Fall 2017 by California Academy of Family Physicians

VO L . 68 N O. 4 Fa l l 201 7

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ϭϱϮϬ WĂĐŝĮĐ ǀĞŶƵĞ • ^ĂŶ &ƌĂŶĐŝƐĐŽ͕ ĂůŝĨŽƌŶŝĂ ϵϰϭϬϵ • ǁǁǁ͘ĨĂŵŝůǇĚŽĐƐ͘ŽƌŐ WŚŽŶĞ ;ϰϭϱͿ ϯϰϱͲϴϲϲϳ • &Ăǆ ;ϰϭϱͿ ϯϰϱͲϴϲϲϴ • ͲŵĂŝů͗ ĐĂĨƉΛĨĂŵŝůǇĚŽĐƐ͘ŽƌŐ

Officers and Board President DŝĐŚĞůůĞ YƵŝŽŐƵĞ͕ D Immediate Past President >ĞĞ ZĂůƉŚ͕ D Speaker >ŝƐĂ tĂƌĚ͕ D ͕ DW, Vice-Speaker tĂůƚĞƌ DŝůůƐ͕ D Secretary/Treasurer ĂǀŝĚ ĂǌǌŽ͕ D Executive Vice President ^ƵƐĂŶ ,ŽŐĞůĂŶĚ͕ Foundation President ŶƚŚŽŶǇ ŚŽŶŐ͕ D AAFP Delegates :ĞĨĨ >ƵƚŚĞƌ͕ D ĂƌůĂ <ĂŬƵƚĂŶŝ͕ D AAFP Alternates ĂƌŽů ,ĂǀĞŶƐ͕ D :ĂǇ t͘ >ĞĞ͕ D ͕ DW, CMA Delegation ƐŚďǇ tŽůĨĞ͕ D ͕ DW ͕ DW, ; ŚĂŝƌͿ DĂƌŬ ƌĞƐƐŶĞƌ͕ D ^ƵŵĂŶĂ ZĞĚĚǇ͕ D <ĞǀŝŶ ZŽƐƐŝ͕ D >ĂƵƌĞŶ ^ŝŵŽŶ͕ D ͕ DW, &Ğůŝǆ EƵŶĞǌ͕ D ͕ DW,

Staff ^ƵƐĂŶ ,ŽŐĞůĂŶĚ͕

Executive Vice President shogeland@familydocs.org

ŽŶƌĂĚ ŵĞŶƚĂ

Director, Health Policy camenta@familydocs.org

DŽƌŐĂŶ ůĞǀĞůĂŶĚ

Manager, FP-PAC and Membership mcleveland@familydocs.org

:Ğƌƌŝ ĂǀŝƐ͕ , W

Director, CME/CPD jdavis@familydocs.org

ƌŝĂŶ ĞǀŝŶĞ

Manager, Finance bdevine@familydocs.org

ĚĂŵ &ƌĂŶĐŝƐ

Director, Government Affairs afrancis@familydocs.org

^ŚĂŶŶŽŶ 'ŽĞĐŬĞ

Director, Membership and Marketing sgoecke@familydocs.org

WĂŵĞůĂ DĂŶŶ͕ DW,

Program Manager pmann@familydocs.org

^ŽŶŝĂ <ĂŶƚĂŬ͕ DW,

Manager, Medical Practice Affairs skantak@familydocs.org

Looking for a job? 'Ž ƚŽ ǁǁǁ͘ĨƉũŽďƐŽŶůŝŶĞ͘ĐŽŵ YƵĞƐƟŽŶƐ͍ Ăůů ϴϴϴͲϴϴϰͲϴϮϰϮ ĂŶĚ a HEALTHeCAREERS ƌĞƉƌĞƐĞŶƚĂƟǀĞ ǁŝůů ŚĞůƉ ǇŽƵ͘

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Nathan Hitzeman, MD, Editor Shelly Rodrigues, CAE, Managing Editor The California Family Physician is published quarterly by the California Academy of Family Physicians. Opinions are those of the authors and not necessarily those of the members and staff of the CAFP. Non-member subscriptions are $35 per year. Call 415-345-8667 to subscribe.

pcipublishing.com Created by Publishing Concepts, Inc. David Brown, President • dbrown@pcipublishing.com For Advertising info contact Michelle Gilbert • 800.561.4686 ext 120 mgilbert@pcipublishing.com EDITION 24

California Family Physician Fall 2017

California

FAMILY PHYSICIAN s tron g

m edi ci ne

fo r

Cal i for ni a

features Kimberly Duir, MD; Emily Ebert, MD

14 Generational Voices 16 Are You Protected? Tips for CyberSecurity 18 Must Have Apps for Family Physicians

William O. Woo, MD Tipu V. Khan, MD, FAAFP

20 Looking Back at the Meaningful Use EHR Incentive Program

Conrad Amenta

24 Telemedicine and Telehealth in 2017: Innovation, Disruption, and Transformation

Chris Flores, MD and Maricela Fernandez, JD

26 Online Education: Is It Really the Future of learning?

Carol Havens, MD and Shelly Rodrigues, CAE

28 Why You Need to Be on Social Media

Alex Mroszczyk-McDonald, MD

departments 6

Editorial

All Things Digital

President’s Message

Count to Three Alligators!

Nathan Hitzeman, MD Michelle Quiogue, MD, FAAFP

10 Political Pulse

CAFP-Supported Bills are Sitting on the Threshold

Carla Kakutani, MD

12 Membership News

You Are the Best Part of Membership

Shannon Goecke

38 EVP Forum

What Does the Future Hold for ACA?

Susan Hogeland, CAE

&Žƌ ƵƉĐŽŵŝŶŐ D ĂĐƟǀŝƟĞƐ ǀŝƐŝƚ ĨĂŵŝůǇĚŽĐƐ͘ŽƌŐͬĐŵĞ California Family Family Physician Physician Fall Fall 2017 ϮϬϭϳ California

editorial

Nathan Hitzeman, MD

All Things Digital We recognize the heresy of having you read your paper copy of California Family Physician given that our theme is cyber medicine and all things digital. But doesn’t the paper feel ŐŽŽĚ ĂŐĂŝŶƐƚ ǇŽƵƌ ĨŝŶŐĞƌƚŝƉƐ͍ 'Ž ĂŚĞĂĚ͘ ZƵƐƚůĞ ŝƚ͘ ŐŝƚĂƚĞ it a bit. Feel the texture. This is something real. Like a boil erupting pus onto your lab coat or a placenta leaking into the edge of your shoe. Some things can only be appreciated Old School. But like the statistic about spiders, I’m sure that your ĞůĞĐƚƌŽŶŝĐ ĚĞǀŝĐĞ ŝƐ ǁŝƚŚŝŶ ƐĞǀĞƌĂů ĨĞĞƚ ŽĨ ǇŽƵ͕ ŶŽ͍ What kinds of apps are ŽŶ ƚŚĞƌĞ͍ ŝĚ ǇŽƵƌ ŬŝĚƐ ůŽĂĚ ƐŽŵĞ ƚŽŽ͍ ŝĚ ǇŽƵ remember to do that ƋƵŝĨĂǆ ƚŚŝŶŐ͍ KŚ͕ ůĞƚ ŵĞ see if I can set up that account. “Kids, do your ŚŽŵĞǁŽƌŬ ƉůĞĂƐĞ͊͟ KŚ ǁĂŝƚ͕ EĂŶŶĂ ũƵƐƚ sŝďĞƌĞĚ me about her dog Sparky learning to roll over. Then there’s a text from DŝĐŚĞůůĞ ĚŽǁŶ ƚŚĞ ƐƚƌĞĞƚ ǁŽŶĚĞƌŝŶŐ ŝĨ ǁĞ ĐĂŶ ĚŽ a play date soon. What’s ƚŚŝƐ ŶĞǁƐ ĨůĂƐŚ ĂďŽƵƚ ƚŚĞ ĨĂƚďƵƌŐ ŝŶ >ŽŶĚŽŶ͍ ŽŶŐĞĂůĞĚ ĨĂƚ ĂŶĚ ĚŝĂƉĞƌ ǁŝƉĞƐ ĐůŽŐŐŝŶŐ ƐĞǀĞƌĂů ďůŽĐŬƐ ŽĨ ƐĞǁĂŐĞ ůŝŶĞ͍ zƵĐŬ͕ / ďĞƚƚĞƌ ƐƚŽƉ ĨůƵƐŚŝŶŐ ƚŚŽƐĞ ƚŚŝŶŐƐ͘ ͞<ŝĚƐ͕ ŚŽŵĞǁŽƌŬ͊͊͊͟ ŶŽƚŝĐĞ ƚŽ ƵƉŐƌĂĚĞ ŵǇ ƐŽĨƚǁĂƌĞ͘ ŝĚŶ͛ƚ / ĚŽ ƚŚŝƐ ůĂƐƚ ǁĞĞŬ͍ hŚ ŽŚ͕ ƉŽǁĞƌ͛Ɛ ŐĞƚƚŝŶŐ ůŽǁ͘ ĞƚƚĞƌ ƌĞĐŚĂƌŐĞ͘ EŽǁ ǁŚǇ ĚŝĚ / ŐĞƚ ŽŶ ŵǇ ƉŚŽŶĞ ĂŐĂŝŶ͍ KŚ ǇĞĂŚ͕ ƋƵŝĨĂǆ͘ /͛ůů do it later.

increasingly complex digital processes, codes and algorithms. tĞ ĂůŵŽƐƚ ƚĂŬĞ ƚŚĞŵ ĨŽƌ ŐƌĂŶƚĞĚ Žƌ ĂĐĐĞƉƚ ƚŚĂƚ ƚŚĞǇ ǁŝůů be there like the hard ground beneath our next foot fall — that is, until they’re not. dĞĐŚŶŽůŽŐǇ ŝŶ ŵĞĚŝĐŝŶĞ ŚĂƐ ĂůǁĂǇƐ ďĞĞŶ ĞƐƉĞĐŝĂůůǇ ĐůƵŵƐǇ͘ When the product is hands-on care and compassion, three ŝŶ ƚŚĞ ƌŽŽŵ ŽĨƚĞŶ ďĞĐŽŵĞƐ Ă ĐƌŽǁĚ͘ /Ŷ ĨĂĐƚ͕ ƚŚĞ ĐŽŵƉƵƚĞƌ ŝŶ ĐůŝŶŝĐ ŚĂƐ ďĞĐŽŵĞ ƐŽ ƐǇŶŽŶǇŵŽƵƐ ǁŝƚŚ ƉĂƚŝĞŶƚ ĐĂƌĞ͕ ƚŚĂƚ ǁŚĞŶ ƌĞƐŝĚĞŶƚƐ ƉƌĞƐĞŶƚ Ă ĐĂƐĞ ƚŽ ŵĞ ŝŶ ƚŚĞ ƉƌĞĐĞƉƚŽƌ room, they often look at the computer screen – even if nothing’s on it – as if that ǁĞƌĞ ƚŚĞ ƉĂƚŝĞŶƚ ǁĞ͛ƌĞ ƚĂůŬŝŶŐ about. Hey, my eyes are over ŚĞƌĞ͕ ƵĚĚǇ͊ ; dt͕ / ůŽǀĞ ŽƵƌ residents.) Depending on your generational affiliation, you probably use technology to different degrees and for ĚŝĨĨĞƌĞŶƚ ƉƵƌƉŽƐĞƐ͘ DǇ ǁŝĨĞ ǁŽƵůĚŶ͛ƚ ŚĂǀĞ ƚĞǆƚĞĚ ŽŶ ŚĞƌ ƉŚŽŶĞ ǁŚĞŶ ƉƵƐŚŝŶŐ ŽƵƚ ŽƵƌ ĚĂƵŐŚƚĞƌƐ͕ ďƵƚ ŝƚ ǁĂƐ ŽŬ ĨŽƌ ŵǇ ϭϳͲǇĞĂƌͲŽůĚ K ƉĂƚŝĞŶƚ yesterday. My dad can spend ŚŽƵƌƐ ǁĂƚĐŚŝŶŐ ƌĞŐƵůĂƌ ds ǁŚŝĐŚ ŝƐ ŚĂůĨ ĐŽŵŵĞƌĐŝĂůƐ͕ ďƵƚ / ǁŽŶ͛ƚ ǁĂƚĐŚ Ă ƐŚŽǁ ƵŶůĞƐƐ / ĐĂŶ ĨĂƐƚ ĨŽƌǁĂƌĚ ƚŚƌŽƵŐŚ ƚŚĂƚ ƐƚƵĨĨ͘ ,Žǁ ŝŶƚŝŵĂƚĞ ĂƌĞ ǇŽƵ ǁŝƚŚ ǇŽƵƌ ĚĞǀŝĐĞƐ ĂŶĚ ŚĂǀĞ ǇŽƵ ďĞĞŶ ƚĞƐƚĞĚ ůĂƚĞůǇ͍

tĞ ŚŽƉĞ ƚŚŝƐ ŝƐƐƵĞ ǁŝůů ŵĂŬĞ ǇŽƵ ƚŚŝŶŬ ŵŽƌĞ ĂďŽƵƚ ƚŚĞ technology that you use, or could use or shouldn’t be using, ĂŶĚ ŚŽǁ ǇŽƵ ĐĂŶ ŬĞĞƉ ǇŽƵƌ ƚĞĐŚŶŽůŽŐŝĐĂů ŐŽŽĚŝĞƐ ŽƵƚ ŽĨ dĞĐŚŶŽůŽŐǇ ŝƐ ƵƐĞĨƵů͕ ĂŶĚ ŶŽŝƐǇ͘ ,Žǁ ĐĂŶ ǁĞ ŚĂƌŶĞƐƐ ŝƚ͕ ƚŚĞ ƌĞĂĐŚ ŽĨ ĐǇďĞƌƚŚŝĞǀĞƐ͕ ƚƌŽůůĞƌƐ͕ ďŝƚĐŽŝŶ ƉŝƌĂƚĞƐ͕ ĚĂƌŬ ǁĞď ƌĞŐƵůĂƚĞ ŝƚ͕ ŵĂŬĞ ŝƚ ǁŽƌŬ ĨŽƌ ƵƐ ĂŶĚ ŶŽƚ ĂŐĂŝŶƐƚ ƵƐ͍ dŚŝƐ ŝƐ ƚŚĞ ŵŽŶƐƚĞƌƐ͕ ĞƚĐ͘ dĞƌƌŽƌ ŝƐ ŶŽƚ ƚŚĂƚ ĚĞƌĂŶŐĞĚ ĐůŽǁŶ ŝŶ ƚŚĞ ƐƚŽƌŵ ƐƚƌƵŐŐůĞ ŽĨ ϮϭƐƚ ĞŶƚƵƌǇ ŚƵŵĂŶŝƚǇ͘ &Žƌ ĞǀĞƌǇ ϭ͕ϬϬϬ ƉĞŽƉůĞ ĚƌĂŝŶ͘ /ƚ͛Ɛ ƚŚĂƚ ĞǆƚƌĂ ƐǁŝƉĞ ŽĨ ƚŚĞ ƐĐƌĞĞŶ Žƌ ĐůŝĐŬ ŽĨ ƚŚĞ ŵŽƵƐĞ ǁŽƌŬŝŶŐ ŽŶ ŵĂŬŝŶŐ ǇŽƵƌ ĐĂƌ ƐĞůĨͲĚƌŝǀŝŶŐ͕ ƚŚĞƌĞ͛Ɛ ƉƌŽďĂďůǇ ŽŶĞ ƚŚĂƚ ǇŽƵ ƐŚŽƵůĚŶ͛ƚ ŚĂǀĞ ƚĂŬĞŶ͘ zŽƵƌ ŽŶƚƌŽů ƉŽǁĞƌ ŽŶůǇ ƉůĂŶŶŝŶŐ ŚŽǁ ƚŽ ŚŝũĂĐŬ ƚŚĞ ƉƌŽŐƌĂŵŵŝŶŐ ĂŶĚ ŵĂŬĞ ǇŽƵ ĐƌĂƐŚ ŐŽĞƐ ƐŽ ĨĂƌ͊ ŝŶƚŽ Ă ĐƌŽǁĚ͘ tŚĂƚ ĚŽ ǁĞ ĚŽ ŝĨ ƚŚĞ ƉŽǁĞƌ ŐŽĞƐ ŽƵƚ͍ tŚĂƚ ŝĨ ůĂƌŐĞƐƚ ƐŽůĂƌ ĨůĂƌĞ ŝŶ ƌĞĐŽƌĚĞĚ ŚŝƐƚŽƌǇ ŽĨ ϭϴϱϵ Śŝƚ ĂŐĂŝŶ ŝŶ Ok, enough about technology. There’s a reason editors can’t ϮϬϱϵ͍ ůŵŽƐƚ ĞǀĞƌǇƚŚŝŶŐ ǁĞ ĚŽ ĂŶĚ ƚŽƵĐŚ ŝƐ ŶŽǁ ƚŝĞĚ ƚŽ ǁƌŝƚĞ ŵŽƌĞ ƚŚĂŶ ŽŶĞ ƉĂŐĞ͘ /͛ŵ ŐŽŝŶŐ ƉŚŝƐŚŝŶŐ͊

California Family Physician Fall 2017

Seeking Family Medicine Physician (Bilingual-Spanish) at our Novato, California clinic location 32-40 hours per week doing Primary Care, generous benefits, including CME and Sabbatical Program.

PHYSICIANS

Marin Community Clinics is a Federally Qualified Health Center (FQHC), the largest in Marin County. We serve 35,000 patients annually. We offer a multi-clinic network with a wide array of primary care and specialty services. Our mission is to improve the health of our patients and community by providing high quality, cost-effective, culturally sensitive, patient-centered health care.

For more information visit:

www.marinclinics.org

California Family Physician Fall 2017

p r e s i d e n t ’s m e s s a g e

Michelle Quiogue, MD, FAAFP

Count to Three Alligators! /Ŷ ŽƵƌ ǁŽƌůĚ ŽĨ ƌĂƉŝĚůǇ ĐŚĂŶŐŝŶŐ ƚĞĐŚŶŽůŽŐŝĞƐ͕ ǁĞ ŽŌĞŶ ĨŽƌŐĞƚ ŚŽǁ ďƌŝĞĨ ŽƵƌ ƟŵĞ ǁŝƚŚ ƉĞƌƐŽŶĂů ŵŽďŝůĞ ĐŽŵƉƵƚĞƌƐ ŚĂƐ ďĞĞŶ͘ ǀĞŶ ƚŚŽƵŐŚ / ŬŶŽǁ ƚŚĞ ĨĞĞů ŽĨ ĚŝĂůŝŶŐ Ă ƌŽƚĂƌǇ ƉŚŽŶĞ ďĞŶĞĂƚŚ ŵǇ ĮŶŐĞƌƟƉ ĂŶĚ ƚŚĞ ďƵǌǌͲĐƌĂƐŚͲďƵǌǌ ŽĨ ĚŝĂůͲƵƉ ŝŶƚĞƌŶĞƚ͕ / ƐƟůů ŐĞƚ ƋƵŝĐŬůǇ ĨƌƵƐƚƌĂƚĞĚ ǁŚĞŶ ŵǇ ĞůĞĐƚƌŽŶŝĐ ŚĞĂůƚŚ ƌĞĐŽƌĚ ; ,ZͿ ƐƚĂůůƐ ĨŽƌ ƚŚƌĞĞ ƐĞĐŽŶĚƐ͘ Ɛ Ă ŵŽŵĞŶƚ ŽĨ ŵĞĚŝƚĂƟŽŶ͕ / ŚĂǀĞ begun to replace my habit of repeatedly clicking the mouse ǁŚĞŶ ƚŚŝƐ ŚĂƉƉĞŶƐ ĂŶĚ͕ ŝŶƐƚĞĂĚ͕ ƉƵƚ Ă ƉŽƐŝƟǀĞ ƐƉŝŶ ŽŶ ƚŚŝƐ ŝŶĐŽŶǀĞŶŝĞŶĐĞ ďǇ ĐŽƵŶƟŶŐ ŵǇ ďƌĞĂƚŚ͘ Ɛ / ŝŶŚĂůĞ ĂŶĚ ĞǆŚĂůĞ͕ / ƌĂƌĞůǇ ĐŽƵŶƚ ƚŽ ƚŚƌĞĞ ĂůůŝŐĂƚŽƌƐ ůĞƚ ĂůŽŶĞ ĐŽŵƉůĞƚĞ Ă ǁŚŽůĞ ďƌĞĂƚŚ ĐǇĐůĞ͘ ,Žǁ ĐŽƵůĚ ŝƚ ďĞ ƚŚĂƚ ƐƵĐŚ Ă ďƌŝĞĨ ƉĂƵƐĞ ĐŽƵůĚ ĨĞĞů ůŝŬĞ ĞŶĚůĞƐƐ ǁĂƐƚĞĚ ƟŵĞ ĂŶĚ ƉƵƐŚ ŵĞ ƚŽ ƚŚĞ ǀĞƌŐĞ ŽĨ ƚŚƌŽǁŝŶŐ ƐŽŵĞƚŚŝŶŐ Ăƚ ƚŚĞ ĐŽŵƉƵƚĞƌ͍ dŚŝƐ ĐŚĂŶĐĞ ƚŽ ƌĞĐĂůŝďƌĂƚĞ ĞǆƉĞĐƚĂƟŽŶƐ ŝƐ Ă ŐŝŌ͘ ƚ ƚŚĞ &W ŶŶƵĂů ŚĂƉƚĞƌ >ĞĂĚĞƌƐ &ŽƌƵŵ ; >&Ϳ ŝŶ <ĂŶƐĂƐ ŝƚǇ ƚŚŝƐ ǇĞĂƌ͕ ůŝĨ <ŶŝŐŚƚ͕ D ͕ W ͕ & &W͕ ^ĞŶŝŽƌ sŝĐĞ WƌĞƐŝĚĞŶƚ ĨŽƌ ĚƵĐĂƟŽŶ͕ ŐĂǀĞ ŵĞ ƚŚŝƐ ŐŝŌ ĚƵƌŝŶŐ ŚŝƐ ƐĞƐƐŝŽŶ ĂďŽƵƚ ƉŚǇƐŝĐŝĂŶ ǁĞůůŶĞƐƐ͘ /Ŷ ĚĞƐĐƌŝďŝŶŐ ƚŚĞ ŶĞŐĂƟǀĞ ŝŵƉĂĐƚ ŽĨ ,ZƐ ŽŶ ƉƌŽĨĞƐƐŝŽŶĂů ƐĂƟƐĨĂĐƟŽŶ ĂŶĚ ƌŝƐŬ ŽĨ ďƵƌŶŽƵƚ͕ ŚĞ ƐŚŽǁĞĚ ƵƐ Ă ƐůŝĚĞ ŽĨ ƚŚĞ ĞĂƌůǇ ĐĞůůƉŚŽŶĞƐ͘ ,Ğ ƌĞŵŝŶĚĞĚ ƵƐ ƚŚĂƚ ǁĞ ĂƌĞ ůŝǀŝŶŐ ƚŚƌŽƵŐŚ ƚŚĞ early adolescence of EHRs. dŚĂƚ ĂǁŬǁĂƌĚ ƉĞƌŝŽĚ ďĞƚǁĞĞŶ ĐĞůůƉŚŽŶĞƐ ;ƚŚĞ ĮƌƐƚ ŝWŚŽŶĞ ǁĂƐ ƌĞůĞĂƐĞĚ ŽŶůǇ ϭϬ ǇĞĂƌƐ ĂŐŽͿ ĂŶĚ ƚŚĞ ŝŶƚĞƌŶĞƚ ĂƐ ǁĞ ŬŶŽǁ ŝƚ today happened during my adolescence and years of medical ƚƌĂŝŶŝŶŐ͘ WĞƌŚĂƉƐ ƚŚĂƚ ĞǆƉůĂŝŶƐ ƚŚĞ ĞǆƉĞĐƚĂƟŽŶ / ŚĂǀĞ ĨŽƌ ĂŶ ŝŶƚƵŝƟǀĞ ŝŶƚĞƌĨĂĐĞ ĂŶĚ ĨŽƌ ƐĞĂŵůĞƐƐ ĂƵƚŽŵĂƟŽŶ ŽĨ ŵǇ ĚĂŝůǇ ŵĞĚŝĐĂů ǁŽƌŬ͘ hŶĨŽƌƚƵŶĂƚĞůǇ͕ ƚŚĞ ƐŝŐŶŝĮĐĂŶƚ ĚŝīĞƌĞŶĐĞ ďĞƚǁĞĞŶ ƚŚĞ ĞǀŽůƵƟŽŶ ŽĨ ƉĞƌƐŽŶĂů ĐŽŵƉƵƚĞƌƐ ĂŶĚ ŽĨ ,ZƐ ŝƐ ƚŚĞ ĂďƐĞŶĐĞ ŽĨ ĞŶĚ ƵƐĞƌƐ͕ ĂŬĂ ƉŚǇƐŝĐŝĂŶƐ͕ ŝŶ ďĞƚĂ ƚĞƐƟŶŐ ĂŶĚ ĨĞĞĚďĂĐŬ ĂďŽƵƚ ĚĞƐŝŐŶ ĂƐ ŝƚ ƌĞůĂƚĞƐ ƚŽ ƚŚĞ ĐƌŝƟĐĂů ĂƐƉĞĐƚ ŽĨ ŵĞĚŝĐŝŶĞ͗ ďƵŝůĚŝŶŐ ƌĞůĂƟŽŶƐŚŝƉƐ͘ Today’s EHRs are designed for coding and billing because those ĨŽůŬƐ ƐĂƚ Ăƚ ƚŚĞ ĚƌĂǁŝŶŐ ƚĂďůĞ ǁŚŝůĞ ƉŚǇƐŝĐŝĂŶƐ ǁĞƌĞ ĨŽƌ ƚŚĞ ŵŽƐƚ ƉĂƌƚ ĂďƐĞŶƚ ƵŶƟů ŶŽǁ͘ tĞ ĂƌĞ Ăƚ ƚŚĞ ďƌŝŶŬ ŽĨ ĂŶŽƚŚĞƌ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƌĞǀŽůƵƟŽŶ͘ /Ŷ :ƵŶĞ͕ / ƌĞĐĞŝǀĞĚ ĂŶŽƚŚĞƌ ŐŝŌ ǁŚĞŶ / ĂƩĞŶĚĞĚ ĂŶ ,Z ƚƌĂŝŶŝŶŐ ƐƉŽŶƐŽƌĞĚ ďǇ ŵǇ ŵĞĚŝĐĂů ŐƌŽƵƉ͕ ^ WD'͘ /ƚ ǁĂƐ ƵŶůŝŬĞ ĂŶǇ other EHR training I had experienced in the past. Instead of

