Journal of general internal medicine
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This JGIM Perspective discusses new and emerging challenges with accessing controversial medical therapies like medical aid in dying and abortion. While some states permit these therapies for only their residents, other states prohibit these therapies for their own residents. We summarize recent developments and growing challenges for clinicians treating "medical tourism" patients from other jurisdictions.
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Academic clinician-educators who teach health professions trainees and lead educational programs have been penalized by the mismatch between their daily contributions to the academic mission and traditional promotion criteria focused on peer-reviewed publications and external reputation. Despite two decades of incremental approaches, inconsistency and inequity persist in the promotion process for clinician-educators. ⋯ Achieving meaningful change requires transforming entrenched traditions and policies at multiple levels. Changes that advance equity are necessary to retain academic faculty members who train the next generation of health professionals.
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Diagnostic schemas are frameworks that depict organized clinical knowledge and serve as a bridge between problem representation and differential diagnosis generation. Schema-based problem solving is increasingly used among clinician educators and is widely featured in digital media. We examine the origins of schemas and their theoretical background, review existing literature on their applications in medicine, and explore their utility for learners and teachers.
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In modern primary care practice, clinicians face increasing volumes of asynchronous, electronic, non-visit care (NVC). Systems for completing this work, however, remain under-developed and often lack definition around patient and practice expectations for work completion and team member contributions. ⋯ Herein, we propose that primary care practices take an intentional, holistic approach to managing systems of NVC and offer a conceptual model for managing NVC work, analogizing the flow of these tasks to the flow of water through a river system: (1) by carefully controlling the inputs into the NVC system (the tributaries entering the river system); (2) by carefully defining the workflows, roles and responsibilities for completion of common tasks (the direction of river flow); (3) by improving the interface of the electronic health record (obstacles encountered in the river); and (4) by optimizing effectiveness of primary care teams (the contours of the river determining rate of flow). This framework for managing NVC, viewed from a broader system perspective, has the potential to improve productivity, quality of care, and clinician work experience.
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Editorial
A Roadmap for Modifying Clinician Behavior to Improve the Detection of Cognitive Impairment.
A staggering number of individuals live with cognitive decline. Primary care providers are ideally situated to detect the first signs of cognitive decline, but many persons remain undiagnosed. ⋯ There is a great need for interventions to address this problem. This article applies an implementation science framework, the Behavioral Change Wheel, to evaluate the factors that influence detection of cognitive impairment in primary care and proposes candidate interventions for future study.