Annals of family medicine
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Annals of family medicine · Nov 2022
Continuous Glucose Monitoring in Primary Care: Understanding and Supporting Clinicians' Use to Enhance Diabetes Care.
Diabetes affects approximately 34 million Americans and many do not achieve glycemic targets. Continuous glucose monitoring (CGM) is associated with improved health outcomes for patients with diabetes. Most adults with diabetes receive care for their diabetes in primary care practices, where uptake of CGM is unclear. ⋯ Primary care clinicians are interested in using CGM for patients with diabetes, but many lack the resources to implement use of this diabetes technology. Use of CGM can be supported with education in the form of workshops and consultation on insurance issues targeted toward residents, recent graduates, and practices without a nearby endocrinologist. Continued expansion of Medicare and Medicaid coverage for CGM can also support CGM use in primary care.
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Contemplating retirement after 38 years as a family physician has, for me, been an uncomfortably revealing process. I can't help but remember the few patient-care regrets that still upset me after all these years, and I find myself wishing I could go back in time; do things differently; conjure up better outcomes. I can't, of course, but those memories of individual patients eventually led me to consider my entire practice life, the legacy I might leave, and my role in a health care system that has changed so dramatically over the course of my career. ⋯ In this article I try to come to grips with why I was mostly silent, and I share what I am trying to do now at the end of my career to effect change and find my voice. Better late than never, I am speaking up for my colleagues and patients. Now, more than ever, I hope that we physicians will insist on being heard.
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Minutes after starting my family medicine rotation, my first patient crumpled before my eyes. She shared a story of anguish and worry, overwhelmed with the grief of her partner's unexpected death and consequential housing instability. ⋯ It is one thing to read about structural trauma and deeply embedded inequalities; it is another to look into the eyes of the patients whose families are, in part, shaped by them. In this essay, I grapple with a myriad of emotions on my first day of family medicine-and contemplate the courage required to show up, wholeheartedly, for our patients.