Jeff Susman, MD

One of the most important foundations of any journal is its reviewers. Every article and feature in the Journal undergoes peer review, and we are very fortunate to have this cadre of excellent, dedicated individuals who provide feedback and guidance. I invite new reviewers to this distinguished group. Whether you are a practicing clinician or an academic physician, your expertise is valuable. So if you are interested in making JFP more valuable, e-mail me at [email protected], noting any special areas of interest. Please include your full name, address and contact information. I sincerely appreciate your sage advice.

One of the most important foundations of any journal is its reviewers. Every article and feature in the Journal undergoes peer review, and we are very fortunate to have this cadre of excellent, dedicated individuals who provide feedback and guidance. I invite new reviewers to this distinguished group. Whether you are a practicing clinician or an academic physician, your expertise is valuable. So if you are interested in making JFP more valuable, e-mail me at [email protected], noting any special areas of interest. Please include your full name, address and contact information. I sincerely appreciate your sage advice.

One of the most important foundations of any journal is its reviewers. Every article and feature in the Journal undergoes peer review, and we are very fortunate to have this cadre of excellent, dedicated individuals who provide feedback and guidance. I invite new reviewers to this distinguished group. Whether you are a practicing clinician or an academic physician, your expertise is valuable. So if you are interested in making JFP more valuable, e-mail me at [email protected], noting any special areas of interest. Please include your full name, address and contact information. I sincerely appreciate your sage advice.

My route to drug smuggling did not begin on a coca farm in Columbia or a dark alley in Cincinnati. I was not looking to score a vial of crack or an ounce of pot. I wasn’t even looking for drugs for myself. No, my foray into the drug underground began, like that of Americans, in a doctor’s office. Looking for affordable medication to treat infertility, I turned to a Mexican “connection.”

I am sure many of your patients—perhaps even your parents or grand-parents—have traveled a similar journey in search of affordable prescription medications. Many Americans have been purchasing their drugs on the internet, buying them on trips out of the country, or doing without.

Barring hanging chads and Supreme Court theatrics, you already know the outcome of our 2004 presidential election. But I suspect the debate on healthcare coverage and drug costs has only begun to heat up. Whether the implementation of drug discount cards and the transition to a pharmacy benefit for Medicare recipients, drug importing, or pharmaceutical profits, the struggle for affordable medicines is only beginning to gain attention.

Following are pertinent issues from a recent day in the office:

• A young couple struggling with the cost of infertility treatments (alluded to earlier)—“an uncovered service” according to their insurance plan—wonders if a trip to Mexico is warranted
• An elder using essential medications for heart failure, coronary disease, hypertension, diabetes and depression, is confused by the discount plans and pays hundreds of dollars out-of-pocket each month
• A middle-aged executive out of a job because of corporate restructuring faces an astronomical bill for treating his hepatitis C.

Why is this happening? One reason is the influence of the drug industry. Marcia Angell, former editor-in-chief of NEJM, is masterful in telling the story in her recent book, The Truth About the Drug Companies: How They Deceive Us and What to Do About It. Dr Angell explores myths such as the industry’s devotion to research, while revealing their artful manipulation of laws supposed to protect consumers and the promulgation of marketing under the guise of education. While occasionally strident, and overlooking the industry’s accomplishments and the context of fre-market competition, this book should be required reading in this year of Presidential promises.

Another reason is the inability of Congress to address the issues of comprehensive healthcare coverage for all that is affordable, portable, and accessible. Too often, patients face huge bills because of gaps in coverage, changes in employment, or convoluted requirements for reimbursement. It would appear neither the Democratic nor the Republican parties are willing to tackle these issues in an all-embracing manner.

There is no doubt in my mind that we are both in “the best of times, and the worst of times.” I simply hope, whoever has assumed the Presidency begins to seriously address this issue facing all Americans. Or I may once again become a drug “smuggler.”

My route to drug smuggling did not begin on a coca farm in Columbia or a dark alley in Cincinnati. I was not looking to score a vial of crack or an ounce of pot. I wasn’t even looking for drugs for myself. No, my foray into the drug underground began, like that of Americans, in a doctor’s office. Looking for affordable medication to treat infertility, I turned to a Mexican “connection.”

I am sure many of your patients—perhaps even your parents or grand-parents—have traveled a similar journey in search of affordable prescription medications. Many Americans have been purchasing their drugs on the internet, buying them on trips out of the country, or doing without.

Barring hanging chads and Supreme Court theatrics, you already know the outcome of our 2004 presidential election. But I suspect the debate on healthcare coverage and drug costs has only begun to heat up. Whether the implementation of drug discount cards and the transition to a pharmacy benefit for Medicare recipients, drug importing, or pharmaceutical profits, the struggle for affordable medicines is only beginning to gain attention.

Following are pertinent issues from a recent day in the office:

• A young couple struggling with the cost of infertility treatments (alluded to earlier)—“an uncovered service” according to their insurance plan—wonders if a trip to Mexico is warranted
• An elder using essential medications for heart failure, coronary disease, hypertension, diabetes and depression, is confused by the discount plans and pays hundreds of dollars out-of-pocket each month
• A middle-aged executive out of a job because of corporate restructuring faces an astronomical bill for treating his hepatitis C.

Why is this happening? One reason is the influence of the drug industry. Marcia Angell, former editor-in-chief of NEJM, is masterful in telling the story in her recent book, The Truth About the Drug Companies: How They Deceive Us and What to Do About It. Dr Angell explores myths such as the industry’s devotion to research, while revealing their artful manipulation of laws supposed to protect consumers and the promulgation of marketing under the guise of education. While occasionally strident, and overlooking the industry’s accomplishments and the context of fre-market competition, this book should be required reading in this year of Presidential promises.

Another reason is the inability of Congress to address the issues of comprehensive healthcare coverage for all that is affordable, portable, and accessible. Too often, patients face huge bills because of gaps in coverage, changes in employment, or convoluted requirements for reimbursement. It would appear neither the Democratic nor the Republican parties are willing to tackle these issues in an all-embracing manner.

