RoS: Review of Systems

Welcome to Recovery Month! In celebration of primary care’s role in addiction care, we are featuring a show about caring for patients with addiction. Our guests this week are Adele Ojeda, the office based opioid treatment (or OBOT) nurse for Barre Family Health Center and Dr. Stephen Martin. Dr. Martin is Associate Professor of Family Medicine and Community Health at University of MA Medical School and a faculty physician at Berry Family Health Center, and affiliate faculty for the HMS Center for Primary Care. They share their experiences caring for patients with OUD in the primary care setting, and we also discuss an article Dr. Martin published with several colleagues in Annals of Internal Medicine in November 2018 entitled The Next Stage of Buprenorphine Care for Opioid Use Disorder that focuses on a number of widely accepted, yet not evidence-based, and potentially harmful practices in buprenorphine care. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspod@gmail.com.

This week, we are joined by Russ Phillips! Dr. Russell Phillips is Director of the Center for Primary Care and the William Applebaum Professor of Medicine and Professor of Global Health and Social Medicine at Harvard Medical School. He is a devoted primary care general internist at Beth Israel Deaconess Medical Center (BIDMC) where he manages a panel of patients. Within the Center for Primary Care, he leads programs that are transforming education and care systems, developing entirely new approaches to improving primary care and health, and performing research on high performing health systems and practices, and the impact of changes in payment and primary care practice structure on the finances of primary care practices. He joins us to talk about a recent publication in JAMA IM that he wrote with a number of collaborators including other Center for Primary Care faculty, entitled: Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015. We also reference the accompanying editorial by Zabar et al and the paper that inspired their work, by Starfield, Shi and collaborators. This interview has been lightly edited for length and clarity.

Our guest this week is Dr. Margot Kushel, a Professor of Medicine at UCSF and Director of the UCSF Center for Vulnerable Populations, as well as the Director of the UCSF Benioff Homelessness and Housing Initiative. Dr. Kushel’s research focuses on homelessness among older adults and the adverse health effects associated with homelessness. She developed and continues to follow the HOPE HOME cohort, an ongoing longitudinal cohort study examining the causes and effects of homelessness among adults 50 and over in Oakland, CA. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspod@gmail.com.

Our guest this week is Dr. Steven Woolf. He is the C. Kenneth and Dianne Wright Distinguished Chair in Population health and Health Equity at VCU as well as Director Emeritus and Senior Advisor to the VCU Center on Society and Health. He joins us this week to talk about his work improving our understanding of the increasing death rates among mid-life Americans, on which he published a crucial paper about in 2018 in BMJ, entitled Changes in midlife death rates across racial and ethnic groups in the United States: systematic analysis of vital statistics, as well as authoring in an extensive report entitled US Health in International Perspective: Shorter Lives, Poorer Health. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspodATgmail.com.

Christopher Morley joins us this week to talk about prior authorizations, or PAs – a bureaucratic headache well known to anyone in primary care in which a physician’s office must complete additional paperwork or phone calls to a patient’s insurance company in order to get a medication or procedure covered by the insurance. This used to be a fairly rare occurrence, but it has dramatically increased in frequency over the last 20 years or so. Dr. Morley set out with some colleagues to try to quantify how much the PA process may cost, and moreover, to help us all think about who pays those costs in reality – ultimately, it is our patients. Dr. Morley is the Chair of the Department of Public Health and Preventive Medicine at SUNY Upstate Medical University, as well as the Vice Chair for Research in the Department of Family Medicine. He is a medical social scientist with principal interests in health disparities, particularly those that occur in primary care settings; health workforce development and medical education. Review of Systems is a podcast hosted by Audrey Provenzano featuring conversations about the changing healthcare landscape from the Harvard Center for Primary Care. Check out our website, primarycare.hms.harvard.edu to find our podcast library, subscribe in your favorite podcast app, and find us at @rospodcast and @audreymdmph Tweet us feedback and suggestions or email us at reviewofsystemspod@gmail.com. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues.

Our guest this week is Stacey Chang. He is the executive Director of the Design Institute for Health at Dell Medical School. He joins us today to talk about design in medicine and how we can use design thinking as a tool to improve healthcare, and in particular how he and colleagues went about designing a series of clinics at Dell Medical School without any waiting rooms! I hope you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspodATgmail.com.

What happens when a medical complex young person turns 18, and then, suddenly, they make their own medical decisions rather than their parents? How does one navigate the sometimes very thorny issues of sexual health and fertility? What about insurance issues? This week, we have a very special show for you featuring a number of guests on this topic talking about the Weitzman Family Bridges Adult Transition Program at Boston Children’s Hospital and how the program addresses these questions. We have Kitty O’Hare, a practicing med-peds primary care physician and Assistant Professor of Medicine and Pediatrics, Harvard Medical School; Ahmet Uluer, the Medical Director of the Weitzman Family Bridges Adult Transition Program; Amy, a patient who helped give input in the design of the program, helped to write the transition in care guide One Step at a Time, and has gone on to become a nurse; Susan Shanske, MSW, LICSW, the Director of Transitional Care Support; and Julia Roboff, a Nurse Practitioner with the program. Thanks for listening!

In this reprise episode, Michelle Kondo and Eugenia South join us to talk about their research looking at how neighborhood contexts impact health and safety in urban environments, and their recent publication in JAMA Network Open looking at the relationship between neighborhood greening and mental health. Dr. South and Dr. Kondo collaborate from two different perspectives – Dr. South is an emergency physician and health services researcher at UPenn; and Dr. Kondo is a PhD research social scientist with the USDA-Forest Service, Philadelphia Field Station. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop me a line at contactATrospod.org.

