CHA Family Medicine Residency

Tufts family medicine residents have "the best of both worlds"


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TUFMR at the Boston Marathon

On Patriot’s Day several of our teaching faculty volunteered for the Boston Marathon with current and former residents. Former resident Nathan Cardoos is currently at UMass doing a sports medicine fellowship and current PGY2 resident Sam Hwu is applying for sports medicine fellowship. Jess Knapp is our new sports medicine faculty member from UConn and this was her second year volunteering at the marathon. Nicole O’Connor recently graduated from our family medicine residency and was scooped up to stay on as faculty. This is Nicole’s 3rd year as a volunteer and she ran the marathon in 2011 as well! Our tent was busier than in years past and at one point we reached max capacity and runners were diverted to other finish line tents. Most of the runners were seen for hypothermia due to the running conditions and improved with warm blankets and warm drink. Overall we had fun listening to the stories told by runners and volunteers while patching up our nations athletes.

Boston Strong!

IMG_2132 IMG_2133


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UberDx Chapter 4

So now you know about Overdiagnosis Bias. The answer to Question 1 in Chapter 3 is “False”. In this scenario, screening does not diagnose more cancers, but the numerator and denominator are inflated because of all the false positives and “pseudodisease” screening creates. So it looks like the 10 year survival is better. Have you had to deal with this recently, as CHA has embarked on screening smokers for lung cancer? I certainly have. I really try to engage patients in shared decision-making about that and I basically try to talk them out of it. We know how to prevent lung cancer.

Ok, so take a look at this:

Cancer incidence

 

Can you think if some cancers that fit the A graph: we pick up more aggressive cancers by screening? How about the B graph: we seem to diagnose more, but there is no corresponding increase in number of people dying from the diagnosis? In B we are: 1. Picking up more benign cancers, 2. Simultaneously improving treatment while picking up more cancers, 3. Diagnosing more, maybe earlier, but having no effect on survival.

There aren’t too many good examples of “A”, at least for cancer. Alzheimer’s disease fits the graph pretty well, though. Cervical cancer is actually a good example, but the death rate begins to fall off after time, because we have good interventions.

There are a lot of examples that fit “B”. Prostate cancer. Thyroid cancer. Can you think of any others?


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Match Day 2015!

March 20, 2015

MATCH DAY is an exciting day for all residency programs in the US and for thousands of soon-to-be doctors who learn their “match” for which residency program they will be joining.

We are thrilled to welcome Danielle, Faiz, Jennifer, Matthew, Kanthi, Devorah, Ian and Meera into our Tufts FMR @ CHA family!! (see attached Tufts FMR Interns 2015 pdf or the sidebar of our main page in the media section) This is a diverse and dynamic group of individuals that I’m confident will help us continue to grow as a program and discipline and will be leaders in the “primary care revolution” a flame that we are aggressively fanning.

Cambridge Health Alliance is the last public hospital system in Massachusetts and has a deep social justice mission to meet the needs of our diverse underserved patient population. We know that “nonwhite physicians provide a disproportionate share of care to underserved populations. Hence, increasing the racial and ethnic diversity of the physician workforce may be key to meeting national goals to eliminate health disparities.”For this reason, this year our program adopted a new strategic approach to our recruiting and interview season with a goal of recruiting a higher portion minority residents with diverse racial and ethnic origin. Practicing in Malden, a school district with the most diversity in Massachusetts, we hoped to recruit an intern class with broader diversity that better mirrors the populations we serve. We were wildly successful on this front with five of our eight new interns being underrepresented minorities and bringing language skills in 12 . . . yes, I said 12 languages other than English!

Our clinic has undergone a major expansion in the last year as we aim to double our capacity from 13,000 to 26,000 patients that we care for. The success of the “Massachusetts Healthcare Experiment” has shown us that when people get insured (and 98.2% of Massachusetts is now insured!), they want to use it and get seen, so we’re busier than ever (Monday we had 763 phone calls to our clinic – a new record). With our new cohort of additional faculty, PA’s, nurses, front desk, medical assistants, complex care managers, planned care coordinators and integrated mental health team, our team-based care model is maturing and performing better than ever. It’s thrilling to watch a medical assistant light up and take pride in her ownership for proactively increasing our cancer screening rates through outreach and patient engagement. To make primary care sustainable and successful, it HAS to be a team sport and it’s trilling to watch that transformation take place her at the CHA Malden Family Medicine Center.