There is no doubt in my mind that we are both in “the best of times, and the worst of times.” I simply hope, whoever has assumed the Presidency begins to seriously address this issue facing all Americans. Or I may once again become a drug “smuggler.”

My route to drug smuggling did not begin on a coca farm in Columbia or a dark alley in Cincinnati. I was not looking to score a vial of crack or an ounce of pot. I wasn’t even looking for drugs for myself. No, my foray into the drug underground began, like that of Americans, in a doctor’s office. Looking for affordable medication to treat infertility, I turned to a Mexican “connection.”

I am sure many of your patients—perhaps even your parents or grand-parents—have traveled a similar journey in search of affordable prescription medications. Many Americans have been purchasing their drugs on the internet, buying them on trips out of the country, or doing without.

Barring hanging chads and Supreme Court theatrics, you already know the outcome of our 2004 presidential election. But I suspect the debate on healthcare coverage and drug costs has only begun to heat up. Whether the implementation of drug discount cards and the transition to a pharmacy benefit for Medicare recipients, drug importing, or pharmaceutical profits, the struggle for affordable medicines is only beginning to gain attention.

Following are pertinent issues from a recent day in the office:

• A young couple struggling with the cost of infertility treatments (alluded to earlier)—“an uncovered service” according to their insurance plan—wonders if a trip to Mexico is warranted
• An elder using essential medications for heart failure, coronary disease, hypertension, diabetes and depression, is confused by the discount plans and pays hundreds of dollars out-of-pocket each month
• A middle-aged executive out of a job because of corporate restructuring faces an astronomical bill for treating his hepatitis C.

Why is this happening? One reason is the influence of the drug industry. Marcia Angell, former editor-in-chief of NEJM, is masterful in telling the story in her recent book, The Truth About the Drug Companies: How They Deceive Us and What to Do About It. Dr Angell explores myths such as the industry’s devotion to research, while revealing their artful manipulation of laws supposed to protect consumers and the promulgation of marketing under the guise of education. While occasionally strident, and overlooking the industry’s accomplishments and the context of fre-market competition, this book should be required reading in this year of Presidential promises.

Another reason is the inability of Congress to address the issues of comprehensive healthcare coverage for all that is affordable, portable, and accessible. Too often, patients face huge bills because of gaps in coverage, changes in employment, or convoluted requirements for reimbursement. It would appear neither the Democratic nor the Republican parties are willing to tackle these issues in an all-embracing manner.

There is no doubt in my mind that we are both in “the best of times, and the worst of times.” I simply hope, whoever has assumed the Presidency begins to seriously address this issue facing all Americans. Or I may once again become a drug “smuggler.”

We have all heard the phrase, “Vote early—and often.” I thought this quote was attributable to Richard J. Daley, Chicago’s mayor from 1955 to 1976, or to the notorious gangster, Al Capone. But, evidently, it was an earlier Chicago mayor, William Hale Thompson, who thus exhorted his supporters to bring in the vote.

As family physicians we are incredibly busy, and finding time to become informed voters can be challenging. There are good reasons to find the time, however. From funding for health professions training to support for community health centers to changes in Medicare financing-—much of what we are trained to do as family physicians stands to be influenced by the outcome of this election. So, with all due respect to Chicago—and party politics aside—let me highlight Eric Henley’s Practice Alert in this issue, summarizing the Presidential candidates’ healthcare positions.

While a bit more prosaic than the shenanigans of Tammany Hall, the last presidential election, you’ll remember, was decided by a handful of ballots. No matter your political persuasion or interest in health policy, the responsibility for electing presidents is partly yours. It does not belong solely to party loyalists or leaders. Please peruse Dr Henley’s article and remember to vote on November 2.

Who knows, your ballot might be the deciding one!

We have all heard the phrase, “Vote early—and often.” I thought this quote was attributable to Richard J. Daley, Chicago’s mayor from 1955 to 1976, or to the notorious gangster, Al Capone. But, evidently, it was an earlier Chicago mayor, William Hale Thompson, who thus exhorted his supporters to bring in the vote.

As family physicians we are incredibly busy, and finding time to become informed voters can be challenging. There are good reasons to find the time, however. From funding for health professions training to support for community health centers to changes in Medicare financing-—much of what we are trained to do as family physicians stands to be influenced by the outcome of this election. So, with all due respect to Chicago—and party politics aside—let me highlight Eric Henley’s Practice Alert in this issue, summarizing the Presidential candidates’ healthcare positions.

While a bit more prosaic than the shenanigans of Tammany Hall, the last presidential election, you’ll remember, was decided by a handful of ballots. No matter your political persuasion or interest in health policy, the responsibility for electing presidents is partly yours. It does not belong solely to party loyalists or leaders. Please peruse Dr Henley’s article and remember to vote on November 2.

Who knows, your ballot might be the deciding one!

We have all heard the phrase, “Vote early—and often.” I thought this quote was attributable to Richard J. Daley, Chicago’s mayor from 1955 to 1976, or to the notorious gangster, Al Capone. But, evidently, it was an earlier Chicago mayor, William Hale Thompson, who thus exhorted his supporters to bring in the vote.

As family physicians we are incredibly busy, and finding time to become informed voters can be challenging. There are good reasons to find the time, however. From funding for health professions training to support for community health centers to changes in Medicare financing-—much of what we are trained to do as family physicians stands to be influenced by the outcome of this election. So, with all due respect to Chicago—and party politics aside—let me highlight Eric Henley’s Practice Alert in this issue, summarizing the Presidential candidates’ healthcare positions.

While a bit more prosaic than the shenanigans of Tammany Hall, the last presidential election, you’ll remember, was decided by a handful of ballots. No matter your political persuasion or interest in health policy, the responsibility for electing presidents is partly yours. It does not belong solely to party loyalists or leaders. Please peruse Dr Henley’s article and remember to vote on November 2.