This week, we are joined by Allison Hess, VP of Health for the Steele Institute for Innovation at Geisinger to talk about Geisinger’s Fresh Food Farmacy, a program that provides food insecure patients with poorly controlled diabetes access to fresh healthy foods as part of a comprehensive diabetes care plan. Read more about the Fresh Food Farmacy and also check out the feature about their program on Care Zooming, a social enterprise company aimed at connecting healthcare professionals and disseminating innovative programs. Tweet us your thoughts at @RoSpodcast or you can email us at contactATrospod.org.

This week, we are joined by Russ Phillips! Dr. Russell Phillips is Director of the Center for Primary Care and the William Applebaum Professor of Medicine and Professor of Global Health and Social Medicine at Harvard Medical School. He is a devoted primary care general internist at Beth Israel Deaconess Medical Center (BIDMC) where he manages a panel of patients. Within the Center for Primary Care, he leads programs that are transforming education and care systems, developing entirely new approaches to improving primary care and health, and performing research on high performing health systems and practices, and the impact of changes in payment and primary care practice structure on the finances of primary care practices. He joins us to talk about a recent publication in JAMA IM that he wrote with a number of collaborators including other Center for Primary Care faculty, entitled: Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015. We also reference the accompanying editorial by Zabar et al and the paper that inspired their work, by Starfield, Shi and collaborators. This interview has been lightly edited for length and clarity.

This week, we have two amazing guests, Cheryl Pritlove and Elizabeth Metraux. They are joining us to talk about gender disparities in medicine. Cheryl Pritlove is a Research Scientist at the Applied Health Research Centre at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Ontario, Canada. She is a qualitative methodologist and health equity researcher with specific interests in gender disparities. Please read her recent Lancet article The good, the bad, and the ugly of implicit bias that we discuss on the show. Elizabeth Metraux is the founder of the Boston-based start-up, Women Writers in Medicine, with a mission to break glass ceilings using the power of the pen. Formerly at the National Institutes of Health, she worked in the Office of the NIH Director as communications lead for Workforce Diversity. Prior to jumping into healthcare, she served in the Middle East and Central Asia in civil society development through the State Department, USAID, and a number of local NGO’s and media outlets. Elizabeth’s work has appeared in The New England Journal of Medicine, Health Affairs, STAT, Medium, and more. She regularly speaks across the country, hosts the healthcare podcast “Relational Rounds,” and the live storytelling series, “Scrubs, Spirits, and Stories: Tales from the Trenches of Healthcare,” both sponsored by Primary Care Progress. We’d love to hear from you! Please tweet at us @RoSpodcast or @HMSPrimaryCare or drop us a line at contact@rospod.org. This interview has been lightly edited for length and clarity.

Why is change so difficult? So often, we know what needs to be done – but actually making change is where we get stuck. Kate Hilton, our guest last week and this week for a 2-part series, is on the Faculty of the Institute for Healthcare Improvement and is the lead author of a new white paper entitled The IHI Psychology of Change Framework. Kate Hilton is also on the leadership of a 100 Million Healthier Lives, a founding director of ReThink Health, and Leadership Faculty for the Atlantic Fellows for Health Equity. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. You can find our guest Kate on twitter @katebhilton, and you can find me at @audreymdmph and our show @rospodcast. Tweet us feedback and suggestions, or email me at contactATrospod.org. Thanks for listening! This interview has been lightly edited for length and clarity.

Why is change so difficult? So often, we know what needs to be done – but actually making change is where we get stuck. Kate Hilton, our guest this week and next for a 2-part series, is on the Faculty of the Institute for Healthcare Improvement and is the lead author of a new white paper entitled The IHI Psychology of Change Framework. Kate Hilton is also on the leadership of a 100 Million Healthier Lives, a founding director of ReThink Health, and Leadership Faculty for the Atlantic Fellows for Health Equity. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. You can find our guest Kate on twitter @katebhilton, and you can find me at @audreymdmph and our show @rospodcast. Tweet us feedback and suggestions, or email me at contactATrospod.org. Thanks for listening! This interview has been lightly edited for length and clarity.

Utibe Essien, a Health Equity researcher, primary care physician in the VA Pittsburgh Health System, and Assistant Professor of Medicine at University of Pittsburgh School of Medicine joins us this week. Dr. Essien studies racial disparities in healthcare, and recently published a major study in JAMA Cardiology, demonstrating significant racial disparities in the management of atrial fibrillation. He also recently published an important commentary about the dramatic racial disparities in outcomes seen among pregnant and postpartum women in the United States. We talk about his research, and how it is connected with some of the larger instances of racial discrimination and high-profile deaths of predominantly black men that we see so often and have become part of our discourse about racial discrimination in our country. We also read and discuss the poem Martin Luther King Jr Mournes Trayvon Martin by Lauren Alleyne. Follow Utibe on twitter at @UREssien, me @audreymdmph and our show @rospodcast. Tweet us feedback and suggestions, or email us at contactATrospod.org. Thanks for listening!

This week, we have a very special collaborative show with the Harvard T.H. Chan School of Public Health’s podcast, This Week in Health. We are featuring perspectives on gun violence from the trauma bay of the emergency room with Megan Ranney, and from public health, with David Hemenway. Megan Ranney, MD MPH is currently an Associate Professor in the Department of Emergency Medicine at Rhode Island Hospital/Alpert Medical School of Brown University and also Chief Research Officer for the American Foundation for Firearm Injury Reduction in Medicine, a non-partisan philanthropy focused on filling the funding gap for high-quality, medically-focused, firearm injury research. David Hemenway is Professor of Health Policy, is Director of the Harvard Injury Control Research Center at the TH Chan School of Public Health. Dr. Hemenway teaches classes on injury and on economics. Dr. Hemenway has written widely on injury prevention, including articles on firearms, violence, suicide, child abuse, motor vehicle crashes, fires, falls and fractures. This interview has been lightly edited for length and clarity.