California Family Physician Fall 2017

non-medical or peripherally medical IT folks, the leaders of this ƚƌĂŝŶŝŶŐ ǁĞƌĞ ĨƌŽŶƚ ůŝŶĞ ĨĂŵŝůǇ ĚŽĐƐ͘ ĂĐŚ ŽĨ ƚŚĞŵ ďƌŽƵŐŚƚ ƚŚĞŝƌ ĚŝǀĞƌƐĞ ĞǆƉĞƌŝĞŶĐĞƐ͕ ŝĚĞŶƟƟĞƐ͕ ƐŬŝůůƐ ĂŶĚ ƚĂůĞŶƚƐ ƚŽ ƚŚĞ ƐĞƌǀŝĐĞ ŽĨ ƚŚĞŝƌ ĐŽůůĞĂŐƵĞƐ͘ KŶĞ ĨĂŵŝůǇ ĚŽĐ ŝŶ ƉĂƌƟĐƵůĂƌ ƐƚĂŶĚƐ ŽƵƚ ĞŶŽƵŐŚ ƚŽ ŚŝŐŚůŝŐŚƚ͘ ĞĨŽƌĞ ŚĞ ǁĞŶƚ ƚŽ ŵĞĚŝĐĂů ƐĐŚŽŽů͕ ŚĞ ǁĂƐ Ă ĐŽŵƉƵƚĞƌ ƉƌŽŐƌĂŵŵĞƌ͘ tŝƚŚ ƚŚŝƐ ďĂĐŬŐƌŽƵŶĚ͕ ŚĞ ǁĂƐ ĂďůĞ ƚŽ ǁƌŝƚĞ Ă ƉƌŽŐƌĂŵ ƚŚĂƚ ƌƵŶƐ ĂůŽŶŐƐŝĚĞ ƚŚĞ ,Z͘ &ŝƌƐƚ͕ ŚĞ ƌĞĐŽƌĚĞĚ Ăůů ŽĨ ƚŚĞ ĐůŝĐŬƐ ŶĞĞĚĞĚ ƚŽ ĐŽŵƉůĞƚĞ Ăůů ŽĨ ƚŚĞ ƚĂƐŬƐ ƚŚĂƚ ǁĞ ĚŽ ŚƵŶĚƌĞĚƐ ŽĨ ƟŵĞƐ ĞǀĞƌǇ ĚĂǇ͘ dŚĞŶ͕ ŚĞ ĂƵƚŽŵĂƚĞĚ ƚŚŽƐĞ ƚĂƐŬƐ͘ ĂĐŚ ŝƚĞƌĂƟŽŶ ŽĨ ƚŚŝƐ ƉƌŽŐƌĂŵ ŐĞƚƐ ďĞƩĞƌ ĂŶĚ ďĞƩĞƌ ǁŝƚŚ ƚŚĞ input from dozens of other physician super users. Another ŐĞŶŝƵƐ ĨĂŵŝůǇ ĚŽĐ ŚĂƐ ĂĐƚƵĂůůǇ ĂƵƚŽŵĂƚĞĚ ĮůůŝŶŐ ŽƵƚ ĨŽƌŵƐ͊ dŚĞ ,Z ƐƟůů ŚĂƐ ŝƚƐ ĚĞĮĐŝĞŶĐŝĞƐ͕ ďƵƚ ƚŚĞƐĞ ĨĂŵŝůǇ ĚŽĐƐ ŚĂǀĞ ĐƌĞĂƚĞĚ Ă ǁĂǇ ƚŽ ƌĞŵŽǀĞ ƚŚŽƵƐĂŶĚƐ ŽĨ ĐůŝĐŬƐ ĂŶĚ ŵŝŶƵƚĞƐ ŽĨ ĚƌƵĚŐĞƌǇ ƚŽ ŐŝǀĞ ƵƐ ďĂĐŬ ƚŚŽƐĞ ƉƌĞĐŝŽƵƐ ŵŽŵĞŶƚƐ ĨŽƌ ĐŽŶŶĞĐƟŽŶ ĂŶĚ ƌĞŇĞĐƟŽŶ͘ ^ŽŵĞ ǁŚŽ ŚĂǀĞ ĂƩĞŶĚĞĚ ƚŚŝƐ ƚƌĂŝŶŝŶŐ ŚĂǀĞ ĞǀĞŶ ƉƌŽĨĞƐƐĞĚ ƚŚĂƚ ƚŚŝƐ ƉŚǇƐŝĐŝĂŶͲĐĞŶƚĞƌĞĚ ĂƵƚŽŵĂƟŽŶ and intelligent design has literally saved their careers, their marriages and, in some cases, their lives. While not the only factor in the rise of physician burnout, redesigning EHRs to be physician-centered could turn the ƟĚĞ ŝŶ ĨĂǀŽƌ ŽĨ ŝŵƉƌŽǀĞĚ ǁŽƌŬ ůŝĨĞ ďĂůĂŶĐĞ ĂŶĚ ƉƌŽĨĞƐƐŝŽŶĂů ƐĂƟƐĨĂĐƟŽŶ͘ >ĞƐƐ ƚĞĚŝƵŵ ǁŽƵůĚ ĂůůŽǁ ƵƐ ƚŽ ĨŽĐƵƐ ŵŽƌĞ ŽŶ ĐĂƌŝŶŐ ĂŶĚ ƚŽ ĨĞĞů ŐƌĂƟƚƵĚĞ ĨŽƌ ƚŚĞ ŐŝŌƐ ŽĨ ŚĞĂůŝŶŐ͘ / ĨĞůů ŝŶ ůŽǀĞ ǁŝƚŚ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĚƵƌŝŶŐ ŵĞĚŝĐĂů ƐĐŚŽŽů ǁŚĞŶ / ůĞĂƌŶĞĚ ƚŽ ƐĞĞ Ă ďĞĂƵƟĨƵů ƐƚŽƌǇ ŝŶ ĂůŵŽƐƚ ĞǀĞƌǇ ĞǆĂŵ ƌŽŽŵ͗ ƚŚĞ ĞŶĚƵƌŝŶŐ love of an elderly couple, the faith of those facing a grave ĚŝĂŐŶŽƐŝƐ͕ ƚŚĞ ƵŶŝǀĞƌƐĂů ƚƌĂŶƐŝƟŽŶƐ ŽĨ ůŝĨĞ͘ /Ĩ ǇŽƵ ĂƌĞ Ă ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶ ǁŝƚŚ ƚŚĞ ƐŬŝůůƐ ĂŶĚ ďĂĐŬŐƌŽƵŶĚ ƚŽ create meaningful change, please consider yourself called to ůĞĂĚ ǇŽƵƌ ŵĞĚŝĐĂů ŐƌŽƵƉ͘ ^ŚŽǁ ƚŚĞŵ ŚŽǁ ŝƚ ĐŽƵůĚ ďĞ͘ ^ŽŵĞƚŚŝŶŐ ďĞƩĞƌ ŝƐ ŽƵƚ ƚŚĞƌĞ͘ dŚĞ ǁĂǇ ĨŽƌǁĂƌĚ ƌĞůŝĞƐ ŽŶ ƚŚĞ ƉƌĞƐĞŶĐĞ ŽĨ Ăůů ƐƚĂŬĞŚŽůĚĞƌƐ Ăƚ ƚŚĞ ĚƌĂǁŝŶŐ ďŽĂƌĚ͘ zŽƵƌ ƵŶŝƋƵĞ ĞǆƉĞƌŝĞŶĐĞ͕ ŝĚĞŶƟƚǇ͕ ƐŬŝůůƐ ĂŶĚ ƚĂůĞŶƚƐ ĂƌĞ ŶŽƚ ŽŶůǇ ŶĞĞĚĞĚ ƚŽ ŚĞĂů ǇŽƵƌ ƉĂƟĞŶƚƐ ďƵƚ ĂůƐŽ ƚŽ ŚĞĂů ĂŶĚ η ĞdŚĞ ŚĂŶŐĞ ĨŽƌ ǇŽƵƌ ĐŽůůĞĂŐƵĞƐ ĂŶĚ ǇŽƵƌ ƉƌŽĨĞƐƐŝŽŶ͘ dŚĞ ŶĂƌƌĂƟǀĞ ŽĨ ŽƵƌ ƉƌŽĨĞƐƐŝŽŶ ŝƐ ŝŶĐŽŵƉůĞƚĞ ǁŝƚŚŽƵƚ ǇŽƵƌ ƐƚŽƌǇ͘ dŽŐĞƚŚĞƌ͕ ǁĞ ĐĂŶ ĐŚĂŶŐĞ ƚŚĞ ƐƚŽƌǇ ŽĨ ƉŚǇƐŝĐŝĂŶ ďƵƌŶŽƵƚ͘ dŽŐĞƚŚĞƌ͕ ǁĞ ĐĂŶ ŐĞƚ ƚŚƌŽƵŐŚ ƚŚŝƐ ĂǁŬǁĂƌĚ ĂĚŽůĞƐĐĞŶĐĞ͘

Leading the future of health care. ADULT & FAMILY MEDICINE PHYSICIAN OPPORTUNITIES Northern & Central California

The Permanente Medical Group, Inc. (TPMG) is one of the largest medical groups in the nation with over 9,000 physicians, 22 medical centers, numerous clinics throughout Northern and Central California and a 70 year tradition of providing quality medical care. WE OFFER • Physician-led organization–career growth and leadership • Professional freedom • State-of-the-art facilities • Multi-specialty collaboration and integration • Technology driven • Mission driven, patient care-centered and one of the largest progressive medical groups in the nation! EXTRAORDINARY BENEFITS • Shareholder track • Unparalleled stability–70 years strong • Shared call • Moving allowance • No cost medical and dental • Home loan assistance (approval required) • Malpractice and tail insurance • Three retirement plans, including pension • Paid holidays, sick leave, education leave (with generous stipend)

FORGIVABLE LOAN PROGRAM $150,000-$275,000 (based on experience)

Nos apasiona nuestro trabajo.

En Kaiser Permanente, a nosostros los médicos nos encanta nuestro trabajo. Nuestra misión es servir a nuestros pacientes. Innovar, avanzar, ser inclusivos. Intégrate a nuestro equipo de atención de la salud, en apoyo a la comunidad.

LA SALUD PERMANENTE

At The Permanente Medical Group, Inc., we practice a multi-lingual, culturally inclusive approach to care that celebrates the diversity of our patients and physicians. By developing medical programs that are in tune with every aspect of our patients’ lives—from the language they speak to the heritage they embrace—we are actively investing in initiatives and services that reflect the diversity of our member community. Here, our bilingual physicians can act as true advocates for their patients, delivering care that’s as medically advanced as it is culturally sensitive.

FAMILY MEDICINE OPPORTUNITIES: Contact Aileen Ludlow at: Aileen.M.Ludlow@kp.org | (800) 777-4912 INTERNAL MEDICINE OPPORTUNITIES: Contact Bianca Davis at: Bianca.X.Davis@kp.org | (800) 777-4912 http://physiciancareers-ncal.kp.org

We are an EOE/AA/M/F/D/V Employer. VEVRAA Federal Contractor.

California Family Physician Fall 2017

political pulse

Carla Kakutani, MD

CAFP-Supported Bills are Sitting on the Threshold dŽ ĚĂƚĞ͕ ǁĞ ƐƵĐĐĞƐƐĨƵůůǇ ƉƌŽƚĞĐƚĞĚ ŽƵƌ ŚĂƌĚͲǁŽŶ ΨϭϬϬ ŵŝůůŝŽŶ ƚŚƌĞĞͲǇĞĂƌ ƐƚĂƚĞ ŝŶǀĞƐƚŵĞŶƚ ŝŶ ƚŚĞ ^ŽŶŐͲ ƌŽǁŶ WŚǇƐŝĐŝĂŶ dƌĂŝŶŝŶŐ WƌŽŐƌĂŵ ;ǁŚŝĐŚ ĨƵŶĚƐ ƉƌŝŵĂƌǇ ĐĂƌĞ ƌĞƐŝĚĞŶĐǇ ƉƌŽŐƌĂŵƐ ŝŶ ƵŶĚĞƌƐĞƌǀĞĚ ĂƌĞĂƐ ƚŚĂƚ ƉƌŽǀŝĚĞ ĐĂƌĞ ĨŽƌ ƵŶĚĞƌƐĞƌǀĞĚ ƉŽƉƵůĂƟŽŶƐͿ͘ tĞ ĂůƐŽ ŚĂǀĞ ĞŶƐƵƌĞĚ ƚŚĂƚ Ă ƐŝŐŶŝĮĐĂŶƚ ƉŽƌƟŽŶ ŽĨ ƚŚĞ ƌĞǀĞŶƵĞ ĨƌŽŵ ƚŚĞ ƌĞĐĞŶƚůǇ ƉĂƐƐĞĚ WƌŽƉŽƐŝƟŽŶ ϱϲ ;ƚŽďĂĐĐŽ ƚĂǆͿ ŝƐ ƐƉĞŶƚ ŽŶ DĞĚŝͲ Ăů ƉƌŽǀŝĚĞƌ ƉĂǇŵĞŶƚ ;ŵŽƌĞ ƚŚĂŶ Ψϭ ďŝůůŝŽŶ ǁŚĞŶ ŵĂƚĐŚĞĚ ǁŝƚŚ ĨĞĚĞƌĂů ĨƵŶĚƐͿ ĂŶĚ ƉƌŝŵĂƌǇ ĐĂƌĞ ƌĞƐŝĚĞŶĐǇ ƚƌĂŝŶŝŶŐ ;ΨϰϬ million annually). Ɛ ŽĨ ƚŚŝƐ ǁƌŝƟŶŐ͕ ƐĞǀĞƌĂů &WͲƐƵƉƉŽƌƚĞĚ ĂŶĚ ĐŽͲƐƉŽŶƐŽƌĞĚ ďŝůůƐ ĂƌĞ ŽŶ ƚŚĞ ǀĞƌŐĞ ŽĨ ŵĂŬŝŶŐ ŝƚ ƚŽ ƚŚĞ 'ŽǀĞƌŶŽƌ͛Ɛ ĚĞƐŬ͕ ŝŶĐůƵĚŝŶŐ͗ ϰϬ ;^ĂŶƟĂŐŽͿ hZ ^ ĚĂƚĂďĂƐĞ͗ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ ƚĞĐŚŶŽůŽŐǇ ƐǇƐƚĞŵ dŚŝƐ ďŝůů ĂůůŽǁƐ ƋƵĂůŝĮĞĚ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ ƚĞĐŚŶŽůŽŐǇ ƐǇƐƚĞŵƐ͕ ƐƵĐŚ ĂƐ ,ZƐ͕ ƚŽ ĐŽŶŶĞĐƚ ƚŽ ƚŚĞ ŽŶƚƌŽůůĞĚ ^ƵďƐƚĂŶĐĞ hƟůŝǌĂƟŽŶ ZĞǀŝĞǁ ĂŶĚ ǀĂůƵĂƟŽŶ ^ǇƐƚĞŵ ; hZ ^Ϳ ĚĂƚĂďĂƐĞ ƚŽ ĞŶĂďůĞ ĚŝƌĞĐƚ ŝŵƉŽƌƚĂƟŽŶ ŽĨ hZ ^ ĚĂƚĂ ŝŶƚŽ ƉĂƟĞŶƚ ƌĞĐŽƌĚƐ͘

ŶĂŵĞ ĚƌƵŐƐ ĂŶĚ ƐƉĞĐŝĂůƚǇ ĚƌƵŐƐ͘ dŚĞ ƐƚĂƚĞ ŐŽǀĞƌŶŵĞŶƚ ǁŝůů ĐŽŵƉŝůĞ ƚŚĞ ŝŶĨŽƌŵĂƟŽŶ ŝŶ Ă ƌĞƉŽƌƚ ĨŽƌ ƚŚĞ ƉƵďůŝĐ ĂŶĚ ůĞŐŝƐůĂƚŽƌƐ that demonstrates the overall impact of drug costs on health care premiums. The bill also requires health plans to disclose ŝŶĨŽƌŵĂƟŽŶ ƌĞŐĂƌĚŝŶŐ ƚŚĞ ƌĞůĂƟŽŶ ŽĨ ƉƌĞƐĐƌŝƉƟŽŶ ĚƌƵŐ ĐŽƐƚƐ ƚŽ plan or insurer spending and premium charges. Finally, the bill ƌĞƋƵŝƌĞƐ Ă ŵĂŶƵĨĂĐƚƵƌĞƌ ŽĨ Ă ƉƌĞƐĐƌŝƉƟŽŶ ĚƌƵŐ ǁŝƚŚ Ă ǁŚŽůĞƐĂůĞ ĂĐƋƵŝƐŝƟŽŶ ĐŽƐƚ ŽĨ ŵŽƌĞ ƚŚĂŶ ΨϰϬ ƚŽ ŶŽƟĨǇ ƉƵƌĐŚĂƐĞƌƐ ŽĨ ĂŶ ŝŶĐƌĞĂƐĞ ŝŶ ƚŚĞ ǁŚŽůĞƐĂůĞ ĂĐƋƵŝƐŝƟŽŶ ĐŽƐƚ ŽĨ Ă ƉƌĞƐĐƌŝƉƟŽŶ͘

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To date, we successfully protected our hard-won $100 million three-year state investment in the Song-Brown Physician Training Program.

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dŚĂŶŬƐ ƚŽ ŽƵƌ ŵĞŵďĞƌƐ͕ <ĞǇ ŽŶƚĂĐƚƐ ĂŶĚ 'ŽǀĞƌŶŵĞŶƚ ZĞůĂƟŽŶƐ team, CAFP has already had one of its most successful advocacy ǇĞĂƌƐ ĞǀĞƌ͘ ŶĚ͕ ĂƐ ǁĞ ǁƌĂƉ ƵƉ ƚŚĞ ĮƌƐƚ ǇĞĂƌ ŽĨ ƚŚĞ ϮϬϭϳͲϭϴ >ĞŐŝƐůĂƟǀĞ ^ĞƐƐŝŽŶ͕ ǁĞ ŚĂǀĞ ƐĞǀĞƌĂů ǁŝŶƐ ƐƟůů ŝŶ ƉůĂǇ͘

ϯϭϱ ;tŽŽĚͿ WŚĂƌŵĂĐǇ ďĞŶĞĮƚƐ ŵĂŶĂŐĞŵĞŶƚ ƚƌĂŶƐƉĂƌĞŶĐǇ dŚŝƐ ďŝůů ĞŶƐƵƌĞƐ ƚŚĂƚ Ăůů ƉƌĞƐĐƌŝƉƟŽŶ ƉƵƌĐŚĂƐĞƌƐ͕ ƌĞŐĂƌĚůĞƐƐ ŽĨ ƚŚĞŝƌ ƐŝǌĞ͕ ƌĞĐĞŝǀĞ ƐƚĂŶĚĂƌĚ ŝŶĨŽƌŵĂƟŽŶ ĨƌŽŵ ƉŚĂƌŵĂĐǇ ďĞŶĞĮƚƐ ŵĂŶĂŐĞƌƐ ;W DͿ ƚŽ ĂƐƐŝƐƚ ƚŚĞ ƉƵƌĐŚĂƐĞƌ ŝŶ ƉƌŽƉĞƌůǇ ĞǀĂůƵĂƟŶŐ ǁŚĞƚŚĞƌ ƚŚĞ W D͛Ɛ ƐĞƌǀŝĐĞƐ ĂƌĞ ĚĞůŝǀĞƌŝŶŐ ƉƌŽŵŝƐĞĚ ƐĂǀŝŶŐƐ͘ W DƐ ƉůĂǇ Ă ŵĂũŽƌ ƌŽůĞ ŝŶ ŶĞŐŽƟĂƟŶŐ ƉƌĞƐĐƌŝƉƟŽŶ ĚƌƵŐ ƉƌŝĐĞƐ͕ ĐƌĞĂƟŶŐ ĂŶĚ ŵĂŶĂŐŝŶŐ ĨŽƌŵƵůĂƌŝĞƐ ĂŶĚ ƐĞǀĞƌĂů ŽƚŚĞƌ ĨƵŶĐƟŽŶƐ ŬĞǇ ƚŽ ƚŚĞ ŵĂŶĂŐĞŵĞŶƚ ŽĨ ƉŚĂƌŵĂĐǇ ďĞŶĞĮƚƐ ĨŽƌ ŵŝůůŝŽŶƐ ŽĨ ĂůŝĨŽƌŶŝĂŶƐ͘ sĞƌǇ ůŝƩůĞ ŝƐ ŬŶŽǁŶ͕ ŚŽǁĞǀĞƌ͕ ĂďŽƵƚ ƚŚĞ ĚŝƐĐŽƵŶƚƐ ĂŶĚ ƉƌŝĐŝŶŐ ĂŐƌĞĞŵĞŶƚƐ W DƐ ŵĂŬĞ ǁŝƚŚ ĚƌƵŐ ŵĂŶƵĨĂĐƚƵƌĞƌƐ͕ ŚĞĂůƚŚ ƉůĂŶƐ ĂŶĚ ƉŚĂƌŵĂĐŝĞƐ͘ dŚŝƐ ďŝůů ƐŚŝŶĞƐ Ă ůŝŐŚƚ ŽŶ ƚŚĞŝƌ ĮŶĂŶĐŝĂů ĂƌƌĂŶŐĞŵĞŶƚƐ ĂŶĚ ĚĞƚĞƌŵŝŶĞ ǁŚĞƚŚĞƌ ƉĂƟĞŶƚƐ ĂĐƚƵĂůůǇ ďĞŶĞĮƚ ĨƌŽŵ W DƐ͛ ĂĐƟǀŝƟĞƐ͘

^ ϮϮϯ ; ƚŬŝŶƐͿ ,ĞĂůƚŚ ĐĂƌĞ ůĂŶŐƵĂŐĞ ĂƐƐŝƐƚĂŶĐĞ ƐĞƌǀŝĐĞƐ dŚŝƐ ďŝůů ĞŶƐƵƌĞƐ Ăůů ĂůŝĨŽƌŶŝĂŶ ƉĂƟĞŶƚƐ ƌĞĐĞŝǀĞ ĞƋƵĂů ĂĐĐĞƐƐ ƚŽ ůĂŶŐƵĂŐĞ ĂƐƐŝƐƚĂŶĐĞ ĂŶĚ ĐůĞĂƌ ŶŽƟĮĐĂƟŽŶ ŽĨ ƚŚĞŝƌ ƌŝŐŚƚƐ ƚŽ ƌĞĐĞŝǀĞ ŚĞĂůƚŚ ĐĂƌĞ ǁŝƚŚŽƵƚ ĚŝƐĐƌŝŵŝŶĂƟŽŶ͕ ƌĞŐĂƌĚůĞƐƐ ŽĨ ĨĞĚĞƌĂů ĐŚĂŶŐĞƐ͘

^ ϭϳ ;,ĞƌŶĂŶĚĞǌͿ ,ĞĂůƚŚ ĐĂƌĞ͗ ƉƌĞƐĐƌŝƉƟŽŶ ĚƌƵŐ ĐŽƐƚƐ dŚŝƐ ďŝůů ƌĞƋƵŝƌĞƐ ŚĞĂůƚŚ ƉůĂŶƐ ƚŽ ƌĞƉŽƌƚ ĐŽƐƚ ŝŶĨŽƌŵĂƟŽŶ ƌĞŐĂƌĚŝŶŐ ĐŽǀĞƌĞĚ ƉƌĞƐĐƌŝƉƟŽŶ ĚƌƵŐƐ͕ ŝŶĐůƵĚŝŶŐ ŐĞŶĞƌŝĐ ĚƌƵŐƐ͕ ďƌĂŶĚ

ƌ͘ <ĂŬƵƚĂŶŝ ŝƐ ŚĂŝƌ ŽĨ ƚŚĞ >ĞŐŝƐůĂƟǀĞ īĂŝƌƐ ŽŵŵŝƩĞĞ ĂŶĚ WƌĞƐŝĚĞŶƚ ŽĨ ƚŚĞ &ĂŵŝůǇ WŚǇƐŝĐŝĂŶƐ WŽůŝƟĐĂů ĐƟŽŶ ŽŵŵŝƩĞĞ ;&WͲW Ϳ͘

California Family Physician Fall 2017

We cannot thank enough all the Key Contacts, CAFP members, &ĂŵŝůǇ DĞĚŝĐŝŶĞ ZĞƐŝĚĞŶĐǇ WƌŽŐƌĂŵƐ͕ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ƐƚƵĚĞŶƚƐ ǁŚŽ ƚŽŽŬ ĂĐƟŽŶ ƚŽ ŵĂŬĞ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͛Ɛ ǀŽŝĐĞ ŚĞĂƌĚ ĂŶĚ ƉƵƐŚ ĨŽƌ &W͛Ɛ ƉƌŝŽƌŝƟĞƐ͘ WůĞĂƐĞ ĐŽŶƚĂĐƚ ǇŽƵƌ ůĞŐŝƐůĂƚŽƌƐ ĂŶĚ ƚŚĂŶŬ ƚŚĞŵ ĨŽƌ their support of primary care. ŶĚ͕ ŽĨ ĐŽƵƌƐĞ͕ ƚŚĂŶŬ ǇŽƵ ƚŽ Ăůů ŽƵƌ ŵĞŵďĞƌƐ ǁŚŽ ĮŐŚƚ ŽŶ ďĞŚĂůĨ ŽĨ ƉĂƟĞŶƚƐ ĂŶĚ Ăůů ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĞǀĞƌǇ ĚĂǇ͊

FOR SOME OF OUR MOST ELITE SOLDIERS, THE EXAMINATION ROOM IS THE FRONT LINE. Becoming a family medicine physician and ofﬁcer on the U.S. Army health care team is an opportunity like no other. You will provide the highest quality health care to Soldiers, family members, retirees and others, as well as conduct medical research of military importance. With this elite team, you will be a leader – not just of Soldiers, but in family health care. See the beneﬁts of being an Army medical professional at healthcare.goarmy.com/hb76 To learn more about the U.S. Army health care team, call 310-216-4433.

California Family Physician Fall 2017

Shannon Goecke Director, Membership and Member Services

membership news

You Are the Best Part of Membership dŚĞ ďĞƐƚ ƉĂƌƚ ŽĨ ŵĞŵďĞƌƐŚŝƉ ŝŶ ĂŶǇ ƉƌŽĨĞƐƐŝŽŶĂů ĂƐƐŽĐŝĂƟŽŶ ŝƐ ƚŚĞ ĐŽŵŵƵŶŝƚǇ͘ DĞŵďĞƌƐ ĐŽŵĞ ĨƌŽŵ ŵĂŶǇ ĚŝīĞƌĞŶƚ ďĂĐŬŐƌŽƵŶĚƐ ĂŶĚ ǁŽƌŬ ƐĞƫŶŐƐ ĂŶĚ ŚĂǀĞ ĚŝīĞƌĞŶƚ ŶĞĞĚƐ ŝŶ ƚŚĞŝƌ ĞǀĞƌǇĚĂǇ ƉƌĂĐƟĐĞ ůŝǀĞƐ͘ KŶĞ ƚŚŝŶŐ ŵĞŵďĞƌƐŚŝƉ ƉƌŽǀŝĚĞƐ͕ ǁŚŝĐŚ ďĞŶĞĮƚƐ ĞǀĞƌǇŽŶĞ͕ ŝƐ Ă ƐĞŶƐĞ ŽĨ ĐŽŶŶĞĐƟŽŶ ĂŶĚ ƐŚĂƌĞĚ ƉƵƌƉŽƐĞ ǁŝƚŚ ŽŶĞ͛Ɛ ƉĞĞƌƐ͘ tĞ strive to provide that experience to all CAFP members. Community has certainly been the best part of my membership in my ƉƌŽĨĞƐƐŝŽŶĂů ƐŽĐŝĞƚǇ͕ ƚŚĞ ŵĞƌŝĐĂŶ ƐƐŽĐŝĂƟŽŶ ŽĨ DĞĚŝĐĂů ^ŽĐŝĞƚǇ ǆĞĐƵƟǀĞƐ ; D^ Ϳ͘ DǇ ŵĞŵďĞƌƐŚŝƉ ŚĂƐ ůĞƚ ŵĞ ĐŽŶŶĞĐƚ ǁŝƚŚ ĂŶĚ ůĞĂƌŶ ĨƌŽŵ ĂŵĂǌŝŶŐ ƉĞŽƉůĞ / ŽƚŚĞƌǁŝƐĞ ŶĞǀĞƌ ǁŽƵůĚ ŚĂǀĞ ŵĞƚ͕ ĂŶĚ / ŶŽǁ ůŽŽŬ ĨŽƌǁĂƌĚ ƚŽ ƐĞĞŝŶŐ ƚŚĞŵ ĞǀĞƌǇ ǇĞĂƌ͘ D^ ǁĂƐ ĨŽƌŵĞĚ ŝŶ ϭϵϰϲ ĂƐ ƚŚĞ DĞĚŝĐĂů ^ŽĐŝĞƚǇ ǆĞĐƵƟǀĞ ŽŶĨĞƌĞŶĐĞ ƚŽ ƉŽƐŝƟŽŶ ŵĞĚŝĐĂů ƐŽĐŝĞƚǇ ĞǆĞĐƵƟǀĞƐ͕ ƚŚĞŝƌ ŽƌŐĂŶŝǌĂƟŽŶƐ ĂŶĚ ƚŚĞ ƉŚǇƐŝĐŝĂŶƐ ƚŚĞǇ ƐĞƌǀĞ ƚŽ ĞǆĐĞů ŝŶ ƚŚĞ ĮĞůĚ ŽĨ organized medicine. AAMSE produces professional development ƌĞƐŽƵƌĐĞƐ ĂŶĚ ĂĐƟǀŝƟĞƐ ĨŽƌ Ă ŵĞŵďĞƌƐŚŝƉ ŽĨ ŵŽƌĞ ƚŚĂŶ ϭ͕ϯϬϬ ŵĞĚŝĐĂů ƐŽĐŝĞƚǇ ĞǆĞĐƵƟǀĞƐ ĂŶĚ ƐƚĂī ƐƉĞĐŝĂůŝƐƚƐ͘ KŶĞ ŽĨ ƚŚŽƐĞ ĂĐƟǀŝƟĞƐ ŝƐ ƚŚĞ ŶŶƵĂů ŽŶĨĞƌĞŶĐĞ͕ ŚĞůĚ ĞĂĐŚ ƐƵŵŵĞƌ͘ dŚŝƐ ƉĂƐƚ :ƵůǇ͕ / ĂƩĞŶĚĞĚ ƚŚĞ ŵĞĞƟŶŐ ŝŶ DŝŶŶĞĂƉŽůŝƐ ǁŝƚŚ ŵǇ ĐŽůůĞĂŐƵĞƐ͕ &W ĞƉƵƚǇ sW ^ŚĞůůǇ ZŽĚƌŝŐƵĞƐ͕ ĂŶĚ ŽŵŵƵŶŝĐĂƟŽŶƐ DĂŶĂŐĞƌ >ŝǌǌǇ >ƵŬƌŝĐŚ͘ tĞ ĞŶũŽǇĞĚ ƚŚƌĞĞ ĚĂǇƐ ŽĨ ĞĚƵĐĂƟŽŶĂů ƉƌŽŐƌĂŵŵŝŶŐ ŽŶ ƚŽƉŝĐƐ ŝŶĐůƵĚŝŶŐ ŵĞŵďĞƌƐŚŝƉ engagement, strategic planning, MACRA, storytelling, and much ŵŽƌĞ͘ tĞ ĂůƐŽ ŚĞĂƌĚ ƚǁŽ ĐŽŵƉĞůůŝŶŐ ŬĞǇŶŽƚĞƐ͕ ƉĂƌƟĐŝƉĂƚĞĚ ŝŶ ƚŚĞ ĂǁĂƌĚƐ ĐĞƌĞŵŽŶǇ ĂŶĚ ĨĞůůŽǁƐ͛ ĐŽŶǀŽĐĂƟŽŶ͕ ĂŶĚ ĞŶũŽǇĞĚ ƐŽĐŝĂů ĂĐƟǀŝƟĞƐ͘ ^ŽƵŶĚ ĨĂŵŝůŝĂƌ͍