Who knows, your ballot might be the deciding one!

Three articles on spirituality in one issue? If you are wondering, “What was he thinking!”, let me explain by way of analogy as I describe my interest in art pottery.

Like many family physicians, I pursue a number of passions. My parents instilled in me a love of antiques and an excitement about collecting. What began as casual admiration of a decorative tile floor at the Josyln Art Museum in Omaha, Nebraska, soon became a feverish hunt. I discovered that reproductions of these tiles, made from the original molds, were produced at the Moravian Pottery in Pennsylvania. Having purchased a few reproductions, I was soon in passionate pursuit of art tile produced in the US at the turn of the century (yes, I know this ranks in the top 10 of eccentric hobbies). Of course, I had to visit other historical potteries, such as the Rookwood Pottery here in Cincinnati. I subscribed to the Journal of the American Art Pottery Association (take that, JAMA). Soon I wanted to make tiles, and so took classes in throwing pots, hand-building, and sculpting. To design better tiles, I had to learn to draw, and from there ... you get the idea.

Indeed, I have come to believe that much of our lives revolves around finding passion and meaning. For some of us, it is found in relationships with family and friends, in contemplation of nature, and, for many of you, in religious worship. Unfortunately, as physicians, we too often ignore our patients’ spiritual health. I hope, after reading this issue of JFP, you will agree that we all can practice more effectively by understanding our patients’ spiritual perspectives.

Throughout my journey described above, I have also been reminded about the value of experience. Only experience demystifies the way a glaze pools and puddles or the manner in which clays fire. Wise potters, collectors, and dealers have greatly contributed to my understanding and appreciation of tile. While in medicine it has become almost cultish to discount personal experience, I am regularly reminded—particularly when working with my senior colleagues—of the value of the “wisdom of the ageds” (as my colleague, Rick Ricer, has coined). Rick spent his sabbatical asking physicians across the country about their “Practice Pearls”—and we will be regularly sharing these unabashedly personal observations (see page 649).

As always, I invite you to share your comments and experiences from practice. While you may find this issue thought-provoking, even a bit challenging, I trust you will find some relevance to your work.

Three articles on spirituality in one issue? If you are wondering, “What was he thinking!”, let me explain by way of analogy as I describe my interest in art pottery.

Like many family physicians, I pursue a number of passions. My parents instilled in me a love of antiques and an excitement about collecting. What began as casual admiration of a decorative tile floor at the Josyln Art Museum in Omaha, Nebraska, soon became a feverish hunt. I discovered that reproductions of these tiles, made from the original molds, were produced at the Moravian Pottery in Pennsylvania. Having purchased a few reproductions, I was soon in passionate pursuit of art tile produced in the US at the turn of the century (yes, I know this ranks in the top 10 of eccentric hobbies). Of course, I had to visit other historical potteries, such as the Rookwood Pottery here in Cincinnati. I subscribed to the Journal of the American Art Pottery Association (take that, JAMA). Soon I wanted to make tiles, and so took classes in throwing pots, hand-building, and sculpting. To design better tiles, I had to learn to draw, and from there ... you get the idea.

Indeed, I have come to believe that much of our lives revolves around finding passion and meaning. For some of us, it is found in relationships with family and friends, in contemplation of nature, and, for many of you, in religious worship. Unfortunately, as physicians, we too often ignore our patients’ spiritual health. I hope, after reading this issue of JFP, you will agree that we all can practice more effectively by understanding our patients’ spiritual perspectives.

Throughout my journey described above, I have also been reminded about the value of experience. Only experience demystifies the way a glaze pools and puddles or the manner in which clays fire. Wise potters, collectors, and dealers have greatly contributed to my understanding and appreciation of tile. While in medicine it has become almost cultish to discount personal experience, I am regularly reminded—particularly when working with my senior colleagues—of the value of the “wisdom of the ageds” (as my colleague, Rick Ricer, has coined). Rick spent his sabbatical asking physicians across the country about their “Practice Pearls”—and we will be regularly sharing these unabashedly personal observations (see page 649).

As always, I invite you to share your comments and experiences from practice. While you may find this issue thought-provoking, even a bit challenging, I trust you will find some relevance to your work.

Three articles on spirituality in one issue? If you are wondering, “What was he thinking!”, let me explain by way of analogy as I describe my interest in art pottery.

Like many family physicians, I pursue a number of passions. My parents instilled in me a love of antiques and an excitement about collecting. What began as casual admiration of a decorative tile floor at the Josyln Art Museum in Omaha, Nebraska, soon became a feverish hunt. I discovered that reproductions of these tiles, made from the original molds, were produced at the Moravian Pottery in Pennsylvania. Having purchased a few reproductions, I was soon in passionate pursuit of art tile produced in the US at the turn of the century (yes, I know this ranks in the top 10 of eccentric hobbies). Of course, I had to visit other historical potteries, such as the Rookwood Pottery here in Cincinnati. I subscribed to the Journal of the American Art Pottery Association (take that, JAMA). Soon I wanted to make tiles, and so took classes in throwing pots, hand-building, and sculpting. To design better tiles, I had to learn to draw, and from there ... you get the idea.

Indeed, I have come to believe that much of our lives revolves around finding passion and meaning. For some of us, it is found in relationships with family and friends, in contemplation of nature, and, for many of you, in religious worship. Unfortunately, as physicians, we too often ignore our patients’ spiritual health. I hope, after reading this issue of JFP, you will agree that we all can practice more effectively by understanding our patients’ spiritual perspectives.

Throughout my journey described above, I have also been reminded about the value of experience. Only experience demystifies the way a glaze pools and puddles or the manner in which clays fire. Wise potters, collectors, and dealers have greatly contributed to my understanding and appreciation of tile. While in medicine it has become almost cultish to discount personal experience, I am regularly reminded—particularly when working with my senior colleagues—of the value of the “wisdom of the ageds” (as my colleague, Rick Ricer, has coined). Rick spent his sabbatical asking physicians across the country about their “Practice Pearls”—and we will be regularly sharing these unabashedly personal observations (see page 649).

