Family Medicine Vital Signs

By: Benjamin Brown MD, MPH

Our residency program is filled with assignments and projects that run alongside our demanding clinical responsibilities. One of these ongoing curricular components is that each year, the third-year residents lead a quality improvement project. These projects focus on improving health and well-being in our patients at the Madsen Health Center and the Sugar House Health Center. The focus is to impact not just individual patients but the patient population as a whole. Efforts might include increasing the percentage of patients screened for colon cancer, tested for chlamydia, or screened for breast cancer. For the most part, these projects focus on disease prevention or early detection of disease.

During my second year of residency, I had the pleasure of participating in a quality improvement project led by Dr. Erin McAdams (who is now one of our exceptional faculty). Our multi-disciplinary team was made up of clinic providers, medical assistants, pharmacists, and a care manager. Our project was focused on improving diabetic control in our adult patients with type 2 diabetes mellitus at the Sugar House Health Center. Our team identified barriers to achieve control and then developed interventions to meet our goals for improvement. Our primary intervention was to help providers diversify their treatment plans for their patients with diabetes. We utilized our electronic medical record system to send providers personalized messages that addressed treatment, screening, and resource recommendations. Our project ultimately result in improved control of diabetes for many of the clinic’s patient population.

One of the great opportunities after completing a project like this is to disseminate your work and findings. Through the generosity of the Dr. George D. Gross and Dr. Esther S. Gross Educational Endowed Scholarship Fund in Family Medicine I was able to attend the 22^nd WONCA World Conference and present a poster about this project. The conference was held in Seoul, Korea (more specifically in the Gangnam district, which many people may know about due to the famous song by Psy – Gangnam Style). The conference theme was “Primary Care in the Future: Professional Excellence.”

I have never been in a setting with such a vastly diverse group of clinicians, very few of which were from the United States. Approximately 130 countries were represented. I met physicians and residents from Japan, Malaysia, Nepal, Indonesia, Australia, Britain, Netherlands, Malawi, and Sri Lanka. I shared the details of our project while at the same time learned from many others about initiatives in their nations. I heard about the experiences of family medicine residents working in Brazilian favelas, Egypt’s work in providing free Hepatitis C treatment nationwide, a resident who works with sex workers in the Netherlands, and a young doctor who works in a tuberculosis hospital in South East Asia.

Family Medicine is continuing to develop around the world. Some nations, like Bangladesh, are just developing the ground work for departments of academic Family Medicine. In others, such as the United States and Australia, it is a well-established field. I had the opportunity to meet Dr. John Cullen, President of the AAFP, and discuss his role at WONCA as well as learn a little bit about his own Family Medicine practice in Alaska. In retrospect, I feel that this international experience strengthened my cultural insight and my understanding of healthcare on a global scale. As I see patients who have immigrated from other countries here in my practice in Salt Lake City, I need to remember that their concepts of healthcare may be vastly different than the health culture that exists in the United States, and that these persons need to be treated in our system with equity and understanding.

I did not expect that my involvement in our quality improvement project would lead me to Korea to meet physicians from around the world. I found this experience important to gain a better appreciation for a more global view of medicine, one that is different from the one we experience here in the United States. At the conference, the United States was jokingly blamed for spreading bad health habits abroad. To some extent, there may some truth to that. Every nation has its place in what and how it promotes global progression of health and healthcare and the United States is a big player…maybe for both good (innovation and research) and bad (high costs and fewer social support systems). What I found that we have in common with our colleagues throughout the world is a desire to improve the quality of care that is delivered to patients. Whether it be small efforts like our clinic’s project with our diabetic patients, or larger efforts, such as seeking to decrease malaria transmission, there is a united effort around the world to make our planet, which is a shared environment, a safer and healthier place to live.

Benjamin Brown MD, MPH, is a third year resident in the Division of Family Medicine at the Department of Family and Preventive Medicine in Salt Lake City, UT. His medical areas of interest include identifying and addressing disparities in health and social determinants of health, health policy, and community outreach.