^ƵƐĂŶ ,ŽŐĞůĂŶĚ͕ &W͛Ɛ ǆĞĐƵƟǀĞ sŝĐĞ WƌĞƐŝĚĞŶƚ͕ ĂŶĚ ^ŚĞůůǇ ŚĂǀĞ ďĞĞŶ ŝŶǀŽůǀĞĚ ǁŝƚŚ D^ ĨŽƌ ŵĂŶǇ ǇĞĂƌƐ͖ ^ŚĞůůǇ ǁĂƐ D^ ƉƌĞƐŝĚĞŶƚ ŝŶ ϮϬϬϬͲϮϬϬϭ͘ dŚŝƐ ǁĂƐ >ŝǌǌǇ͛Ɛ ĮƌƐƚ ŵĞĞƟŶŐ͕ ďƵƚ ƐŚĞ ŐĂŵĞůǇ ĂŐƌĞĞĚ ƚŽ ũŽŝŶ ŵĞ ŝŶ ůĞĂĚŝŶŐ ĂŶ ĞĚƵĐĂƟŽŶĂů ƐĞƐƐŝŽŶ ŽŶ ŵĞŵďĞƌ ƉĞƌƐŽŶĂƐ ĂŶĚ ƚĂƌŐĞƚĞĚ ŵĂƌŬĞƟŶŐ͘ tĞ ƉƌĞƐĞŶƚĞĚ ƚŽ Ă ƉĂĐŬĞĚ ƌŽŽŵ ĂŶĚ ƌĞĐĞŝǀĞĚ ŵĂŶǇ ĐŽŵƉůŝŵĞŶƚƐ͕ ǁŚŝĐŚ ŵĞĂŶƚ ƐŽ much coming from our esteemed peers. ŶŽƚŚĞƌ ŚŝŐŚůŝŐŚƚ ǁĂƐ ƚŚĞ ĂǁĂƌĚƐ ůƵŶĐŚĞŽŶ ĚƵƌŝŶŐ ǁŚŝĐŚ D^ ƌĞĐŽŐŶŝǌĞƐ ƐŵĂůů ĂŶĚ ůĂƌŐĞ ŵĞĚŝĐĂů ƐŽĐŝĞƟĞƐ ĨŽƌ ƚŚĞŝƌ ĂĐĐŽŵƉůŝƐŚŵĞŶƚƐ ŝŶ ŵĞŵďĞƌƐŚŝƉ͕ ĐŽŵŵƵŶŝĐĂƟŽŶƐ͕ ĂĚǀŽĐĂĐǇ͕ ĞĚƵĐĂƟŽŶ ĂŶĚ ůĞĂĚĞƌƐŚŝƉ͘ zŽƵƌ ĐĂĚĞŵǇ ǁĂůŬĞĚ ĂǁĂǇ ǁŝƚŚ ƚǁŽ ĂǁĂƌĚƐ ŝŶ ƚŚĞ ůĂƌŐĞ ĂƐƐŽĐŝĂƟŽŶ ĐĂƚĞŐŽƌǇ ʹ ƚŚĞ ĞĚƵĐĂƟŽŶ ĂǁĂƌĚ ĨŽƌ ŽƵƌ ǁŽƌŬ ŽŶ ƚŚĞ ŶĚͲŽĨͲ>ŝĨĞ ŽŶǀĞƌƐĂƟŽŶƐ WƌŽũĞĐƚ ĂŶĚ ƚŚĞ ĂĚǀŽĐĂĐǇ ĂǁĂƌĚ ĨŽƌ ŽƵƌ ǁŽƌŬ ƐĞĐƵƌŝŶŐ ƚŚĞ ΨϭϬϬ ŵŝůůŝŽŶ ďƵĚŐĞƚ ĂƉƉƌŽƉƌŝĂƟŽŶ ƚŽ ĨƵŶĚ ĂůŝĨŽƌŶŝĂ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ residency programs. / ĐĂŵĞ ŚŽŵĞ ĨƌŽŵ DŝŶŶĞĂƉŽůŝƐ ǁŝƚŚ ŶĞǁ ƐŬŝůůƐ ĂŶĚ ŝĚĞĂƐ ƚŚĂƚ ǁŝůů ƚƌĂŶƐůĂƚĞ ĚŝƌĞĐƚůǇ ƚŽ ŵǇ ǁŽƌŬ ĂƐ ǇŽƵƌ &W ŵĞŵďĞƌƐŚŝƉ ĚŝƌĞĐƚŽƌ͕ ĂŶĚ / ŚĂĚ Ă ǁŽŶĚĞƌĨƵů ƟŵĞ ƌĞĐŽŶŶĞĐƟŶŐ ǁŝƚŚ ŵĞŵďĞƌƐ ŽĨ ŵǇ ͞ƚƌŝďĞ͘͟ KƚŚĞƌ ƵƐŝŶĞƐƐ Ǉ ƚŚĞ ƟŵĞ ƚŚŝƐ ŝƐƐƵĞ ŝƐ ƉƵďůŝƐŚĞĚ͕ ŵĞŵďĞƌƐ ǁŝůů ďĞ ĂďůĞ ƚŽ ƌĞŶĞǁ ĨŽƌ ϮϬϭϴ Ăƚ ĂĂĨƉ͘ŽƌŐͬĐŚĞĐŬŵǇĚƵĞƐ͘ dŚĞ ĮƌƐƚ ŚĂƌĚ ĐŽƉǇ ŝŶǀŽŝĐĞƐ ǁŝůů ŐŽ ŽƵƚ ƚŚŝƐ ŵŽŶƚŚ͘ ZĞŶĞǁ ĞĂƌůǇ ĂŶĚ ĐƌŽƐƐ ŝƚ Žī ǇŽƵƌ ůŝƐƚ ʹ ǇŽƵ ĐĂŶ ĞǀĞŶ ƐŝŐŶ ƵƉ ĨŽƌ ĞĂƐǇ ŵŽŶƚŚůǇ ŝŶƐƚĂůůŵĞŶƚ ƉĂǇŵĞŶƚƐ ĂŶĚͬŽƌ ĂƵƚŽͲ ƌĞŶĞǁĂů ʹ ƉƌĞǀĞŶƟŶŐ ĂŶ ŝŶƚĞƌƌƵƉƟŽŶ ŝŶ ǇŽƵƌ ŵĞŵďĞƌƐŚŝƉ ďĞŶĞĮƚƐ͕ ĂŶĚ ĂůůŽǁŝŶŐ &W ƐƚĂī ƚŽ ƐƉĞŶĚ ůĞƐƐ ƟŵĞ ŽŶ ƌĞŶĞǁĂů ƌĞŵŝŶĚĞƌƐ ĂŶĚ ŵŽƌĞ ƟŵĞ ŽŶ ƉƌŽǀŝĚŝŶŐ Ă ŵŝůůŝŽŶͲĚŽůůĂƌ ŵĞŵďĞƌƐŚŝƉ ĞǆƉĞƌŝĞŶĐĞ ǇĞĂƌͲƌŽƵŶĚ͊ &W ŝƐ ĂůƐŽ ĞŶƚĞƌŝŶŐ ŝƚƐ ŶĞǆƚ ƐƚƌĂƚĞŐŝĐ ƉůĂŶŶŝŶŐ ĐǇĐůĞ͖ ƚŽ ŚĞůƉ ƵƐ ďĞƐƚ ƐĞƌǀĞ ƚŚĞ ĐŚĂŶŐŝŶŐ ŶĞĞĚƐ ŽĨ ŽƵƌ ĚŝǀĞƌƐĞ ŵĞŵďĞƌƐŚŝƉ͕ ǁĞ ŶĞĞĚ ƚŽ ŬŶŽǁ ŵŽƌĞ ĂďŽƵƚ ǇŽƵ͘ /Ĩ ǇŽƵ ŚĂǀĞ ŶŽƚ ĂůƌĞĂĚǇ ĐŽŵƉůĞƚĞĚ the CAFP demographic survey and the AAFP Census survey, please ƚĂŬĞ Ă ŵŽŵĞŶƚ ƚŽ ĚŽ ƐŽ ŝŶ ƚŚĞ ŶĞǆƚ ĐŽƵƉůĞ ŽĨ ǁĞĞŬƐ͘ ŽŶƚĂĐƚ ŵĞ Ăƚ &W Ăƚ ;ϰϭϱͿ ϯϰϱͲϴϲϲϳ Žƌ ƐŐŽĞĐŬĞΛĨĂŵŝůǇĚŽĐƐ͘ŽƌŐ ŝĨ ǇŽƵ ŶĞĞĚ ĂƐƐŝƐƚĂŶĐĞ͕ ĂŶĚ ĂŶǇ ƟŵĞ ǇŽƵ ŚĂǀĞ ƋƵĞƐƟŽŶƐ Žƌ ĨĞĞĚďĂĐŬ ĂďŽƵƚ your CAFP membership.

>ŝǌǌǇ >ƵŬƌŝĐŚ͕ ^ŚĞůůǇ ZŽĚƌŝŐƵĞƐ͕ ĂŶĚ ^ŚĂŶŶŽŶ 'ŽĞĐŬĞ ĂĐĐĞƉƚ &W ĂǁĂƌĚƐ Ăƚ D^ :ƵůǇ ϮϬϭϳ͘

California Family Physician Fall 2017

DƐ͘ 'ŽĞĐŬĞ ŝƐ ƚŚĞ ŝƐ ŝƌĞĐƚŽƌ DĞŵďĞƌƐŚŝƉ ĂŶĚ DĂƌŬĞƟŶŐ͘

Adventist Health offers full- and part-time physician careers all along the West Coast and Hawaii. We offer a comprehensive employment package:

•Competitive salary •Generous benefits including 401k match •Opportunity to work where you play Join 5,000 other providers who chose to provide care where passion meets mission.

phyjobs@ah.org • 916-865-1905 • physiciancareers.ah.org

Physician Opportunity’s Santa Barbara, CA

PHYSICIAN OPPORTUNITIES • Open 8 to 8 every day • Flexible schedules, no call • Guaranteed $240,000 averaging 4 shif hiftts a weekk • Ad Addi dititition di onall bon onus us payy basedd on p od pr oduc ductitivivitity ty • Ma Malp lpra ract ctiice ice co cove vera rage g ge • Me Medi dica call an ca a d de dentall for phy dent hysiicician ian and ddeepeend nden entsts at no cos ostt • Lo L ng ng ter e m dissabi sabi bililility ty insur nsur ns u an a ce • RReeti etitire r me m nt n plan with withh mat atch chhin chin ingg fund funds ndds Contact Merl O’Brien, MD, at: (916) 791-1300, ext.11111; or email CV to:sherry@med7atwork.com.

Based in Santa Barbara, Sansum Clinic is the oldest and largest non-profit, multi-specialty group between San Francisco and Los Angeles with over 200 physicians and surgeons and a staff of healthcare professionals in over 30 specialized areas of medicine. Sansum Clinic has garnered recognition, accreditation and awards from national and state agencies.

Our current openings are Family Medicine Urgent Care Occupational Medicine Geriatrician/Palliative Care

For More Information Contact: Shawneen Flanders-Clark Physician Recruiter sflander@sansumclinic.org 805-689-8256 www.sansumclinic.org

Benefits Free Medical/Dental/Vision CME Stipend 1 MA Per Provider

Malpractice Insurance Disability Retirement: 401K & Profit Sharing

Annual Leave Licensure/DEA Fees Board Exam Fee

generational voices

Kimberly Duir, MD; Emily Ebert, MD

little plastic onboard pen and a special secret alphabet for Ăůů ĚĂƚĂ ĞŶƚƌǇ ƚŚĂƚ ƚƵƌŶĞĚ ŵǇ ƐĐƌĂǁů ŝŶƚŽ ƚǇƉĞĨĂĐĞ͘ dŚĞ WĂůŵ WŝůŽƚ ĂůůŽǁĞĚ ŵĞ ƚŽ ŵĂŶĂŐĞ ŵǇ ƐĐŚĞĚƵůĞ ĂŶĚ ŵǇ ĐŽŶƚĂĐƚƐ ĂŶĚ ŵǇ ƚŽͲĚŽ ůŝƐƚ Ăůů ŝŶ ŽŶĞ ƉůĂĐĞ E ŬĞĞƉ ŝƚ ŝŶ ŵǇ ƉŽĐŬĞƚ͊ ĚŵŝƚƚĞĚůǇ ƚŚĞ ĐŽŵďŝŶĞĚ ǁĞŝŐŚƚ ŽĨ ƚŚĞ WĂůŵ WŝůŽƚ ĂŶĚ ŵǇ ƉĂŐĞƌ ĂŶĚ ĂŶ ĞĂƌůǇ ĐĞůů ƉŚŽŶĞ ǁĂƐ Ă ĐŚĂůůĞŶŐĞ ĨŽƌ ŬĞĞƉŝŶŐ ŵǇ ǁĂŝƐƚďĂŶĚ ŝŶ ƉůĂĐĞ ďƵƚ Ɛƚŝůů͕ ǁŚĂƚ ĂŶ ĂĚǀĂŶĐĞ͊ EŽǁĂĚĂǇƐ͕ ŽĨ ĐŽƵƌƐĞ͕ ǁĞ ŚĂǀĞ Ă ƐŝŶŐůĞ ƐůĞĞŬ ĚĞǀŝĐĞ ƚŚĂƚ does all that and so much more. I can access the National Library of Medicine from my pocket, not to mention check the dosage of that medication I don’t use very often, find an evidence based recommendation for treatment or diagnosis or preventive care, use a calculator to assess the need for ƚŚĂƚ yͲƌĂǇ Žƌ ƚŚĂƚ ƐƚĂƚŝŶ ƌŝŐŚƚ ŝŶ ƚŚĞ ƌŽŽŵ ǁŝƚŚ ŵǇ ƉĂƚŝĞŶƚ͘ When younger colleagues approach my grey-haired self for ĐůŝŶŝĐĂů ĂĚǀŝĐĞ͕ / ĚŽŶ͛ƚ ŚĂǀĞ ƚŽ ĨĂŬĞ ŝƚ ĂŶĚ ŚŽƉĞ ƚŚĞ ĂŶƐǁĞƌ hasn’t changed since the last time I looked it up. I can invite ƚŚĞŵ ƚŽ ůŽŽŬ ŝƚ ƵƉ ǁŝƚŚ ŵĞ͕ ͞ǇŽƵƌ ĚĞǀŝĐĞ Žƌ ŵŝŶĞ͍͟ ĂŶĚ ǁĞ ĐĂŶ ĚŝƐĐƵƐƐ ŚŽǁ ĐƵƌƌĞŶƚ ĞǀŝĚĞŶĐĞ ĐĂŶ ďĞƐƚ ďĞ ƚĂŝůŽƌĞĚ ĨŽƌ this particular patient. ŶĚ ƚŚĞƌĞ ŝƐ ĂůǁĂǇƐ 'ŽŽŐůĞ ƚŽ ĨŝŶĚ ƚŚĞ ŶĂŵĞ ŽĨ ƚŚĂƚ ƉĞƐŬǇ 'ĞƌŵĂŶ ĚŽĐƚŽƌ͛Ɛ ƉĞƚ ĚŝƐĞĂƐĞ ǁŚĞŶ / ĐĂŶ͛ƚ ŚĂƵů ŝƚ ƵƉ ĨƌŽŵ ŵǇ ĂŐŝŶŐ ŶĞƵƌŽŶĂů ƉĂƚŚǁĂǇƐ͊

Emily Ebert, MD Kimberly Duir, MD

A Registry Is Not So Much a Thing, as an Idea

The Baby Boomer Doctor and her Exogenous Brain

dĞĐŚŶŽůŽŐǇ ŝŶ ŵĞĚŝĐŝŶĞ ĂŶĚ ůŝĨĞ͕ ǁŚĂƚ ĚŽ ǁĞ ƌĞĂůůǇ ŵĞĂŶ ďǇ ƚŚŝƐ ƚĞƌŵ͍ dŚƌŽƵŐŚ ǁŽŶĚĞƌĨƵů ŚĂŶĚͲŚĞůĚ ĐŽŵƉƵƚĞƌƐ͕ ǁĞ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ĂĐĐĞƐƐ ĂŵĂǌŝŶŐ ŝŶĨŽƌŵĂƚŝŽŶ Ăƚ ŽƵƌ fingertips right at the point of care. We use these machines ƚŽ ĐŽŵŵƵŶŝĐĂƚĞ ǁŝƚŚ ŽƵƌ ƉĂƚŝĞŶƚƐ ǁŝƚŚŽƵƚ ďĞŝŶŐ ŝŶ ƚŚĞ ƐĂŵĞ ƌŽŽŵ͘ tĞ ŚĂƌŶĞƐƐ ƚŚĞŝƌ ƉŽǁĞƌ ƚŽ ŵĂǆŝŵŝǌĞ ƉĂƚŝĞŶƚ education leading patients to a deeper understanding of ƚŚĞŝƌ ŽǁŶ ďŽĚŝĞƐ ĂŶĚ ĐŽŶĚŝƚŝŽŶƐ͘ ƌĞĂƚŝŶŐ ĚĂƚĂ ďĂƐĞƐ͕ ǁĞ can automatically provide reminders for our health care delivery systems and our patients to ensure the maximum number of people get certain proven care components best suited to their age, gender, risk factors and health conditions. For those of us old enough to remember care before this transition, it is almost magical.

>ŝŬĞ ŵĂŶǇ ŽĨ ǇŽƵ͕ / ŚĂǀĞ ĂůǁĂǇƐ ŚĂĚ Ă ƉƌĞƚƚǇ ŐŽŽĚ ŵĞŵŽƌǇ͕ reliable for regurgitating facts on a board exam and remembering the names of those obscure diseases that ƐŽŵĞ 'ĞƌŵĂŶ ĚĞĐŝĚĞĚ ƚŽ ŶĂŵĞ ĂĨƚĞƌ ŚŝŵƐĞůĨ͘ dŚĞŶ ĐĂŵĞ menopause, then came age-related cognitive decline and ŶŽǁ ŵǇ ĨƌŝĞŶĚƐ ĂŶĚ / ũŽŬĞ ƚŚĂƚ ŝƚ ͞ƚĂŬĞƐ Ă ǀŝůůĂŐĞ ƚŽ ĨŝŶŝƐŚ Ă ƐĞŶƚĞŶĐĞ͘͟ ǀĞƌǇ ĚĂǇ / ƚŚĂŶŬ ǁŚĂƚĞǀĞƌ ƉŽǁĞƌƐ Žƌ ^ŝůŝĐŽŶ sĂůůĞǇ ŵǇƐƚĞƌŝĞƐ ĐĂƵƐĞĚ ĐŽŵƉƵƚĞƌƐ ƚŽ ďĞ ĚĞǀĞůŽƉĞĚ ƌŝŐŚƚ ĂƌŽƵŶĚ ƚŚĞ ƚŝŵĞ / ǁĂƐ ƐƚĂƌƚŝŶŐ ƚŽ ůŽƐĞ ŵǇ ŵŝŶĚ͘ / ǁĂƐ ĂŶ ĞĂƌůǇ ĂĚŽƉƚĞƌ ǁŝƚŚ ƚŚĞ WĂůŵ WŝůŽƚ͕ ǁŚŝĐŚ ǁĂƐ ĂĐĐĞƐƐŝďůĞ ƚŽ ƚŚŽƐĞ ŽĨ ƵƐ ǁŝƚŚ ŶŽ ŬĞǇďŽĂƌĚŝŶŐ ƐŬŝůůƐ ǀŝĂ ƚŚĞ

California Family Physician Fall 2017

to be intuitive and simple. I pleaded that medical assistants ŚĂĚ ƚŽ ͞ǁĂŶƚ ƚŽ͟ ƌƵŶ ƌĞƉŽƌƚƐ ƉƵƐŚŝŶŐ ƚŚĞŝƌ ƉƌŽǀŝĚĞƌƐ ĨŽƌǁĂƌĚ in the pursuit of improved health outcomes. He tried to ĞǆƉůĂŝŶ ŚŽǁ ƉƌŽŐƌĂŵŝŶŐ ǁŽƌŬƐ ĂŶĚ ǁŚǇ ŝƚ ǁĂƐ ƐŽ ŝŵƉŽƌƚĂŶƚ ƚŽ ŬŶŽǁ ǁŚĞƌĞ ĂŶĚ ŝŶ ǁŚĂƚ ůĂŶŐƵĂŐĞ ƚŚĞ ĚĂƚĂ ǁĂƐ ƐƚŽƌĞĚ͘ ,Ğ ƐƵĨĨĞƌĞĚ ƚŚƌŽƵŐŚ ǁƌŝƚŝŶŐ ĂŶĚ ƌĞǁƌŝƚŝŶŐ ĐŽŵŵĂŶĚƐ ďĞĐĂƵƐĞ ǁĞ ĐŽƵůĚŶ͛ƚ ĂĚĞƋƵĂƚĞůǇ ĞǆƉůĂŝŶ ǁŚĂƚ ǁĞ ǁĂŶƚĞĚ Žƌ ďĞĐĂƵƐĞ ǁĞ ǁŽƵůĚ ĐŚĂŶŐĞ ŽƵƌ ŵŝŶĚƐ ĂĨƚĞƌ ǁĞ ƐĂǁ ƚŚĞ data. We brought in other members of the health care team – nurses, medical assistants, and other physicians. We also brought analysts and other IT specialists to help translate. We really did not understand one another, so these interpreters had a huge job.

ŵŝůǇ ďĞƌƚ͕ D ŝŶ ƚŚĞ ĐĞŶƚĞƌ͘

Ɛ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͕ ŚŽǁĞǀĞƌ͕ ƚŚĞ ƚĞĐŚŶŽůŽŐǇ ŝƐ ŶŽƚ ǁŚĂƚ ƌĞƐŽŶĂƚĞƐ ǁŝƚŚ ƵƐ ŝƐ ŝƚ͍ dŽ ƵƐ ŝƚ ŝƐ ƚŚĞ ŝŶƚĞƌĂĐƚŝŽŶ ďĞƚǁĞĞŶ ƚŚĞ ƚĞĐŚŶŽůŽŐǇ ĂŶĚ ƚŚĞ ƉĞŽƉůĞ͕ ǁŚŝĐŚ ŝƐ ǁŚǇ / ĐŚŽƐĞ ƚŽ tell the story of our disease management and health ŵĂŝŶƚĞŶĂŶĐĞͲƉƌŽŵŽƚŝŶŐ ƌĞŐŝƐƚƌǇ͘ /Ŷ ϮϬϭϬ ŽƵƌ ƉƌĂĐƚŝĐĞ͕ ǁŚŝĐŚ ŝƐ Ă ŐƌŽƵƉ ŽĨ ƚŚƌĞĞ ĨĂŵŝůǇ ŚĞĂůƚŚ ĐĞŶƚĞƌƐ ƐĞƌǀŝŶŐ ĂƐ ƚŚĞ ƉƌĂĐƚŝĐĞ ƐŝƚĞ ĨŽƌ ŽƵƌ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƌĞƐŝĚĞŶĐǇ ƉƌŽŐƌĂŵ͕ ǁĂƐ ĞǆƉĞƌŝŵĞŶƚŝŶŐ ǁŝƚŚ ĂŶ ĞůĞĐƚƌŽŶŝĐ ŵĞĚŝĐĂů ƌĞĐŽƌĚ͘ tĞ ĂƌĞ part of the public hospital in San Bernardino County. Like ŵŽƐƚ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ƉƌĂĐƚŝĐĞƐ͕ ǁĞ ǁĞƌĞ ŵŽǀŝŶŐ ƚŽǁĂƌĚ the patient centered medical home model. Our electronic ŚĞĂůƚŚ ƌĞĐŽƌĚ ; ,ZͿ ǁĂƐ ŶŽƚ ĨƵůůǇ ŝŵƉůĞŵĞŶƚĞĚ ĂĐƌŽƐƐ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ĐŽŶƚŝŶƵƵŵ ĂŶĚ ĚĞƐƉŝƚĞ ǁŚĂƚ ƐŽŵĞ ŽĨ ƚŚĞ salespeople said, it did not really have a registry function. ůƐŽ͕ ĂƐ Ă ƉƵďůŝĐ ŝŶƐƚŝƚƵƚŝŽŶ͕ ƌĞƐŽƵƌĐĞƐ ĂƌĞ ĂůǁĂǇƐ ƐĐĂƌĐĞ͘ WƵƌĐŚĂƐŝŶŐ ĂŶ ŽĨĨͲƚŚĞͲƐŚĞůĨ ƌĞŐŝƐƚƌǇ ǁĂƐ ũƵƐƚ ŶŽƚ ŝŶ ƚŚĞ ĐĂƌĚƐ͘ /ŶƐƚĞĂĚ͕ ůĞĂĚĞƌƐŚŝƉ ƐĂŝĚ͕ ͞ ƵŝůĚ ǇŽƵƌ ŽǁŶ ŝĨ ǇŽƵ ǁĂŶƚ ŽŶĞ͘͟ ŶƚĞƌ ŽŶĞ ĐƌĂǌǇ ƉŚǇƐŝĐŝĂŶ͕ ŵĞ͕ ĂŶĚ ŽŶĞ ƐŵĂƌƚ ĂŶĚ talented programmer, Mr. Ledbetter. Challenges immediately ƐƵƌĨĂĐĞĚ͗ ϭ͘ Ϯ͘ 3. ϰ͘ 5.

Both of us had day jobs and building the registry had ƚŽ ŽĐĐƵƌ ĚƵƌŝŶŐ ĚŽǁŶ ƚŝŵĞƐ͘ We spoke different languages. KƵƌ ďĂĐŬŐƌŽƵŶĚƐ ǁĞƌĞ ƐŽ ĚŝĨĨĞƌĞŶƚ͖ ǁĞ ůŽŽŬĞĚ Ăƚ nothing in a similar fashion. Neither of us had ever used a registry. tĞ ǁĞƌĞ ďƵŝůĚŝŶŐ Ă ƚŽŽů ĨŽƌ Ă ŐƌŽƵƉ ŽĨ ƉĞŽƉůĞ ƚŚĂƚ ŚĂĚ not particularly requested to use one.

KǀĞƌ ƚŚĞ ŶĞǆƚ ĨŽƵƌ ǇĞĂƌƐ͕ ǁĞ ŵĞƚ ĂůŵŽƐƚ ĞǀĞƌǇ ǁĞĞŬ ĨŽƌ ŽŶĞ ƚŽ ƚǁŽ ŚŽƵƌƐ͘ / ŚĂŵŵĞƌĞĚ ŽŶ ŚŽǁ ƚŚĞ ƌĞƉŽƌƚ ǁƌŝƚŝŶŐ ŚĂĚ

dǁŽ ǇĞĂƌƐ ŝŶƚŽ ƚŚĞ ƉƌŽũĞĐƚ͕ ƚŚĞ ƚŚƌĞĞ ĨĂŵŝůǇ ŚĞĂůƚŚ ĐĞŶƚĞƌƐ joined other public health care systems in California led by the Safety Net Institute arm of the California Association of Public Hospitals to aggressively increase the percentage of ǁŽŵĞŶ ǁŚŽ ƌĞĐĞŝǀĞĚ ĂƉƉƌŽƉƌŝĂƚĞ ďƌĞĂƐƚ ĐĂŶĐĞƌ ƐĐƌĞĞŶŝŶŐ͘ hƐŝŶŐ ŵƵůƚŝƉůĞ ƉůĂŶͲĚŽͲƐƚƵĚǇͲĂĐƚ ;W ^ Ϳ ĐǇĐůĞƐ ĂŶĚ ƐŽŵĞ ŐŽŽĚ ŶĂƚƵƌĞĚ ĐŽŵƉĞƚŝƚŝǀĞ ĞǆƉĞƌŝŵĞŶƚĂƚŝŽŶ ďĞƚǁĞĞŶ ƚŚĞ different physician-medical assistant groups, the practice ǁĂƐ ĂďůĞ ƚŽ ĂĐŚŝĞǀĞ ϴϯ ƉĞƌĐĞŶƚ ĐŽŵƉůŝĂŶĐĞ͕ ǁŚŝĐŚ ŝƐ ŽǀĞƌ ƚŚĞ ϵϬƚŚ ƉĞƌĐĞŶƚŝůĞ ĂŵŽŶŐ DĞĚŝĐĂŝĚ ƉŽƉƵůĂƚŝŽŶƐ͘ &ŽƵƌ ǇĞĂƌƐ into the project, I turned the lead physician role over to Dr. DĞůĞŶĚĞǌ͘ ,Ğƌ ƚĞĐŚŶŽůŽŐǇ ƉƌŽǁĞƐƐ ĨĂƌ ƐƵƌƉĂƐƐĞƐ ŵŝŶĞ͘ ^ŚĞ ĐŽŶƚŝŶƵĞƐ ƚŽ ǁŽƌŬ ǁŝƚŚ Dƌ͘ >ĞĚďĞƚƚĞƌ ĂŶĚ ƚŚĞ ƌĞŐŝƐƚƌǇ ŚĂƐ improved exponentially. >ĞƐƐŽŶƐ ůĞĂƌŶĞĚ͗ ϭ͘ A registry is not so much a thing as an idea. The ǀĂůƵĞ ŝƐ ŝŶ ƚŚĞ ǁĂǇ ŝŶ ǁŚŝĐŚ ƚŚĞ ƉŚǇƐŝĐŝĂŶ ĂŶĚ ŽƚŚĞƌ ŵĞŵďĞƌƐ ŽĨ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƚĞĂŵ ĐŚĂŶŐĞ ŚŽǁ ƚŚĞǇ ǀŝĞǁ ŚĞĂůƚŚ ĐĂƌĞ͘ /ƚ ŝƐ ŶŽƚ Ă ůĂď ƚĞƐƚ ƚŚĂƚ ŐŝǀĞƐ ǇŽƵ ŝŶĨŽƌŵĂƚŝŽŶ ĂďŽƵƚ Ă ƉĂƚŝĞŶƚ ƚŚĂƚ ĚĂǇ͖ ŝƚ ŝƐ ŵŽƌĞ ůŝŬĞ using the science of laboratory medicine to improve the health of your patient population. Ϯ͘ /d ƉƌŽĨĞƐƐŝŽŶĂůƐ ƐĂǀĞ ůŝǀĞƐ ƚŽŽ͘ hƐĞ ŽĨ Ă ƌĞŐŝƐƚƌǇ ĂůůŽǁƐ the health care team to identify and address health ĐĂƌĞ ŶĞĞĚƐ ƚŚĂƚ ǁŽƵůĚ ŶŽƚ ďĞ ŶŽƚŝĐĞĚ ŽŶ ĞƉŝƐŽĚŝĐ visits. 3. ^ŽĐŝĞƚǇ ǁĂŶƚƐ ƚŽ ƐƚŽƉ ƉĂǇŝŶŐ ƵƐ ĨŽƌ ƚŚĞ ŶƵŵďĞƌ ŽĨ visits, tests, procedures and hospitalizations and instead pay us for improved health outcome results ǁĞ ĐĂŶ ƉƌŽǀĞ͘ ZĞŐŝƐƚƌŝĞƐ ĨĂĐŝůŝƚĂƚĞ ƚŚŝƐ͘ ϰ͘ The registry is never actually finished. It is asymptomatic. The people in the practice ĐŽŶƚŝŶƵĞ ƚŽ ŝŶƚĞƌĂĐƚ ǁŝƚŚ ŝƚ͕ ĂĚĚŝŶŐ ŵĞĂƐƵƌĞƐ ĂŶĚ features that continue to push the envelope on quality improvement.