This week, Thomas Kim, David Rosenthal, and Audrey Provenzano bring you a journal club episode. Audrey talks about: Effect of Peer Comparison Letters for High-Volume Primary Care Prescribers of Quetiapine in Older and Disabled Adults: A Randomized Clinical Trial by Adam Sacarny, PhD, Michael L. Barnett, MD, MS, Jackson Le, PharmD, Frank Tetkoski, RPh, David Yokum, PhD & Shantanu Agrawal, MD. David Rosenthal talks about Effect of Community Health Worker Support on Clinical Outcomes of Low-Income Patients Across Primary Care Facilities: A randomized Control trial By Shreya Kangovi , Nadita Mitra, Lindsey Norton, Rory Harte, Xinzi Zhao, Tamala Carter, David Grande, and Judith Long. Thomas Kim brings us a discussion of Women from racial or ethnic minority and low socioeconomic backgrounds receive more prenatal education: Results from the 2012 to 2014 Pregnancy Risk Assessment Monitoring System by Minh N. Nguyen PhD, Mohammad Siahpush PhD, Brandon L. Grimm PhD, Gopal K. Singh PhD & Melissa K. Tibbits PhD. If you enjoy the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.

How long have we all, collectively in healthcare, spent on hold with medical records departments, listening to mind-numbing muzac or assembled around the fax machine, waiting for your patient’s crucial imaging reports or culture results from another hospital to come through? Way too long. Difficulty accessing medical records can be extremely difficult, which we explore today with two guests. Ilana Yurkiewicz is a physician and writer, and recently published an article on Undark, entitled Paper Trails: Living and Dying with Fragmented Medical Records, which explores how poor communication of medical records resulted in harm to one of her patients. Carolyn Lye, a medical student and law student at Yale, also joins us; she is lead author of an article published in JAMA Open, entitled Assessment of US Hospital Compliance With Regulations for Patients’ Requests for Medical Records, which studied the difficulties patients experience in requesting medical records through a secret shopper study model. They both join us today to talk about how difficult it is to access medical records. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. You can find me at @audreymdmph and our show @rospodcast. Tweet us feedback and suggestions, or email me at contactATrospod.org. Thanks for listening! This interview has been lightly edited for length and clarity.

In this reprise episode, our guests are Sarah Dauber, Ph.D & Lindsey Vuolo JD, MPH of Center on Addiction, a science-based non-profit, non-partisan organization dedicated to finding and promoting solutions to end addiction. They join us to discuss policies that affect how pregnant women with substance use disorders may or may not access care and how we can better align policy with evidence-based care of women with substance use disorders. Lindsey is the associate director of health law and policy at Center on Addiction and specializes in legal, regulatory and policy work related to addiction prevention and treatment with a focus on health care system reform. Sarah is the associate director of adolescent and family research at Center on Addiction. Her work is focused on evaluating the implementation of empirically-supported interventions for substance use and co-occurring mental health and family risk in usual care settings. In addition, a primary focus of her work is on developing and testing strategies for improving access to quality substance use and mental health treatment for pregnant and postpartum women. You can find the Vice article we discussed about Melissa here. You can find the data on policies surrounding pregnant women and substance use disorders that we discussed here. Be sure to go back in your feed or click here and here for the first two shows in this series featuring a program providing SUDs care to pregnant women at Lynn Community Health Center. Please tweet us @RoSPodcast or @HMSPrimarycare, or send us an email with comments and suggestions at contact@rospod.org. Thanks for listening!

Our guest this week is Dr. Mark Friedberg. Mark is a senior physician policy researcher at the RAND corporation and a practicing primary care physician at Brigham and Women’s Hospital, where he trained in primary care after attending medical school at Harvard. RAND is a non-profit, non-partisan research organization that develops solutions to public policy challenges to make communities healthier and more prosperous. Mark’s research covers a range of topics but focuses in particular on quality measurement and pay for performance. He joins us today to talk about his work, and in particular an exhaustive report he recently published with colleagues from RAND and also the AMA, looking at the effects of alternative payment models on the practice of medicine in the US, a follow up study from work initially done in 2014. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. Follow Mark and Audrey on twitter, and tweet your feedback and suggestions to us at Review of Systems. Or, you can email me at contactATrospod.org. Thanks for listening!

In this reprise series on the care of pregnant women with substance use disorders, Landrey Fagan and Pat Lee join us to talk about their experience forming their team called the Sunflower team at Lynn Community Health Center, which provides full-spectrum care for women suffering from SUDs during and after pregnancy in an effort to reduce stigma, reduce fragmentation of care, and keep women engaged in care throughout their pregnancy, delivery, and in the post-partum period. They developed this care program while participating in the Harvard Center for Primary Care’s Advancing Teams in Community Health program. Landrey Milton Fagan, MD is a board-certified Family Physician who provides full spectrum family care including surgical obstetrics. She has been working at Lynn Community Health Center in Lynn, MA for the past six years and has recently relocated to Boulder, Colorado where she will be joining Salud Family Medical Center in nearby Longmont. Patrick Lee, MD is Chair of Medicine at North Shore Medical Center in Salem, MA and Assistant Professor of Medicine at Harvard Medical School. He has dedicated his career to solving two problems: helping individuals and teams reach their fullest potential, and creating health systems that deliver the safe, kind, and timely care that patients deserve. Dr. Lee believes “the secret of quality is love” and tries to deepen his understanding of, and align his daily actions to, this essential lesson.