As always, I invite you to share your comments and experiences from practice. While you may find this issue thought-provoking, even a bit challenging, I trust you will find some relevance to your work.

In October of 1989, 3 patients with severe myalgia and unexplained eosinophilia prompted a New Mexico physician to play medical detective and ultimately uncover the association of contaminated L-tryptophan with the development of the eosinophilia myalgia syndrome.

Indeed, some of the most profound influences on medicine have arisen from observations from practice: from the days of John Snow and the Broad Street pump (the point source of a cholera epidemic in London in 1854) to Curtis Hames’s groundbreaking research in cardiac disease. Many seldom sung heroes make such observations daily. It is in this spirit that The Journal Of Family Practice Presents the curious case of Dr McMichael: does unexplained itching warrant surveillance for a future skin malignancy? A careful review of the literature yields neither clear support nor refutation of this hypothesis (we invite you to correct us if you know otherwise). But I hope you will be as intrigued by the case as I was and will consider sending us your own Observations from Practice.

I am interested in neither the obscure presentation of common diseases nor rare “fascinomas.” Nor am I predisposed to publish a case series of 1000 sore throats, unless it holds important new implications for our colleagues. But I would be fascinated by those truly original or tantalizing provocative observations from daily family practice. Who knows, one of you might be the next John Snow!

In October of 1989, 3 patients with severe myalgia and unexplained eosinophilia prompted a New Mexico physician to play medical detective and ultimately uncover the association of contaminated L-tryptophan with the development of the eosinophilia myalgia syndrome.

Indeed, some of the most profound influences on medicine have arisen from observations from practice: from the days of John Snow and the Broad Street pump (the point source of a cholera epidemic in London in 1854) to Curtis Hames’s groundbreaking research in cardiac disease. Many seldom sung heroes make such observations daily. It is in this spirit that The Journal Of Family Practice Presents the curious case of Dr McMichael: does unexplained itching warrant surveillance for a future skin malignancy? A careful review of the literature yields neither clear support nor refutation of this hypothesis (we invite you to correct us if you know otherwise). But I hope you will be as intrigued by the case as I was and will consider sending us your own Observations from Practice.

I am interested in neither the obscure presentation of common diseases nor rare “fascinomas.” Nor am I predisposed to publish a case series of 1000 sore throats, unless it holds important new implications for our colleagues. But I would be fascinated by those truly original or tantalizing provocative observations from daily family practice. Who knows, one of you might be the next John Snow!

In October of 1989, 3 patients with severe myalgia and unexplained eosinophilia prompted a New Mexico physician to play medical detective and ultimately uncover the association of contaminated L-tryptophan with the development of the eosinophilia myalgia syndrome.

Indeed, some of the most profound influences on medicine have arisen from observations from practice: from the days of John Snow and the Broad Street pump (the point source of a cholera epidemic in London in 1854) to Curtis Hames’s groundbreaking research in cardiac disease. Many seldom sung heroes make such observations daily. It is in this spirit that The Journal Of Family Practice Presents the curious case of Dr McMichael: does unexplained itching warrant surveillance for a future skin malignancy? A careful review of the literature yields neither clear support nor refutation of this hypothesis (we invite you to correct us if you know otherwise). But I hope you will be as intrigued by the case as I was and will consider sending us your own Observations from Practice.

I am interested in neither the obscure presentation of common diseases nor rare “fascinomas.” Nor am I predisposed to publish a case series of 1000 sore throats, unless it holds important new implications for our colleagues. But I would be fascinated by those truly original or tantalizing provocative observations from daily family practice. Who knows, one of you might be the next John Snow!

The old adage, “When you hear hoof beats, think of horses, not zebras,” is a great principle for our students and residents. Unfortunately, for many common conditions or presenting complaints, we lack robust epidemiologic evidence based on unselected patients from the community with which to inform our decisions. Consider irritable bowel syndrome.

In medical school, I was taught that this condition was a diagnosis of exclusion, even for younger patients. (“You wouldn’t want to miss a diagnosis of cancer, would you?”) Countless patients endured barium enemas, barium swallows, and a host of evaluations before receiving (largely ineffective) therapies.

Like so many “pearls” I embraced then, this approach has been discarded, as Dr Keith Holten outlines in this issue of The journal of family practice (“Irritable bowel syndrome: Minimize testing, let symptoms guide treatment,”). What we really should be doing, according to latest recommendations, is to stratify patients on the basis of risk (pretest probability) of serious conditions, and test (or treat presumptively) on this basis.

Of course this appeals to my practical FP genes, but I am discomforted by how thin the evidence is to warrant this recommendation. How can we provide cost-effective, evidence-based care when so little of our “knowledge” is derived from the patients who come to our offices?

If America’s health care system is to truly reform and become value-driven and evidence-based, we need a common electronic health record and data repository that can generate representative epidemiologic data. The Netherlands, I understand, has such vision—why not the US? We must fund further primary care research efforts that look at common conditions and the “meaning” of presenting symptoms over time. As we wade through increasingly byzantine MediCare rules, we practice a medieval alchemy of divining hoof beats.

Don’t our patients deserve better?

The old adage, “When you hear hoof beats, think of horses, not zebras,” is a great principle for our students and residents. Unfortunately, for many common conditions or presenting complaints, we lack robust epidemiologic evidence based on unselected patients from the community with which to inform our decisions. Consider irritable bowel syndrome.

In medical school, I was taught that this condition was a diagnosis of exclusion, even for younger patients. (“You wouldn’t want to miss a diagnosis of cancer, would you?”) Countless patients endured barium enemas, barium swallows, and a host of evaluations before receiving (largely ineffective) therapies.

Like so many “pearls” I embraced then, this approach has been discarded, as Dr Keith Holten outlines in this issue of The journal of family practice (“Irritable bowel syndrome: Minimize testing, let symptoms guide treatment,”). What we really should be doing, according to latest recommendations, is to stratify patients on the basis of risk (pretest probability) of serious conditions, and test (or treat presumptively) on this basis.