Congratulations to us, to our new class, and to all newly matched residents and residency program. It’s a very exciting time of year for all of us, and I can’t wait to get to know and work with our new amazing group of young physicians that will be joining our family at TuftsFMR@CHA!

Onward,
~g

Gregory Sawin MD MPH
Program Director
Tufts University Family Medicine Residency
at Cambridge Health Alliance
www.tuftsfmr.org
Assistant Professor of Family Medicine
Tufts University School of Medicine
Clinical Instructor of Population Medicine
Harvard Medical School


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Referrals to Malden Family Medicine Sports Medicine Clinic

What to do prior to Sports Medicine referral

  1. Work up patient as appropriate with comfort level (labs, imaging etc)
  2. Include previous work up/history (imaging, past providers seen, studies, etc.) in your note
  3. Include chronic pain/medication history
  4. Formulate question you want me to answer

Appropriate referral
Young athlete low back pain
MSK/Sports injury
Injections
Fracture care and casting
Concussion management
Female Athlete issues (disordered eating, pregnancy and exercise, etc)
Exercise Induced Bronchospasm
Athlete with heart issues or risk factors
Exercise Prescription and counseling on Exercise is Medicine
Clearance of Athlete with history of MSK injuries after initial Sports Physical with PCP

Do not refer for
Epidurals
Back pain/Neck pain
Chronic pain
Fibromyalgia
Pain that is not related to joint or muscle
Sciatica
First evaluation after car accident 

Please feel free to curbside Dr Jess Knapp for opinion or help in clinic


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Ancillary Services

 

What: Family Planning and Health Education
Who should come: Patients who want to discuss anything related to sexual or reproductive health.
Some of the services the Health Educator can provide are:
-Starting a birth control method
-Access to emergency contraception (like Plan B)
-Pregnancy testing and pregnancy options counseling
-Sexually transmitted infections testing and prevention information
-Talking about sexuality, sexual identity and gender identity
-Talking about relationships in a safe space
Where: Malden Family Medicine Clinic at 195 Canal St., Malden MA
When: Mondays, Tuesdays and Fridays 9:00-5:00; Wednesday and Thursday 9:00-1:30
Who to contact: If you would like meet with the family planning health educator, please schedule an appointment at the front desk or call 781-338-0500.

 

What: Nutrition counseling provided by a registered dietitian
Who should come (and Why):  Nutrition is an important of a healthy lifestyle.  A registered dietitian works with clients to assess their dietary intake and identify area where change is needed.  Nutrition counseling assists all ages to make and maintain the needed dietary changes, helping to improve overall health. People of all ages with different medical conditions and nutritional questions may benefit from nutrition counseling provided by a registered dietitian.
Where: Malden Family Health Center
When: Wednesday 12pm-6pm, and Thursday 9:30am-4pm
Who to contact (and How): Please call 781-338-0500 to schedule an appointment with the registered dietitian.  All clients, except pregnant women, need a referral from primary care provider.

 

Pharmacotherapy
Hours:
Monday 8:30-12 pm and 1:30-4:30 pm
Tuesday 9am-12 noon and 1:30 to 5 pm
Wednesday 9 am-12pm and 1- 7 pm
Thursday 9 am-12 pm
Friday 8:30 am-12pm and 1pm-4:30 pm
What: anticoagulation, Diabetes, hypertension, cholesterol, asthma and medication management. Extensive patient education on disease state, goals of therapy and medications is provided during appointments.
Who should come (and Why): Any patient who needs help getting blood sugars, cholesterol, blood pressure or asthma under control. Patients who will benefit the most are patients who need help managing their medications, have medication related problems, problems with taking their medications, patients who are taking too many medications or recently discharged from the hospital, reduction of pill burden or problems affording medications.
Where: of Malden Family Medicine Clinic at 195 Canal St., Malden MA
Who to contact (and How): please ask your PCP to refer you or call or call the clinic to speak to Alexandra Santamaria.

 


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Integrative, Complementary and Alternative Medicine

Acupuncture with the New England School of Acupuncture

“Our program is distinguished by its concentration in Japanese Acupuncture Styles (JAS), including Shakuju Therapy, an approach based on non-insertive needling technique. JAS relies on exquisite sensitivity in palpatory techniques, taught by pre-eminent senior faculty from Japan and the United States. Programs are academically rigorous, with a strong core of small-group, hands-on practice of our craft.”
“Chinese Herbal Medicine (CHM) is also distinctive at NESA. Taught by expert herbalists trained in China and the United States. CHM relies on a clinical tradition honed from generations of practitioners. The study of CHM is the task of a lifetime, to manage safe and effective use of traditional Chinese herbs for modern patients.”