In this reprise series on the care of pregnant women with substance use disorders, Landrey Fagan and Pat Lee join us to talk about their experience forming their team called the Sunflower team at Lynn Community Health Center, which provides full-spectrum care for women suffering from SUDs during and after pregnancy in an effort to reduce stigma, reduce fragmentation of care, and keep women engaged in care throughout their pregnancy, delivery, and in the post-partum period. They developed this care program while participating in the Harvard Center for Primary Care’s Advancing Teams in Community Health program. Landrey Milton Fagan, MD is a board-certified Family Physician who provides full spectrum family care including surgical obstetrics. She has been working at Lynn Community Health Center in Lynn, MA for the past six years and has recently relocated to Boulder, Colorado where she will be joining Salud Family Medical Center in nearby Longmont. Patrick Lee, MD is Chair of Medicine at North Shore Medical Center in Salem, MA and Assistant Professor of Medicine at Harvard Medical School. He has dedicated his career to solving two problems: helping individuals and teams reach their fullest potential, and creating health systems that deliver the safe, kind, and timely care that patients deserve. Dr. Lee believes “the secret of quality is love” and tries to deepen his understanding of, and align his daily actions to, this essential lesson.

As everyone in primary care knows, oral health care in the US can be very difficult to access. Tien Jiang, DMD MEd, an instructor of oral health policy and epidemiology at Harvard School of Dental Medicine and Christine Riedy, PhD MPH a researcher with the Center for the Integration of Primary Care and Oral Health, or CIPCOH, and the Delta Dental Associate Professor of Oral Health Policy and Epidemiology at the Harvard School of Dental Medicine join us today to talk about their work at CIPCOH, their research, and their vision of oral health and primary care integration. If you are interested in oral health and missed it previously, have a listen to Audrey talk with Mary Otto, a healthcare journalist who published a book about oral health in the US called Teeth. If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @rospodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audreyATrospod.org. We’d love to hear from you, and thanks for listening.

These days, primary care is all about teamwork. We are all asking ourselves – how can we make our teams function better? And – a question we should ask, but often don’t: should this task be done by the team? Or is this task actually better understood as sequential interdependence or pooled interdependence? Our guests this week and last, Ann O’Malley and Patricia Satterstrom, join us for the second of a two week series about teams and can help us start to answer some of those questions. If you missed last week’s show, go back in your feed and listen to the first. Patricia, who goes by Pat, is an Assistant Professor at the NYU Wagner Graduate School of Public Service and an affiliate of the Management and Organizations Department at the NYU School of Business and she studies how to enable team members to collaborate despite power differences arising from professional and demographic boundaries, and how to facilitate improved collaboration in health care organizations. Ann O’Malley is a physician and a Senior Fellow with Mathematica Policy research. Her work focuses on quality of care and primary care, and part of her research, which we focus on in the show involves qualitative interviews with primary care stakeholders on teamwork. You can find the qualitative study we discussed at length on the show here; some of Pat Satterstrom’s publications here; here is the Bodenheimer and Ghorob paper Ann referenced putting forward pillars for teamwork in primary care; and here is the paper from Dr. Sam Edwards showing that delegating some tasks from PCPs reduced burnout in PCPs but increased burnout in nurses. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We love to hearing from you, so please tweet at us @RoSpodcast or @HMSPrimaryCare – we got some great comments from folks on twitter about teamwork that we are including in this series – so thank you to everyone who commented! Or you can drop me a line at contact@rospod.org.

These days, primary care is all about teamwork. We are all asking ourselves – how can we make our teams function better? And – a question we should ask, but often don’t: should this task be done by the team? Or is this task actually better understood as sequential interdependence or pooled interdependence? Our guests this week and next, Ann O’Malley and Patricia Satterstrom, join us for a two week series about teams and can help us start to answer some of those questions. Patricia, who goes by Pat, is an Assistant Professor at the NYU Wagner Graduate School of Public Service and an affiliate of the Management and Organizations Department at the NYU School of Business and she studies how to enable team members to collaborate despite power differences arising from professional and demographic boundaries, and how to facilitate improved collaboration in health care organizations. Ann O’Malley is a physician and a Senior Fellow with Mathematica Policy research. Her work focuses on quality of care and primary care, and part of her research, which we focus on in the show involves qualitative interviews with primary care stakeholders on teamwork. You can find the qualitative study we discussed at length on the show here; some of Pat Satterstrom’s publications here; here is the Bodenheimer and Ghorob paper Ann referenced putting forward pillars for teamwork in primary care; and here is the paper from Dr. Sam Edwards showing that delegating some tasks from PCPs reduced burnout in PCPs but increased burnout in nurses. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We love to hearing from you, so please tweet at us @RoSpodcast or @HMSPrimaryCare – we got some great comments from folks on twitter about teamwork that we are including in this series – so thank you to everyone who commented! Or you can drop me a line at contact@rospod.org.

Dr. Nicolas Nguyen is our guest this week. Dr. Nguyen is a practicing Family Physician and the Director of Physician Experience and Provider Development at Beth Israel Deaconess HealthCare. He has created a model for clinician community building, which was highlighted and published in NEJM Catalyst, and he joins us to talk about his initiative. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @audreymdmph, or drop me a line at contactATrospod.org.

This week, Michelle Kondo and Eugenia South join us to talk about their research looking at how neighborhood contexts impact health and safety in urban environments, and their recent publication in JAMA Network Open looking at the relationship between neighborhood greening and mental health. Dr. South and Dr. Kondo collaborate from two different perspectives – Dr. South is an emergency physician and health services researcher at UPenn; and Dr. Kondo is a PhD research social scientist with the USDA-Forest Service, Philadelphia Field Station. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop me a line at contactATrospod.org.

This week, Thomas, Audrey, and David bring you a journal club featuring discussion of three recent papers: Fatal and Nonfatal Overdose Among Pregnant and Postpartum Women in Massachusetts by Davida M Shiff, Timothy Nielsen, Mishka Terplan, Malena Hood, Dana Bernson, Hafsato Diop, Monica Bharel, Timothy Wilens, Marc LaRochelle, Alexander Walley, and Thomas Land; Changes in midlife death rates across racial and ethnic groups in the United States: systematic analysis of vital statistics by Steven H Woolf, Derek Chapman, Jeanine Buchanich, Kendra Bobby, Emily Zimmerman, and Sarah Blackburn; and Association of Medical Scribes in Primary care with physician workflow and patient experience by Pranita Mishra, Jacquelin Kiang and Richard Grant. Links for our pearls: amazing fish and an excellent commentary from John Frey on loneliness.