California Family Physician Fall 2017

cyber world and medicine

William O. Woo, MD

Are You Protected? Tips for CyberSecurity tĂƐ ƉƌŽƚĞĐƟŶŐ ǇŽƵƌ ƉƌĂĐƟĐĞ ĨƌŽŵ ŚĂĐŬŝŶŐ ĐŽǀĞƌĞĚ ŝŶ ǇŽƵƌ ŵĞĚŝĐĂů ƐĐŚŽŽů Žƌ ƌĞƐŝĚĞŶĐǇ ĐƵƌƌŝĐƵůƵŵ͍ /ƚ ǁĂƐŶ͛ƚ ŝŶ ŵŝŶĞ͕ ďƵƚ ŝƚ͛Ɛ ŶŽƚ ƚŽŽ ůĂƚĞ͘ >ĞĂƌŶŝŶŐ ĂďŽƵƚ ƚŚĞ ŵŽƟǀĂƟŽŶ ŽĨ ĐǇďĞƌ ĐƌŝŵŝŶĂůƐ ĂŶĚ ƚŚĞŝƌ ŵŽƐƚ ĐŽŵŵŽŶ ĐǇďĞƌͲĂƩĂĐŬƐ ǁŝůů ŐŽ Ă ůŽŶŐ ǁĂǇ ƚŽ ƉƌĞǀĞŶƚ ƐƵĐŚ ĂƩĂĐŬƐ ĂŐĂŝŶƐƚ ǇŽƵƌ ƉƌĂĐƟĐĞ͘

/ŶŚĞƌĞŶƚ ǁĞĂŬŶĞƐƐĞƐ ŝŶ ŽƵƌ /d ƐǇƐƚĞŵƐ ĂŶĚ ƚŚĞ ĞĂƐǇ ďƵĐŬ ƚŽ ďĞ ŵĂĚĞ ŽŶ ƉƌŽƚĞĐƚĞĚ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ ;W,/Ϳ ĞǆƉůĂŝŶƐ ƚŚĞ ŝŶĐƌĞĂƐŝŶŐ ƌĂƚĞ ŽĨ ĂƩĂĐŬƐ ŽŶ ƚŚĞ ŵĞĚŝĐĂů ƐĞĐƚŽƌ͕ ďƵƚ ŚŽǁ ĂƌĞ ƚŚĞ ĐƌŝŵŝŶĂůƐ ƉƵůůŝŶŐ Žī ƚŚĞŝƌ ĂƩĂĐŬƐ͍ dŚĞ ƚŚƌĞĞ ŵŽƐƚ ĐŽŵŵŽŶ ƐĐŚĞŵĞƐ ĨŽƌ ĂƩĂĐŬ ŝŶĐůƵĚĞ͗ ƉŚŝƐŚŝŶŐ ƐĐŚĞŵĞƐ͕ ĚŝƌĞĐƚ ƉŚǇƐŝĐĂů ĂƩĂĐŬƐ͕ ĂŶĚ ƌĂŶƐŽŵǁĂƌĞ͘

^ŝŶĐĞ ƚŚĞ ŝŶǀĞŶƟŽŶ ŽĨ ƚŚĞ ůĞĐƚƌŽŶŝĐ ,ĞĂůƚŚ ZĞĐŽƌĚ ; ,ZͿ ĐǇďĞƌ ĐƌŝŵŝŶĂůƐ ŚĂǀĞ ďĞĞŶ ĂƩĂĐŬŝŶŐ ƚŚĞ ŚĞĂůƚŚ ĐĂƌĞ ƐĞĐƚŽƌ Ăƚ ĂŶ ŝŶĐƌĞĂƐŝŶŐůǇ ĂůĂƌŵŝŶŐ ƌĂƚĞ͕ ƐƚĞĂůŝŶŐ ƉĂƟĞŶƚ ŝŶĨŽƌŵĂƟŽŶ ĨŽƌ ƐƵďƐĞƋƵĞŶƚ ƐĂůĞ ŽŶ ƚŚĞ ďůĂĐŬ ŵĂƌŬĞƚ ĂŶĚ ĞǆƚŽƌƟŶŐ ŵŽŶĞǇ ĚŝƌĞĐƚůǇ ĨƌŽŵ ŚĞĂůƚŚ ĐĂƌĞ ŽƌŐĂŶŝǌĂƟŽŶƐ͘ /Ŷ ϮϬϬϵ͕ ŽŶĞ ŽĨ ƚŚĞ ůĂƌŐĞƐƚ ĚĂƚĂ ďƌĞĂĐŚĞƐ ĞǆƉŽƐŝŶŐ ƉĂƟĞŶƚ ŝŶĨŽƌŵĂƟŽŶ ŝŶǀŽůǀĞĚ ůƵĞ ƌŽƐƐ н ůƵĞ ^ŚŝĞůĚ dE͕ ĂīĞĐƟŶŐ ĂƉƉƌŽǆŝŵĂƚĞůǇ ŽŶĞ ŵŝůůŝŽŶ ƉĂƟĞŶƚƐ͘ dŚĞ ĞǆƉŽŶĞŶƟĂů ŐƌŽǁƚŚ ŝŶ ƉĂƟĞŶƚ ĚĂƚĂ ƚŚĞŌ ĐƵůŵŝŶĂƚĞĚ ŝŶ ϮϬϭϱ ǁŝƚŚ Ă ďƌĞĂĐŚ ĂŐĂŝŶƐƚ ŶƚŚĞŵ ǁŚŝĐŚ ĂīĞĐƚĞĚ ϴϬ ŵŝůůŝŽŶ ƉĂƟĞŶƚ ƌĞĐŽƌĚƐ͘

WŚŝƐŚŝŶŐ ƐĐŚĞŵĞƐ͗ ƩĂĐŬƐ ĚĞƐŝŐŶĞĚ ƚŽ ƚƌŝĐŬ ƉĞŽƉůĞ ŝŶƚŽ ĚŽŝŶŐ ƚŚŝŶŐƐ ůŝŬĞ ŐŝǀŝŶŐ ƵƉ ƐĞŶƐŝƟǀĞ ŝŶĨŽƌŵĂƟŽŶ Žƌ ŽƉĞŶŝŶŐ ĞŵĂŝů ĂƩĂĐŚŵĞŶƚƐ ǁŚŝĐŚ ĐŽŶƚĂŝŶ ŵĂůŝĐŝŽƵƐ ƐŽŌǁĂƌĞ͘ WŚŝƐŚŝŶŐ ƐĐŚĞŵĞƐ ƉƌĞĚĂƚĞ ƚŚĞ ĞůĞĐƚƌŽŶŝĐ ĞƌĂ ĂŶĚ ƉƌĞǀŝŽƵƐůǇ ŝŶĐůƵĚĞĚ ŵĂŝůĞĚ ůĞƩĞƌƐ ǁŚŝĐŚ ĂƩĞŵƉƚĞĚ ƚŽ ƐŽůŝĐŝƚ ŝŶĨŽƌŵĂƟŽŶ ƵŶĚĞƌ ĨĂůƐĞ ƉƌĞƚĞŶƐĞƐ͘ /Ŷ ƚŚĞ ƐĂŵĞ ǁĂǇ͕ ĞŵĂŝůƐ ĂŶĚ ĨĂŬĞ ǁĞďƐŝƚĞƐ ĂƌĞ ŶŽǁ ƵƐĞĚ ƚŽ ƐŽůŝĐŝƚ ƐƵĐŚ ŝŶĨŽƌŵĂƟŽŶ͘ ǇďĞƌĐƌŝŵŝŶĂůƐ ŚĂǀĞ ĞǀŽůǀĞĚ ĂŶĚ ďĞĐŽŵĞ ŵŽƌĞ ƐŽƉŚŝƐƟĐĂƚĞĚ͕ ĂŶĚ ŶŽǁ ĂƌĞ ƵƐŝŶŐ ƐŽĐŝĂů ĞŶŐŝŶĞĞƌŝŶŐ ƚŽ ďĂŝƚ ƉĞŽƉůĞ ŝŶƚŽ ŐŝǀŝŶŐ ƵƉ ŝŶĨŽƌŵĂƟŽŶ Žƌ ŽƉĞŶŝŶŐ ƚŚĞŝƌ ƐǇƐƚĞŵƐ ƚŽ ĂƩĂĐŬ͘ ,ĞƌĞ ĂƌĞ Ă ĨĞǁ ĞǆĂŵƉůĞƐ͗ • &ĂŬĞ ĞŵĂŝůƐ ĨƌŽŵ ǁŚĂƚ ĂƉƉĞĂƌƐ ƚŽ ďĞ ĂŶ ŽĸĐŝĂů ǁĞďƐŝƚĞͬ ŝŶƐƟƚƵƟŽŶ ƐƚĂƟŶŐ ǇŽƵƌ ĂĐĐŽƵŶƚ ŚĂƐ ďĞĞŶ ĐŽŵƉƌŽŵŝƐĞĚ͘ hƐĞƌƐ ĂƌĞ ĂƐŬĞĚ ƚŽ ĐůŝĐŬ ŽŶ Ă ůŝŶŬ ƚŽ ƌĞƐĞƚ ƚŚĞ ƉĂƐƐǁŽƌĚ͘ dŚĞ ůŝŶŬ ƚĂŬĞƐ ƚŚĞ ƉĞƌƐŽŶ ƚŽ ĂŶ ŽĸĐŝĂů ůŽŽŬŝŶŐ ǁĞďƐŝƚĞ ǁŚĞƌĞ ƚŚĞǇ ĞŶƚĞƌ ƐĞŶƐŝƟǀĞ ŝŶĨŽƌŵĂƟŽŶ ǁŚŝĐŚ ŝƐ ƚŚĞŶ ƐƚŽůĞŶ͘ • ŵĂŝůƐ ǁŝƚŚ ĂŶ ŽīĞƌ ƚŽŽ ŐŽŽĚ ƚŽ ďĞ ƚƌƵĞ͘ dŚĞ ĮƌƐƚ ŝƚĞƌĂƟŽŶ ŽĨ ƚŚŝƐ ƐĐŚĞŵĞ ŝŶǀŽůǀĞĚ ƚŚĞ ƌŝĐŚ EŝŐĞƌŝĂŶ ƉƌŝŶĐĞ ǁŚŽ ƉĂƐƐĞĚ ĂǁĂǇ ĂŶĚ ůĞŌ ǇŽƵ ŵŽŶĞǇ͘ tŝƚŚ ƐŽĐŝĂů ĞŶŐŝŶĞĞƌŝŶŐ͕ ĐǇďĞƌ ĐƌŝŵŝŶĂůƐ ůĞĂƌŶ ĂďŽƵƚ ǇŽƵƌ ŵŽƟǀĂƟŽŶƐ ;ƉĞƌŚĂƉƐ ƚŚƌŽƵŐŚ ǇŽƵƌ ƐŽĐŝĂů ŵĞĚŝĂ ƉŽƐƚƐͿ ƚŽ ƚĂŝůŽƌ ĂŶ ĞŶƟĐŝŶŐ ĞŵĂŝů͘ • ŵĂŝůƐ ƚŚĂƚ ƐĞĞŵ ƚŽ ďĞ ĨƌŽŵ ƉĞŽƉůĞ ǇŽƵ ŬŶŽǁ ĂƐŬŝŶŐ ĨŽƌ ŝŶĨŽƌŵĂƟŽŶ Žƌ ĨŽƌ ĂĐƟŽŶ͘ Ŷ ĞǆĂŵƉůĞ ĐŽƵůĚ ŝŶĐůƵĚĞ Ă ĨĂŬĞ email from the head physician of a medical group asking the ŽĸĐĞ ŵĂŶĂŐĞƌ ƚŽ ĐƵƚ Ă ĐŚĞĐŬ ƚŽ ƉĂǇ ĨŽƌ ĂŶ ĞǆƉĞŶƐĞ͘

ƋƵĂůůǇ ĂƐ ĚŝƐƚƵƌďŝŶŐ ŝƐ ƚŚĞ ƚƌĞŶĚ ƚŽǁĂƌĚ ĞǆƚŽƌƟŶŐ ŵŽŶĞǇ ĨƌŽŵ ŚĞĂůƚŚ ĐĂƌĞ ŝŶƐƟƚƵƟŽŶƐ ďǇ ĞŶĐƌǇƉƟŶŐ ĂŶĚ ůŽĐŬŝŶŐ ĚŽǁŶ ƚŚĞŝƌ /d ƐǇƐƚĞŵƐ ĂŶĚ ŚŽůĚŝŶŐ ƚŚĞŵ ĨŽƌ ƌĂŶƐŽŵ͘ /Ŷ DĂǇ ϮϬϭϳ͕ ƚŚĞ ŶŽƚŽƌŝŽƵƐ tĂŶŶĂ ƌǇ ƌĂŶƐŽŵǁĂƌĞ ĂƩĂĐŬ ƐŚƵƚ ĚŽǁŶ ϰϳ EĂƟŽŶĂů ,ĞĂůƚŚ ^ĞƌǀŝĐĞ ;E,^Ϳ ŽƌŐĂŶŝǌĂƟŽŶƐ ŝŶ ƚŚĞ hŶŝƚĞĚ <ŝŶŐĚŽŵ͕ ŐƌŝŶĚŝŶŐ ŚĞĂůƚŚ care delivery in England to a halt for several days. These trends ĂīĞĐƚ ƉŚǇƐŝĐŝĂŶƐ Ăƚ Ăůů ůĞǀĞůƐ ͙ ƐŵĂůů ƉƌĂĐƟĐĞ͕ ůĂƌŐĞ ŐƌŽƵƉ ĂŶĚ hospital based. ^ƵĐĐĞƐƐĨƵů ƉŚǇƐŝĐŝĂŶƐ ƵŶĚĞƌƐƚĂŶĚ ƚŚĞŝƌ ƉĂƟĞŶƚƐ͛ ŵŽƟǀĂƟŽŶƐ ĂŶĚ ƵƐĞ ƚŚĂƚ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ƚŽ ďĞƐƚ ŐƵŝĚĞ ƉĂƟĞŶƚ ĐĂƌĞ͘ /Ŷ ŵƵĐŚ ƚŚĞ ƐĂŵĞ ǁĂǇ͕ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ƚŚĞ ŵŽƟǀĂƟŽŶ ŽĨ ŚĂĐŬĞƌƐ ĂŶĚ ĐǇďĞƌ ĐƌŝŵŝŶĂůƐ ŝŶ ƚŚĞ ĐŽŶƚĞǆƚ ŽĨ ŽƵƌ ŚĞĂůƚŚ ĐĂƌĞ ƐǇƐƚĞŵ ŐŽĞƐ Ă ůŽŶŐ ǁĂǇ ƚŽǁĂƌĚ ƉƌŽƚĞĐƟŶŐ ǇŽƵƌ ƉƌĂĐƟĐĞ ĨƌŽŵ ǀŝƌƚƵĂů ŝŶƚƌƵƐŝŽŶƐ͘ dŚĞ ŵĂŝŶ ŵŽƟǀĂƚŽƌ ĨŽƌ ŚĂĐŬĞƌƐ ƚŽ ƐƚĞĂů ƉĂƟĞŶƚ ƌĞĐŽƌĚƐ ŝƐ ŵŽŶĞƚĂƌǇ ŐĂŝŶ͘ ,ĞĂůƚŚ ĐĂƌĞ ƌĞĐŽƌĚƐ ĐĂŶ ďĞ ƐŽůĚ ŽŶ ƚŚĞ ĚĂƌŬ ǁĞď ;ďůĂĐŬ ŵĂƌŬĞƚ ŽĨ ƚŚĞ ŝŶƚĞƌŶĞƚͿ ĨŽƌ ƵƉǁĂƌĚ ŽĨ ΨϱϬϬ ƉĞƌ ƌĞĐŽƌĚ͘ ĐŽŵƉůĞƚĞ ƉĂƟĞŶƚ ƌĞĐŽƌĚ ŝƐ ŽŌĞŶ more valuable than a stolen credit card. What makes the health ĐĂƌĞ ĮĞůĚ Ă ƉĂƌƟĐƵůĂƌůǇ ĞĂƐǇ ƚĂƌŐĞƚ ŝƐ ƚŚĂƚ ĐǇďĞƌƐĞĐƵƌŝƚǇ ŝŶ ƚŚĞ ŚĞĂůƚŚ care industry lags behind other sectors – and it is not a high priority, ĞƐƉĞĐŝĂůůǇ ŝŶ ƐŵĂůů ƉƌĂĐƟĐĞƐ͘ Ŷ ĂĚĚŝƟŽŶĂů ǀƵůŶĞƌĂďŝůŝƚǇ ŝƐ ƚŚĞ ŝĚĞĂ ƚŚĂƚ /d ƐǇƐƚĞŵƐ ĂƌĞ ŽŌĞŶ ĐĞŶƚƌĂůͬĐƌŝƟĐĂů ƚŽ ƉĂƟĞŶƚ ĐĂƌĞ ďƵƚ ĂƌĞ ŶŽƚ ĂůǁĂǇƐ ŬĞƉƚ ƵƉͲƚŽͲĚĂƚĞ ǁŝƚŚ ƚŚĞ ůĂƚĞƐƚ ƐŽŌǁĂƌĞ͘ ŽŶƐĞƋƵĞŶƟĂůůǇ ŚĞĂůƚŚ ĐĂƌĞ ŽƌŐĂŶŝǌĂƟŽŶƐ ĂƌĞ ǁŝůůŝŶŐ ƚŽ ƉĂǇ ůĂƌŐĞ ĂŵŽƵŶƚƐ ŽĨ ŵŽŶĞǇ ǁŚĞŶ ƚŚĞƐĞ ƐǇƐƚĞŵƐ ĂƌĞ ƚŚƌĞĂƚĞŶĞĚ͘ 16

California Family Physician Fall 2017

ŝƌĞĐƚ ƉŚǇƐŝĐĂů ĂƩĂĐŬ͗ /ŶǀŽůǀĞƐ Ă ĐƌŝŵŝŶĂů Žƌ ŝŶƐŝĚĞ ŵĂŶ ǁŚŽ ĂĐƚƵĂůůǇ ŐŽĞƐ ŽŶ ƉƌĞŵŝƐĞƐ ƚŽ ƐƚĞĂů ŝŶĨŽƌŵĂƟŽŶ͘ ĐŽŵŵŽŶ ǁĂǇ ƚŽ ĂĐŚŝĞǀĞ ƚŚŝƐ ŝƐ ďǇ ŚĂǀŝŶŐ Ă ǀŝƌƵƐͬŵĂůǁĂƌĞ ŽŶ Ă h^ ƐƟĐŬ ĂŶĚ ŝŶƐĞƌƟŶŐ ŝƚ ŝŶƚŽ Ă ĐŽŵƉƵƚĞƌ ŽŶ ƚŚĞ ŶĞƚǁŽƌŬ͘ dŚŝƐ ĐĂŶ ďĞ ĚŽŶĞ ŬŶŽǁŝŶŐůǇ Žƌ ŝŶĂĚǀĞƌƚĞŶƚůǇ͘ ĚĚŝƟŽŶĂůůǇ͕ ŚĂĐŬĞƌƐ ĐĂŶ ƐŽŵĞƟŵĞƐ ŐĂŝŶ ĂĐĐĞƐƐ ƚŽ ĐŽŵƉƵƚĞƌƐ ŽŶ ƐŝƚĞ ǀŝĂ ƚŚĞ ǁŝƌĞůĞƐƐ ŶĞƚǁŽƌŬ͕ ĞƐƉĞĐŝĂůůǇ ŝĨ ŶŽ ĞŶĐƌǇƉƟŽŶ is used to secure the Wi-Fi. ZĂŶƐŽŵǁĂƌĞ͗ DĂůŝĐŝŽƵƐ ƐŽŌǁĂƌĞ ƚŚĂƚ ĞŶĐƌǇƉƚƐ ĐŽŵƉƵƚĞƌƐ ŽŶ ƚŚĞ ŶĞƚǁŽƌŬ ŵĂŬŝŶŐ ƚŚĞŵ ƵƐĞůĞƐƐ ƵŶƟů Ă ƌĂŶƐŽŵ ŝƐ ƉĂŝĚ͘ dŚŝƐ ƚĞĐŚŶŝƋƵĞ ŝƐ ŽŌĞŶ ĞŵƉůŽǇĞĚ ƚŚƌŽƵŐŚ ƚŚĞ ƵƐĞ ŽĨ Ă ƉŚŝƐŚŝŶŐ ƐĐŚĞŵĞ͘ hƐĞƌƐ ĂƌĞ ďĂŝƚĞĚ ŝŶƚŽ ĐůŝĐŬŝŶŐ ŽŶ Ă ůŝŶŬ ŝŶ ĂŶ ĞŵĂŝů͕ ŽƉĞŶŝŶŐ ĂŶ ĞŵĂŝů ĂƩĂĐŚŵĞŶƚ͕ Žƌ ĐůŝĐŬŝŶŐ Ă ůŝŶŬ ŽŶ Ă ǁĞďƐŝƚĞ ǁŚŝĐŚ ůŽĂĚƐ ƚŚĞ ƌĂŶƐŽŵǁĂƌĞ ŽŶƚŽ ƚŚĞ ƐǇƐƚĞŵ͘ dŚĞ ƐŽŌǁĂƌĞ ƚƌĂǀĞůƐ ƚŚƌŽƵŐŚ Ăůů ŽĨ ƚŚĞ ĐŽŵƉƵƚĞƌƐ ŽŶ ƚŚĞ ŶĞƚǁŽƌŬ ĞŶĐƌǇƉƟŶŐ Ăůů ƚŚĞ ĮůĞƐ ŵĂŬŝŶŐ ƚŚĞŵ ƵŶƵƐĂďůĞ͘ dŚĞ ŵŽƐƚ ǀƵůŶĞƌĂďůĞ ƐǇƐƚĞŵƐ ĂƌĞ ƚŚŽƐĞ ǁŝƚŚ ƵŶƉĂƚĐŚĞĚ Žƌ ŽƵƚĚĂƚĞĚ ƐŽŌǁĂƌĞ ƐǇƐƚĞŵƐ ǁŚŝĐŚ ĂůůŽǁ ĂŶ ĂƩĂĐŬĞƌ ƚŽ ŐĂŝŶ unauthorized access.

>ŽŽŬŝŶŐ ĨŽƌ ŵŽƌĞ ŝŶĨŽƌŵĂƟŽŶ͍ • ĞƉĂƌƚŵĞŶƚ ŽĨ ,ĞĂůƚŚ ĂŶĚ ,ƵŵĂŶ ^ĞƌǀŝĐĞƐ ʹ ŝŶĨŽƌŵĂƟŽŶ ŽŶ ZĂŶƐŽŵǁĂƌĞ͗ ŚƩƉƐ͗ͬͬǁǁǁ͘ŚŚƐ͘ŐŽǀͬƐŝƚĞƐͬĚĞĨĂƵůƚͬĮůĞƐͬ ZĂŶƐŽŵǁĂƌĞ&ĂĐƚ^ŚĞĞƚ͘ƉĚĨ • h^ ŽŵƉƵƚĞƌ ŵĞƌŐĞŶĐǇ ZĞĂĚŝŶĞƐƐ dĞĂŵ ;h^Ͳ ZdͿ ʹ ǀŽŝĚŝŶŐ ^ŽĐŝĂů ŶŐŝŶĞĞƌŝŶŐ ĂŶĚ WŚŝƐŚŝŶŐ ƩĂĐŬƐ͗ ŚƩƉƐ͗ͬͬ ǁǁǁ͘ƵƐͲĐĞƌƚ͘ŐŽǀͬŶĐĂƐͬƟƉƐͬ^dϬϰͲϬϭϰ • ĞƉĂƌƚŵĞŶƚ ŽĨ :ƵƐƟĐĞ ǇďĞƌƐĞĐƵƌŝƚǇ hŶŝƚ ʹ ĞƐƚ WƌĂĐƟĐĞƐ ĨŽƌ sŝĐƟŵ ZĞƐƉŽŶƐĞ ĂŶĚ ZĞƉŽƌƟŶŐ ŽĨ ǇďĞƌ /ŶĐŝĚĞŶƚƐ͗ ŚƩƉ͗ͬͬǁǁǁ͘ũƵƐƟĐĞ͘ŐŽǀͬƐŝƚĞƐͬĚĞĨĂƵůƚͬĮůĞƐͬŽƉĂͬƐƉĞĞĐŚĞƐͬ ĂƩĂĐŚŵĞŶƚƐͬϮϬϭϱͬϬϰͬϮϵͬĐƌŝŵŝŶĂůͺĚŝǀŝƐŝŽŶͺŐƵŝĚĂŶĐĞͺŽŶͺ ďĞƐƚͺƉƌĂĐƟĐĞƐͺĨŽƌͺǀŝĐƟŵͺƌĞƐƉŽŶƐĞͺĂŶĚͺƌĞƉŽƌƟŶŐͺĐǇďĞƌͺ incidents.pdf • ĞƉĂƌƚŵĞŶƚ ŽĨ ,ĞĂůƚŚ ĂŶĚ ,ƵŵĂŶ ^ĞƌǀŝĐĞƐ͕ KĸĐĞ ĨŽƌ ŝǀŝů ZŝŐŚƚƐ Ͳ ,/W ^ĞĐƵƌŝƚǇ ZƵůĞ ĂŶĚ 'ƵŝĚĂŶĐĞ ŝŶĨŽƌŵĂƟŽŶ͗ ŚƩƉ͗ͬͬǁǁǁ͘ŚŚƐ͘ŐŽǀͬŚŝƉĂĂͬĨŽƌͲƉƌŽĨĞƐƐŝŽŶĂůƐͬƐĞĐƵƌŝƚǇͬ ŐƵŝĚĂŶĐĞͬŝŶĚĞǆ͘Śƚŵů

ƌ͘ tŽŽ ƉƌĂĐƟĐĞƐ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ Ăƚ <ĂŝƐĞƌ WĞƌŵĂŶĞŶƚĞ͕