 

Integrative Medicine Clinic
What:  One morning a week when patients who are referred are seen by a family physician who is trained in Integrative medicine and osteopathic manipulation techniques (OMT) . These are long appointments so that we can discuss the many factors that may influence your health and well-being.
Who should come (and Why):
– Patients referred by their doctors for a more holistic approach to a problem, Patients who may be interested in using modalities other than conventional medicine, such as herbs or mind-body techniques,
-Patients who could benefit from an osteopathic approach to physical pain or issues like repetitive injuries
Where: at Malden FMC
When: Wednesday mornings
Who to contact (and How): Your doctor can refer you or ask the front desk.

 

Join Dr Randi Wertheimer and Dr Lisa Yeung on a journey towards peace and relaxation by participating in the Malden Family Medicine Center’s Stress Reduction Group. We are all confronted with stress and adversity in our lives, and we offer this group as a way to build resiliency and learn calming and relaxing techniques to improve your happiness and over all well-being. If you are a Malden Family Medicine Center patient, and are experiencing stress in your life, we hope that you will join us every Tuesday starting September 2014 from 9:00-11:00am.

 

CHA Yoga:

When: Monday through Thursday
Time: Early morning, afternoon and evening classes.
Where: Cambridge , Somerville, Whidden, Assembly Square.

Interested in Yoga, but not quite sure if you are ready? Speak with your CHA Provider to learn more and receive your discount code. Your first class is always free. Receive a patient discount for all future classes with a referral from a CHA provider.

 


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Group Visits

What: Living Well with Diabetes! A Group Visit
Who should come: for Patients with Diabetes, English-speaking
This is a new kind of appointment where a group of people meet monthly with a doctor, nutritionist, pharmacist and other staff.  We work together to learn ways to control diabetes through nutrition, exercise, stress reduction and medications.  Members meet as a group and one-on-one with the doctor to address any personal health needs.  We look forward to seeing you at our next meeting! Healthy snacks are provided.
Where: Conference room A/B of Malden Family Medicine Clinic at 195 Canal St., Malden MA
When: Thursday
Who to contact: If you would like to attend, please call 781-338-0500 to RSVP with our front desk staff..

 

What: Patient Advisory Council (PAC)
Who should come (and Why): All patients and family members of patients at MFMC who are interested in collaborating with other patient partners and staff to improve the experience and care provided at Malden are encouraged to contact the PAC.  The group regularly provides feedback to clinic leadership and staff on proposed clinic projects as well as generates new ideas for improvement based.  Some projects currently in process include creating a friendlier and cleaner waiting room, improving the MyChart experience and developing ways to better communicate to patients changes occurring at MFMC.
Where: Malden Family Medicine Center – Conference Room A/B
When: 3rd Wednesday of each month, 6-7:30pm; Dinner is provided!
Who to contact (and How): Please contact the front desk for details.  Member recruitment happens on a yearly basis.

 

What: Wellness group
Who should come (and Why): Any English-speaking adult patient who is interested in being well!  In collaboration with a physician, nutritionist and other Malden patients, we discuss practical healthy eating and exercise strategies for weight loss and overall health.  The group often cooks simple snacks and meals together, engages in low-impact exercise such as walking or yoga (tailored to individual abilities) and sets goals for healthy behaviors.  Gain knowledge, techniques and motivation for healthy living.
Where: MFMC – conference room TBD
When: 1-2 evenings per month
Who to contact (and How): please let the front desk know if you are interested in joining the group.  Enrollment will likely occur for an 8-12 week block.

 

(On hiatus)
Join Dr Randi Wertheimer and Dr Lisa Yeung on a journey towards peace and relaxation by participating in the Malden Family Medicine Center’s Stress Reduction Group. We are all confronted with stress and adversity in our lives, and we offer this group as a way to build resiliency and learn calming and relaxing techniques to improve your happiness and over all well-being. If you are a Malden Family Medicine Center patient, and are experiencing stress in your life, we hope that you will join us every Tuesday starting September 2014 from 9:00-11:00am.