For the second show in our series about gun violence, we are joined by Dr. Mark Rosenberg. Dr. Rosenberg worked for many years at the CDC, and helped to found the National Center for Injury Prevention and Control, or the NCIPC, and was it’s first permanent director in 1994. He oversaw the agency during the now-notorious hearings about findings of firearms research that at the time was funded by the NCIPC, and the later passage of the Dickey Amendment in 1996, which prevented the CDC from using funding to advocate or promote gun control. He tells us all about that time in his life, and his later surprising friendship with his foe at that time, Arkansas Congressman Jay Dickey. Dr. Rosenberg is now the president and CEO of the Task Force for Global Health. You can find the op-ed that Dr. Rosenberg wrote with Jay Dickey calling for restoration of funding specifically to examine gun violence research here. Last week, we spoke with student leaders who organized an op-ed writing contest for health professionals students on gun violence, and talked about advocacy as health professionals and with the winner of the contest, Mike Rose. You can find that show here. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contact@rospod.org.

This week, our guests are Sarah Dauber, Ph.D & Lindsey Vuolo JD, MPH of Center on Addiction, a science-based non-profit, non-partisan organization dedicated to finding and promoting solutions to end addiction. They join us to discuss policies that affect how pregnant women with substance use disorders may or may not access care and how we can better align policy with evidence-based care of women with substance use disorders. Lindsey is the associate director of health law and policy at Center on Addiction and specializes in legal, regulatory and policy work related to addiction prevention and treatment with a focus on health care system reform. Sarah is the associate director of adolescent and family research at Center on Addiction. Her work is focused on evaluating the implementation of empirically-supported interventions for substance use and co-occurring mental health and family risk in usual care settings. In addition, a primary focus of her work is on developing and testing strategies for improving access to quality substance use and mental health treatment for pregnant and postpartum women. You can find the Vice article we discussed about Melissa here. You can find the data on policies surrounding pregnant women and substance use disorders here. Be sure to go back in your feed or click here and here for the first two shows in this series featuring a program providing SUDs care to pregnant women at Lynn Community Health Center. Please tweet us @RoSPodcast or @HMSPrimarycare, or send us an email with comments and suggestions at contact@rospod.org. Thanks for listening!

In the second of our series on the care of pregnant women with substance use disorders, Landrey Fagan and Pat Lee join us to talk about the hard work that went into forming the Sunflower team at Lynn Community Health Center. The Sunflower Team provides full-spectrum care for women suffering from SUDs during and after pregnancy in an effort to reduce stigma, reduce fragmentation of care, and keep women engaged in care throughout their pregnancy, delivery, and in the post-partum period. Landrey Milton Fagan, MD is a board-certified Family Physician who provides full spectrum family care including surgical obstetrics. She has been working at Lynn Community Health Center in Lynn, MA for the past six years and has recently relocated to Boulder, Colorado where she will be joining Salud Family Medical Center in nearby Longmont. Patrick Lee, MD is Chair of Medicine at North Shore Medical Center in Salem, MA and Assistant Professor of Medicine at Harvard Medical School. He has dedicated his career to solving two problems: helping individuals and teams reach their fullest potential, and creating health systems that deliver the safe, kind, and timely care that patients deserve. Dr. Lee believes “the secret of quality is love” and tries to deepen his understanding of, and align his daily actions to, this essential lesson.

In the first of our series on the care of pregnant women with substance use disorders, Landrey Fagan and Pat Lee join us to talk about their experience forming their team called the Sunflower team at Lynn Community Health Center, which provides full-spectrum care for women suffering from SUDs during and after pregnancy in an effort to reduce stigma, reduce fragmentation of care, and keep women engaged in care throughout their pregnancy, delivery, and in the post-partum period. Landrey Milton Fagan, MD is a board-certified Family Physician who provides full spectrum family care including surgical obstetrics. She has been working at Lynn Community Health Center in Lynn, MA for the past six years and has recently relocated to Boulder, Colorado where she will be joining Salud Family Medical Center in nearby Longmont. Patrick Lee, MD is Chair of Medicine at North Shore Medical Center in Salem, MA and Assistant Professor of Medicine at Harvard Medical School. He has dedicated his career to solving two problems: helping individuals and teams reach their fullest potential, and creating health systems that deliver the safe, kind, and timely care that patients deserve. Dr. Lee believes “the secret of quality is love” and tries to deepen his understanding of, and align his daily actions to, this essential lesson.

Shari Erickson, MPH is our guest this week. She with us about the proposed rules recently released by CMS that would drastically change how physicians bill, especially in primary care, how these proposed changes could help decrease administrative burdens on physicians, and where ACP, the largest physician advocacy organization in the US, landed on these policy proposals. Shari is the VP of Governmental Affairs and Medical Practice with the American College of Physicians (ACP). Among other things, Shari manages ACP’s overall advocacy and policy initiatives relating to federal regulatory agencies, including HHS, CMS, CMMI, and other federal bodies. Click here for ACP’s statement on the proposed billing rule changes, and the rules overall. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or @audreymdmph or drop me a line at contact@rospod.org.