EŽǁ ƚŚĂƚ ǇŽƵ ŬŶŽǁ ǁŚǇ ĐǇďĞƌ ĐƌŝŵŝŶĂůƐ ĂŶĚ ŚĂĐŬĞƌƐ ĚŽ ǁŚĂƚ ƚŚĞǇ KƌĂŶŐĞ ĂŶĚ ŝƐ Ă ŵĞŵďĞƌ ŽĨ &W͛Ɛ ŽŵŵŝƩĞĞ ŽŶ ŽŶƟŶƵŝŶŐ ĚŽ ĂŶĚ ŚŽǁ ƚŚĞǇ ĚŽ ŝƚ͕ ŚĂůĨ ŽĨ ƚŚĞ ďĂƩůĞ ŝƐ ǁŽŶ͘ hŶĨŽƌƚƵŶĂƚĞůǇ͕ ƐŚŽƵůĚ WƌŽĨĞƐƐŝŽŶĂů ĞǀĞůŽƉŵĞŶƚ͘ ǇŽƵ Žƌ ǇŽƵƌ ŽƌŐĂŶŝǌĂƟŽŶ ĨĂůů ǀŝĐƟŵ ƚŽ Ă ŚĂĐŬĞƌ͕ ŝƚ ŝƐ ǇŽƵƌ ƌĞƐƉŽŶƐŝďŝůŝƚǇ ƚŽ ƉƌŽǀĞ ƚŚĂƚ W,/ ǁĂƐ ŶŽƚ ƐƚŽůĞŶ Žƌ ǇŽƵ ĐŽƵůĚ ďĞ ĮŶĞĚ͘ ,ĞƌĞ ĂƌĞ ƐŽŵĞ ƐŝŵƉůĞ ƟƉƐ ŽŶ ŚŽǁ ǇŽƵ ĐĂŶ ŚĞůƉ ƚŽ ƉƌŽƚĞĐƚ ǇŽƵƌ ƉĂƟĞŶƚƐ ĂŶĚ ƉƌĂĐƟĐĞ͗ • ,ĂǀĞ Ă ĚĞĚŝĐĂƚĞĚ W ĨŽƌ ǁŽƌŬ ʹ ǁŝƚŚ Ă ^dZKE' ƉĂƐƐǁŽƌĚ͘ <ĞĞƉ ƚŚĞ ĐŽŵƉƵƚĞƌ locked unless using it. • hƐĞ ĞŶĐƌǇƉƟŽŶ ƚĞĐŚŶŽůŽŐǇ ŽŶ ǇŽƵƌ ŚĂƌĚ ĚƌŝǀĞƐ͖ ƚŚŝƐ ĐĂŶ ŵŝƟŐĂƚĞ ůŽƐƐ ŽĨ W,/ ĚƵƌŝŶŐ ĂŶ ĂƩĂĐŬ͘ • Ž ŶŽƚ ŽƉĞŶ ĞŵĂŝůƐ Žƌ ĐůŝĐŬ ŽŶ ůŝŶŬƐͬ ĂƩĂĐŚŵĞŶƚƐ ĨƌŽŵ ƉĞŽƉůĞ ǇŽƵ ĚŽ ŶŽƚ ŬŶŽǁ Žƌ ǇŽƵ ǁĞƌĞ ŶŽƚ ĞǆƉĞĐƟŶŐ͘ DĂŬĞ sure to look at the email addresses The UCSF Fresno Medical Education Program and Central California Faculty Medical Group (CCFMG) are recruiting for a physician to join the teaching faculty. The successful applicant must ǀĞƌǇ ĐĂƌĞĨƵůůǇ͘ /Ĩ ŝŶ ĚŽƵďƚ ĐĂůů͊ be board certified in Family Medicine, have a license to practice medicine in the United States, • <ĞĞƉ ǇŽƵƌ ŽƉĞƌĂƟŶŐ ƐǇƐƚĞŵƐ ĂŶĚ and be eligible to obtain a California medical license at the time of hire. This position provides an ďƌŽǁƐĞƌƐ ƵƉͲƚŽͲĚĂƚĞ͘ ŽŵƉĂŶŝĞƐ opportunity for teaching, clinical research, and community practice. Proficiency in OB optional. ƐƵĐŚ ĂƐ DŝĐƌŽƐŽŌ ŽŌĞŶ ƐĞŶĚ ŽƵƚ Administrative/leadership opportunities are available. A competitive salary is offered. updates that protect against the latest ǀƵůŶĞƌĂďŝůŝƟĞƐ ĂŶĚ ƚŚƌĞĂƚƐ͘ The program is based in Fresno, California, which offers a high standard of living combined with a • ŶƐƵƌĞ Ăůů ƐƚĂī ĂƌĞ ƚƌĂŝŶĞĚ ƌĞŐƵůĂƌůǇ low cost of living. The result is a quality of life uniquely Californian, yet surprisingly affordable. ŽŶ ,/W ͬ,/d , ĂƐ ǁĞůů ĂƐ Fresno is a vibrant, growing city located in Central California. There is much to see and do in phishing techniques. Fresno and the city is ideally located for fast, convenient getaways to the scenic Central Coast as well as the majestic Sierra Nevada mountains. Fresno is the only major city in the country with • ^Ğƚ ƐĞĐƵƌŝƚǇͬƉƌŝǀĂĐǇ ĨŽƌ ǇŽƵƌ close proximity to three national parks, including renowned Yosemite National Park. social media. • ^ĞĐƵƌĞ ǇŽƵƌ tŝͲ&ŝ ŶĞƚǁŽƌŬ ǁŝƚŚ Ă PLEASE APPLY ONLINE AT: https://aprecruit.ucsf.edu/apply/JPF01168 ƉĂƐƐǁŽƌĚͬĞŶĐƌǇƉƟŽŶ͘ Visit our websites: www.fresno.ucsf.edu | www.communitymedical.org • ZĞƉŽƌƚ ĂŶǇ ĂƩĂĐŬƐ Žƌ ƐƵƐƉĞĐƚĞĚ UC San Francisco seeks candidates whose experience, teaching, research, or community service that has prepared them to contribute to our commitment to diversity ĂƩĂĐŬƐ ƚŽ ůĂǁ ĞŶĨŽƌĐĞŵĞŶƚ͘ and excellence. The University of California is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status. • Hire an IT security consultant

UCSF FRESNO FAMILY MEDICINE FACULTY OPPORTUNITY

California Family Physician Fall 2017

Tipu V. Khan, MD, FAAFP

Must Have Apps for Family Physicians ǀĞƌǇ ĚĂǇ ŶĞǁ ĂƉƉůŝĐĂƟŽŶƐ ĂƌĞ ĚĞǀĞůŽƉĞĚ ĂŶĚ ƌĞůĞĂƐĞĚ ĨŽƌ ƐŵĂƌƚƉŚŽŶĞƐ͘ ^ŽŵĞ ĂƌĞ ĨƌĞĞ ĂŶĚ ƐŽŵĞ ƌĞƋƵŝƌĞ Ă ƐƵďƐĐƌŝƉƟŽŶ Žƌ ŽŶĞͲƟŵĞ ĨĞĞ͘ dŚĞ ŶƵŵďĞƌ ŽĨ ŵĞĚŝĐĂů ĂƉƉƐ ŝƐ ĂƐƚŽŶŝƐŚŝŶŐ ĂŶĚ ǀĂƌŝĞƐ ŐƌĞĂƚůǇ ďĂƐĞĚ ŽŶ ŶĞĞĚ͘ &Žƌ ĞǆĂŵƉůĞ͕ ǁŚĞŶ / ǁŽƌŬ ŝŶ ƚŚĞ ĞŵĞƌŐĞŶĐǇ ĚĞƉĂƌƚŵĞŶƚ͕ / ƵƐĞ Ă ƐƉĞĐŝĮĐ ƐĞƚ ŽĨ ĂƉƉƐ ĨŽƌ ƋƵŝĐŬ͕ ƉŽŝŶƚͲŽĨͲĐĂƌĞ ĚĞĐŝƐŝŽŶ ŵĂŬŝŶŐ ĂŶĚ ĂůŐŽƌŝƚŚŵ ƌĞǀŝĞǁ͘ tŚĞŶ /͚ŵ ŝŶ ĐůŝŶŝĐ Žƌ ŽŶ ƚŚĞ ǁĂƌĚƐ͕ ŚŽǁĞǀĞƌ͕ / ƵƐĞ ĚŝīĞƌĞŶƚ apps and calculators. tŚĞŶ / ĮƌƐƚ ďĞŐĂŶ ƵƐŝŶŐ ŵǇ ƐŵĂƌƚƉŚŽŶĞ ĂƐ Ă ŵĞĚŝĐĂů ƌĞƐŽƵƌĐĞ͕ / ĚŽǁŶůŽĂĚĞĚ ŚƵŶĚƌĞĚƐ ŽĨ ĂƉƉƐ ĂŶĚ ĨŽƵŶĚ ŵǇƐĞůĨ ƌĂƌĞůǇ ƵƐŝŶŐ ŵŽƐƚ͘ KǀĞƌ ƚŚĞ ǇĞĂƌƐ͕ /͛ǀĞ ŚŽŶĞĚ ƚŚĂƚ ůŝƐƚ ĚŽǁŶ ƚŽ Ă ĨĞǁ ĐƌŝƟĐĂů ͞ŐŽ ƚŽ͟ ĂƉƉƐ / ĚŽŶ͛ƚ ŵŝŶĚ ƉĂǇŝŶŐ Ă ĨĞĞ ƚŽ ƵƐĞ͘ ^Ž͕ ŚĞƌĞ͛Ɛ ŵǇ ŚŝŐŚůŝŐŚƚ ŽĨ Ă ĨĞǁ ĂƉƉƐ ƉƌĂĐƟĐŝŶŐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ŵĂǇ ĮŶĚ ƵƐĞĨƵů ŽǀĞƌ ƚŚĞ ĐŽƵƌƐĞ ŽĨ Ă ƉƌĂĐƟĐĞ ĚĂǇ͘ DŽƐƚ ŽĨ ƚŚĞƐĞ ĂƉƉƐ ǁŝůů ŐŝǀĞ ǇŽƵ Ă ĨƌĞĞ ƚƌŝĂů͕ ƐŽ ĚŽǁŶůŽĂĚ ĂŶĚ ŐŝǀĞ ƚŚĞŵ Ă ƐŚŽƚ͊

WŚĂƌŵĂĐŽƉĞŝĂƐ Ɛ ĨĂƌ ĂƐ ƉŚĂƌŵĂĐŽƉĞŝĂƐ ŐŽ͕ Ă ĨĞǁ ďŝŐ ŚŝƩĞƌƐ ĂƌĞ ĂǀĂŝůĂďůĞ͗ Epocrates, Tarascon, Lexicomp, and Micromedex. All ĨŽƵƌ ĂƌĞ ǁĞůů ŬŶŽǁŶ ĂŶĚ ƉƌŽǀŝĚĞ ĞƐƐĞŶƟĂůůǇ ƚŚĞ ƐĂŵĞ ŝŶĨŽƌŵĂƟŽŶ͘ / ŚĂǀĞ ďĞĞŶ ƵƐŝŶŐ ƉŽĐƌĂƚĞƐ ƐŝŶĐĞ / ǁĂƐ Ă ŵĞĚŝĐĂů ƐƚƵĚĞŶƚ ĂŶĚ Ăŵ ƋƵŝƚĞ ĨĂŵŝůŝĂƌ ǁŝƚŚ ŝƚƐ ŝŶƚĞƌĨĂĐĞ͘ dŚĞ ĚƌƵŐ ƌĞĨĞƌĞŶĐĞ ƉŽƌƟŽŶ ŽĨ ƚŚĞ ĂƉƉ ŝƐ ĨƌĞĞ͕ ďƵƚ / ŐůĂĚůǇ ĨŽƌŬ ŽǀĞƌ ƚŚĞ ĞǆƚƌĂ ĚŽůůĂƌƐ ĨŽƌ ƚŚĞ ƉƌĞŵŝƵŵ ǀĞƌƐŝŽŶ ǁŚŝĐŚ ƉƌŽǀŝĚĞƐ Ă ĚŝĂŐŶŽƐƟĐ ĂŶĚ ƚƌĞĂƚŵĞŶƚ ƌĞƐŽƵƌĐĞ ĂƐ ǁĞůů ʹ ƚŚƵƐ ĂůƐŽ ĨƵŶĐƟŽŶŝŶŐ ĂƐ Ă ŵĞĚŝĐĂů ĚŝƐĞĂƐĞ ƌĞĨĞƌĞŶĐĞ ŐƵŝĚĞ all in one app. This is by far my most used app and I open ƚŚŝƐ ĂƉƉ ŽŶ ĂǀĞƌĂŐĞ ϮϬ ƟŵĞƐ ƉĞƌ ĚĂǇ͘

ZĞĨĞƌĞŶĐĞ ƉƉƐ

UpToDate: DŽƐƚ ĐůŝŶŝĐŝĂŶƐ ŚĂǀĞ ƵƐĞĚ hƉdŽ ĂƚĞ ĚƵƌŝŶŐ ƚŚĞŝƌ ŵĞĚŝĐĂů ĐĂƌĞĞƌ͘ /Ĩ ǇŽƵ ĮŶĚ ǇŽƵƌƐĞůĨ ƐƵďƐĐƌŝďŝŶŐ ƚŽ hƉdŽ ĂƚĞ͕ ǇŽƵ͛ůů ĮŶĚ ƚŚĞ ĂƉƉ ŚĂƐ Ăůů ƚŚĞ ŽŶůŝŶĞ ƌĞƐŽƵƌĐĞƐ available on your phone. AHRQ ePSS: dŚŝƐ ĂƉƉ ŝƐ ƉŽǁĞƌĞĚ ďǇ ƚŚĞ ŐĞŶĐǇ ĨŽƌ ,ĞĂůƚŚĐĂƌĞ ZĞƐĞĂƌĐŚ ĂŶĚ YƵĂůŝƚǇ ; ,ZYͿ ĂŶĚ ƉƵůůƐ h^ WƌĞǀĞŶƟǀĞ ^ĞƌǀŝĐĞƐ dĂƐŬ &ŽƌĐĞ ;h^W^d&Ϳ ĚĂƚĂ͘ zŽƵ ƉůƵŐ ŝŶ ǇŽƵƌ ƉĂƟĞŶƚ ŝŶĨŽ ;ĂŐĞ͕ ƐĞǆ͕ ƌŝƐŬ ĨĂĐƚŽƌƐͿ ĂŶĚ ǇŽƵ͛ůů ŐĞƚ h^W^d& ƐĐƌĞĞŶŝŶŐ ƌĞĐŽŵŵĞŶĚĂƟŽŶƐ͘ VisualDx: This is a great resource for dermatology. It has Ă ŶŝŌǇ ĚŝīĞƌĞŶƟĂů ĚŝĂŐŶŽƐŝƐ ďƵŝůĚĞƌ ƚŚĂƚ ĂůůŽǁƐ ǇŽƵ ƚŽ ƉůƵŐ ŝŶ ƉĞƌƟŶĞŶƚ ĚĞƚĂŝůƐ ĂŶĚ ĚĞƐĐƌŝƉƟŽŶƐ ŽĨ ƚŚĞ ƌĂƐŚ ;ŚĂƐ ƉŝĐƚƵƌĞƐ ƚŽ ŚĞůƉ ǇŽƵ ĐŚŽŽƐĞͿ ĂŶĚ ŝƚ ǁŝůů ŽƵƚƉƵƚ Ă ĚŝīĞƌĞŶƟĂů ĂůŽŶŐ ǁŝƚŚ ŽƚŚĞƌ ƌĞĨĞƌĞŶĐĞ ŝŶĨŽƌŵĂƟŽŶ ƐƵĐŚ ĂƐ ƚĞƐƟŶŐ͕ ƚƌĞĂƚŵĞŶƚ͕ ĨŽůůŽǁͲƵƉ ĂŶĚ ƚŽŶƐ ŽĨ ƉŝĐƚƵƌĞƐ͘ Recently they expanded to include other problem sets ƐƵĐŚ ĂƐ Ed͕ ŶĞƵƌŽůŽŐǇ͕ '/͕ ĞƚĐ͘ / ŚĂǀĞŶ͛ƚ ĨŽƵŶĚ ƚŚĞƐĞ other parts as useful but the dermatology part makes this ĞǆƉĞŶƐŝǀĞ ĂƉƉ ǁĞůů ǁŽƌƚŚ ƚŚĞ ƐƵďƐĐƌŝƉƟŽŶ͘ 18

California Family Physician Fall 2017

Southern California Permanente Medical Group

ĂůĐƵůĂƚŽƌƐ

Calculate by QxMD and MD Calc: These are both great calculators but I’ve found using only one is ŽŌĞŶ ŶŽƚ ĞŶŽƵŐŚ͘ &Žƌ ĞǆĂŵƉůĞ͕ YǆD ĚŽĞƐ ŶŽƚ ŚĂǀĞ Ă Kt^ ; ůŝŶŝĐĂů KƉŝĂƚĞ tŝƚŚĚƌĂǁĂů ^ĐŽƌĞͿ ďƵƚ MD Calc does. Therefore, I keep and use both apps. ^ s ZŝƐŬ ƐƟŵĂƚŽƌ͗ WůƵŐ ŝŶ ǇŽƵƌ ƉĂƟĞŶƚ͛Ɛ ĚĂƚĂ ĂŶĚ ŝƚ ǁŝůů ŽƵƚƉƵƚ ƚŚĞ ^ s ƌŝƐŬ ĂƐ ǁĞůů ĂƐ recommended treatment per ACC guidelines.

KƚŚĞƌƐ

The Answer to Health Care in America

Family Medicine & Urgent Care Opportunities in Southern California

LactMed from NIH: This app provides detailed ŝŶĨŽƌŵĂƟŽŶ ĂďŽƵƚ ƚŚĞ ƐĂĨĞƚǇ ŽĨ ĚŝīĞƌĞŶƚ ŵĂƚĞƌŶĂů ŵĞĚŝĐĂƟŽŶƐ ĚƵƌŝŶŐ ůĂĐƚĂƟŽŶ ĂƐ ǁĞůů ĂƐ ƐĂĨĞ ĂůƚĞƌŶĂƟǀĞƐ ŝĨ Ă ƋƵĞƌŝĞĚ ŵĞĚŝĐĂƟŽŶ ŝƐ ŶŽƚ ƐĂĨĞ ĚƵƌŝŶŐ ďƌĞĂƐƞĞĞĚŝŶŐ͘

The future of health care is happening today at Kaiser Permanente Southern California. By pursuing new breakthroughs, promoting proactive care and employing innovative technologies, we’re giving our physicians the tools they need to create a healthier tomorrow for everyone. As part of our practice, you’ll be working in a progressive environment that encourages cross-specialty collaboration, professional autonomy and work-life balance.

Pedi Stat: ŵƵƐƚ ŚĂǀĞ ĨŽƌ ƚŚŽƐĞ ǁŽƌŬŝŶŐ ŝŶ ŵĞƌŐĞŶĐǇ ĂŶĚ hƌŐĞŶƚ ĂƌĞ ƐĞƫŶŐƐ͘ WƵƚ ŝŶ Ă ǁĞŝŐŚƚ͕ ĂŐĞ͕ Žƌ ƌŽƐĞůŽǁ ĐŽůŽƌ ĂŶĚ ƚŚĞ ĂƉƉ ǁŝůů ŽƵƚƉƵƚ ƐƉĞĐŝĮĐ ƌĞĐŽŵŵĞŶĚĂƟŽŶƐ ĨŽƌ ŚƵŶĚƌĞĚƐ ŽĨ ĐůŝŶŝĐĂů ƐĐĞŶĂƌŝŽƐ ĨƌŽŵ ĂŝƌǁĂǇ ŵĂŶĂŐĞŵĞŶƚ ƚŽ ĂƐƚŚŵĂ ŵĞĚŝĐĂƟŽŶƐ͘

• An organization that has served the communities of Southern California for more than 60 years

10 Second EM: ƋƵŝĐŬ ƌĞǀŝĞǁ ĨŽƌ ďĂƐŝĐ ĂŶĚ ĐŽŵŵŽŶ ĞŵĞƌŐĞŶĐǇ ƐŝƚƵĂƟŽŶƐ͘ / ŽŌĞŶ ƵƐĞ ƚŚŝƐ ǁŚĞŶ ǁŽƌŬŝŶŐ Ă ƐŚŝŌ ŝŶ ƚŚĞ ĞŵĞƌŐĞŶĐǇ ĚĞƉĂƌƚŵĞŶƚ͘ OB Wheel by Quartertone: dŽŶƐ ŽĨ K ǁŚĞĞůƐ ĂƌĞ on the market. The premium version of this app lets you enter ultrasound data plus other variables to ĐĂůĐƵůĂƚĞ ǇŽƵƌ K ĚĂƚĞƐ ĂƐ ǁĞůů ĂƐ ŐĞƐƚĂƟŽŶĂů ĂŐĞ ƐƉĞĐŝĮĐ ƌĞĐŽŵŵĞŶĚĞĚ ƚĞƐƟŶŐͬƉƌĞŶĂƚĂů ĐĂƌĞ͘ Tiger Text: ^ĞĐƵƌĞ ,/W ͬ,/d , ĐŽŵƉůŝĂŶƚ ƚĞǆƚ ŵĞƐƐĂŐŝŶŐ ƉůĂƞŽƌŵ ƚŽ ĐŽŵŵƵŶŝĐĂƚĞ ǁŝƚŚ ǇŽƵƌ ƐƚĂī and other providers. Remember, standard SMS is EKd ,/W ͬ,/d , ĐŽŵƉůŝĂŶƚ͘ Doximity: ƉƌŽĨĞƐƐŝŽŶĂů ƐŽĐŝĂů ŵĞĚŝĂ ƉůĂƞŽƌŵ ;ŽŶůǇ ůŝĐĞŶƐĞĚ ƉƌŽǀŝĚĞƌƐ ĐĂŶ ĐƌĞĂƚĞ ĂŶ ĂĐĐŽƵŶƚͿ ĂŶĚ Ă ǁĂǇ ƚŽ ŬĞĞƉ ŝŶ ƚŽƵĐŚ ǁŝƚŚ ĐŽůůĞĂŐƵĞƐ ĂŶĚ ƐŚĂƌĞ ƉĂƟĞŶƚ ŝŶĨŽƌŵĂƟŽŶ ŝŶ Ă ,/W ͬ,/d , ĐŽŵƉůŝĂŶƚ ĨĂƐŚŝŽŶ͘ zŽƵ ĂůƐŽ ƌĞĐĞŝǀĞ Ă ĨƌĞĞ ĨĂǆ ŶƵŵďĞƌ ƚŽ ƐĞŶĚ ĂŶĚ receive faxes electronically.

Kaiser SCPMG is proud to offer its physicians:

• A physician-led practice that equally emphasizes professional autonomy and cross-specialty collaboration • Comprehensive administrative support • An environment that promotes excellent service to patients • A fully implemented electronic medical record system • An excellent salary, comprehensive benefits and partnership eligibility after 3 years For consideration or to apply, please visit our website at http://scpmgphysiciancareers.com. For questions or additional

information, please call (800) 541-7946. We are an AAP/EEO employer.

Dr. Khan is the Core Faculty of Ventura County &ĂŵŝůǇ DĞĚŝĐŝŶĞ ZĞƐŝĚĞŶĐǇ ĂŶĚ ƐƐŝƐƚĂŶƚ ůŝŶŝĐĂů WƌŽĨĞƐƐŽƌ ʹ h > ĂǀŝĚ 'ĞīĞŶ ^ĐŚŽŽů ŽĨ DĞĚŝĐŝŶĞ͘ California Family Physician Fall 2017

Conrad Amenta

Looking Back at the Meaningful Use EHR Incentive Program With the approval of the Medicare Access and CHIP ZĞĂƵƚŚŽƌŝǌĂƟŽŶ Đƚ ;D Z Ϳ ŝŶ ϮϬϭϱ͕ ƚŚĞ ĞŶƚĞƌƐ ĨŽƌ DĞĚŝĐĂƌĞ Θ DĞĚŝĐĂŝĚ ^ĞƌǀŝĐĞƐ͛ ; D^Ϳ ĞůĞĐƚƌŽŶŝĐ ŚĞĂůƚŚ ƌĞĐŽƌĚ ; ,ZͿ ŝŶĐĞŶƟǀĞ ƉƌŽŐƌĂŵ͕ ŽŌĞŶ ĐĂůůĞĚ ͞DĞĂŶŝŶŐĨƵů hƐĞ͕͟ ;DhͿ ǁĂƐ ĐŚĂŶŐĞĚ ĨŽƌĞǀĞƌ͘ ĐƟǀŝƟĞƐ ŽŶĐĞ ĂƐƐŽĐŝĂƚĞĚ ǁŝƚŚ ĂĐŚŝĞǀŝŶŐ ŵĞĂŶŝŶŐĨƵů ƵƐĞ ĂƌĞ ŶŽǁ ĐŽůůĞĐƚĞĚ ƵŶĚĞƌ D Z ͛Ɛ DĞƌŝƚͲ ĂƐĞĚ /ŶĐĞŶƟǀĞ WĂǇŵĞŶƚ ^ǇƐƚĞŵ ;D/W^Ϳ͕ ǁŚŝĐŚ ŝƐ ĚĞƐŝŐŶĞĚ ƚŽ ƉĂǇ ƉŚǇƐŝĐŝĂŶƐ ŽŶ ƚŚĞ ďĂƐŝƐ ŽĨ ƚŚĞ ǀĂůƵĞ ƚŚĞǇ ƉƌŽĚƵĐĞ͘ hƐŝŶŐ ĂŶ ,Z ŝŶ Ă ŵĞĂŶŝŶŐĨƵů ǁĂǇ ŝƐ ĐŽĚŝĮĞĚ ŝŶ D/W^ ĂƐ ͞ ĚǀĂŶĐŝŶŐ ĂƌĞ /ŶĨŽƌŵĂƟŽŶ͘͟ DĞĂŶŝŶŐĨƵů hƐĞ ǁĂƐ ŝŶƚƌŽĚƵĐĞĚ ŝŶ ϮϬϬϵ ǁŝƚŚ ƚŚĞ ƉĂƐƐĂŐĞ ŽĨ ƚŚĞ ,ĞĂůƚŚ /ŶĨŽƌŵĂƟŽŶ dĞĐŚŶŽůŽŐǇ for Economic and Clinical Health ;,/d ,Ϳ Đƚ͘ ůŽŶŐƐŝĚĞ dŚĞ ŵĞƌŝĐĂŶ ZĞŝŶǀĞƐƚŵĞŶƚ Θ ZĞĐŽǀĞƌǇ Đƚ ; ZZ Ϳ͕ ƚŚĞ ,/d , Đƚ ǁĂƐ designed to speed the recovery ŽĨ ƚŚĞ h^ ĞĐŽŶŽŵǇ ŝŶ ƚŚĞ ǁĂŬĞ ŽĨ ƚŚĞ ĮŶĂŶĐŝĂů ĐƌŝƐŝƐ ďǇ ŵŽĚĞƌŶŝǌŝŶŐ the health care industry. DĞĂŶŝŶŐĨƵů hƐĞ͛Ɛ ƉƌŝĐĞ ƚĂŐ ǁĂƐ ŶŽƚ ŝŶƐŝŐŶŝĮĐĂŶƚ͖ ĂƐ ŽĨ ϮϬϭϱ͕ ƚŚĞ ĨĞĚĞƌĂů government has allocated $35 ďŝůůŝŽŶ ƚŽ ƚŚĞ ŝŶĐĞŶƟǀĞ ƉƌŽŐƌĂŵ͘ tĂƐ ŝƚ ǁŽƌƚŚ ŝƚ͍

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ƉƌŽǀŝĚĞƌ ŽƌĚĞƌ ĞŶƚƌǇ ĂŶĚ ŵƵůƟĨƵŶĐƟŽŶĂů ŚĞĂůƚŚ /d ŝŶƚĞƌǀĞŶƟŽŶ͕ Ăůů ĨĂĐĞƚƐ ŽĨ DĞĂŶŝŶŐĨƵů hƐĞ͕ ŚĂǀĞ ƚŚĞ ŐƌĞĂƚĞƐƚ ƉŽƚĞŶƟĂů ƚŽ ƉƌŽĚƵĐĞ ƚŚĞƐĞ ŝŵƉƌŽǀĞŵĞŶƚƐ͘ /Ŷ ƚŚŝƐ ƌĞŐĂƌĚ͕ ŚŽǁĞǀĞƌ͕ ƚŚĞ ƌĞƐƵůƚƐ ŽĨ DĞĂŶŝŶŐĨƵů hƐĞ ŚĂǀĞ ďĞĞŶ ŵŽƌĞ ŝŶĐŽŶĐůƵƐŝǀĞ͘ Dh ďƌŝŐŚƚ ƐƉŽƚƐ͕ ĞƐƉĞĐŝĂůůǇ ĂŵŽŶŐ ƉŚǇƐŝĐŝĂŶƐ ƵƐŝŶŐ ĐŽƌĞ ĨƵŶĐƟŽŶƐ ƐƵĐŚ ĂƐ ƌĞĐŽƌĚŝŶŐ ƉĂƟĞŶƚ ŚŝƐƚŽƌǇ ĂŶĚ ĚĞŵŽŐƌĂƉŚŝĐ ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ĞͲƉƌĞƐĐƌŝďŝŶŐ ĂƌĞ ŶŽƟĐĞĂďůĞ͘ ^ŚĂƌŝŶŐ ŝŶĨŽƌŵĂƟŽŶ ǁŝƚŚ ŝŵŵƵŶŝǌĂƟŽŶ ƌĞŐŝƐƚƌŝĞƐ Žƌ ƉƵďůŝĐ ŚĞĂůƚŚ ĚĂƚĂďĂƐĞƐ͕ ƚŚĞ ƉĂƟĞŶƚƐ͛ ĂďŝůŝƚǇ ƚŽ ĂĐĐĞƐƐ ƚŚĞŝƌ ŽǁŶ ŚĞĂůƚŚ ƌĞĐŽƌĚƐ Žƌ ĐŽŵŵƵŶŝĐĂƚĞ ǁŝƚŚ ƚŚĞŝƌ ƉŚǇƐŝĐŝĂŶƐ ĞůĞĐƚƌŽŶŝĐĂůůǇ ĂŶĚ ƚŚĞ ƋƵĂůŝƚǇ ŽĨ ĐůŝŶŝĐĂů decision support all remain ƌĞůĂƟǀĞůǇ ůŽǁ͕ ŚŽǁĞǀĞƌ͘ The biggest disappointments have been interoperability and the level of ƉŚǇƐŝĐŝĂŶ ƐĂƟƐĨĂĐƟŽŶ ǁŝƚŚ ,ZƐ͘ Ɛ ŽĨ ϮϬϭϱ͕ ŽŶůǇ Ϯϱ ƉĞƌĐĞŶƚ ŽĨ ĞůŝŐŝďůĞ medical providers and hospitals ĂƩĞƐƚĞĚ ƚŽ ĞǀĞŶ ŵŽĚĞƐƚ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ ĞǆĐŚĂŶŐĞ ƌĞƋƵŝƌĞŵĞŶƚƐ͘ And using EHRs has become a source ŽĨ ŵĂũŽƌ ĨƌƵƐƚƌĂƟŽŶ ĨŽƌ ƉŚǇƐŝĐŝĂŶƐ͕ ŝŶĐƌĞĂƐŝŶŐ ĂĚŵŝŶŝƐƚƌĂƟǀĞ ďƵƌĚĞŶ ĂŶĚ ĚĞƚƌĂĐƟŶŐ ĨƌŽŵ ƚŚĞŝƌ ĂďŝůŝƚǇ ƚŽ ŝŶƚĞƌĂĐƚ ǁŝƚŚ ƉĂƟĞŶƚƐ͘ /ŵƉůĞŵĞŶƟŶŐ EHR systems has also been more ĐŽƐƚůǇ ƚŚĂŶ ĞǆƉĞĐƚĞĚ͕ ƌĂŶŐŝŶŐ ĂŶǇǁŚĞƌĞ ĨƌŽŵ Ψϭϱ͕ϬϬϬ ƚŽ ΨϳϬ͕ϬϬϬ per physician.

Family physicians truly do lead the way in the use of EHRs in medical practice.

