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MCE Conferences Attends the Women’s March in Sydney, Australia

January 22, 2018 1:27 pm

While visiting Sydney, Australia, MCE Conferences President, Orly Benaroch Light and her daughter, could not pass up the opportunity to participate in the women’s march that says NO to harassment, devaluation, and violence in the workplace and at home.

women's march sydney

A Message from the President – MCE

January 13, 2018 12:20 pm

The start of a new year is an ideal time for reflection. Looking back on 2017, it’s clear the year was one of growth at MCE Conferences. As we welcome 2018, the MCE culture revolves around a few key concepts: quality, services, and solutions. Proof of our commitment to those values and why they matter is all around us; we’ve worked hard to listen, learn, adapt and grow. Today, our teams are best-in-class in organizing continuing medical education for primary care clinicians.

We remain steadfast in our commitment to offering continuing medical education programs that serve the educational needs of our learners by developing innovative continuing education activities based on best practices or evidence-based medicine that promote quality improvements in clinical practice and healthcare and lifelong learning.

We would like to thank our MCE teams – including our presenting faculty speakers, attendees, and the American Academy of Family Physicians (AAFP) – for their support throughout 2017. We are eager to celebrate the successes of 2018 together.

Orly Benaroch Light
MCE Conferences

Sexual Harassment in Medicine — #MeToo

December 26, 2017 7:46 pm

Reshma Jagsi, M.D., D.Phil.

The news is filled with stories of celebrities who have engaged in egregious sexual misconduct. A recent poll suggested that more than half of U.S. women have experienced “unwanted and inappropriate sexual advances” at some point in their lives.1 Because I led a study of workplace sexual harassment in medicine,2 I was not surprised when reporters contacted me for comments on the recent disclosures. When a secretary filling in for my usual assistant relayed one reporter’s request, she told me she presumed the story was about my personal experience of sexual harassment. Disturbed, I leapt to correct her misapprehension: I was being sought out as a scholarly expert, not a victim. Then I wondered why it seemed so urgent to make that distinction.

sexual harassment in medicineAn easy explanation is that I feared she would assume that someone in my department had engaged in misconduct — I would never want anyone to think that of any of my upstanding colleagues. Indeed, when I published my research findings, my department chair expressed shock: “Thirty percent of the women had been harassed? Are you sure that’s right? I just would never . . . .” Like many well-intentioned and normally highly articulate men who are astonished by the #MeToo movement’s revelation that they’re surrounded by women who’ve had such experiences, he was left speechless.

But that’s not the whole story. I rushed to correct the secretary partly because I worried that she might tell others that I’d been victimized and also that victims do not fare well in our society. I aspire to become a leader in academic medicine. Being cast as a victim would tarnish my narrative. Who cares if research suggests that women are more vulnerable to harassment both when they’re perceived as weak and when they’re so strong that they challenge traditional hierarchies? Having come of age in the era of Anita Hill’s testimony against Clarence Thomas during his confirmation hearings for the Supreme Court, I know that women who report sexual harassment experience marginalization, retaliation, stigmatization, and worse. Even in the #MeToo era, reporting such behavior is far from straightforward.

The many heartfelt messages I’ve received from strangers since publishing my research reinforce these intuitions. The brave physicians who’ve contacted me say they remained silent and questioned their self-worth after their experiences, wondering whether they brought it on themselves. The details of their experiences are appalling. One told of having a senior male leader in her field unzip the front zipper of her dress at a conference social event. Many report unwanted touching of breasts and buttocks. One described having a “tormentor” during training, and others noted remarkably consistent experiences in the operating room that ironically they thought were unique. One even described a rape by a superior during her training that she had never reported.

In fact, none of the women who’ve contacted me have reported their experiences. They speak of challenging institutional cultures, with workplaces dominated by men who openly engage in lewd “locker-room conversation” or exclude them from all-male social events, leaving them without allies in whom to confide after suffering an indignity or a crime. As one told me: “The machismo culture seemed so pervasive. One of the women even talked about how consent for sex was overrated, since some women use alcohol to have sex and later say that it was because they were so drunk and ‘all guys had raped someone.’”

