J Am Board Fam Med
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In 2020, as a 24-year-old MD PhD student studying cardiovascular population health, I suffered a non-ST elevated myocardial infarction while playing basketball. It was confirmed the cause was familial hypercholesterolemia leading to 95%+ occlusions of both the left anterior descending and left circumflex arteries. The following reflective essay describes my experience as a patient grappling with his own mortality and how those experiences have shaped how I now view my purpose as a future physician. The purpose of this essay is to encourage all physicians and physicians in training to practice reflection and to allow themselves to fully experience the pain and suffering of the patients for whom they care, even amidst times of personal uncertainty.
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Preventing and ending homelessness for women veterans, a priority of the Department of Veterans Affairs (VA), can be aided by identifying factors that increase their risk for housing instability. ⋯ These risk factors and their effect on women veterans' housing instability can be mitigated by new and increased supportive interventions, targeted to those at highest risk.
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The COVID-19 pandemic has added further urgency to the need for primary care payment reform. Fee-for-service payments limit the flexibility of practices to respond to crises and leave practices without sufficient revenues when visit volumes decrease. ⋯ Evidence suggests setting primary care investment at 10% to 12% of the total cost of care, approximately translating to an average $85 per member per month, with significant variation based on age and adjustment for medical and social measures of risk. Enhanced investment in primary care should be aligned across payers and support practice transformation to advanced models of care.
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Even before social distancing disrupted normative expectations and prompted an immediate shift to remote doctor/patient interactions, technology companies-Amazon, Apple, and Google-were preparing to disrupt medical care through the innovative use of technology. This article presents a possible scenario for how technology, in the near future, will completely up-end primary care practice. ⋯ In addition, family physicians bring wisdom, making decisions in the liminal state between patient and physician, the resulting product of the human connection but also the ability to manage complexity using the best evidence. The ability to do both gives family medicine physician the skills to leverage but also control the coming big data.