director of Behavioral Medicine, Department of Family Practice, College of Human Medicine, Michigan State University. David Kallen, PhD, is Professor and Susan Scheurer, MD, is Assistant Professor, Department of Pediatrics, College of Human Medicine, Michigan State University. Search for other works by this author on: Oxford Academic PubMed Google Scholar David Kallen, David Kallen Cyrus Stewart, PhD, is Professor of Social Science, Michigan State University, Vice President of Meridian Professional Psychological Consultants, 5031 Park Lake Drive, East Lansing, MI 48824. Mary Margaret Senger, PhD, is Director of Behavioral Medicine, Department of Family Practice, College of Human Medicine, Michigan State University. David Kallen, PhD, is Professor and Susan Scheurer, MD, is Assistant Professor, Department of Pediatrics, College of Human Medicine, Michigan State University. Search for other works by this author on: Oxford Academic PubMed Google Scholar Susan Scheurer Susan Scheurer Cyrus Stewart, PhD, is Professor of Social Science, Michigan State University, Vice President of Meridian Professional Psychological Consultants, 5031 Park Lake Drive, East Lansing, MI 48824. Mary Margaret Senger, PhD, is Director of Behavioral Medicine, Department of Family Practice, College of Human Medicine, Michigan State University. David Kallen, PhD, is Professor and Susan Scheurer, MD, is Assistant Professor, Department of Pediatrics, College of Human Medicine, Michigan State University. Search for other works by this author on: Oxford Academic PubMed Google Scholar Social Work, Volume 32, Issue 6, November-December 1987, Pages 529–531, https://doi.org/10.1093/sw/32.6.529 Published: 01 January 1987 Article history Accepted: 26 November 1985 Published: 01 January 1987

Division of Physician Time-Reply

In Reply. —I appreciate Dr Chao's comments. We are essentially in agreement. When I categorized medicine, I was thinking generically for my purposes rather than distinguishing medicine or internal medicine from family practice or general medicine. Dr Chao is correct in suggesting that my approximation for medicine as practiced by the voluntary hospital staff attendings could be considered closely akin, for our purposes, to the experience of primary care practitioners, including accredited family practice specialists. I am pleased to learn that the excellent study to which Dr Chao refers (and which I have now read) generally conforms to the percentages that I have compiled from my experience and general observations alone. I can assure that I intended no slight to family practice in the context of my tabulation. Rather, my main vantage point has been with an institution that has no single department of family practice.

Private physicians in ambulatory care training in U.S. medical schools.

The contribution of private physicians to medical student education in ambulatory care was determined by a questionnaire directed to departments of family practice, internal medicine, and pediatrics in 124 U.S. medical schools and their branch campuses. The response rate was 84 percent. Of the responding departments, 82 percent offered an ambulatory care course in curricular years three and/or four, and 56 percent utilized private physicians in their courses. Departments of internal medicine were least likely to offer such a course, and their courses less frequently included teaching by private physicians (p less than 0.0001). When offered, internal medicine courses in ambulatory care were least likely to be required for graduation and involved the fewer students. Departments of family practice were most likely to offer ambulatory care courses and were most likely to utilize private physicians in their courses.