One woman, whose experience indirectly came to the attention of her institution’s human resources group, consulted a lawyer who confirmed her suspicions that “making this an HR issue” could hurt her own career. “HR is about protecting the institution, not you,” the lawyer said. Fearing being labeled a troublemaker, she deflected the inquiry. Yet she felt guilty over not protecting younger women from the man who’d harassed her. Another woman asked my advice on convening a workshop on sexual harassment, wondering whether it would be career suicide.

One young physician described the shame and fear she felt after being harassed during training. She said, “If any women ever tell you that they had any experience like mine, please tell them to get out of there. Please tell them not to worry about the red flag it might be to transfer residencies, not to worry about potential damage to their reputation, not to worry about ‘who would believe [them] anyway,’ not to worry about appearing weak, not to worry about the old boys’ club that lets men cover for each other and makes the woman ‘sound crazy,’ the opportunities that they may miss in going to a smaller program, unwanted attention that would impinge on their privacy.” Although she had not reported the harassment to her mentors — “They judge me based on my work. I don’t want them to change the way they perceive me” — she said she “would advise any woman who came to me for advice to do something different from what I actually did.”

But standing up to harassment is clearly hard. In one case, a talented physician researcher had engaged in a witnessed act of unwanted sexual contact with a trainee. Yet two department chairs in his field independently told me they were trying to recruit the transgressor, who was considered a hot prospect, even as sexual misconduct proceedings were under way at his home institution. “It was just a mistake; we need to forgive and forget,” said one. “I have both sons and daughters, so I can see both sides,” said the other. Both worried about fallout if the behavior were to recur, but neither wanted to forgo the opportunity to steal away a superstar. These discussions highlighted how easy it can be to turn a blind eye to offenses by luminaries like Harvey Weinstein and Kevin Spacey. And yet it remains unacceptable.

It was a luminary who provided my sole personal experience with workplace-related sexual harassment. Because it was a more minor transgression than some other women have faced, until very recently I hadn’t thought of it as harassment, although it meets the criteria outlined by experts — a disconnect that’s remarkably common.3 After a group dinner at a professional society meeting where I spent my time politely rebuffing sexual advances from a prominent surgeon, I became concerned when he accosted me at the cloakroom, intent on walking me to my room. He winked at the attendant and said, “She loves surgeons.” Just then, a senior female surgeon happened by. I said, “I do adore surgeons, which is why I planned to walk home with her.” Wordlessly, the female surgeon sized up the situation and took me by the arm, rescuing me from what was rapidly evolving from an uncomfortable situation into something potentially worse. I now keep my distance from that male surgeon; I even gave up a valuable scholarly opportunity just to avoid him. And the experience did make me silently question my self-worth: Why was my scholarship not substantial enough for this man to see me as a colleague who has done important research and has worthy ideas, instead of objectifying me?

Academic astronomers have formalized a rescue system like the one that fortuitously presented itself to me. Recognizing that mandatory reporting can dissuade people who need help, they maintain a list of “astronomy allies” — senior female astronomers, who wear prominent buttons at national society meetings and make themselves available to remove colleagues from problematic situations ( No questions are asked, although formal reporting is encouraged and facilitated where appropriate; the aim is to provide “judgment-free” help when someone believes it’s needed. It is a shameful statement about our society that such a system is required in a professional setting.

Reporters often ask me whether medicine is any different in this way from other fields. Some expect it to be better, given the compassion and altruistic impulses that lead people to pursue medicine. Others expect it to be worse, given the history of male domination and a hierarchical structure with strong power differentials, factors correlated with the incidence of workplace sexual harassment.4 Added to the mix are frequent “field experiences,” with easy access to beds and late-night work when hallways are emptier and inhibitions may be lowered. My intuition is that the problem is at least as bad in medicine as elsewhere, especially if one adds harassment by patients to that by colleagues and superiors. And the data show that the problem for female physicians is certainly bad enough that the profession must work together to correct it.

I wish I had brilliant insights about how our society can address the deep-rooted, pervasive causes of this behavior proactively rather than simply reactively. Nevertheless, I find it valuable to have the opportunity to participate in this now open conversation and draw from the example of innovators like the astronomy allies, whose website explains: “Seeing us wear those buttons tells you not only that there is someone friendly around should you need us, but reminds people who might think about committing harassment that there are always people holding beacons of light to shine in the corners they are hoping to keep dark.