“

/Ĩ ǁĞ ƵƐĞ ĂĚŽƉƟŽŶ ŽĨ ,ZƐ ĂƐ Ă ƉƌŽǆǇ ĨŽƌ DĞĂŶŝŶŐĨƵů hƐĞ͕ ƚŚĞ ĂŶƐǁĞƌ might be ͞ǇĞƐ͘͟ /Ŷ ϮϬϬϴ͕ ďĞĨŽƌĞ ƚŚĞ ,/d , Đƚ͕ ŽŶůǇ ϰϮ ƉĞƌĐĞŶƚ ŽĨ ŽĸĐĞͲďĂƐĞĚ ƉŚǇƐŝĐŝĂŶƐ ŚĂĚ ĂĚŽƉƚĞĚ ĂŶǇ ŬŝŶĚ ŽĨ ,Z͘ Ǉ ϮϬϭϱ͕ ƚŚĂƚ ŶƵŵďĞƌ ŚĂĚ ŵŽƌĞ ƚŚĂŶ ĚŽƵďůĞĚ͕ ƚŽ ϴϲ͘ϵ ƉĞƌĐĞŶƚ͘ dŚĞ ĂĚŽƉƟŽŶ ƌĂƚĞ ŝƐ ĞǀĞŶ ŵŽƌĞ ƉƌŽŶŽƵŶĐĞĚ ĂŵŽŶŐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͗ ĂƐ ŽĨ ϮϬϭϲ͕ ϵϱ ƉĞƌĐĞŶƚ ŽĨ ƚŚŽƐĞ ƐƉĞĐŝĂůŝǌŝŶŐ ŝŶ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ ĂƌĞ ͞ůŝǀĞ͟ ŽŶ ĂŶ ,Z͕ ĂŶĚ ϴϮ ƉĞƌĐĞŶƚ ŚĂǀĞ ĚĞŵŽŶƐƚƌĂƚĞĚ ĂĚǀĂŶĐĞĚ ƵƐĞ ŽĨ ƚŚĞ ƚĞĐŚŶŽůŽŐǇ͘ &ĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ƚƌƵůǇ ĚŽ ůĞĂĚ ƚŚĞ ǁĂǇ ŝŶ ƚŚĞ ƵƐĞ ŽĨ ,ZƐ ŝŶ ŵĞĚŝĐĂů ƉƌĂĐƟĐĞ͘

What has become clear is that meaningful use of EHRs should not be pursued as a standalone strategy. The health systems ĚĞŵŽŶƐƚƌĂƟŶŐ ƚŚĞ ŵŽƐƚ ĞīĞĐƟǀĞ ƵƐĞ ŽĨ ,ZƐ͕ ƐƵĐŚ ĂƐ <ĂŝƐĞƌ Permanente in California and Intermountain Healthcare ŝŶ hƚĂŚ͕ ĐŽŶƐŝĚĞƌ ,ZƐ ŽŶĞ ůĞŐ ŽĨ Ă ƚŚƌĞĞͲůĞŐŐĞĚ ƋƵĂůŝƚǇͲ ŝŵƉƌŽǀĞŵĞŶƚ ƐƚƌĂƚĞŐǇ͗ • &ŝƌƐƚ͕ ,ZƐ ŵĞĂƐƵƌĞ ǀĂƌŝĂƟŽŶƐ ŝŶ ƉƌĂĐƟĐĞ͘ DĞĂŶŝŶŐĨƵů hƐĞ ǁĂƐ ĚĞƐŝŐŶĞĚ ƚŽ ĂĐŚŝĞǀĞ ŵŽƌĞ ƚŚĂŶ ŵĞƌĞ • ^ĞĐŽŶĚ͕ ĐŽŶƐƚƌƵĐƟǀĞ ĐŽŶǀĞƌƐĂƟŽŶƐ ĂďŽƵƚ ǀĂƌŝĂƟŽŶ ƚĂŬĞ ĚŝŐŝƟǌĂƟŽŶ͘ dŚĞŽƌĞƟĐĂůůǇ͕ ŝŶƚƌŽĚƵĐŝŶŐ ,ZƐ ƉƌŽĚƵĐĞƐ ĚŽǁŶƐƚƌĞĂŵ place to improve care. ďĞŶĞĮƚƐ͕ ƐƵĐŚ ĂƐ ŝŶĐƌĞĂƐŝŶŐ ĞĸĐŝĞŶĐǇ͕ ƌĞĚƵĐŝŶŐ ĐŽƐƚƐ ĂŶĚ • dŚŝƌĚ͕ ŝŶŶŽǀĂƟǀĞ ƉĂǇŵĞŶƚ ŵŽĚĞůƐ ĞŶƐƵƌĞ ƚŚĞ ƉŚǇƐŝĐŝĂŶ ŝƐ ŝŵƉƌŽǀŝŶŐ ƚŚĞ ƋƵĂůŝƚǇ ŽĨ ĐĂƌĞ͘ ƐǇƐƚĞŵĂƟĐ ƌĞǀŝĞǁ ŽĨ ƚŚĞ free to think about quality and not about the sustainability literature reveals that clinical decision support, computerized ŽĨ ƚŚĞ ƉƌĂĐƟĐĞ͘ ĐŽŶƟŶƵĞĚ ŽŶ ƉĂŐĞ ϮϮ х 20

California Family Physician Fall 2017

Put Yourself on the Road to Continued Success! Sports Medicine Essentials February 21-25, 2018 Sheraton San Diego Hotel & Marina San Diego, California USA

9th World Congress on

ACSMâ&#x20AC;&#x2122;s 6

World Congress on

The Basic Science of Muscle Hypertrophy and Atrophy

May 29-June 2, 2018 Hyatt Regency Minneapolis/ Minneapolis Convention Center Minneapolis, Minnesota USA

Attend this interactive workshop to learn new perspectives in the orthopedic, primary care and emergency medicine aspects of sports medicine.

Join more than 6,000 industry professionals from around the world at this conference where youâ&#x20AC;&#x2122;ll find sessions covering every aspect of sports medicine, exercise science and physical activity.

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Mayo Clinic School of Continuous Professional Development

PRINCIPLES OF PAIN MANAGEMENT & PALLIATIVE CARE Essential Tools for the Clinician

Join leading experts to review evidence-based pain treatment strategies, improve symptomatic management of complex medical illness, and facilitate crucial patient conversations.

FAIRMONT ORCHID KOHALA COAST, BIG ISLAND, HAWAII MARCH 5â&#x20AC;&#x201C;9, 2018 Optional Pre-Course Sessions: March 4, 2018

FAIRMONT ORCHID KOHALA COAST, BIG ISLAND, HAWAII MARCH 5â&#x20AC;&#x201C;9, 2018 CE.MAYO.EDU/PPMPC2018 Photo courtesy of the Fairmont Orchid

California Family Physician Fall 2017

AHF Ǉ ŵĞƌŐŝŶŐ ƚŚĞ DĞĂŶŝŶŐĨƵů hƐĞ ƉƌŽŐƌĂŵ ǁŝƚŚ D/W^ ƵŶĚĞƌ D Z ͕ D^ ƚŽŽŬ Ă ǁĞůĐŽŵĞ ƐƚĞƉ ƚŽǁĂƌĚ reframing the discussion about ĂĚŽƉƟŶŐ ,ZƐ ĂƐ Ă ĚŝƐĐƵƐƐŝŽŶ ŽŶ ƉƌŽĚƵĐŝŶŐ ǀĂůƵĞ ĨŽƌ ƉĂƟĞŶƚƐ͘ ,ŝƐƚŽƌǇ ŵĂǇ ũƵĚŐĞ DĞĂŶŝŶŐĨƵů hƐĞ ĂƐ Ă ůĞƐƐͲƚŚĂŶͲƉĞƌĨĞĐƚ ƐŽůƵƟŽŶ ƚŽ a longstanding problem. Dr. Jack Wennberg pioneered the study of ƵŶǁĂƌƌĂŶƚĞĚ ĐůŝŶŝĐĂů ƉƌĂĐƟĐĞ ǀĂƌŝĂƟŽŶ ĂƐ ĞĂƌůǇ ĂƐ ϭϵϲϳ͕ ĂŶĚ ĂƐ ŵƵĐŚ ĂƐ Ă ƚŚŝƌĚ ŽĨ ǁŚĂƚ ƚŚĞ h^ ƐƉĞŶĚƐ ĂŶŶƵĂůůǇ ŽŶ ŚĞĂůƚŚ ĐĂƌĞ ŵĂǇ ďĞ ǁĂƐƚĞĨƵů͘ dŚĞ ǁŝŶĚŽǁ ĨŽƌ ĂĐƟŽŶ ǁĂƐ ďƌŝĞĨ͗ ǁŚĂƚ ŵŝŐŚƚ ŚĂǀĞ ďĞĞŶ Ă ĚŝĸĐƵůƚ ŶĞŐŽƟĂƟŽŶ ŽŶ ŝƚƐ ŽǁŶ ĐŽƵůĚ ďĞ ŝŶĐůƵĚĞĚ ŝŶ ƚŚĞ ĨĞĚĞƌĂů ŐŽǀĞƌŶŵĞŶƚ͛Ɛ ƟŵĞůǇ ƌĞƐƉŽŶƐĞ ƚŽ ƚŚĞ ĮŶĂŶĐŝĂů ĐƌŝƐŝƐ͘ dŚŽƵŐŚƚ ŽĨ ƚŚĂƚ ǁĂǇ͕ ŝƚ͛Ɛ ƵŶƐƵƌƉƌŝƐŝŶŐ ƚŚĂƚ DĞĂŶŝŶŐĨƵů hƐĞ ƌĞƉƌĞƐĞŶƚƐ ƉĂŝŶĨƵůůǇͲĨŽƌĐĞĚ ŐƌŽǁƚŚ Ăƚ ŐƌĞĂƚ ĮŶĂŶĐŝĂů ĂŶĚ ƉĞƌƐŽŶĂů ĐŽƐƚ͘ Ƶƚ ŶĞĂƌůǇ ϭϬ ǇĞĂƌƐ ůĂƚĞƌ͕ ŽŶĞ ĐĂŶ ƐĂǇ ƚŚĂƚ ŝƚ ǁĂƐ ŐƌŽǁƚŚ͕ ŶŽŶĞƚŚĞůĞƐƐ͕ ĂŶĚ ŵĞĚŝĐŝŶĞ may never be the same as a result.

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ŚƩƉƐ͗ͬͬĚĂƐŚďŽĂƌĚ͘ŚĞĂůƚŚŝƚ͘ŐŽǀͬƋƵŝĐŬƐƚĂƚƐͬƉĂŐĞƐͬ ƉŚǇƐŝĐŝĂŶͲĞŚƌͲĂĚŽƉƟŽŶͲƚƌĞŶĚƐ͘ƉŚƉ ŚƩƉƐ͗ͬͬĚĂƐŚďŽĂƌĚ͘ŚĞĂůƚŚŝƚ͘ŐŽǀͬƋƵŝĐŬƐƚĂƚƐͬƉĂŐĞƐͬ &/'ͲZ ͲWŚǇƐŝĐŝĂŶƐͲ>ŝǀĞͲDhͲ^ƉĞĐŝĂůŝƚǇ͘ƉŚƉ ŚƩƉƐ͗ͬͬĚĂƐŚďŽĂƌĚ͘ŚĞĂůƚŚŝƚ͘ŐŽǀͬƋƵŝĐŬƐƚĂƚƐͬƉĂŐĞƐͬ &/'Ͳ,ĞĂůƚŚͲ/dͲ>ŝƚĞƌĂƚƵƌĞͲZĞǀŝĞǁͲ^ƵŵŵĂƌǇͲŽĨͲ &ŝŶĚŝŶŐƐͲDĞĂŶŝŶŐĨƵůͲhƐĞͲ&ƵŶĐƟŽŶĂůŝƟĞƐͲŽŶͲ YƵĂůŝƚǇͲ^ĂĨĞƚǇͲĂŶĚͲ ĸĐŝĞŶĐǇ͘ƉŚƉ ŚƩƉ͗ͬͬŚĞĂůƚŚĂīĂŝƌƐ͘ŽƌŐͬďůŽŐͬϮϬϭϱͬϬϯͬϬϰͬǁŚĞƌĞͲ ŝƐͲŚŝƚĞĐŚƐͲϯϱͲďŝůůŝŽŶͲĚŽůůĂƌͲŝŶǀĞƐƚŵĞŶƚͲŐŽŝŶŐͬ ŚƩƉƐ͗ͬͬĚĂƐŚďŽĂƌĚ͘ŚĞĂůƚŚŝƚ͘ŐŽǀͬƋƵŝĐŬƐƚĂƚƐͬ ƉĂŐĞƐͬ&/'ͲƉŚǇƐŝĐŝĂŶƐͲǁŝƚŚͲŵĞĂŶŝŶŐĨƵůͲƵƐĞͲ ĨƵŶĐƟŽŶĂůŝƟĞƐͲŝŶͲƚŚĞŝƌͲ ,Z͘ƉŚƉ ŚƩƉƐ͗ͬͬĚĂƐŚďŽĂƌĚ͘ŚĞĂůƚŚŝƚ͘ŐŽǀͬƋƵŝĐŬƐƚĂƚƐͬƉĂŐĞƐͬ &/'ͲWĞƌĐĞŶƚͲWŚǇƐŝĐŝĂŶƐͲĞZǆͲƚŚƌŽƵŐŚͲ ,Z͘ƉŚƉ

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Dƌ͘ ŵĞŶƚĂ ŝƐ &W͛Ɛ ŝƌĞĐƚŽƌ ŽĨ Health Policy.

AIDS HEALTHCARE F OU N DAT ION

AIDS Healthcare Foundation (AHF), was founded in 1987 and is the largest specialized provider of HIV/AIDS medical care in the nation. We provide cutting edge medicine & advocacy regardless of ability to pay.

Primary Care Practitioners Needed in California AHF is seeking dedicated full-time Family/Internal Medicine Practitioners (MD/DO/RNP) Hollywood, CA - https://careers-aidshealth.icims.com/jobs/6355/physician--hollywood/job

Experience/Educational Requirements: 1. Must possess a State Medical Board license MD/DO in Internal/Family Medicine. (without restrictions)

2. 3.

3+ years recent experience treating and diagnosing HIV/AIDS clients in an outpatient Primary Care Setting. Candidates will be required to obtain DEA furnishing licenses.

4. 5.

Must obtain AAHIVM Certification within 18 months of hire. Current CPR (Cardio Pulmonary Resuscitation) required.

(without restrictions)

Base Salary with Retention/Productivity Bonus, Relocation Assistance, On-Call Schedule 5 Weeks Per Year, 28 Days PTO Annually, CME Stipend, 401K, Liability Coverage and Comprehensive, Loan Repayment Plan. We sponsor H-1 Visas

Email: Miyoshi.LaFourche@aidshealth.org • Telephone: 310-999-6089

W H AT T O O K Y O U A L I F E T I M E TO LEARN CAN BE LOST IN MINUTES.

WITH A STROKE, TIME LOST IS BRAIN LOST.

Le arn the warning signs at StrokeAssociation.org or 1-888-4-STROKE.

California Family Physician Fall 2017

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alifornia Family Physician Fall 2017

Chris Flores, MD and Maricela Fernandez, JD

Telemedicine and Telehealth in 2017: Innovation, Disruption, and Transformation ,ĂǀĞ ǇŽƵ ŚĞĂƌĚ ŽĨ ĂŶ ͞Ğ/ h͍͟ Ŷ ĞŵĞƌŐĞŶĐǇ ƌŽŽŵ ƚĞůĞƐƚƌŽŬĞ ƉƌŽŐƌĂŵ͍ Kƌ͕ ǀŝƌƚƵĂů ƉĞĚŝĂƚƌŝĐ ĂŶĚ ͞ƚĞůĞŵĞŶƚĂů ŚĞĂůƚŚ͟ ƐĞƌǀŝĐĞƐ ƚŽ ŝŶĚŝǀŝĚƵĂůƐ ĚŝƐƉůĂĐĞĚ ĂŌĞƌ ,ƵƌƌŝĐĂŶĞƐ ,ĂƌǀĞǇ ĂŶĚ /ƌŵĂ͍ Everyone is talking about telehealth these days, but for the vast majority of physicians in primary care, this concept is ŶŽƚŚŝŶŐ ŵŽƌĞ ƚŚĂŶ Ă ŶĞǁƐ ŚĞĂĚůŝŶĞ Žƌ ďƌŝĞĨ ďůƵƌď ŵĞŶƟŽŶĞĚ ŝŶ ŚŽƐƉŝƚĂů Žƌ ŚĞĂůƚŚ ƉůĂŶ ŶĞǁƐůĞƩĞƌƐ͘ ůƚŚŽƵŐŚ ŵĂũŽƌ advances are happening in terms of telehealth technology and promising pilot programs, most family physicians have not ŝŶƚĞŐƌĂƚĞĚ ĂŶǇ ƚĞůĞŵĞĚŝĐŝŶĞ Žƌ ƚĞůĞŚĞĂůƚŚ ƐŽůƵƟŽŶƐ ŝŶƚŽ ƚŚĞŝƌ ĚĂŝůǇ ƉĂƟĞŶƚ ŇŽǁƐ͘ DĂŶǇ ĐŽůůĞĂŐƵĞƐ ǁĞ ƚĂůŬ ǁŝƚŚ ĂƌĞ ƚĂŬŝŶŐ Ă ͞ǁĂŝƚ ĂŶĚ ƐĞĞ͟ ĂƫƚƵĚĞ ĂŶĚ ŚĂǀĞ ŶŽƚ ǇĞƚ ƐƚĂƌƚĞĚ ƉƌŽǀŝĚŝŶŐ ĂŶǇ telehealth services. /ƚ ŵĂǇ ďĞ ƟŵĞ ƚŽ ƌĞĐŽŶƐŝĚĞƌ ƚŚŝƐ ĂƉƉƌŽĂĐŚ͘ tĞ͕ ĂƐ ĨĂŵŝůǇ physicians, need to start looking seriously at all the changes ŐŽŝŶŐ ŽŶ ŝŶ ƚŚĞ ƚĞůĞŚĞĂůƚŚ ĐĂƌĞ ŵĂƌŬĞƚƉůĂĐĞ ůĞƐƚ ǁĞ ůŽƐĞ ƚŽƵĐŚ ǁŝƚŚ ƚŚĞ ͞ƐƚĂŶĚĂƌĚ ŽĨ ĐĂƌĞ͟ ŝŶ ŵĞĚŝĐŝŶĞ͕ ĂŶĚ ďĞĨŽƌĞ ǁĞ ůŽƐĞ ŽƵƌ ƉĂƟĞŶƚƐ ƚŽ ǀŝƌƚƵĂů ŽŶͲůŝŶĞ ƉƌŽǀŝĚĞƌƐ͘ ƚ ĮƌƐƚ ďůƵƐŚ͕ ŝƚ ƐĞĞŵƐ ĂƐ ŝĨ ƐŽŵĞ ŽĨ ƚŚĞ ŵŽƌĞ ŝŶŶŽǀĂƟǀĞ ĂŶĚ ĚŝƐƌƵƉƟǀĞ ƚĞůĞŚĞĂůƚŚ ƉƌĂĐƟĐĞƐ ŚĂǀĞ ůŝƩůĞ ƚŽ ĚŽ ǁŝƚŚ ƉƌŝŵĂƌǇ ĐĂƌĞ͘ tĞ ŚĞĂƌ ŵŽƌĞ ĂďŽƵƚ ƚĞůĞŚĞĂůƚŚ ĂƉƉůŝĐĂƟŽŶƐ ŝŶ ŚŽƐƉŝƚĂůͬ ƐƉĞĐŝĂůƚǇ ƐĞƫŶŐƐ͘ &Žƌ ĞǆĂŵƉůĞ͕ ƚŚĞ Ğ/ h͕ ĂůƚŚŽƵŐŚ Ă ŶĞǁ concept to some, is actually one of the more mature and ǀĂůŝĚĂƚĞĚ ƚĞůĞŚĞĂůƚŚ ĂƉƉůŝĐĂƟŽŶƐ ŝŶ ƵƐĞ͘ &ƌŽŵ Ă ĐĞŶƚƌĂůŝǌĞĚ ŚƵď or headquarters, a group of intensivist physicians and nurses ƵƐŝŶŐ ƚĞůĞŵĞĚŝĐŝŶĞ ĂŶĚ ŝŶƚĞƌŶĞƚ ĐŽŶŶĞĐƟŽŶ ƚŽŽůƐ ƚƌĞĂƚ ĂŶĚ ŵĂŶĂŐĞ / h ƉĂƟĞŶƚƐ ŚŽƵƐĞĚ ŝŶ ƐŵĂůů ƌƵƌĂů ŚŽƐƉŝƚĂůƐ ŚƵŶĚƌĞĚƐ ŽĨ ŵŝůĞƐ ĂǁĂǇ͘ DĞƌĐǇ sŝƌƚƵĂů ĂƌĞ ďĂƐĞĚ ŝŶ ^ƚ͘ >ŽƵŝƐ͕ DK ŝƐ ŽŶĞ of the most recognized and celebrated leaders in this area. DĞƌĐǇ ŚĂƐ ďĞĞŶ ŵĂŶĂŐŝŶŐ ƚŚĞ ^ĂĨĞ tĂƚĐŚ ƌŝƟĐĂů ĂƌĞ WƌŽŐƌĂŵ ĨŽƌ ŵĂŶǇ ǇĞĂƌƐ͘ Ɛ Ă ƌĞƐƵůƚ ŽĨ ƚŚŝƐ ƉƌŽŐƌĂŵ͕ ϯϮ ŚŽƐƉŝƚĂů / hƐ ŝŶ Ɛŝǆ ĚŝīĞƌĞŶƚ ƐƚĂƚĞƐ ŚĂǀĞ ƐĞĞŶ Ă ϯϱ ƉĞƌĐĞŶƚ ĚĞĐƌĞĂƐĞ ŝŶ ůĞŶŐƚŚ ŽĨ ƐƚĂǇ ĂŶĚ Ă ϯϬ ƉĞƌĐĞŶƚ ĚĞĐƌĞĂƐĞ ŝŶ ŵŽƌƚĂůŝƚǇ͘ KďǀŝŽƵƐůǇ͕ ƚŚĞ ƉƌŽĨĞƐƐŝŽŶĂů ůŝĨĞ ĂŶĚ ǁŽƌŬŇŽǁ ŽĨ ƚŚĞ ƉŚǇƐŝĐŝĂŶƐ ŝŶǀŽůǀĞĚ ǁŝƚŚ ƚŚŝƐ ƉƌŽŐƌĂŵ ŚĂƐ ĐŚĂŶŐĞĚ ŝŵŵĞŶƐĞůǇ ʹ ŵŽƐƚůǇ ĨŽƌ ƚŚĞ ďĞƩĞƌ͘ ^ŝŵŝůĂƌůǇ͕ ŽƚŚĞƌ ŚŽƐƉŝƚĂůƐ ĂƌĞ ŝŵƉůĞŵĞŶƟŶŐ ƚĞůĞŚĞĂůƚŚ emergency room specialty consult programs.

California Family Physician Fall 2017

DǇ ŚŽƐƉŝƚĂů͕ ŝƐĞŶŚŽǁĞƌ DĞĚŝĐĂů ĞŶƚĞƌ ŝŶ ZĂŶĐŚŽ DŝƌĂŐĞ͕ ŚĂƐ Ă ŶĞǁůǇ ŝŵƉůĞŵĞŶƚĞĚ ƚĞůĞƐƚƌŽŬĞ ƉƌŽŐƌĂŵ ǁŝƚŚ h ^ĂŶ ŝĞŐŽ͘ dƌĂĚŝƟŽŶĂůůǇ͕ ǁŚĞŶ Ă ƉĂƟĞŶƚ ǁŝƚŚ ĂĐƵƚĞ ƐƚƌŽŬĞ ĂƌƌŝǀĞĚ Ăƚ ŽƵƌ ĞŵĞƌŐĞŶĐǇ ĚĞƉĂƌƚŵĞŶƚ͕ ŽŶĞ ŽĨ ŽƵƌ ůŽĐĂů ƐƚĂī ŶĞƵƌŽůŽŐŝƐƚƐ ǁŽƵůĚ ďĞ ĐŽŶƐƵůƚĞĚ ĞŵĞƌŐĞŶƚůǇ ƚŽ ĞǀĂůƵĂƚĞ ĂŶĚ ŵĂŶĂŐĞ ƚŚĞ ƉĂƟĞŶƚ ĨĂĐĞͲƚŽͲĨĂĐĞ ŽŶ ƐŝƚĞ͘ WĂƟĞŶƚƐ ŶŽǁ have immediate access to a tele-neurologist. Although the ƉĂƟĞŶƚ ĂŶĚ ƚĞůĞͲŶĞƵƌŽůŽŐŝƐƚ ĂƌĞ ƐĞƉĂƌĂƚĞĚ ďǇ ϭϮϬ ŵŝůĞƐ͕ ƚŚĞǇ ŝŶƚĞƌĂĐƚ ĂŶĚ ĞŶŐĂŐĞ ǀŝĂ Ă ůŝǀĞ ƚǁŽͲǁĂǇ ǀŝĚĞŽ ĐŽŶŶĞĐƟŽŶ through the Internet. The tele-neurologist also has full access ƚŽ ƚŚĞ ƉĂƟĞŶƚ͛Ɛ ŝŵĂŐŝŶŐ͕ ůĂď ƚĞƐƚƐ ĂŶĚ ŽƚŚĞƌ ĞǀĂůƵĂƟŽŶƐ ĂŶĚ results. Published studies demonstrate improved outcomes and enhanced adherence to standard of care guidelines using telestroke services. The intended purpose of this program is ƚŚĂƚ ůŽĐĂů ƉĂƟĞŶƚƐ ǁŝůů ďĞŶĞĮƚ ĨƌŽŵ ƚŚŝƐ ŶĞǁ ƉƌŽŐƌĂŵ͘ dŚĞ ƵŶŝŶƚĞŶĚĞĚ ĐŽŶƐĞƋƵĞŶĐĞ͕ ŚŽǁĞǀĞƌ͕ ŝƐ ƚŚĂƚ ŝƚ ŝƐ ĂīĞĐƟŶŐ ƚŚĞ ǁŽƌŬůŽĂĚ ŽĨ ŽƵƌ ƐƚĂī ŶĞƵƌŽůŽŐŝƐƚƐ ʹ ŽƵƌ ůŽĐĂů ŶĞƵƌŽůŽŐŝƐƚƐ ǁŚŽ ŚĂĚ ƉƌĞǀŝŽƵƐůǇ ďĞĞŶ ŬĞƉƚ ďƵƐǇ ŽŶ ĐĂůů Ăƚ ƚŚĞ ŚŽƐƉŝƚĂů͕ ŵƵƐƚ ŶŽǁ ĮŶĚ ŽƚŚĞƌ ƉĂƟĞŶƚ ĐĂƌĞ ĂĐƟǀŝƟĞƐ ƚŽ Įůů ƚŚĞŝƌ ƟŵĞ͘ ůƚŚŽƵŐŚ͕ ƚŚĞƐĞ ĞǆĂŵƉůĞƐ ŵĂǇ ƐĞĞŵ ͞ƐƉĞĐŝĂůƚǇͲŽƌŝĞŶƚĞĚ͟ ĂŶĚ ŶŽƚ ƌĞůĞǀĂŶƚ ƚŽ ŽƵƌ ƉƌŝŵĂƌǇ ĐĂƌĞ ƉƌĂĐƟĐĞƐ͕ ǁĞ ƐŚŽƵůĚ ŶŽƚ ďĞ lulled into a false sense of security. &Žƌ ƚŚŽƐĞ ŽĨ ƵƐ ǁŚŽ ƉƌĂĐƟĐĞ ŝŶ ĂůŝĨŽƌŶŝĂ͕ ŝƚ ŝƐ ǀĞƌǇ ůŝŬĞůǇ ƚŚĂƚ ƐŽŵĞ ŽĨ ŽƵƌ ŽǁŶ ƉĂƟĞŶƚƐ ŚĂǀĞ ƵƐĞĚ ƚĞůĞŵĞĚŝĐŝŶĞ ƐĞƌǀŝĐĞƐ ǁŝƚŚŽƵƚ ŽƵƌ ŬŶŽǁůĞĚŐĞ Žƌ ĂĚǀŝĐĞ͘ ŽŵƉĂŶŝĞƐ ƐƵĐŚ ĂƐ dĞůĂĚŽĐ͕ Doctor on Demand, American Well and HealthTap are seeing ƌĂƉŝĚ ŐƌŽǁƚŚ ŝŶ ƚĞůĞŵĞĚŝĐŝŶĞ ĂƉƉŽŝŶƚŵĞŶƚƐ ĨŽƌ ƐƵĐŚ ƵƌŐĞŶƚ ĐĂƌĞ ĐŽŶĚŝƟŽŶƐ ĂƐ hZ/͕ hd/ ĂŶĚ ďĂĐŬ ƉĂŝŶ͕ ĞƐƉĞĐŝĂůůǇ ĂŵŽŶŐ young tech-savvy consumers. These companies are quickly ĞǆƉĂŶĚŝŶŐ ŝŶƚŽ ĐĂƌĞ ŽĨ ĐŚƌŽŶŝĐ ĐŽŶĚŝƟŽŶƐ ůŝŬĞ ĚŝĂďĞƚĞƐ ĂŶĚ ŚǇƉĞƌƚĞŶƐŝŽŶ͘ Ɛ ƚŚĞǇ ĐŽŶƟŶƵĞ ƚŽ ŐĂŝŶ ŵĂƌŬĞƚ ƐŚĂƌĞ͕ ĚĞŵŽŶƐƚƌĂƟŶŐ ǀĂůƵĞ ƚŽ ƉĂƟĞŶƚƐ͕ ĂŶĚ ŽƵƚĐŽŵĞƐ ƐƚƵĚŝĞƐ ĮŶĚ ďĞƩĞƌ Žƌ ĐŽŵƉĂƌĂďůĞ ƋƵĂůŝƚǇ ǀĞƌƐƵƐ ĨĂĐĞͲƚŽͲĨĂĐĞ ǀŝƐŝƚƐ͕ ƚƌĂĚŝƟŽŶĂů ďƌŝĐŬͲĂŶĚͲŵŽƌƚĂƌ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ǁŝůů ĨĞĞů ĐŽŵƉĞƟƟŽŶ ĂŶĚ ĞƌŽƐŝŽŶ ŽĨ ƚŚĞŝƌ ƉƌĂĐƟĐĞ͕ ůŽƐŝŶŐ ƉĂƟĞŶƚƐ ƚŽ ǀŝƌƚƵĂů ŽŶͲůŝŶĞ ŚĞĂůƚŚ ƉƌŽǀŝĚĞƌƐ͘ /Ŷ ĨĂĐƚ͕ ŝŶƐƵƌĞƌƐ ǁŝůů ůŝŬĞůǇ ĚŝǀĞƌƚ ƉĂƟĞŶƚƐ ƚŽ ƚĞůĞŚĞĂůƚŚ ĐŽŵƉĂŶŝĞƐ ŝĨ ĐŽƐƚƐ ĂƌĞ ůŽǁĞƌ ĂŶĚ ŽƵƚĐŽŵĞƐ ĂƌĞ ĞƋƵŝǀĂůĞŶƚ Žƌ ďĞƩĞƌ͘

