Annals of family medicine
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Annals of family medicine · May 2018
White Privilege in a White Coat: How Racism Shaped my Medical Education.
In this essay, I reflect on some of the ways racial privilege influenced my experience as a white physician in training. While white Americans often think of "racism" as a social construct primarily affecting people of color, "racism" is a system of both racial disadvantage as well as reciprocal racial advantage. Medical professionals are increasingly aware of how social determinants of health lead to important health disparities, however white physicians seldom ask how their own racial privilege reinforces a white supremacist culture and what effects this may have on our patients' health. Drawing attention to the powerful legacy of racial discrimination in medical institutions, I call on other white physicians to name their privilege in order to dismantle the systems that propagate racism in our profession.
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Annals of family medicine · May 2018
Physician Burnout: Resilience Training is Only Part of the Solution.
Physicians and physician trainees are among the highest-risk groups for burnout and suicide, and those in primary care are among the hardest hit. Many health systems have turned to resilience training as a solution, but there is an ongoing debate about whether that is the right approach. ⋯ Resilience training may be helpful in addressing unavoidable suffering, but it is the wrong treatment for the organizational pathologies that lead to avoidable suffering- and may even compound the harm doctors experience. To address avoidable suffering, health systems would be better served by engaging doctors in the co-design of work systems that promote better mental health outcomes.
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Annals of family medicine · Apr 2018
Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?
The methods and costs to enroll small primary care practices in large, regional quality improvement initiatives are unknown. We describe the recruitment approach, cost, and resources required to recruit and enroll 500 practices in the Northwest and Midwest regional cooperatives participating in the Agency for Healthcare Research and Quality (AHRQ)-funded initiative, EvidenceNOW: Advancing Heart Health in Primary Care. ⋯ Recruitment of practices for large-scale practice quality improvement transformation initiatives is difficult and costly. The cost of recruiting practices without existing partnerships is expensive, costing 7 times more than reaching out to familiar practices. Investigators initiating and studying practice quality improvement initiatives should budget adequate funds to support high-touch recruitment strategies, including building trusted relationships over a long time frame, for a year or more.