In Defense of Reproductive Health Care

December 7, 2017 2:19 pm

My patient, Joe, had tried diligently to bring down his blood sugar with diet and exercise. His A1c was still too high, and we needed to start pharmacologic treatment. A highly effective medication, metformin, was easily available to Joe at our pharmacy and covered by his insurance.

Another patient, Lisa, had struggled with ovarian cysts for years. She had experienced painful cyst ruptures and debilitating bloating. Lisa was not able to use a highly effective medication for ovarian cysts, TriNessa, to treat her condition because she couldn’t afford to pay for it out of pocket. Her insurance didn’t cover it because her employer had filed for a religious exemption to avoid paying for contraception coverage.

Why wasn’t Lisa’s medication for ovarian cysts covered while Joe’s diabetes medication was?

Starting Jan. 1, employers can refuse to provide insurance coverage for contraception based on religious or moral objections. Lost in the partisan arguments about birth control is the fact that contraception is a safe, effective treatment for many medical conditions. Contraceptive medications treat endometriosis, dysmenorrhea, menorrhagia, fibroids, ovarian cysts, dysfunctional uterine bleeding and the secondary anemia that can result, among other conditions.

In addition, contraception helps many patients plan their pregnancies and family size. It helps them space healthy pregnancies, allowing them to continue to provide optimal care to their children and families.

Only 11 states have higher infant mortality numbers than Ohio, where I live and practice. Cuyahoga County, home to three large hospital systems, has the second-highest rate in the state. The infant mortality rate for black infants in the county is more than twice that of white infants. One critical recommendation to reduce infant mortality is allowing an interval of at least 18 months between pregnancies. This requires affordable, accessible and highly effective contraception.

The Patient Protection and Affordable Care Act (ACA) allowed more than 55 million people to access birth control by requiring that all insurance plans cover the benefit without cost-sharing such as copayments and deductibles. The Trump administration’s move to reverse that policy means that hundreds of thousands of patients may lose that benefit. Since many women are unable to afford contraception without insurance coverage, this policy would disproportionately reduce reproductive autonomy for poor and low-income women.

Furthermore, research has shown access to contraception is associated with higher completion rates of education and ability to maintain employment. Removing that access from poor and low-income women perpetuates the cycle of poverty.

Long-acting reversible contraception, or LARC, is the most effective reversible form of pregnancy prevention for sexually active individuals. IUDs and implants, like other contraception, can be used to treat many medical conditions in addition to being highly effective at preventing unplanned pregnancy. LARC removes the possibility of human error, because these devices are placed in the arm or uterus and can stay in place for several years.

The efficacy of natural family planning methods, on the other hand, varies widely by study. According to HHS, one in four women will become pregnant while using natural family planning to prevent pregnancy.

When contraception fails to prevent unwanted pregnancy or is not accessible, patients must choose between staying pregnant or ending the pregnancy. This year, we have seen repeated threats to patient access for both choices — continued pregnancy and abortion — through higher costs and increased restrictions.

Repealing or replacing the ACA would make things even more difficult for women. The American Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA) would have permitted states to use a waiver process to alter or otherwise change the essential health benefits package, which includes maternity care. This, in turn, would have allowed states to drop maternity coverage as an essential health benefit. Although plans would still be required to offer maternity coverage as a policy rider, this obviously would increase costs to the patient.

The AHCA and the BCRA also would have defunded Planned Parenthood for one year. That’s significant because each year, 2 million Americans receive their health care — including cervical and breast cancer screening, sexually transmitted infection screening, and contraception — from Planned Parenthood.

We must do more for our patients. We must do more for women. Contraception is health care. Maternity care is health care. Abortion is health care.

And it’s important to note that these are not only women’s issues. Allowing women reproductive autonomy is an issue of public health; it benefits partners, families and children. Reproductive autonomy allows women to keep their jobs, complete their education and care for their loved ones. The financial well-being of women has ripple effects on the financial well-being of whole communities — communities we live in alongside our patients.

When women can control if and when they have children, as well as how many children they have, we all benefit. When that autonomy is taken away, we all suffer.