Ɛ ƚŚŝƐ ĂƌƟĐůĞ ǁĂƐ ǁƌŝƩĞŶ͕ ŵƵůƟƉůĞ ŚƵƌƌŝĐĂŶĞƐ ǁĞƌĞ ƉƵŵŵĞůŝŶŐ ŽƵƌ ĐŽƵŶƚƌǇ leaving thousands of people homeless ĂŶĚ ǁŝƚŚŽƵƚ ďĂƐŝĐ ŶĞĐĞƐƐŝƟĞƐ ůŝŬĞ ŵĞĚŝĐĂů ĐĂƌĞ͘ sĂƌŝŽƵƐ ƚĞůĞŵĞĚŝĐŝŶĞ companies are stepping in and ƉƌŽǀŝĚŝŶŐ ĨƌĞĞ ƌĞŵŽƚĞ ͞ǀŝƌƚƵĂů͟ ĐĂƌĞ ƚŽ ƚŚŽƐĞ ĚŝƐƉůĂĐĞĚ ďǇ ƚŚĞ ŇŽŽĚŝŶŐ ĂŶĚ ĚĞƐƚƌƵĐƟŽŶ͘ &Žƌ ŵĂŶǇ ŽĨ ƚŚĞƐĞ ƉĂƟĞŶƚƐ ŝƚ ǁŝůů ďĞ ƚŚĞŝƌ ǀĞƌǇ ĮƌƐƚ ŝŶƚƌŽĚƵĐƟŽŶ ƚŽ ƚĞůĞŵĞĚŝĐŝŶĞ ʹ Ă ŶĞǁ ǁĂǇ ƚŽ ĂĐĐĞƐƐ primary care and mental health ƐĞƌǀŝĐĞƐ͘ tŚĞŶ ƚŚĞǇ ƐĞĞ ŚŽǁ ŚĞůƉĨƵů͕ ĞĸĐŝĞŶƚ ĂŶĚ ůŽǁ ĐŽƐƚ ƚŚŝƐ ƐĞƌǀŝĐĞ ĐĂŶ ďĞ͕ ŝƚ ŝƐ ǀĞƌǇ ůŝŬĞůǇ ƚŚŝƐ ŝŶƚƌŽĚƵĐƟŽŶ ǁŝůů ĐƌĞĂƚĞ Ă ƉŽƐŝƟǀĞ ůĂƐƟŶŐ ŝŵƉƌĞƐƐŝŽŶ͕ ĂŶĚ ƚŚĞǇ ŵĂǇ ĞŶĚ ƵƉ ƐǁŝƚĐŚŝŶŐ ĚŽĐƚŽƌƐ because of it. &ƌĂŶŬůǇ͕ ƚŽ ƌĞŵĂŝŶ ǀŝĂďůĞ ŝŶ ƚŚŝƐ ŶĞǁ emerging health care marketplace, ǁĞ ĂƐ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ ŵƵƐƚ ĂĚĂƉƚ ĂŶĚ ĞĚƵĐĂƚĞ ŽƵƌƐĞůǀĞƐ ĂďŽƵƚ ƉŽƚĞŶƟĂů ƚĞůĞŵĞĚŝĐŝŶĞ ƐŽůƵƟŽŶƐ ĨŽƌ ŽƵƌ ŽĸĐĞƐ͘ tĞ ĚŽ ŶŽƚ ǁĂŶƚ ƚŽ ďĞ ůĞŌ ďĞŚŝŶĚ ĂŶĚ ůĞŌ ŽƵƚ ŽĨ ŝŶƐƵƌĂŶĐĞ ŶĞƚǁŽƌŬƐ ĂƐ telehealth companies expand their ƐĞƌǀŝĐĞ ĂƌĞĂƐ͖ ĂŶĚ͕ ǁĞ ĚŽŶ͛ƚ ǁĂŶƚ ƚŽ ďĞĐŽŵĞ ŝƌƌĞůĞǀĂŶƚ ƚŽ ŽƵƌ ƉĂƟĞŶƚƐ͘

ƌ͘ &ůŽƌĞƐ ƉƌĂĐƟĐĞƐ ŝŶ ZĂŶĐŚŽ DŝƌĂŐĞ͖ DƐ͘ &ĞƌŶĂŶĚĞǌ ŝƐ ƚŚĞ WƌĂĐƟĐĞ ĚŵŝŶŝƐƚƌĂƚŽƌͬKĸĐĞ DĂŶĂŐĞƌ͘ ,Ğ ŝƐ ĐŽͲĐŚĂŝƌ ŽĨ &W͛Ɛ ŽŵŵŝƩĞĞ ŽŶ ŽŶƟŶƵŝŶŐ WƌŽĨĞƐƐŝŽŶĂů ĞǀĞůŽƉŵĞŶƚ͘

INSPIRE greatness

At Dignity Health, we lead by example. By always striving to give our personal best-and encouraging our patients and colleagues to do the same-we're able to achieve and do more than we ever imagined. If you're ready to inspire greatness in yourself and others, join us today.

OUTPATIENT FAMILY MEDICINE PHYSICIANS Northern and Central California (Folsom, Grass Valley, Merced, Redding, Sacramento, Santa Cruz, & Stockton)

Practice Highlights: • Autonomy with administrative and clinical support

• Salary guarantee period and excellent earning potential based on productivity model

• An established, growing medical group OR an independent single specialty group practice

• Attractive bonus structure

• Full-time and part-time practice options

FAMILY MEDICINE/OB/GYN MEDICINE

Vista Community Clinic

With locations in Vista/No San Diego County, Lake Elsinore/So Riverside County and La Habra/Orange County Seeking: Full-time, part-time and per diem Family Medicine Physicians and OB/GYN Physicians. Requirements: California license, DEA license, CPR certiﬁcation and board certiﬁed in family medicine. Bilingual English/Spanish preferred.

Contact c Us: Visitt our website at a ww www.vistacommunityclinic.org r Forward resume to hr@vistacommunityc t linic.org r or fax resume to 760-414-3702

• A Medical Foundation aligned with one of the largest health systems in the nation and the largest hospital system in California

• Sunny California locations with easy access to San Francisco, Napa, and Lake Tahoe

Please contact/send your CV to: Physician Recruitment providers@dignityhealth.org | 888-599-7787 www.dignityhealth.org/physician-careers

Hello humankindness California Family Physician Fall 2017

Carol Havens, MD and Shelly Rodrigues, CAE

Online Education: Is It Really the Future of Learning? tŚĞƌĞ ĚŽ ƚŚĞ ŐĞŶĞƌĂƟŽŶƐ ŽĨ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ͕ ƌĞƐŝĚĞŶƚƐ ĂŶĚ ƉƌĂĐƟĐŝŶŐ ƉŚǇƐŝĐŝĂŶƐ ĨĂůů ŝŶ ƚŚĞ ƐƉĞĐƚƌƵŵ ŽĨ ůĞĂƌŶŝŶŐ ƐƚǇůĞƐ ĂŶĚ ŝŶ ƉĂƌƟĐƵůĂƌ͕ ŽŶůŝŶĞ ůĞĂƌŶŝŶŐ͍͟ dŚĞ ĂŶƐǁĞƌ ŝƐ ͞Ăůů ŽǀĞƌ ƚŚĞ ƉůĂĐĞ͊͟ ŶĚ ǁŝƚŚ ŶŽ ŽŶĞ ƌŝŐŚƚ ĂŶƐǁĞƌ͕ ƚŚĞ ĮĞůĚ ŝƐ ǁŝĚĞ ŽƉĞŶ ĨŽƌ ĚŝƐĐƵƐƐŝŽŶ͘ dŚĞ ǁŝĚĞͲŽƉĞŶ ĮĞůĚ ŝƐ ŽƵƌ ĚŝůĞŵŵĂ ĂƐ ĂŶ ŽƌŐĂŶŝǌĂƟŽŶ ǁŝƚŚ Ă ƉƌŝŽƌŝƚǇ ƚŽ ƉƌŽǀŝĚĞ ŚŝŐŚ ƋƵĂůŝƚǇ͕ ĞǀŝĚĞŶĐĞͲďĂƐĞĚ͕ ƉƌĂĐƟĐĂů ĂŶĚ ƌĞůĞǀĂŶƚ ĞĚƵĐĂƟŽŶ ƚŽ ĨĂŵŝůǇ ƉŚǇƐŝĐŝĂŶƐ͊ 'ĞŶĞƌĂƟŽŶĂů ůĞĂƌŶŝŶŐ ƐƚǇůĞ ƌĞƐĞĂƌĐŚ ƚĞůůƐ ƵƐ ƚŚĂƚ ƚŚĞ ^ŝůĞŶƚ 'ĞŶĞƌĂƟŽŶ ;ϭϵϮϱͲϭϵϰϱͿ ĂƌĞ ƉƌŽĐĞƐƐ ŽƌŝĞŶƚĞĚ͖ ƚŚĞǇ ůĞĂƌŶĞĚ ŝŶ Ă ƐĐŚŽŽů ƌŽŽŵ ǁŝƚŚ text books and tests. They may dive into some online learning for personal development, but are not really our online audience. ŽŽŵĞƌƐ ;ϭϵϰϲͲϭϵϲϰͿ ůĞĂƌŶĞĚ ŝŶ ŵƵĐŚ ƚŚĞ ƐĂŵĞ ǁĂǇ ĂƐ ƚŚĞ ^ŝůĞŶƚ 'ĞŶĞƌĂƟŽŶ͘ They tend to be dependent on educators, prefer the lecture format ;ƚŚŝŶŬ ŽĨ ƚŚŽƐĞ ƌƵŶŶŝŶŐ ĨƌŽŵ ƚŚĞ ƌŽŽŵ ǁŚĞŶ Ă ƐƉĞĂŬĞƌ ƐĂǇƐ ͞ǁĞ͛ƌĞ ŐŽŝŶŐ ƚŽ ƌŽůĞ ƉůĂǇ͟Ϳ ĂŶĚ ůŝŬĞ ĂĐƟǀŝƟĞƐ ƚŽ ďĞ ƐĐƌŝƉƚĞĚ͘ dŚĞǇ ĂůƐŽ ĂƌĞ ƵƐŝŶŐ ŽŶůŝŶĞ ĞĚƵĐĂƟŽŶ͕ ƉĂƌƟĐƵůĂƌůǇ ƐŝƚĞƐ ůŝŬĞ DĞĚƐĐĂƉĞ͕ ďƵƚ ĂƌĞ ŶŽƚ ĚŝŐŝƚĂů ŶĂƟǀĞƐ͘ 'ĞŶy ;ϭϵϲϱͲϭϵϴϬͿ ĂƌĞ ŵƵĐŚ ŵŽƌĞ ĐŽŵĨŽƌƚĂďůĞ ǁŝƚŚ ŽŶůŝŶĞ ůĞĂƌŶŝŶŐ͕ ďƵƚ ƚŚĞǇ ĂƌĞ ĂůƐŽ ŝŶĚĞƉĞŶĚĞŶƚ͕ ĞǀĞŶ ƐŽůŽ͕ ůĞĂƌŶĞƌƐ͕ ǁŝƚŚ Ă ĚĞƐŝƌĞ ƚŽ ůĞĂƌŶ ŽŶ ƚŚĞ ũŽď͕ ƌĂƚŚĞƌ ƚŚĂŶ ŽŶůŝŶĞ͘ 'ĞŶyĞƌƐ ĂƌĞ ŽƵƚĐŽŵĞ ŽƌŝĞŶƚĞĚ͘ dŚĞ ŶĞǆƚ ŐĞŶĞƌĂƟŽŶ͕ DŝůůĞŶŶŝĂůƐ ;ϭϵϴϭͲϮϬϬϬͿ͕ ůŽŽŬ ĨŽƌ ƚĞĂŵͲďĂƐĞĚ ƚĞĐŚŶŽůŽŐǇ ĞŶĂďůĞĚ ͞ĞĚƵƚĂŝŶŵĞŶƚ͘͟ KŶůŝŶĞ ĞĚƵĐĂƟŽŶ ŵĞĞƚƐ ƚŚĞŝƌ ŶĞĞĚƐ ĨŽƌ ŬĞǇ ƉŽŝŶƚƐ ƌĂƚŚĞƌ ƚŚĂŶ ĞǆŚĂƵƐƟǀĞ ƌĞǀŝĞǁ ĂŶĚ ƚŚĞŝƌ ŐĞŶĞƌĂůůǇ ůŽǁ ƚŽůĞƌĂŶĐĞ ĨŽƌ ďŽƌĞĚŽŵ͘ dŚŝƐ ůĞĂĚƐ ƵƐ ƚŽ ƚŚĞ ŶĞǆƚ ŐĞŶĞƌĂƟŽŶ͕ ŽŶĞ ǁĞ ĂƌĞ ũƵƐƚ encountering. 'ĞŶ ;ǁŝƚŚ ŶŽ ĚĞĮŶŝƟǀĞ ƐƚĂƌƚͲĞŶĚ ďŝƌƚŚ ĚĂƚĞƐͿ ĂƌĞ ƚƌƵůǇ ĚŝŐŝƚĂů ŶĂƟǀĞƐ͕ ĨƵůůǇ ĨƵŶĐƟŽŶĂů ŝŶ ĂŶ ŽŶůŝŶĞ ǁŽƌůĚ͘ 'ĞŶ Ɛ ǁŝůů ĐƌĞĂƚĞ Ă document on their school computer, do research on their phone or ƚĂďůĞƚ͕ ǁŚŝůĞ ƚĂŬŝŶŐ ŶŽƚĞƐ ŽŶ Ă ŶŽƚĞƉĂĚ͕ ƚŚĞŶ ĮŶŝƐŚ ŝŶ ĨƌŽŶƚ ŽĨ ƚŚĞ ds ǁŝƚŚ Ă ůĂƉƚŽƉ͕ ǁŚŝůĞ ĨĂĐĞͲƟŵŝŶŐ Ă ĨƌŝĞŶĚ͘ DĞĚŝĐĂů ƐĐŚŽŽůƐ ĂƌĞ ŝŶĐƌĞĂƐŝŶŐůǇ ƌĞůǇŝŶŐ ŽŶ ƚĞĐŚŶŽůŽŐǇ ďĂƐĞĚ ƉůĂƞŽƌŵƐ ĨŽƌ ŬŶŽǁůĞĚŐĞ ĂĐƋƵŝƐŝƟŽŶ͘ dŚĞ hŶŝǀĞƌƐŝƚǇ ŽĨ sĞƌŵŽŶƚ ŵĞĚŝĐĂů ƐĐŚŽŽů ƌĞĐĞŶƚůǇ ĚĞĐŝĚĞĚ ƚŽ ŐŽ ͞ůĞĐƚƵƌĞ ĨƌĞĞ͟ ĐŽŵƉůĞƚĞůǇ͘ dŚŝƐ ƚƌĞŶĚ͕ ĐŽŵďŝŶĞĚ ǁŝƚŚ ŚĂŶĚƐ ŽŶ ŝŶƚĞƌĂĐƟǀĞ ĐĂƐĞͲďĂƐĞĚ ƉƌŽďůĞŵƐ ƚŽ ůĞĂƌŶ ŚŽǁ ƚŽ ĂƉƉůǇ ƚŚĂƚ ŬŶŽǁůĞĚŐĞ͕ ƐĞĞŵƐ ƚŽ ďĞ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ŵĞĚŝĐĂů ƐĐŚŽŽů͘ ZĞƐŝĚĞŶĐǇ ƉƌŽŐƌĂŵƐ ŚĂǀĞ ŝŶĐŽƌƉŽƌĂƚĞĚ ŽŶůŝŶĞ ůĞĂƌŶŝŶŐ ƉůĂƞŽƌŵƐ ĂƐ ǁĞůů͘ &Žƌ ĞǆĂŵƉůĞ͕ ^ƚĂŶĨŽƌĚ hŶŝǀĞƌƐŝƚǇ͛Ɛ ^ƵĐĐĞƐƐĨƵů dƌĂŶƐŝƟŽŶ ƚŽ ŶĞƐƚŚĞƐŝĂ ZĞƐŝĚĞŶĐǇ dƌĂŝŶŝŶŐ ;^d ZdͿ ŝƐ Ă ϭϬͲŵŽŶƚŚ ŽŶůŝŶĞ ĐŽƵƌƐĞ ĮůůĞĚ ǁŝƚŚ ůĞĐƚƵƌĞƐ͕ ǀŝĚĞŽͲƉŽĚĐĂƐƚƐ͕ ŝŶƚĞƌĂĐƟǀĞ ŐƌŽƵƉ ƉƌŽũĞĐƚƐ͕ ǀŝƌƚƵĂů ĐůĂƐƐƌŽŽŵƐ ĂŶĚ ǀŝƌƚƵĂů ŵĞŶƚŽƌŝŶŐ͘ dŚŝƐ ďƌŝŶŐƐ ƵƐ ƚŽ ƉƌĂĐƟĐŝŶŐ ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ ǁŚĞƌĞ ƚŚĞǇ ůĂŶĚ ŝŶ ƚŚŝƐ ǁŽƌůĚ ŽĨ ŽŶůŝŶĞ ĞĚƵĐĂƟŽŶ͕ ĂŶĚ ŝƚ ŽƉĞŶƐ ĨŽƌ &W Ă ĐŚĂůůĞŶŐŝŶŐ ĚŝĂůŽŐƵĞ ŽŶ ŚŽǁ ďĞƐƚ ƚŽ ƉƌŽǀŝĚĞ ŵĞĂŶŝŶŐĨƵů ĞĚƵĐĂƟŽŶĂů ĂĐƟǀŝƟĞƐ ƚŽ Ăůů ůĞǀĞůƐ ŽĨ ŵĞŵďĞƌƐŚŝƉ͘ /Ĩ ǁĞ ƚĂŬĞ Ă ƐƚĞƉ ďĂĐŬ͕ ůŽŽŬŝŶŐ Ăƚ ǁŚĂƚ͛Ɛ ŚĂƉƉĞŶŝŶŐ ŝŶ ŐĞŶĞƌĂů ŽŶůŝŶĞ ĞĚƵĐĂƟŽŶ͕ ƉĞƌŚĂƉƐ ǁĞ ĐĂŶ ŵĂŬĞ ĐŽƌƌĞůĂƟŽŶƐ ƚŚĂƚ ǁŝůů ŚĞůƉ ŐƵŝĚĞ ƵƐ ĂƐ 26

California Family Physician Fall 2017

ǁĞ ĞŶŐĂŐĞ ǁŝƚŚ ŽƵƌ ƉƌĂĐƟĐŝŶŐ ŵĞŵďĞƌƐ ʹ ƵƐŝŶŐ ƚŚĞ ďĞƐƚ ŽĨ ďŽƚŚ ŽŶůŝŶĞ ĂŶĚ ůŝǀĞ ǁŽƌůĚƐ͊ /Ŷ ƚŚĞ ƉĂƐƚ ĨĞǁ ǇĞĂƌƐ͕ ŵŽƌĞ ƐƚƵĚĞŶƚƐ ĞŶƌŽůůĞĚ ŝŶ ŽŶůŝŶĞ ĐŽƵƌƐĞƐ͖ ŵŽƌĞ ŽƌŐĂŶŝǌĂƟŽŶƐ ŽīĞƌĞĚ ĂůƚĞƌŶĂƟǀĞ ĐƌĞĚĞŶƟĂůƐ ƐƵĐŚ ĂƐ ĚŝŐŝƚĂů ďĂĚŐĞƐ ĂŶĚ ŶĂŶŽĚĞŐƌĞĞƐ͖ ĂŶĚ ŵŽƌĞ ĞŵƉůŽǇĞƌƐ ĂĐĐĞƉƚĞĚ ŽŶůŝŶĞ ĚĞŐƌĞĞƐ ĨƌŽŵ ũŽď ĐĂŶĚŝĚĂƚĞƐ͘ 'Ž ŽŶƋƌ͛Ɛ ϮϬϭϳ KŶůŝŶĞ >ĞĂƌŶŝŶŐ ZĞƉŽƌƚ ŝĚĞŶƟĮĞĚ ƚŚƌĞĞ ƚƌĞŶĚƐ ƚŚĂƚ ŚŽůĚ ŝŶƐŝŐŚƚ ĨŽƌ &W ĂƐ ǁĞ ĚŝǀĞ ŝŶƚŽ ƚŚĞ ŽŶůŝŶĞ ĞĚƵĐĂƟŽŶ ƉŽŽů͗ ŽůůĂďŽƌĂƟǀĞ >ĞĂƌŶŝŶŐ • ϳϵ ƉĞƌĐĞŶƚ ŽĨ ƚŚŽƐĞ ƐƵƌǀĞǇĞĚ ĐŚŽŽƐĞ ŶŽƚ ƚŽ ƐƚƵĚǇ ĐŽůůĂďŽƌĂƟǀĞůǇ ĞǀĞŶ ǁŚĞŶ ƚŚĞǇ ĂƌĞ ŽŶůŝŶĞ͘ • ZĞƐĞĂƌĐŚĞƌƐ ďĞůŝĞǀĞ ƚŚŝƐ ůĂĐŬ ŽĨ ŽŶůŝŶĞ ĐŽůůĂďŽƌĂƟŽŶ ŝƐ Ă ůĞŐĂĐǇ ŽĨ ƚƌĂĚŝƟŽŶĂů ůĞĂƌŶŝŶŐ ŵĞƚŚŽĚŽůŽŐŝĞƐ͘ • ƐƚĞĂĚǇ ŝŶĐƌĞĂƐĞ ŝŶ ŐƌŽƵƉ ĂĐƟǀŝƚǇ ŚĂƐ ŽĐĐƵƌƌĞĚ ƐƵŐŐĞƐƟŶŐ ƚŚĂƚ Ă ͞ĐƵůƚƵƌĂů ƐŚŝŌ ŝƐ ƵŶĚĞƌǁĂǇ ǁŚĞƌĞ ƚŚĞ ƉŽǁĞƌ ŽĨ ƐŽĐŝĂů ŶĞƚǁŽƌŬƐ ĨŽƌ ĞĚƵĐĂƟŽŶ͕ ĂŶĚ ŶŽƚ ũƵƐƚ ĞŶƚĞƌƚĂŝŶŵĞŶƚ͕ ŝƐ ďĞŝŶŐ ƌĞĐŽŐŶŝǌĞĚ͘͟ DŽďŝůĞ >ĞĂƌŶŝŶŐ • ^ƚƵĚŝĞƐ ĮŶĚ ƚŚĞ ŐƌŽǁƚŚ ƌĂƚĞ ĨŽƌ ŵŽďŝůĞ ŝƐ ŶŽƚ ĂƐ ĂĐĐĞůĞƌĂƚĞĚ ĂƐ ƚŚĞ ŐĞŶĞƌĂů ŵŽďŝůĞ ǁĞď ƵƐĂŐĞ ƚƌĞŶĚƐ͘ tŚĞŶ ĐŽŵƉĂƌĞĚ ƚŽ ŐůŽďĂů ŵŽďŝůĞ ƵƐĂŐĞ ƐƚĂƚƐ ŽĨ ϰϱ ƉĞƌĐĞŶƚ ŽĨ Ăůů ǁĞď ƚƌĂĸĐ͕ ŝƚ ďĞĐŽŵĞƐ ĞǀŝĚĞŶƚ ƚŚĂƚ ůĞĂƌŶŝŶŐ ŽŶ ĚĞǀŝĐĞƐ ͞ŝƐ ƐƟůů ŶŽƚ ĂƐ ƉƌĞǀĂůĞŶƚ ĂƐ ŐĞŶĞƌĂů ďƌŽǁƐŝŶŐ͘͟ ͞dŚĞƐĞ ĚĂƚĂ ƐƵŐŐĞƐƚ ƚŚĂƚ ůĞĂƌŶŝŶŐ ŝƐ ůŽǁĞƌ ĚŽǁŶ ƚŚĞ ůŝƐƚ ŽĨ ƉƌŝŽƌŝƟĞƐ ĨŽƌ ƵƐĞƌƐ ŽĨ ŵŽďŝůĞ ĚĞǀŝĐĞƐ͘͟ • WŚŽŶĞ ƵƐĂŐĞ ŝƐ ŝŶĐƌĞĂƐŝŶŐ ǁŝƚŚ Ɛŝǆ ǀŝƐŝƚƐ ǀŝĂ Ă ŵŽďŝůĞ ƉŚŽŶĞ ĨŽƌ every one visit via a tablet. • ŶĚƌŽŝĚ ĚŽŵŝŶĂƚĞƐ ŐůŽďĂůůǇ ǁŝƚŚ ŵŽƌĞ ƚŚĂŶ ϳϬ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞ ŵŽďŝůĞ ĐŽŶŶĞĐƟŽŶƐ ǀƐ͘ ϲϱ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞ ŵŽďŝůĞ ĐŽŶŶĞĐƟŽŶƐ ŝŶ ƚŚĞ h^ ǀŝĂ ŝK^͘ • DŽďŝůĞ ƵƐĞƌƐ ƉƌĞĨĞƌ ƚŽ ǀŝĞǁ ĐŽŶƚĞŶƚ ƌĂƚŚĞƌ ƚŚĂŶ ĐƌĞĂƚĞ ŝƚ ǀŝĂ ƚŚĞŝƌ ŵŽďŝůĞ ĚĞǀŝĐĞ͗ ĚĞƐŬƚŽƉ ƵƐĞƌƐ ƐƉĞŶĚ ŽŶ ĂǀĞƌĂŐĞ Ɛŝǆ ŵŝŶƵƚĞƐ ĐƌĞĂƟŶŐ Ă ƌĞƐŽƵƌĐĞ͕ ǁŚŝůĞ ŽŶůǇ Ă ƐŵĂůů ƉƌŽƉŽƌƟŽŶ ŽĨ ƚŚŽƐĞ ƐƵƌǀĞǇĞĚ ĐƌĞĂƚĞ ƚŚĞŝƌ ŽǁŶ ĐŽŶƚĞŶƚ͖ ĂŶĚ ǁŚĞŶ ƚŚĞǇ ĚŽ͕ ƚŚĞǇ spend an average of three minutes. >ĞĂƌŶŝŶŐ ĂŶĚ dĞĂĐŚŝŶŐ ^ƚǇůĞƐ • dŚŽƐĞ ƐƵƌǀĞǇĞĚ ƚĞŶĚ ƚŽ ĨĂǀŽƌ ŝŶƚĞƌĂĐƟǀĞ ƌĞƐŽƵƌĐĞƐ ;ŵŝŶĚ ŵĂƉƐ͕ ŇĂƐŚĐĂƌĚƐ ĂŶĚ ƋƵŝǌǌĞƐͿ ŽǀĞƌ ƚƌĂĚŝƟŽŶĂů ŽŶĞƐ ;ŶŽƚĞƐ ĂŶĚ ƐůŝĚĞƐͿ ŝŶ Ă ƌĂƟŽ ŽĨ ĂďŽƵƚ ϴ͗ϭ͘ ŵŽŶŐ ƚŚĞ ĐŽŶƚĞŶƚ ĐƌĞĂƟŽŶ ƚŽŽůƐ ĂǀĂŝůĂďůĞ ƚŽ ůĞĂƌŶĞƌƐ͕ ƚŚĞ ŵŽƐƚ ƉŽƉƵůĂƌ ďǇ Ă ƐŝŐŶŝĮĐĂŶƚ ŵĂƌŐŝŶ ŝƐ ƚŚĞ DŝŶĚ DĂƉ ƚŽŽů͗ Ă ŚŝŐŚůǇ ǀŝƐƵĂů ƐƚƵĚǇ ƚŽŽů ŝŶ ǁŚŝĐŚ Ă ĐĞŶƚƌĂů ŝĚĞĂ Žƌ ƚŚĞŵĞ ŝƐ ĞǆƉůŽƌĞĚ ƚŚƌŽƵŐŚ ŝƚƐ ĐŽŶŶĞĐƟŽŶƐ ǁŝƚŚ Ă ƐĞƌŝĞƐ ŽĨ related ideas or topics.