Of course this appeals to my practical FP genes, but I am discomforted by how thin the evidence is to warrant this recommendation. How can we provide cost-effective, evidence-based care when so little of our “knowledge” is derived from the patients who come to our offices?

If America’s health care system is to truly reform and become value-driven and evidence-based, we need a common electronic health record and data repository that can generate representative epidemiologic data. The Netherlands, I understand, has such vision—why not the US? We must fund further primary care research efforts that look at common conditions and the “meaning” of presenting symptoms over time. As we wade through increasingly byzantine MediCare rules, we practice a medieval alchemy of divining hoof beats.

Don’t our patients deserve better?

The old adage, “When you hear hoof beats, think of horses, not zebras,” is a great principle for our students and residents. Unfortunately, for many common conditions or presenting complaints, we lack robust epidemiologic evidence based on unselected patients from the community with which to inform our decisions. Consider irritable bowel syndrome.

In medical school, I was taught that this condition was a diagnosis of exclusion, even for younger patients. (“You wouldn’t want to miss a diagnosis of cancer, would you?”) Countless patients endured barium enemas, barium swallows, and a host of evaluations before receiving (largely ineffective) therapies.

Like so many “pearls” I embraced then, this approach has been discarded, as Dr Keith Holten outlines in this issue of The journal of family practice (“Irritable bowel syndrome: Minimize testing, let symptoms guide treatment,”). What we really should be doing, according to latest recommendations, is to stratify patients on the basis of risk (pretest probability) of serious conditions, and test (or treat presumptively) on this basis.

Of course this appeals to my practical FP genes, but I am discomforted by how thin the evidence is to warrant this recommendation. How can we provide cost-effective, evidence-based care when so little of our “knowledge” is derived from the patients who come to our offices?

If America’s health care system is to truly reform and become value-driven and evidence-based, we need a common electronic health record and data repository that can generate representative epidemiologic data. The Netherlands, I understand, has such vision—why not the US? We must fund further primary care research efforts that look at common conditions and the “meaning” of presenting symptoms over time. As we wade through increasingly byzantine MediCare rules, we practice a medieval alchemy of divining hoof beats.

Don’t our patients deserve better?

Like many of you, I enjoy going to the Academy’s Annual Scientific Assembly to renew friendships, participate in CME, and learn where our specialty is heading. Between these activities, I also enjoy wandering the exhibit hall to see what’s new—devices to ease vasectomies, the latest depression therapy, an innovative contraceptive agent.

Among my favorite booths to browse (after securing the requisite Dove bar to fortify me on my quest) are the technology companies. Another killer electronic medical record (EMR), a “smart” wireless system to transmit prescriptions, a new PDA product—it’s better than cruising the aisles of Home Depot (this must be a “guy thing”).

Technology living up to its promise? Two thoughts struck me this year at the Assembly in New Orleans. First, it is amazing how few technology vendors have made it 5 years running. Whether due to bankruptcy, merger, or simply outdated technology (how could anyone market a DOS-based product today?), the turnover rate of vendors is remarkable.

Second, it appears we are on the verge of having truly functional EMR: problems lists that update automatically, useful templates, links to prescribing services. And more PDA programs are fulfilling the promise of their features—whether advising on prescriptions or coding more accurately, these programs give me more reason to update my Palm.

Moreover, some of these products may save time. (I am enduringly skeptical of vendors who claim I will be financially ahead by turning our offices and workflow upside down.) Overall, my impression is that we are on the cusp of technology revolutionizing medicine.

JFP’s bead on technology. Our new feature, “Reinventing Practice,” edited by Gary Fox, described an exciting evidence resource, UpToDate, in the September 2003 issue. Future subjects will include an examination of PDxMD and major EMR systems that may enhance practice and streamline care. Let us know what your experiences, both good and bad, have been.

Whether you are a solo physician in rural practice, or a member of a 500-person multispecialty group, I urge you to see what the latest in technology has to offer your practice. Just don’t expect every vendor you meet to be at the following year’s Assembly.

Like many of you, I enjoy going to the Academy’s Annual Scientific Assembly to renew friendships, participate in CME, and learn where our specialty is heading. Between these activities, I also enjoy wandering the exhibit hall to see what’s new—devices to ease vasectomies, the latest depression therapy, an innovative contraceptive agent.

Among my favorite booths to browse (after securing the requisite Dove bar to fortify me on my quest) are the technology companies. Another killer electronic medical record (EMR), a “smart” wireless system to transmit prescriptions, a new PDA product—it’s better than cruising the aisles of Home Depot (this must be a “guy thing”).

Technology living up to its promise? Two thoughts struck me this year at the Assembly in New Orleans. First, it is amazing how few technology vendors have made it 5 years running. Whether due to bankruptcy, merger, or simply outdated technology (how could anyone market a DOS-based product today?), the turnover rate of vendors is remarkable.

Second, it appears we are on the verge of having truly functional EMR: problems lists that update automatically, useful templates, links to prescribing services. And more PDA programs are fulfilling the promise of their features—whether advising on prescriptions or coding more accurately, these programs give me more reason to update my Palm.

Moreover, some of these products may save time. (I am enduringly skeptical of vendors who claim I will be financially ahead by turning our offices and workflow upside down.) Overall, my impression is that we are on the cusp of technology revolutionizing medicine.

JFP’s bead on technology. Our new feature, “Reinventing Practice,” edited by Gary Fox, described an exciting evidence resource, UpToDate, in the September 2003 issue. Future subjects will include an examination of PDxMD and major EMR systems that may enhance practice and streamline care. Let us know what your experiences, both good and bad, have been.

Whether you are a solo physician in rural practice, or a member of a 500-person multispecialty group, I urge you to see what the latest in technology has to offer your practice. Just don’t expect every vendor you meet to be at the following year’s Assembly.