Natalie Hinchcliffe, D.O., loves teaching residents, advocating for her patients and addressing stigmas in medicine. She is passionate about providing care for lesbian, gay, bisexual, transgender and queer patients; HIV primary care; and reproductive health and family planning services where access to such care is limited. She practices in Ohio.

Homemade, Low-Sugar Apple Cinnamon Raisin Granola Recipe

November 10, 2017 7:27 am

Yes, it has sugar, but it’s all naturally occurring fruit sugars, no processed added sugars.

Yes, it has fat, but mostly naturally occurring healthy fats from nuts. The small amount of added oil helps to brown the mixture, as it has no added sugars coating it.

Don’t like this particular mix?

low sugar granola recipeTry substituting: You can use any two cups of nuts, like pistachios, walnuts, macadamia, hazelnuts… Seeds, you can use all sunflower or pumpkin seeds, or try sesame seeds. Raw and unsalted nuts work best, and these are found in the bulk section of grocery stores, in smaller quantities on grocery store shelves, or, can be bought online, explore your options! Fruit, any chopped dried fruits will work. Imagine dried cherries, cranberries, or chopped dates. You can skip the cinnamon, or try a different blend of spices. Want it to taste just like apple pie? Try apple pie spice, which has ginger and nutmeg in addition to cinnamon. Go crazy!


3 cups of rolled oats (can be regular or quick)
1 cup almonds, raw, unsalted, coarsely chopped
1 cup cashews, raw, unsalted, coarsely chopped
1 cup pepitas (pumpkin seeds), raw, unsalted
1 cup sunflower seeds, raw, unsalted
2 cups raisins
1/2 cup crushed apple chips OR chopped dried apple
1/2 teaspoon sea salt
4 tablespoons cinnamon
2 cups applesauce (Preferably unsweetened. Apple or pumpkin butter will also work well here)
1/4 cup vegetable oil (can be sunflower, coconut, anything that doesn’t have too strong a flavor)


Preheat the oven to 350°.

Use a LARGE mixing bowl and add all of the dry ingredients (up to the cinnamon). Mix it all together with a wooden spoon or your hands.
Pour the applesauce and oil over and mix, until the dry ingredients are just moistened.

Use two large cookie sheets (lightly greased OR use a silicone nonstick mat) and spread the mixture out over them both, as evenly and flat as you can.

Bake for 15 minutes, then check, and mix it up a bit with your wooden spoon. Bake for another 15 minutes and check. If the corners are turning dark brown, take it out and leave it to cool. If not, leave for another 5 to 10 minutes, until the corners are browned. As it cools, it will crisp up.

This recipe makes about twelve cups of granola, and I divide it up: some stays with us to top yogurt and fruit for breakfast, and some goes in pretty cellophane bags with metallic ties to give away to family and friends.

Nutrition information

Calories per half-cup portion: 261
Fat: 11 gm (2 gm saturated, 0 trans fat, 0 cholesterol)
Protein: 5 gm
Carbohydrate: 40 gm (6 gm fiber, 23 gm sugars)
Sodium: 89 mg
Potassium: 268 mg
Iron: 14% RDA
Calcium: 4% RDA


The Power and Prevalence of Loneliness

November 7, 2017 2:17 pm

by Charlotte S. Yeh, MD, Chief Medical Officer, AARP Services

All the lonely people, where do they all come from?
All the lonely people, where do they all belong?
—The Beatles, “Eleanor Rigby”

power and prevalence of lonelinessA few years ago, when I was the attending emergency physician working in the emergency department, the senior medical resident asked permission to discharge an older man. The resident was convinced the patient was a malingerer, having been seen multiple times in the last week at the medical clinic with “shortness of breath.” The patient had multiple tests, scans, and more — all normal — and yet here he was again, in the emergency department complaining of continued difficulty breathing. “Wait,” I said. “There must be a reason that he keeps coming back. Let me take a look at him with you.”

We entered the room, and saw an old man, shrunken in the corner with no animation in his face. He looked forlorn, so I asked, “Are you sad?” He burst into tears and told me that his partner of more than 20 years had died a week ago; he was devastated.

His real condition? Not shortness of breath, not crying wolf to get attention, and certainly not a malingerer. What he had was pure and simple: loneliness.