Asaf Bitton MD, MPH is our guest this week. Asaf talks with us about what he sees as crucial steps in improving primary care in the US and what we can learn from primary care systems globally, particularly drawing on a recent healthcare system reform in Costa Rica which he wrote about last year in Health Affairs. We also talk about a noteworthy editorial he wrote in the Annals of Family Medicine laying out what he sees as a path forward in primary care, with parsimony and also being clear-eyed about the limits of current capitation efforts. Dr. Bitton is the Director of Primary Health Care at Ariadne Labs where he leads the Primary Health Care Performance Initiative, a joint effort with the Bill and Melinda Gates Foundation, The World Bank, the World Health Organization, and The Results for Development Institute. He is also a senior advisor to the Center for Medicare and Medicaid Innovation (CMMI) on their Comprehensive Primary Care Plus initiative. He practices primary care in the Boston area. We love to hear from our listeners, so please tweet us @RoSPodcast or @HMSPrimary care, leave us a message on facebook, or send us an email with comments and suggestions at contact@rospod.org. Thanks for listening! Audio Player

This week, Drs. Sonja Solomon, Krisda Chaiyachati, and John Moriarty join us to discuss a paper they published in JGIM in 2016 entitled Why Aren’t More Primary Care Residents Going into Primary Care? A Qualitative Study. They interviewed residents from three primary care internal medicine programs across the country to better understand what factors within primary care training programs may influence the residents’ career choices. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contact@rospod.org.

This week, Ted Long, the VP for Primary Care at NYC Health + Hospitals joins us to talk about how we can make primary care better for patients and for physicians at various levels of scale. He previously served as the Senior Medical Officer for the Quality Measurement and Value-Based Incentives Group at the Centers for Medicare and Medicaid Services, which covers over 20 federal programs including the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Hospital Readmission Reduction Program, and the Hospital Value-Based Purchasing Program. Earlier, he served as Medical Director at the Rhode Island State Department of Health. He is a practicing primary care physician and is also on the faculty at the Harvard Medical School Center for Primary Care. We love to hear from our listeners, so please tweet us @RoSPodcast or @HMSPrimaryCare, or send us an email with comments and suggestions at contact@rospod.org. Thanks for listening!

This week, we have two very exciting guests: Shreya Kangovi, an internist/pediatrician and researcher who studies CHW interventions and developed a multi-stakeholder team-based CHW model called IMPaCT (Individualized Management towards Patient-Centered Targets), and went on to found the Penn Center for Community Health Workers. These organizations work to deliver care to patients in Philadelphia, provide training and capacity building, as well as performing ongoing research. Our second guest, Lisa Kidd, is a CHW who works at the Penn Center and will join us to talk about her experiences as a CHW. You can find some of Dr. Kangovi’s publications here. If you enjoy the show, please rate and review us wherever you find us, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contactATrospod.org.

Dr. Scott Stonington is a medical and cultural anthropologist, and an internist. He studies decision-making at the end of life in Thailand and spent many years accompanying Thai patients at the end of life and in particular trying to understand pain, suffering, and the role of pain medications from these patient’s points of view. Dr. Stonington also studies medical epistemology in the U.S., specifically looking at how health practitioners decide what constitutes true and/or useful knowledge and how this affects patients. Please read his Perspective in the New England Journal of Medicine about the concept of the debt of life, The Debt of Life – Thai Lessons on a Process-Oriented Ethical Logic, and his article in JAMA entitled Whose Autonomy?, a meditation on how he thinks about decision-making, pain, and pain control. In addition, he wrote further about how his work in Thailand has changed his thought process on pain in The (f)utility of pain, published in the Lancet. Also, a quick note that the day we recorded this show I was still recovering from an upper respiratory infection and you can hear me coughing which is distracting so I apologize about that. If you enjoy the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast or @HMSprimarycare and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audreyATrospod.org. We’d love to hear from you, and thanks for listening.

Elisabeth Rosenthal is a physician and a noted writer and Editor In Chief of Kaiser Health News. She recently published An American Sickness, a book exploring how the business of medicine has gotten in the way of doctors delivering great care to patients and made the system increasingly complex and expensive for patients to navigate. She joins us this week! If you enjoy the show, please rate, review & subscribe to us wherever you listen. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contact@rospod.org.

Our society is coming to a reckoning with how we treat women, and medicine has it’s own reckoning too. This week, we have two guests: Nwando Olayiwola, a family physician, corporate leader, researcher, and author; and Elisabeth Poorman, an internist, speaker, and writer. First, we’ll speak with Dr. Poorman about an article she published in The Guardian about the challenges that women physicians face. We also discuss a paper published by Mark Linzer and Eileen Harwood in JGIM on what particular challenges women face in practicing medicine owing to different expectations of male and female physicians; and the importance of understanding and distinguishing sympathy, empathy, and compassion. Then, we’ll talk with Dr. Olayiwola about an organization she started, Society for Women Minority Professionals, to respond to the specific challenges that she and other minority professional women face. We also talk about imposter syndrome, a feeling so many qualified and successful women can identify with, recently written about in NEJM by Dr. Suzanne Koven. Lastly, Dr. Olayiwola shares with us some experiences of discrimination she experienced in her life and wrote about in her new book, Papaya Head. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contact@rospod.org.

Primary care practices across the US are starting to change the way we practice, incorporating more non-visit types of care such as e-visits or telephonic or even skype visits. Adding these modalities to a practice require investment: in technology, in training staff, in developing, testing, and implementing workflows – and at what point does all of this become financially sustainable? What is the question that Drs. Sanjay Basu and Bruce Landon, along with colleagues Russ Phillips, Zirui Song, and Asaf Bitton set out to look at in their 2017 Health Affairs paper entitled: High Levels Of Capitation Payments Needed To Shift Primary Care Toward Proactive Team And Non-visit Care. Sanjay and Bruce join us today to talk about their research question and their findings. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contactATrospod.org.