Like many of you, I enjoy going to the Academy’s Annual Scientific Assembly to renew friendships, participate in CME, and learn where our specialty is heading. Between these activities, I also enjoy wandering the exhibit hall to see what’s new—devices to ease vasectomies, the latest depression therapy, an innovative contraceptive agent.

Among my favorite booths to browse (after securing the requisite Dove bar to fortify me on my quest) are the technology companies. Another killer electronic medical record (EMR), a “smart” wireless system to transmit prescriptions, a new PDA product—it’s better than cruising the aisles of Home Depot (this must be a “guy thing”).

Technology living up to its promise? Two thoughts struck me this year at the Assembly in New Orleans. First, it is amazing how few technology vendors have made it 5 years running. Whether due to bankruptcy, merger, or simply outdated technology (how could anyone market a DOS-based product today?), the turnover rate of vendors is remarkable.

Second, it appears we are on the verge of having truly functional EMR: problems lists that update automatically, useful templates, links to prescribing services. And more PDA programs are fulfilling the promise of their features—whether advising on prescriptions or coding more accurately, these programs give me more reason to update my Palm.

Moreover, some of these products may save time. (I am enduringly skeptical of vendors who claim I will be financially ahead by turning our offices and workflow upside down.) Overall, my impression is that we are on the cusp of technology revolutionizing medicine.

JFP’s bead on technology. Our new feature, “Reinventing Practice,” edited by Gary Fox, described an exciting evidence resource, UpToDate, in the September 2003 issue. Future subjects will include an examination of PDxMD and major EMR systems that may enhance practice and streamline care. Let us know what your experiences, both good and bad, have been.

Whether you are a solo physician in rural practice, or a member of a 500-person multispecialty group, I urge you to see what the latest in technology has to offer your practice. Just don’t expect every vendor you meet to be at the following year’s Assembly.

The day’s mail was typical: an alert from a pharmaceutical company warning me not to use its antidepressant in children; the latest journals competing for my attention; a handful of offers for real estate and surefire investment schemes; the local business newspaper; and an “exclusive” invitation to dine with the President for the price of a small car (undoubtedly explained by the fact we live in an area known for its generous presidential campaign contributions). And, of course, 3 new guidelines—1 on asthma and 2 on diabetes.

Being an aficionado of guidelines, I was relieved to see my care for children with asthma was not too out of date and that the 2 diabetes guidelines even agreed on some points. Of course, I have almost given up trying to remember which guidelines say what, let alone assess their credibility. Too many guidelines, too little time.

The newest feature in The journal of family practice—Guideline Update—aims to help clear guideline gridlock. Keith Holten, MD, director of the University of Cincinnati–affiliated residency program at Clinton Memorial Hospital, Wilmington, Ohio, will coordinate this feature.

Dr Holten will regularly choose a guideline of broad interest in family medicine, summarize its recommendations, and provide a brief critique that answers important questions. Who are the authors of the guideline and are they impartial? How might the guideline be biased? What “competing” guidelines exist? How can we incorporate the guideline’s recommendations into practice? While he may not be able to advise you on how best to keep up with your mail, Dr Holten, we trust, will enhance your ability to translate best evidence into practice.

If you come across a guideline that interests you, let us know ([email protected]). We plan to review many different types—recently published guidelines, old reliables that can greatly improve practice, and a few we believe are controversial or even misguided. Send us your ideas on how to make this feature more useful. Who knows, by culling a few of those tomes from your mail, you may even make progress on thinning the pile.

The day’s mail was typical: an alert from a pharmaceutical company warning me not to use its antidepressant in children; the latest journals competing for my attention; a handful of offers for real estate and surefire investment schemes; the local business newspaper; and an “exclusive” invitation to dine with the President for the price of a small car (undoubtedly explained by the fact we live in an area known for its generous presidential campaign contributions). And, of course, 3 new guidelines—1 on asthma and 2 on diabetes.

Being an aficionado of guidelines, I was relieved to see my care for children with asthma was not too out of date and that the 2 diabetes guidelines even agreed on some points. Of course, I have almost given up trying to remember which guidelines say what, let alone assess their credibility. Too many guidelines, too little time.

The newest feature in The journal of family practice—Guideline Update—aims to help clear guideline gridlock. Keith Holten, MD, director of the University of Cincinnati–affiliated residency program at Clinton Memorial Hospital, Wilmington, Ohio, will coordinate this feature.

Dr Holten will regularly choose a guideline of broad interest in family medicine, summarize its recommendations, and provide a brief critique that answers important questions. Who are the authors of the guideline and are they impartial? How might the guideline be biased? What “competing” guidelines exist? How can we incorporate the guideline’s recommendations into practice? While he may not be able to advise you on how best to keep up with your mail, Dr Holten, we trust, will enhance your ability to translate best evidence into practice.

If you come across a guideline that interests you, let us know ([email protected]). We plan to review many different types—recently published guidelines, old reliables that can greatly improve practice, and a few we believe are controversial or even misguided. Send us your ideas on how to make this feature more useful. Who knows, by culling a few of those tomes from your mail, you may even make progress on thinning the pile.

The day’s mail was typical: an alert from a pharmaceutical company warning me not to use its antidepressant in children; the latest journals competing for my attention; a handful of offers for real estate and surefire investment schemes; the local business newspaper; and an “exclusive” invitation to dine with the President for the price of a small car (undoubtedly explained by the fact we live in an area known for its generous presidential campaign contributions). And, of course, 3 new guidelines—1 on asthma and 2 on diabetes.

Being an aficionado of guidelines, I was relieved to see my care for children with asthma was not too out of date and that the 2 diabetes guidelines even agreed on some points. Of course, I have almost given up trying to remember which guidelines say what, let alone assess their credibility. Too many guidelines, too little time.

The newest feature in The journal of family practice—Guideline Update—aims to help clear guideline gridlock. Keith Holten, MD, director of the University of Cincinnati–affiliated residency program at Clinton Memorial Hospital, Wilmington, Ohio, will coordinate this feature.