The medical resident was stunned. As he admitted to me later, he learned a powerful lesson that day: that the pain of loss can be as profound as not breathing. And sometimes the symptom comes not from the body, but is a cry from the soul.

The epidemic — and health dangers — of loneliness

Loneliness affects 25% to 60% of older Americans and puts millions of Americans 50 and over at risk of poor health from prolonged loneliness. Loneliness is almost as prevalent as obesity. In a survey of members of the AARP Medicare Supplement Plans, insured by UnitedHealthcare, 27% to 29% were lonely; about 9% were severely lonely. Among those members representing the top 5% with the most chronic conditions, spending 5% of the healthcare dollar, loneliness rises to 55% of that population, half of whom suffer with severe loneliness.

Notwithstanding the impact on quality of life and life satisfaction, loneliness has an equivalent risk factor to health as smoking 15 cigarettes a day, shortening one’s lifespan by eight years.

Per the Harvard Study of Adult Development, a 75-year longitudinal study of men, loneliness is toxic. The more isolated people are, the less happy they are, and brain function declines as well as physical health. Note that isolation is the objective measure of how large your social network is, whereas loneliness is a subjective perception of how one feels. In other words, you can have many friends and be lonely, or no friends and not be lonely. Isolation, whether from becoming homebound, loss of mobility, absence of transportation, or losing a spouse or partner, are all risk factors for loneliness. Hearing loss, too, can foster isolation and miscommunication, and set the stage for loneliness.

Loneliness also can be contagious, just like a cold. According to a recent study, “Alone in a Crowd: The Structure and Spread of Loneliness in a Large Social Network,” lonely people tend to share their loneliness with others. Over time, a group of lonely, disconnected people move to the fringes of social networks. The problem is compounded because lonely people, those on the periphery, tend to lose the few contacts they have.

According to the UK Campaign to End Loneliness, more than half of lonely people simply miss having someone to laugh with. Their research also showed that simply being together with someone is missed most of all (52%), and 46% miss having a hug. Older people experiencing loneliness also miss simple everyday moments, such as sharing a meal (35%), holding hands (30%), taking country walks (32%), or going on holiday (44%).

“Treating” loneliness

Back to my patient. He was classically lonely, having lost his dearest friend of 20 years. We had to allow him to share his grief, support him in his loss, and acknowledge the pain, so he didn’t have to substitute a physical ailment to say he needed help. There is a huge stigma to admit to loneliness, and yet it is such a profound human condition that we all recognize, and yet so often turn our faces away.

Social connection helps us thrive and gives us resilience. The support of family, friends, colleagues, and caregivers allows us to celebrate our experiences, weather our pains, and face each day as we journey forward.

AARP Foundation recently launched a social isolation platform called Connect2Affect. The goal is to create a network that not only builds awareness about social isolation and its impact, but also identifies solutions. The Connect2Affect website features tools and resources to help users evaluate isolation risk, reach out to others who may be feeling disengaged, and find practical ways to reconnect to the community.

Think about who you know who recently lost a loved one, who might be going through a divorce, an empty nester, or someone who might still be lonely even though surrounded by friends and family. They may well be sad, isolated, or feeling lonely. Reach out to them. As the old ad jingle says, reach out and touch someone. You can ease the loneliness and isolation and be a bright spot in their lives. You can laugh with them, reminisce, and thank each other for just being there.

Let us not forget, the power we each hold in our hands — the power of connection, friendship, and being human. Hold a friend’s hand today and every day. You will have just contributed to life itself.

111 NFL Brains

September 29, 2017 5:53 am

cte nfl brains

CTE found in 99% of studied brains from deceased NFL players

Key Points

Question What are the neuropathological and clinical features of a case series of deceased players of American football neuropathologically diagnosed as having chronic traumatic encephalopathy (CTE)?

Findings In a convenience sample of 202 deceased players of American football from a brain donation program, CTE was neuropathologically diagnosed in 177 players across all levels of play (87%), including 110 of 111 former National Football League players (99%).

Meaning In a convenience sample of deceased players of American football, a high proportion showed pathological evidence of CTE, suggesting that CTE may be related to prior participation in football.