This week, Review of Systems joins forces with Harvard Chan This Week in Health for a crossover podcast episode! We’re talking about food stamps, or SNAP, and how upcoming legislation in the Farm Bill will shape SNAP policy over the next five years. Changes in SNAP policy will have important public health implications and affect the food insecure patients we see in our clinics in primary care – so it’s a perfect topic for us to examine together. Audrey Provenzano and Noah Leavitt, the host of Harvard Chan This Week in Health talk with our two guests for this week: Sara Bleich, who is a Professor of Public Health Policy at the Harvard T.H. Chan School of Public Health in the Department of Health Policy and Management. She is also the Carol K. Pforzheimer Professor at the Radcliffe Institute for Advanced Study and is an expert in obesity and food policy; and Hilary Seligman, who is a primary care physician and Associate Professor of Medicine and of Epidemiology and Biostatistics, UCSF. She is also a Senior Medical Advisor for Feeding America, Director of CDC’s Nutrition and Obesity Policy Research and Evaluation Network and the founder of EatSF: A Healthy Food Voucher Program for Low-Income Residents of San Francisco. If you enjoy the show, please rate, review & subscribe to both of our shows wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or @HarvardChanSPH.

There is a growing recognition of the role of trauma, particularly childhood trauma or adverse childhood events on health and health outcomes. Family physician Audrey Stillerman joins Thomas Kim for a two-part series about ACEs and the effects they have on health, and what we as health professionals should know about them. Dr. Stillerman is the Associate Director of Medical Affairs for the University of Illinois Office of Community Engagement and Neighborhood Health Partnerships and the medical director for the School Health Center Program at UI Health as well as at PCC Steinmetz. She is a Clinical Assistant Professor in the UIC Department of Family Medicine. She is board-certified in both Family Medicine and Integrative Medicine; since 1991 she has been providing comprehensive care for the whole family, from babies to senior citizens Dr. Stillerman serves as a steering committee member of the Illinois ACEs Response Collaborative and co-chair of its Health Committee as well as a co-investigator for a multi-site primary care ACE screening project. She is a founding member of the Center for the Collaborative Study of Trauma, Health Equity, and Neurobiology (THEN). She has recommended the following resources for further reading: SAMHSA’s 4 R’s of trauma-informed approached: https://www.samhsa.gov/nctic/trauma-interventions Center for Health Care Strategies 10 key ingredients: https://www.chcs.org/resource/10-key-ingredients-trauma-informed-care/ RWJ Self-Healing Communities: https://www.rwjf.org/en/library/research/2016/06/self-healing-communities.html Center for Center for Collaborative Study of Trauma, Health Equity and Neurobiology (THEN) – www.thencenter.org ACEs Too High: https://acestoohigh.com/ ACEs Connection: https://www.acesconnection.com/ If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show. You can write to us at contact@rospod.org or tweet us @RoSpodcast, or leave a message on our facebook page at facebook.com/reviewofsystems.

There is a growing recognition of the role of trauma, particularly childhood trauma or adverse childhood events on health and health outcomes. Family physician Audrey Stillerman joins Thomas Kim for a two-part series about ACEs and the effects they have on health, and what we as health professionals should know about them. Dr. Stillerman is the Associate Director of Medical Affairs for the University of Illinois Office of Community Engagement and Neighborhood Health Partnerships and the medical director for the School Health Center Program at UI Health as well as at PCC Steinmetz. She is a Clinical Assistant Professor in the UIC Department of Family Medicine. She is board-certified in both Family Medicine and Integrative Medicine; since 1991 she has been providing comprehensive care for the whole family, from babies to senior citizens Dr. Stillerman serves as a steering committee member of the Illinois ACEs Response Collaborative and co-chair of its Health Committee as well as a co-investigator for a multi-site primary care ACE screening project. She is a founding member of the Center for the Collaborative Study of Trauma, Health Equity, and Neurobiology (THEN). She has recommended the following resources for further reading: SAMHSA’s 4 R’s of trauma-informed approached: https://www.samhsa.gov/nctic/trauma-interventions Center for Health Care Strategies 10 key ingredients: https://www.chcs.org/resource/10-key-ingredients-trauma-informed-care/ RWJ Self-Healing Communities: https://www.rwjf.org/en/library/research/2016/06/self-healing-communities.html Center for Center for Collaborative Study of Trauma, Health Equity and Neurobiology (THEN) – www.thencenter.org ACEs Too High: https://acestoohigh.com/ ACEs Connection: https://www.acesconnection.com/ If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show. You can write to us at contact@rospod.org or tweet us @RoSpodcast, or leave a message on our facebook page at facebook.com/reviewofsystems.

All of us like to think that we provide high-value care for our patients; but the truth is, just like the rest of the health care system, primary care provides a lot of low value care too – and we drive a lot of overuse. John Mafi joins us this week to talk about his leading research into these thorny, complex issues. We talk about the definitions of high-value and low value care, his 2016 study in Annals of Internal Medicine examining rates of high and low value care among physicians, NPs, and PAs in the primary care setting, how practice setting may drive high and low value care, and the essential truth that there is no free lunch in trying to solve some of the challenges in fixing primary care in the US. You can find more of John’s research here. If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @rospodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.

Our guests this week and last, Ann O’Malley and Patricia Satterstrom, join us for the second of a two week series about teams and can help us start to answer some of those questions. If you missed last week’s show, go back in your feed and listen to the first. Patricia, who goes by Pat, is an Assistant Professor at the NYU Wagner Graduate School of Public Service and an affiliate of the Management and Organizations Department at the NYU School of Business and she studies how to enable team members to collaborate despite power differences arising from professional and demographic boundaries, and how to facilitate improved collaboration in health care organizations. Ann O’Malley is a physician and a Senior Fellow with Mathematica Policy research. Her work focuses on quality of care and primary care, and part of her research, which we focus on in the show involves qualitative interviews with primary care stakeholders on teamwork. You can find the qualitative study we discussed at length on the show here; some of Pat Satterstrom’s publications here; here is the Bodenheimer and Ghorob paper Ann referenced putting forward pillars for teamwork in primary care; and here is the paper from Dr. Sam Edwards showing that delegating some tasks from PCPs reduced burnout in PCPs but increased burnout in nurses. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We love to hearing from you, so please tweet at us @RoSpodcast or @HMSPrimaryCare – we got some great comments from folks on twitter about teamwork that we are including in this series – so thank you to everyone who commented! Or you can drop me a line at contact@rospod.org.