Dr Holten will regularly choose a guideline of broad interest in family medicine, summarize its recommendations, and provide a brief critique that answers important questions. Who are the authors of the guideline and are they impartial? How might the guideline be biased? What “competing” guidelines exist? How can we incorporate the guideline’s recommendations into practice? While he may not be able to advise you on how best to keep up with your mail, Dr Holten, we trust, will enhance your ability to translate best evidence into practice.

If you come across a guideline that interests you, let us know ([email protected]). We plan to review many different types—recently published guidelines, old reliables that can greatly improve practice, and a few we believe are controversial or even misguided. Send us your ideas on how to make this feature more useful. Who knows, by culling a few of those tomes from your mail, you may even make progress on thinning the pile.

Concerned about the latest public health threat, whether monkey pox or tuberculosis? Interested in evidence-based medicine, but really don’t know what concepts such as the “number needed to treat” mean? Wondering whether new software programs and systems to improve care are really worth the expense?

If you are like me, you find the practice of medicine growing increasingly complex and welcome timely advice to keep up. New features in The journal of family practice—Practice Alert, Language of Evidence, and Reinventing Practice—offer just such advice, and I’m hopeful they will start enhancing your practice today.

Practice Alert. Current clinical issues that affect patient care and public health is the focus of this feature, co-edited by Eric Henley, Chair of the Department of Family Practice, University of Illinois, Rockford, and Doug Campos-Outcalt, Director of the Maricopa County Department of Health in Arizona. They will keep us abreast of critical public health issues. This month’s article, “What FPs need to know about West Nile virus disease”, arrived for review around the time a patient of mine was complaining of headache and myalgias following a mosquito bite.

Language of Evidence. In this issue, you will read about the accuracy of the physical examination in assessing anterior cruciate ligament ruptures. In the accompanying Language of Evidence, “What is an ROC curve?”, Goutham Rao, the Predoctoral Director at the Department of Family Practice, University of Pittsburgh, demystifies the concept of receiver-operator characteristic (ROC) curves, which is discussed in the Applied Evidence article on anterior cruciate ligament rupture.

Reinventing Practice. Finally, in Reinventing Practice, Gary Fox—our longtime software editor and informatics guru—provides us a splendid review of a useful electronic tool in “UpToDate: A comprehensive clinical database”. If you are in the market for a clinical reference library, this product may be just what the doctor ordered.

Let me know what you think of these new features. I can be reached, as always, at [email protected].

Concerned about the latest public health threat, whether monkey pox or tuberculosis? Interested in evidence-based medicine, but really don’t know what concepts such as the “number needed to treat” mean? Wondering whether new software programs and systems to improve care are really worth the expense?

If you are like me, you find the practice of medicine growing increasingly complex and welcome timely advice to keep up. New features in The journal of family practice—Practice Alert, Language of Evidence, and Reinventing Practice—offer just such advice, and I’m hopeful they will start enhancing your practice today.

Practice Alert. Current clinical issues that affect patient care and public health is the focus of this feature, co-edited by Eric Henley, Chair of the Department of Family Practice, University of Illinois, Rockford, and Doug Campos-Outcalt, Director of the Maricopa County Department of Health in Arizona. They will keep us abreast of critical public health issues. This month’s article, “What FPs need to know about West Nile virus disease”, arrived for review around the time a patient of mine was complaining of headache and myalgias following a mosquito bite.

Language of Evidence. In this issue, you will read about the accuracy of the physical examination in assessing anterior cruciate ligament ruptures. In the accompanying Language of Evidence, “What is an ROC curve?”, Goutham Rao, the Predoctoral Director at the Department of Family Practice, University of Pittsburgh, demystifies the concept of receiver-operator characteristic (ROC) curves, which is discussed in the Applied Evidence article on anterior cruciate ligament rupture.

Reinventing Practice. Finally, in Reinventing Practice, Gary Fox—our longtime software editor and informatics guru—provides us a splendid review of a useful electronic tool in “UpToDate: A comprehensive clinical database”. If you are in the market for a clinical reference library, this product may be just what the doctor ordered.

Let me know what you think of these new features. I can be reached, as always, at [email protected].

Concerned about the latest public health threat, whether monkey pox or tuberculosis? Interested in evidence-based medicine, but really don’t know what concepts such as the “number needed to treat” mean? Wondering whether new software programs and systems to improve care are really worth the expense?

If you are like me, you find the practice of medicine growing increasingly complex and welcome timely advice to keep up. New features in The journal of family practice—Practice Alert, Language of Evidence, and Reinventing Practice—offer just such advice, and I’m hopeful they will start enhancing your practice today.

Practice Alert. Current clinical issues that affect patient care and public health is the focus of this feature, co-edited by Eric Henley, Chair of the Department of Family Practice, University of Illinois, Rockford, and Doug Campos-Outcalt, Director of the Maricopa County Department of Health in Arizona. They will keep us abreast of critical public health issues. This month’s article, “What FPs need to know about West Nile virus disease”, arrived for review around the time a patient of mine was complaining of headache and myalgias following a mosquito bite.

Language of Evidence. In this issue, you will read about the accuracy of the physical examination in assessing anterior cruciate ligament ruptures. In the accompanying Language of Evidence, “What is an ROC curve?”, Goutham Rao, the Predoctoral Director at the Department of Family Practice, University of Pittsburgh, demystifies the concept of receiver-operator characteristic (ROC) curves, which is discussed in the Applied Evidence article on anterior cruciate ligament rupture.

Reinventing Practice. Finally, in Reinventing Practice, Gary Fox—our longtime software editor and informatics guru—provides us a splendid review of a useful electronic tool in “UpToDate: A comprehensive clinical database”. If you are in the market for a clinical reference library, this product may be just what the doctor ordered.

Let me know what you think of these new features. I can be reached, as always, at [email protected].