Importance Players of American football may be at increased risk of long-term neurological conditions, particularly chronic traumatic encephalopathy (CTE).

Objective To determine the neuropathological and clinical features of deceased football players with CTE.

Design, Setting, and Participants Case series of 202 football players whose brains were donated for research. Neuropathological evaluations and retrospective telephone clinical assessments (including head trauma history) with informants were performed blinded. Online questionnaires ascertained athletic and military history.

Exposures Participation in American football at any level of play.

Main Outcomes and Measures Neuropathological diagnoses of neurodegenerative diseases, including CTE, based on defined diagnostic criteria; CTE neuropathological severity (stages I to IV or dichotomized into mild [stages I and II] and severe [stages III and IV]); informant-reported athletic history and, for players who died in 2014 or later, clinical presentation, including behavior, mood, and cognitive symptoms and dementia.

Results Among 202 deceased former football players (median age at death, 66 years [interquartile range, 47-76 years]), CTE was neuropathologically diagnosed in 177 players (87%; median age at death, 67 years [interquartile range, 52-77 years]; mean years of football participation, 15.1 [SD, 5.2]), including 0 of 2 pre-high school, 3 of 14 high school (21%), 48 of 53 college (91%), 9 of 14 semiprofessional (64%), 7 of 8 Canadian Football League (88%), and 110 of 111 National Football League (99%) players. Neuropathological severity of CTE was distributed across the highest level of play, with all 3 former high school players having mild pathology and the majority of former college (27 [56%]), semiprofessional (5 [56%]), and professional (101 [86%]) players having severe pathology. Among 27 participants with mild CTE pathology, 26 (96%) had behavioral or mood symptoms or both, 23 (85%) had cognitive symptoms, and 9 (33%) had signs of dementia. Among 84 participants with severe CTE pathology, 75 (89%) had behavioral or mood symptoms or both, 80 (95%) had cognitive symptoms, and 71 (85%) had signs of dementia.

Conclusions and Relevance In a convenience sample of deceased football players who donated their brains for research, a high proportion had neuropathological evidence of CTE, suggesting that CTE may be related to prior participation in football.

Dr. Ann McKee, a neuropathologist, has examined the brains of 202 deceased football players. A broad survey of her findings was recently published in The Journal of the American Medical Association.

Neurology and Psychiatry Continuing Medical Education for Primary Care and Free of Commercial Support. For more information Click Here.

USPSTF Draft Recommendation Statement – Cervical Cancer Screening

September 26, 2017 7:01 am

The US Preventive Services Task Force has New Draft Guidance for Cervical Cancer Screening

These recommendations do NOT apply to women with in utero exposure to diethylstilbestrol or women who have a compromised immune system (e.g., women living with HIV).

The major change from the US Preventive Services Task Force (USPSTF) 2012 recommendation is that testing for high-risk strains of human papillomavirus (hrHPV) alone is now recommended as an alternative to cytology or Papanicolaou (Pap) screening alone beginning at age 30 years; cotesting is no longer recommended.

As in the 2012 recommendation, the USPSTF continues to recommend that women aged 21 to 29 years undergo Pap screening every 3 years.

The USPSTF recommend against screening in women younger than age 21 years because there is adequate evidence that regardless of sexual history, screening younger women does not reduce cervical cancer incidence or mortality.

cervical cancer screening

The USPSTF also continues to give a thumbs down to screening in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer, as well as in women who have had a hysterectomy and their cervix removed and do not have a history of a high-grade precancerous lesions or cervical cancer.

#Women‘s #Health #CME #Conferences for #Primary #Care. For more information click here


Primary Care Has a Dirty Little Secret ~ A Country Doctor Writes

August 22, 2017 11:07 am

We are like restaurants that charge handsomely for sit down dinners but give away food for free at the takeout window. And we pay our providers only for serving the dining room guests. If traffic gets backed up at the drive-through, we hold our providers responsible, even though we never planned for our ever increasing demand for takeout.

In simpler times, patients went to the doctor when they felt unwell, and doctors didn’t claim responsibility for what patients did on their own time between visits.