Our guests this week and next, Ann O’Malley and Patricia Satterstrom, join us for a two week series about teams and can help us start to answer some of those questions. Patricia, who goes by Pat, is an Assistant Professor at the NYU Wagner Graduate School of Public Service and an affiliate of the Management and Organizations Department at the NYU School of Business and she studies how to enable team members to collaborate despite power differences arising from professional and demographic boundaries, and how to facilitate improved collaboration in health care organizations. Ann O’Malley is a physician and a Senior Fellow with Mathematica Policy research. Her work focuses on quality of care and primary care, and part of her research, which we focus on in the show involves qualitative interviews with primary care stakeholders on teamwork. You can find the qualitative study we discussed at length on the show here; some of Pat Satterstrom’s publications here; here is the Bodenheimer and Ghorob paper Ann referenced putting forward pillars for teamwork in primary care; and here is the paper from Dr. Sam Edwards showing that delegating some tasks from PCPs reduced burnout in PCPs but increased burnout in nurses. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We love to hearing from you, so please tweet at us @RoSpodcast or @HMSPrimaryCare – we got some great comments from folks on twitter about teamwork that we are including in this series – so thank you to everyone who commented! Or you can drop me a line at contact@rospod.org.

For the second show in our series about gun violence, we are joined by Dr. Mark Rosenberg. Dr. Rosenberg worked for many years at the CDC, and helped to found the National Center for Injury Prevention and Control, or the NCIPC, and was it’s first permanent director in 1994. He oversaw the agency during the now-notorious hearings about findings of firearms research that at the time was funded by the NCIPC, and the later passage of the Dickey Amendment in 1996, which prevented the CDC from using funding to advocate or promote gun control. He tells us all about that time in his life, and his later surprising friendship with his foe at that time, Arkansas Congressman Jay Dickey.Dr. Rosenberg is now the president and CEO of the Task Force for Global Health. You can find the op-ed that Dr. Rosenberg wrote with Jay Dicky calling for restoration of funding specifically to examine gun violence research here. Last week, we spoke with student leaders who organized an op-ed writing contest for health professionals students on gun violence, and talked about advocacy as health professionals and with the winner of the contest, Mike Rose. Go back in your feed to hear that show. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contact@rospod.org.

This week, we have several guests. Joining us now are members of the HMS center for primary care student leadership committee, Galina Gheihman, Megan Townsend, and Andreas Mitchell. With the recent national focus on gun violence, the leadership council decided to hold an op-ed contest on the issue of gun violence. They are joining us today to talk about the contest with the winner, Mike Rose, and the students’ work on this important public health issue, and opportunities for advocacy as health professionals. Take a moment to read Mike’s winning op-ed, Do we love ducks more than we love children? Be sure to tune in next week to hear from Dr. Mark Rosenberg about his time as Director of the National Center for Injury Prevention and Control, his thoughts on the Dickey Amendment, and his unlikely friendship with Congressman Jay Dickey. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contact@rospod.org.

How many times have you treated a dental infection in your primary care office, or spent 10 minutes after a visit googling a dentist that takes your patient’s insurance? We’ve all done it too many times. There is an epidemic of dental disease in the United States – dental care is expensive and difficult to access. Mary Otto, a journalist, author, and our guest this week, has written a book called Teeth. In it, Mary explores the oral health crisis and explains its wide-reaching effects, such as decreased social mobility and fewer opportunities for employment; also, she talks about how oral health has become so segmented apart from the rest of the healthcare system and what can be done about it. Click here to find more information about Mary Otto, winner of The Studs and Ida Terkel Award, which is dedicated to supporting authors who are committed to exploring aspects of American life that are not adequately represented by the mainstream media. You can find more information about Teeth here. You can find many of Mary’s articles here. If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @rospodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.

We spend lots of our time in medicine communicating through research – standardized, peer-reviewed, and of course crucial! But medicine is full of compelling humanistic narratives. The great Marshall Ganz once wrote, in an article entitled “Why Stories Matter,” that “A story communicates fear, hope, and anxiety, and because we can feel it, we get the moral not just as a concept, but as a teaching of our hearts. That’s the power of story.” This week, we focus on narrative medicine and we are joined by a master physician storyteller, Daniela Lamas, who just published her first book, called You Can Stop Humming Now: A Doctor’s Stories of Life, Death, and In Between. Also, we want to hear from you! To entice you to talk to us, we are going to give away a signed copy of Daniela’s book to a randomly selected commenter or emailer who sends us feedback, suggestions, or comments! You can write to us at audreyATrospod.org or tweet us @RoSpodcast or @HMSPrimaryCare, or leave a message on our facebook page. Just write to us or tweet at us or leave a facebook comment or email us, and your name will go into the hat for a random drawing. We’ll announce the randomly drawn winner next week!

As everyone in primary care tries to shift to team based models of care, task shift, and deliver value rather than volume, we are all looking at staffing and workforce issues. What is the best way to staff a clinic? Should we hire more MAs or LPNs or nurses or NPs? How should we think about these decisions? Our guest today to talk about workforce is Bianca Frogner, PhD. Dr. Frogner is an Associate Professor and health economist in the Department of Family Medicine in University of Washington’s School of Medicine. Dr. Frogner is also the Director of the Center for Health Workforce Studies. She publishes extensively about workforce issues, particularly in the community health center setting. You can find many of her publications here. If you enjoy the show, please rate and review us wherever you find us, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop us a line at contactATrospod.org.