At a recent family practice CME course, I was asked what resources I recommend to stay current with the medical literature. Of course, I suggested The journal of family practice. But to answer this question more thoroughly, I kept track of the resources I used during 2 weeks of precepting and patient care.

I’d be remiss not to begin with JFP’s POEMs, Clinical Inquiries, and Applied Evidence articles. These evidence-based assessments are well-researched and current. I clip these items for reference and try to introduce something I have learned each day I precept. In particular, Clinical Inquiries provide useful answers to clinically relevant questions. In the September JFP, Bernard Ewigman and his colleagues from the Family Practice Inquiries Network (FPIN) will launch a 4-part series that tells the story behind FPIN’s mission and the creation of Clinical Inquiries—from the information needs of practicing doctors to the search of evidence databases to the interpretation of evidence and writing the answers.

I use Cochrane abstracts regularly for my lectures and teaching (www.cochrane.org). Many large medical libraries have full access to this resource, but I find the abstracts are useful reviews in themselves. I often refer to Cochrane for evidence on controversial topics.

A favorite quick reference is Up to Date (www.uptodate.com). While expensive and not as explicitly evidence-based as Cochrane, this service offers answers to most of my “internal medicine” questions. I use Epocrates for quick info about drugs (www.epocrates.com). For more insightful reviews, though, I turn to Prescribers Letter (www.prescribersletter.com). This resource is quite helpful for in-depth evaluations, allowing me to understand the evidence behind each recommendation.

I search the CDC (www.cdc.gov) and American Academy of Pediatrics (www.aap.org) sites regularly for answers about infectious diseases, immunizations, and public health matters. Whether reviewing 2-step tuberculosis screening or catchup Prevnar vaccination, these sites are handy.

Space doesn’t allow me to share more of my resources—and I certainly don’t propose that the ones I’ve mentioned are the best, most up to date, or useful. In fact, in reviewing this list, I realize I have omitted several gems. So, why not send me your favorite resources, at [email protected]. Even books are allowed. I’ll share your picks with our colleagues.

At a recent family practice CME course, I was asked what resources I recommend to stay current with the medical literature. Of course, I suggested The journal of family practice. But to answer this question more thoroughly, I kept track of the resources I used during 2 weeks of precepting and patient care.

I’d be remiss not to begin with JFP’s POEMs, Clinical Inquiries, and Applied Evidence articles. These evidence-based assessments are well-researched and current. I clip these items for reference and try to introduce something I have learned each day I precept. In particular, Clinical Inquiries provide useful answers to clinically relevant questions. In the September JFP, Bernard Ewigman and his colleagues from the Family Practice Inquiries Network (FPIN) will launch a 4-part series that tells the story behind FPIN’s mission and the creation of Clinical Inquiries—from the information needs of practicing doctors to the search of evidence databases to the interpretation of evidence and writing the answers.

I use Cochrane abstracts regularly for my lectures and teaching (www.cochrane.org). Many large medical libraries have full access to this resource, but I find the abstracts are useful reviews in themselves. I often refer to Cochrane for evidence on controversial topics.

A favorite quick reference is Up to Date (www.uptodate.com). While expensive and not as explicitly evidence-based as Cochrane, this service offers answers to most of my “internal medicine” questions. I use Epocrates for quick info about drugs (www.epocrates.com). For more insightful reviews, though, I turn to Prescribers Letter (www.prescribersletter.com). This resource is quite helpful for in-depth evaluations, allowing me to understand the evidence behind each recommendation.

I search the CDC (www.cdc.gov) and American Academy of Pediatrics (www.aap.org) sites regularly for answers about infectious diseases, immunizations, and public health matters. Whether reviewing 2-step tuberculosis screening or catchup Prevnar vaccination, these sites are handy.

Space doesn’t allow me to share more of my resources—and I certainly don’t propose that the ones I’ve mentioned are the best, most up to date, or useful. In fact, in reviewing this list, I realize I have omitted several gems. So, why not send me your favorite resources, at [email protected]. Even books are allowed. I’ll share your picks with our colleagues.

At a recent family practice CME course, I was asked what resources I recommend to stay current with the medical literature. Of course, I suggested The journal of family practice. But to answer this question more thoroughly, I kept track of the resources I used during 2 weeks of precepting and patient care.

I’d be remiss not to begin with JFP’s POEMs, Clinical Inquiries, and Applied Evidence articles. These evidence-based assessments are well-researched and current. I clip these items for reference and try to introduce something I have learned each day I precept. In particular, Clinical Inquiries provide useful answers to clinically relevant questions. In the September JFP, Bernard Ewigman and his colleagues from the Family Practice Inquiries Network (FPIN) will launch a 4-part series that tells the story behind FPIN’s mission and the creation of Clinical Inquiries—from the information needs of practicing doctors to the search of evidence databases to the interpretation of evidence and writing the answers.

I use Cochrane abstracts regularly for my lectures and teaching (www.cochrane.org). Many large medical libraries have full access to this resource, but I find the abstracts are useful reviews in themselves. I often refer to Cochrane for evidence on controversial topics.

A favorite quick reference is Up to Date (www.uptodate.com). While expensive and not as explicitly evidence-based as Cochrane, this service offers answers to most of my “internal medicine” questions. I use Epocrates for quick info about drugs (www.epocrates.com). For more insightful reviews, though, I turn to Prescribers Letter (www.prescribersletter.com). This resource is quite helpful for in-depth evaluations, allowing me to understand the evidence behind each recommendation.

I search the CDC (www.cdc.gov) and American Academy of Pediatrics (www.aap.org) sites regularly for answers about infectious diseases, immunizations, and public health matters. Whether reviewing 2-step tuberculosis screening or catchup Prevnar vaccination, these sites are handy.

Space doesn’t allow me to share more of my resources—and I certainly don’t propose that the ones I’ve mentioned are the best, most up to date, or useful. In fact, in reviewing this list, I realize I have omitted several gems. So, why not send me your favorite resources, at [email protected]. Even books are allowed. I’ll share your picks with our colleagues.