Now, doctors are working just as hard taking care of patients in the office, but they are also expected to, on their own time, handle all sorts of ongoing hand-holding between visits. This happens through phone calls, electronic messaging and reading and commenting on endless streams of reports from case managers, specialists, hospitals, emergency rooms, walk-in clinics, pharmacy benefit managers, insurance companies and medical supply companies.

There is talk about how all this extra work will some day generate income streams from cost savings and improved outcomes, but today, the very foundation of how doctors get paid is how many patients they see in the office on a daily basis. Few health care organizations have the cash on hand to schedule provider time for what isn’t going to bring money in during the present budget year.

The dirty little secret we all deal with in primary care is that we make our doctors, PA’s and NP’s see as many patients as they possibly can, with ever increasing demands on the complexity of care they deliver, and on the comprehensiveness of their documentation and quality reporting, and then we quietly assume they will be able to do all this extra, unscheduled and uncompensated work without falling behind, making medical mistakes or simply burning out.

Imagine a CEO who spent all day in meetings and never had any time to himself or herself available to think, plan or write.

Imagine an average office worker, who is said to spend 25% of their time on business related email, suddenly being told that all company emails from now on have to be done outside working hours.

Imagine a judge, presiding over case after case at the bench from 8 am to 5 pm, without any scheduled time to read briefs or write judgements.

Imagine a TV anchor, broadcasting 8 hours a day, never taking any time to study the issues of the day or to speak with colleagues or newsmakers.

Imagine an orchestra, constantly performing, never practicing, never studying the sheet music.

And we are now offering resilience training to our medical providers to help them not burn out…

A Country Doctor Writes
#Clinician and #Patient #Wellness #Program #Series. For More Information visit our website at

The Third Leading Cause of Death in US is Now Medical Error

June 5, 2017 9:45 am

medical error deathsThe problem of medical error is becoming ever more prominent, thanks to recent reports that show an estimated 251,000 deaths from medical error in 2016, making it the third most common cause of death in the United States. This represents a substantial increase from previous reports, one of the most commonly cited of which being a 1999 Institute of Medicine paper which reported 44k-98k deaths from medical error per year.

However, since that time, much has changed in the way that these statistics are recorded, and the consensus now is that rather than representing an increase in medical error incidence and severity, this represents an improvement in our record-keeping and statistical analysis. Yet this does not mitigate our need to further explore the roots of this issue and strive to improve it while simultaneously improving our statistical analysis and record-keeping.

Defining Medical Error

While it is accepted that errors will occur in any arena which relies on human decision-making and task completion, those errors will clearly fall into a wide range when it comes to severity. As in other high risk professions (aviation, military, law) it can be difficult in medicine to determine which errors will lead to which outcomes. Errors that are large in terms of scope (wrong-sided surgery, widely inaccurate drug amounts) can result in negligible consequences, while seemingly small errors (tiny dose changes, forgetting to schedule follow-ups, missed physical exam findings) can result in permanent complications including death. The effect of these errors is magnified by a host of factors, including allergies, patient sensitivity to medication, drug-drug interactions, and the layers of support surrounding an individual patient. A specific error can have no effect on a patient for thousands of cases but then lead to death under perfectly unfortunate circumstances.

For this reason, it is important to collect a record of as many medical errors as possible, and then determine what (if any) the extent of their impact on patient health may have been.

To this end, the British Medical Journal defines medical error as:

  • – an unintended act of omission or commission
  • – an act that does not achieve its intended outcome
  • – errors of execution, in which a planned action is not completed as originally intended
  • – using the wrong plan to achieve a specific goal
  • – a deviation from standard of care or an established care process.

All of these can be considered medical error whether or not they cause harm to a patient. And with such a broad definition they occur quite frequently.

Systems vs. Individuals

For generations of private practitioners, preventing medical error came down to the provider. And while the onus of safe medical care often remains with providers due to their face-to-face relationship, medical error prevention has now become a major systems issue. With medical systems that span many hospitals, clinics, and thousands of providers, there is now tremendous potential to record and prevent untold cases of medical error.

To this end, it is crucial to face this news of potentially increasing volume of death from medical errors, continue to study it, and use that knowledge toward prevention of future incidents. Now, individual providers have the ability to prevent medical errors on a personal level as well as a systems level through involvement, advocacy and QI research.