Excellent Physician Opportunities Enjoy Work - Life Balance in the Gateway to the Sierras

• Short distance to hiking in 2 National Parks • Numerous lakes • Biking, Fishing, Hunting, Golf, as well as other outdoor activities available

• Close to International airport • Excellent schools • Low cost of living • High Quality Medical Care

Now Seeking: Family Medicine Physician • FNP Competitive compensation, signing bonus, annual physician bonus, malpractice coverage.

Ɛ &W͛Ɛ ŽŵŵŝƩĞĞ ŽŶ ŽŶƟŶƵŝŶŐ WƌŽĨĞƐƐŝŽŶĂů ĞǀĞůŽƉŵĞŶƚ ǁŽƌŬƐ ƚŽ ŵĞĞƚ ǇŽƵƌ ĞĚƵĐĂƟŽŶĂů ŶĞĞĚƐ͕ ǁĞ ǁŝůů ĞǆƉůŽƌĞ ƚŚĞ ǀŝĂďŝůŝƚǇ ŽĨ ŽŶůŝŶĞ ĞĚƵĐĂƟŽŶ͕ ůŽŽŬ Ăƚ ǁŚĞƌĞ ŝƚ ŵĂŬĞƐ ƐĞŶƐĞ ĂŶĚ ƐƵƉƉŽƌƚƐ ůĞĂƌŶŝŶŐ ƐƚǇůĞƐ͕ ŵĂƚĐŚ ŝƚ ǁŝƚŚ ƚŚĞ appropriate content and seek your input ĂŶĚ ĨĞĞĚďĂĐŬ͘ tĞ ǁŝůů ƐƚƵĚǇ ƚŚĞ ĨƌƵƐƚƌĂƟŽŶ ĐĂƵƐĞĚ ďǇ ĞůĞĐƚƌŽŶŝĐ ŚĞĂůƚŚ ƌĞĐŽƌĚƐ ;ĨŽƌ ƚŚĞ ďŽŽŵĞƌƐ͕ ďĞĐĂƵƐĞ ǁĞ ĐĂŶ͛ƚ ĮŐƵƌĞ ƚŚĞŵ ŽƵƚ and for Millennials, because they are not as ƌŽďƵƐƚ ĂƐ ƚŚĞǇ ǁĂŶƚͿ ƐŽ ǁĞ ĚŽŶ͛ƚ ƌĞͲĐƌĞĂƚĞ ƚŚĂƚ environment for your online experiences. Clearly ŽŶĞ ƐŝǌĞ ĚŽĞƐ ŶŽƚ Įƚ Ăůů͕ ďƵƚ ŽŶůŝŶĞ ĞĚƵĐĂƟŽŶ ĚŽĞƐ ƉƌŽŵŝƐĞ ƚĞƌƌŝĮĐ ŶĞǁ ĞǆƉĞƌŝĞŶĐĞƐ ĨŽƌ ĞĂĐŚ ŽĨ ƵƐ ͙ ĨƌŽŵ ŽŽŵĞƌ ƚŽ 'ĞŶ ͊

Please send CV to CVIH HR: 2740 Herndon Ave., Clovis, CA 93611 or email to hr@cvih.org

Central Valley Indian Health, Inc.

Hiring in accordance with Indian Pref. Act.

Voted one of the “Best Places to Work in LA & Orange County” What’s the value of Facebook, LinkedIn, Snapchat, Instagram, Twitter, etc. for physicians? They may certainly serve a marketing niche and perhaps be a way to disseminate brief facts, but are they going to be education tools and resources? That question has yet to be fully explored or answered.

ŶĚ Ă &ŝŶĂů EŽƚĞ KĨ ĐŽƵƌƐĞ͕ ŽƵƌ ƉĂƟĞŶƚƐ ƐƉĂŶ ƚŚĞ ŐĞŶĞƌĂƟŽŶĂů ƐƉĞĐƚƌƵŵ ĂƐ ǁĞůů ʹ ĂŶĚ ŵĂŶǇ ĞǆƉĞĐƚ ƚŽ ďĞ ĂďůĞ ƚŽ ƐĞŶĚ ƐĞĐƵƌĞ ŵĞƐƐĂŐĞƐ ƚŽ ƚŚĞŝƌ ƉŚǇƐŝĐŝĂŶƐ͕ ƌĞǀŝĞǁ test results online, or schedule a telemedicine ĂƉƉŽŝŶƚŵĞŶƚ ĐŽŵƉůĞƚĞ ǁŝƚŚ ƉŚŽƚŽƐ ŽĨ Ă ƌĂƐŚ͕ for example. They expect technology assisted ĚŝĂŐŶŽƐƟĐ ĂŶĚ ƚŚĞƌĂƉĞƵƟĐ ŽƉƟŽŶƐ ĂŶĚ ĞĂƐǇ ĂĐĐĞƐƐ ƚŽ ŝŶĨŽƌŵĂƟŽŶ͕ ĂŶĚ ƚŚĞǇ ǁĂŶƚ ƚŚĞŝƌ ŚĞĂůƚŚ care team to be not only comfortable, but also ĨĂĐŝůĞ͕ ǁŝƚŚ ƚĞĐŚŶŽůŽŐǇ͘ dŚŝƐ ŝƐ &W͛Ɛ ĐŚĂůůĞŶŐĞ ĂƐ ǁĞůů͘ ^ƚĂǇ ƚƵŶĞĚ͗ ǇŽƵ͛ůů ďĞ ŚĞĂƌŝŶŐ ŵƵĐŚ ŵŽƌĞ ĂďŽƵƚ ƚŚĞ ƚŽƉŝĐ ŽĨ ĂĚƵůƚ ĞĚƵĐĂƟŽŶ͕ ŝŶĐůƵĚŝŶŐ ĞŶŐĂŐŝŶŐ ŝŶ ƚŚĞ ĞͲǁŽƌůĚ ŽĨ ĞĚƵĐĂƟŽŶ͕ ŽǀĞƌ ƚŚĞ next several months.

ƌ͘ ,ĂǀĞŶƐ ŝƐ ŝƌĞĐƚŽƌ ŽĨ ůŝŶŝĐĂů ĚƵĐĂƟŽŶ for Northern California Kaiser Permanente ĂŶĚ ĐŽͲĐŚĂŝƌ ŽĨ &W͛Ɛ ŽŵŵŝƩĞĞ ŽŶ ŽŶƟŶƵŝŶŐ WƌŽĨĞƐƐŝŽŶĂů ĞǀĞůŽƉŵĞŶƚ͘ DƐ͘ ZŽĚƌŝŐƵĞƐ ŝƐ &W͛Ɛ ĞƉƵƚǇ sW͘

HealthCare Partners has immediate fulltime and part-time opportunities for Family Medicine Physicians throughout Los Angeles and North Orange County. Ideal candidates will have at least one year of Family Medicine experience. H1B candidates are encouraged to apply. We offer organizational stability, career growth, excellent compensation and benefits for a truly balanced professional/personal lifestyle.

To see a full list of available positions and to apply online visit us at: www.joindavitamedicalgroup.com or email your CV to: ClinicianApplicants@healthcarepartners.com

California Family Physician Fall 2017

Alex Mroszczyk-McDonald, MD

Why You Need to Be on Social Media tŚĂƚ ŝƐ ^ŽĐŝĂů DĞĚŝĂ͕ zŽƵ ƐŬ ͞^ŽĐŝĂů DĞĚŝĂ͟ ŝƐ Ă ďƌŽĂĚ ĂŶĚ ĐŽŶƐƚĂŶƚůǇ ĞǀŽůǀŝŶŐ ƚĞƌŵ͖ ŝƚ ĐĂŶ ŐĞŶĞƌĂůůǇ ďĞ ĚĞĮŶĞĚ ĂƐ ŝŶƚĞƌŶĞƚͲďĂƐĞĚ ƐǇƐƚĞŵƐ ƚŚĂƚ ĂůůŽǁ ŝŶĚŝǀŝĚƵĂůƐ ĂŶĚ ĐŽŵŵƵŶŝƟĞƐ ƚŽ ͞ŐĂƚŚĞƌ͟ ĂŶĚ ĐŽŵŵƵŶŝĐĂƚĞ͘ /Ŷ ďƌŽĂĚ ĐĂƚĞŐŽƌŝĞƐ͕ ƐŽĐŝĂů ŵĞĚŝĂ ĐŽŶƐŝƐƚƐ ŽĨ ƐŽĐŝĂů ŶĞƚǁŽƌŬŝŶŐ ƐŝƚĞƐ͕ ďůŽŐƐ͕ ŵŝĐƌŽďůŽŐƐ͕ ǁŝŬŝƐ͕ ŵĞĚŝĂͲƐŚĂƌŝŶŐ͕ ǀŝƌƚƵĂů ƌĞĂůŝƚǇ ĂŶĚ ŐĂŵŝŶŐ͘ ƵƌƌĞŶƚůǇ͕ ϴϭ ƉĞƌĐĞŶƚ ŽĨ ƚŚĞ h^ ĂĚƵůƚ ƉŽƉƵůĂƟŽŶ ŚĂƐ ƐŽŵĞ ŬŝŶĚ ŽĨ Ă ƐŽĐŝĂů ŵĞĚŝĂ ƉƌŽĮůĞ͘ tŽƌůĚǁŝĚĞ͕ ĂŶ ĞƐƟŵĂƚĞĚ Ϯ͘ϱ ďŝůůŝŽŶ ;ŐƌŽǁŝŶŐ ĚĂŝůǇͿ ƉĞŽƉůĞ ĂƌĞ ƐŽĐŝĂů ŵĞĚŝĂ ƵƐĞƌƐ͘ dŚĞ ĨĂƐƚĞƐƚ ŐƌŽǁŝŶŐ ĚĞŵŽŐƌĂƉŚŝĐ ŝƐ ƉĞŽƉůĞ ĂŐĞƐ ϰϱͲϱϰ͘ dŚĞ ŵŽƐƚ ƉŽƉƵůĂƌ ƐŽĐŝĂů ŵĞĚŝĂ ƐŝƚĞƐ ĂƌĞ &ĂĐĞďŽŽŬ͕ dǁŝƩĞƌ͕ /ŶƐƚĂŐƌĂŵ͕ zŽƵdƵďĞ ĂŶĚ >ŝŶŬĞĚŝŶ͘ Ͳ,ĞĂůƚŚ ŶǀŝƌŽŶŵĞŶƚ tĞ ůŝǀĞ ŝŶ ĂŶ ŝŶĐƌĞĂƐŝŶŐůǇ ĐŽŶŶĞĐƚĞĚ ĂŶĚ ŝŶƚĞƌŶĞƚͲďĂƐĞĚ ǁŽƌůĚ ĂŶĚ ŚĞĂůƚŚ ĐĂƌĞ ŝƐ ŶŽ ĞǆĐĞƉƟŽŶ͘ ŽĐƚŽƌƐ ůŝǀĞ͕ ƚĞĂĐŚ ĂŶĚ ƉƌĂĐƟĐĞ ŝŶ ĂŶ ͞ Ͳ,ĞĂůƚŚ͟ ǁŽƌůĚ͘ ŽŶŇŝĐƟŶŐ ĚĂƚĂ͕ ŚŽǁĞǀĞƌ͕ ƐĂǇ ĂŶǇǁŚĞƌĞ ĨƌŽŵ ϯϬͲϳϬ ƉĞƌĐĞŶƚ ŽĨ ƉĂƟĞŶƚƐ ŚĂǀĞ ƐĞĂƌĐŚĞĚ ƚŚĞ ŝŶƚĞƌŶĞƚ ĨŽƌ ŵĞĚŝĐĂů ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ŵŽƌĞ ƚŚĂŶ ŚĂůĨ ŽĨ ƚŚŽƐĞ ĚŝƐĐƵƐƐĞĚ ƚŚŝƐ ŝŶĨŽƌŵĂƟŽŶ ǁŝƚŚ ƚŚĞŝƌ ĚŽĐƚŽƌ͘ dŚĞ ƉƵďůŝĐ ĂŶĚ ƉƌŽƐƉĞĐƟǀĞ ƉĂƟĞŶƚƐ ĂƌĞ ďĞĐŽŵŝŶŐ ŵŽƌĞ ƚĞĐŚ ƐĂǀǀǇ ĂŶĚ ǁĂŶƚ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ŵĞĚŝĐĂů ĐĂƌĞ Ăƚ ƚŚĞŝƌ ĮŶŐĞƌƟƉƐ͘ DŽƌĞ ƚŚĂŶ Ϯϱ ƉĞƌĐĞŶƚ ŽĨ ƉĂƟĞŶƚƐ ǁŝƚŚ ĐŚƌŽŶŝĐ ŵĞĚŝĐĂů ĐŽŶĚŝƟŽŶƐ ŚĂǀĞ ƵƐĞĚ ƐŽĐŝĂů ŵĞĚŝĂ Žƌ ƚŚĞ ŝŶƚĞƌŶĞƚ ƚŽ ĮŶĚ ĂŶĚ ĞŶŐĂŐĞ ŽƚŚĞƌƐ ǁŝƚŚ ƚŚĞ ƐĂŵĞ ŵĞĚŝĐĂů ĐŽŶĚŝƟŽŶƐ͘ ^ĐŝĞŶƟĮĐ ũŽƵƌŶĂůƐ ĂŶĚ ƉƵďůŝĐĂƟŽŶƐ ĂƌĞ ŝŶĐƌĞĂƐŝŶŐůǇ ĚŝƐƚƌŝďƵƟŶŐ ŝŶĨŽƌŵĂƟŽŶ ƵƐŝŶŐ ƐŽĐŝĂů ŵĞĚŝĂ ĂŶĚ ƐŽĐŝĂů ŵĞĚŝĂ ĐŝƚĂƟŽŶƐ ǁŝƚŚŝŶ ĂĐĂĚĞŵŝĐ ŵĞĚŝĐĂů ůŝƚĞƌĂƚƵƌĞ ĂƌĞ ŽŶ ƚŚĞ ƌŝƐĞ͘ ^ŽĐŝĂů ŵĞĚŝĂ ŽĐĐƵƉŝĞƐ Ă ƐƉĂĐĞ͕ Ăƚ ƚŚĞ ŝŶƚĞƌƐĞĐƟŽŶ ŽĨ ŵĞĚŝĐĂů ŝŶĨŽƌŵĂƟĐƐ͕ ƉƵďůŝĐ ŚĞĂůƚŚ ĂŶĚ ďƵƐŝŶĞƐƐ͕ ǁŚĞƌĞ ĂĚĚŝƟŽŶĂůůǇ͕ ƉŚǇƐŝĐŝĂŶƐ ŵƵƐƚ ǁŽƌŬ͘ dŚĞ ĂĚ ^ŽĐŝĂů ŵĞĚŝĂ ŝƐ Ă ƉŽǁĞƌĨƵů ƚŽŽů ĂŶĚ ĂƐ Ă ƌĞƐƵůƚ ŝƐ ĨƌĂƵŐŚƚ ǁŝƚŚ ƉŽƚĞŶƟĂů ƉŝƞĂůůƐ ĂŶĚ ƉƌŽďůĞŵƐ͘ WĞƌŚĂƉƐ ƚŚĞ ďŝŐŐĞƐƚ ĚŽǁŶƐŝĚĞ ŝƐ an individual’s message can be distorted, misinterpreted or even ĐŚĂŶŐĞĚ ŽǀĞƌ ŵƵůƟƉůĞ ŝƚĞƌĂƟŽŶƐ ĂŶĚ ƌĞƉĞĂƚĞĚ ƐŚĂƌŝŶŐ͕ ŵƵĐŚ ůŝŬĞ ƚŚĞ ŐĂŵĞ ŽĨ ͞ƚĞůĞƉŚŽŶĞ͟ ǁĞ ƉůĂǇĞĚ ĂƐ ĐŚŝůĚƌĞŶ͘ hŶůŝŬĞ ƉĞĞƌ ƌĞǀŝĞǁĞĚ ƌĞƐĞĂƌĐŚ͕ ŝŶĨŽƌŵĂƟŽŶ ĐĂŶ ďĞ ŝŶĐŽŵƉůĞƚĞ͕ ŽĨ ƉŽŽƌ ƋƵĂůŝƚǇ͕ ĂŶĞĐĚŽƚĂů͕ ƵŶƌĞĨĞƌĞŶĐĞĚ͕ ďŝĂƐĞĚ Žƌ ƐŝŵƉůǇ ŝŶĂĐĐƵƌĂƚĞ ĂŶĚ͕ ĂƐ ƐƵĐŚ͕ ŝŶĨŽƌŵĂƟŽŶ must be carefully analyzed. Ɛ ƉŚǇƐŝĐŝĂŶƐ͕ ŽƵƌ ƌĞƉƵƚĂƟŽŶƐ ĂƌĞ ĐƌŝƟĐĂů ƚŽ ĂĚĞƋƵĂƚĞůǇ ĐĂƌĞ ĨŽƌ ŽƵƌ ƉĂƟĞŶƚƐ ĂŶĚ ĐŽŵŵƵŶŝƚǇ͘ ĂƌĞůĞƐƐ ƐŽĐŝĂů ŵĞĚŝĂ ƵƐĞ ĐĂŶ ĐĂƵƐĞ ƐŝŐŶŝĮĐĂŶƚ ĚĂŵĂŐĞ ƚŽ ƉĞƌƐŽŶĂů͕ ƉƌŽĨĞƐƐŝŽŶĂů Žƌ ŝŶƐƟƚƵƟŽŶĂů ƌĞƉƵƚĂƟŽŶ͘ ŶĞŐĂƟǀĞ ĮƌƐƚ ƐŽĐŝĂů ŵĞĚŝĂ ŝŵƉƌĞƐƐŝŽŶ ĐĂŶ ĚŽ ůĂƐƟŶŐ ĚĂŵĂŐĞ͘ ^ŽŵĞ ƐƚƵĚŝĞƐ ŚĂǀĞ ŶŽƚĞĚ ϳϵ ƉĞƌĐĞŶƚ ŽĨ ƉŽƚĞŶƟĂů ĞŵƉůŽǇĞƌƐ search social media accounts of a job applicant. Social media may 28

California Family Physician Fall 2017

ƌĞĚƵĐĞ ƉƌŝǀĂĐǇ ĂŶĚ ŚĂƐ ƚŚĞ ƉŽǁĞƌ ƚŽ ďůƵƌ ƚŚĞ ůŝŶĞƐ ďĞƚǁĞĞŶ ĂŶ ŝŶĚŝǀŝĚƵĂů͛Ɛ ƉĞƌƐŽŶĂů ĂŶĚ ƉƌŽĨĞƐƐŝŽŶĂů ůŝǀĞƐ ĂƐ ǁĞůů ĂƐ ƚŚĞ ĚŽĐƚŽƌͲ ƉĂƟĞŶƚ ƌĞůĂƟŽŶƐŚŝƉ͘ /ŶƐƟƚƵƟŽŶĂů ƉƌŝǀĂĐǇ ƌĞŐƵůĂƟŽŶƐ ĂŶĚͬŽƌ ƉĂƟĞŶƚ ƉƌŝǀĂĐǇͬ,/W ĐĂŶ ĞĂƐŝůǇ ďĞ ďƌĞĂĐŚĞĚ ǀŝŽůĂƚĞĚ ďǇ ƉŽŽƌ ƵƐĞ ŽĨ ƐŽĐŝĂů ŵĞĚŝĂ ƉůĂƞŽƌŵƐ͘ Lastly, and perhaps most concerning to some physicians, are the ŝƐƐƵĞƐ ŽĨ ůŝĐĞŶƐƵƌĞ ĂŶĚ ůĞŐĂů ůŝĂďŝůŝƚǇ͘ WŚǇƐŝĐŝĂŶƐ ŚĂǀĞ ďĞĞŶ ĮŶĞĚ Žƌ reprimanded by state medical boards for unprofessional behavior or ĐŽŶĚƵĐƚ ŽŶ ƐŽĐŝĂů ŵĞĚŝĂ͘ dŚĞ ĂĐƚ ŽĨ͕ Žƌ ĞǀĞŶ ƉĞƌĐĞƉƟŽŶ ŽĨ͕ ŵĞĚŝĐĂů care or advice through social media opens the door to medical liability. ^ŽĐŝĂů DĞĚŝĂ ŝŶ ,ĞĂůƚŚ ĂƌĞ ĂŶĚ DĞĚŝĐĂů ĚƵĐĂƟŽŶ DŽƌĞ ƚŚĂŶ ϵϬ ƉĞƌĐĞŶƚ ŽĨ ĚŽĐƚŽƌƐ ƵƐĞ ƐŽĐŝĂů ŵĞĚŝĂ ŝŶ ƚŚĞŝƌ ƉƌŝǀĂƚĞ ůŝǀĞƐ ĂŶĚ ϲϱ ƉĞƌĐĞŶƚ ƵƐĞ ŝƚ ƉƌŽĨĞƐƐŝŽŶĂůůǇ͘ DĂŶǇ ǇŽƵŶŐ ƉŚǇƐŝĐŝĂŶƐ͕ ƵƉ ƚŽ ϴϬ ƉĞƌĐĞŶƚ ŝŶ ƐŽŵĞ ƐƚƵĚŝĞƐ͕ ƌĞƉŽƌƚ ƚŚĞǇ ͞ĚŽ ŶŽƚ ǁŽƌƌǇ͟ Žƌ ͞ǁŽƌƌǇ ǀĞƌǇ ůŝƩůĞ͟ ĂďŽƵƚ ƉƌŝǀĂĐǇ ĂƐ ŝƚ ƉĞƌƚĂŝŶƐ ƚŽ ƚŚĞŝƌ ƵƐĞ ŽĨ ƐŽĐŝĂů ŵĞĚŝĂ͘ &ƵƌƚŚĞƌŵŽƌĞ͕ ϱϬ ƉĞƌĐĞŶƚ ƌĞƉŽƌƚ ƚŚĂƚ ĂƌĞ ͞ĂůŵŽƐƚ ĂůǁĂǇƐ ŽŶůŝŶĞ͘͟ ,ŽǁĞǀĞƌ͕ ƚŚĞƌĞ ĂƉƉĞĂƌƐ ƚŽ ďĞ Ă ĚŝƐĐŽŶŶĞĐƚ ʹ ϲϬ ƉĞƌĐĞŶƚ ŽĨ ŵĞĚŝĐĂů ƐĐŚŽŽů ĚĞĂŶƐ ƌĞƉŽƌƚ ƚŚĞǇ ŚĂǀĞ ŚĂĚ ƚŽ ĚĞĂů ǁŝƚŚ ŝŶĐŝĚĞŶƚƐ ŽĨ inappropriate social media use by medical students. Despite this, ǀĞƌǇ ĨĞǁ ŵĞĚŝĐĂů ƐĐŚŽŽůƐ ĂƌĞ ƉƌŽǀŝĚŝŶŐ ĂŶǇ ƐŽĐŝĂů ŵĞĚŝĂ ĞĚƵĐĂƟŽŶ͘ >ĞĨĞďǀƌĞ Ğƚ͘ Ăů ƐƵŵŵĞĚ ŝƚ ƵƉ ǁĞůů͖ ͞DŝůůĞŶŶŝĂů ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽǀŝĚĞƌƐ ĂƉƉĞĂƌ ƚŽ ŚĂǀĞ Ă ƌĞůĂǆĞĚ ƐƚĂŶĐĞ ƚŽǁĂƌĚ ŝŶƚĞƌƉƌŽĨĞƐƐŝŽŶĂů ĚŝŐŝƚĂů ŶĞƚǁŽƌŬŝŶŐ ĂŶĚ ŵĂǇ ŶŽƚ ƌĞĐŽŐŶŝǌĞ ƚŚĞ ƉŽƚĞŶƟĂů ƌĂŵŝĮĐĂƟŽŶƐ ŽĨ ďůƵƌƌŝŶŐ ƚŚĞŝƌ ŝĚĞŶƟƟĞƐ ŽŶůŝŶĞ͘͟ tŝƚŚŝŶ ƚŚĞ ƐĂŵĞ ƐƚƵĚǇ͕ ĂŌĞƌ Ă ďƌŝĞĨ ƐŽĐŝĂů ŵĞĚŝĂ ĞĚƵĐĂƟŽŶ ŝŶƚĞƌǀĞŶƟŽŶ͕ ŵĞĚŝĐĂů ƐƚƵĚĞŶƚƐ ĚĞŵŽŶƐƚƌĂƚĞĚ ŝŵƉƌŽǀĞŵĞŶƚ ŝŶ ĚŝŐŝƚĂů ƉƌŽĨĞƐƐŝŽŶĂůŝƐŵ͕ ŬŶŽǁůĞĚŐĞ͕ ĂƫƚƵĚĞƐ ĂŶĚ ƐŽĐŝĂů ŵĞĚŝĂ ƐŬŝůůƐ͘ ^ŝŐŶŝĮĐĂŶƚ ŽƉƉŽƌƚƵŶŝƟĞƐ ƌĞŵĂŝŶ ĨŽƌ ƐŽĐŝĂů ŵĞĚŝĂ ĞĚƵĐĂƟŽŶ ǁŝƚŚŝŶ ŵĞĚŝĐĂů ƐĐŚŽŽů͕ ƉŽƐƚŐƌĂĚƵĂƚĞ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ĂŶĚ ĐŽŶƟŶƵŝŶŐ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ͘ ^ƉĞĐŝĮĐ ĞĚƵĐĂƟŽŶ ƐŚŽƵůĚ ďĞ ĨŽĐƵƐĞĚ ŽŶ ƉĞƌƐŽŶĂů ĂŶĚ ƉĂƟĞŶƚ ƉƌŝǀĂĐǇ͕ ĚŝŐŝƚĂů ƉƌŽĨĞƐƐŝŽŶĂůŝƐŵ ĂƐ ǁĞůů ĂƐ ŬŶŽǁůĞĚŐĞ ŽĨ ĞǆŝƐƟŶŐ ŝŶƐƟƚƵƟŽŶĂů ƐŽĐŝĂů ŵĞĚŝĂů ƉŽůŝĐŝĞƐ͘ dŚĞ 'ŽŽĚ &Žƌ Ăůů ŝƚƐ ƉŽƚĞŶƟĂů ƉŝƞĂůůƐ ĂŶĚ ƉƌŽďůĞŵƐ͕ ƐŽĐŝĂů ŵĞĚŝĂ ƵƐĞ ŚĂƐ ũƵƐƚ ĂƐ ŵĂŶǇ͕ ŝĨ ŶŽƚ ŵŽƌĞ͕ ƉŽƐŝƟǀĞ ĂƉƉůŝĐĂƟŽŶƐ͘ dŚĞ ƉŽƐŝƟǀĞ ƉŽǁĞƌ ŽĨ ƐŽĐŝĂů ŵĞĚŝĂ ƵƐĞ ďǇ ƉŚǇƐŝĐŝĂŶƐ ĐĂŶ ďĞ ůĂƌŐĞůǇ ďƌŽŬĞŶ ŝŶƚŽ ĨŽƵƌ ĐĂƚĞŐŽƌŝĞƐ͖ ĞĚƵĐĂƟŽŶ͕ ƉƵďůŝĐ ŚĞĂůƚŚ͕ ĐŽŵŵƵŶŝƚǇ ĂŶĚ ĂĚǀŽĐĂĐǇ ͙ ƉůƵƐ ƵƐĞƐ ǇĞƚ ƚŽ be imagined. DĂŶǇ ƉŚǇƐŝĐŝĂŶƐ ĮŶĚ ǀĂůƵĂďůĞ ƐŽƵƌĐĞƐ ŽĨ ĐŽŶƟŶƵŝŶŐ ŵĞĚŝĐĂů ĞĚƵĐĂƟŽŶ ĂŝŵĞĚ Ăƚ Ăůů ƚǇƉĞƐ ŽĨ ƉƌĂĐƟĐĞ Žƌ ƐƉĞĐŝĂůƚǇ ǀŝĂ ǀĂƌŝŽƵƐ ƐŽĐŝĂů ŵĞĚŝĂ ƉůĂƞŽƌŵƐ͘ WŚǇƐŝĐŝĂŶƐ ĂůƐŽ ŚĂǀĞ ĂŵƉůĞ ƐŽĐŝĂů ŵĞĚŝĂ ŽƉƉŽƌƚƵŶŝƟĞƐ ƚŽ ĞŶŚĂŶĐĞ ƚŚĞŝƌ ƵŶĚĞƌƐƚĂŶĚŝŶŐ ŽĨ ĐŽŵŵƵŶŝĐĂƟŽŶ͕ professionalism and medical ethics.

DĂŶǇ ƉŚǇƐŝĐŝĂŶƐ ĂůƐŽ ƵƐĞ ƐŽĐŝĂů ŵĞĚŝĂ ƚŽ ĞĚƵĐĂƚĞ ƉĂƟĞŶƚƐ ĂŶĚ ƚŚĞ ƉƵďůŝĐ ďǇ ĚŝƐƚƌŝďƵƟŶŐ ĐƌĞĚŝďůĞ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ Žƌ ĐŽƌƌĞĐƟŶŐ ĐŽŵŵŽŶ ŵŝƐĐŽŶĐĞƉƟŽŶ͘ ^ŽŵĞ ĚŽĐƚŽƌƐ ĂŶĚ ŚĞĂůƚŚ ŐƌŽƵƉƐ ƵƐĞ ƐŽĐŝĂů ŵĞĚŝĂ ƚŽ ƌĞĐƌƵŝƚ ƉĂƟĞŶƚƐ ƚŽ ƉĂƌƟĐŝƉĂƚĞ ŝŶ ƌĞƐĞĂƌĐŚ͘ ^ŽŵĞ ƉĂƟĞŶƚƐ ƌĞĐĞŝǀĞ ĮŶĂŶĐŝĂů ĂŶĚͬŽƌ ŵŽƌĂů ƐƵƉƉŽƌƚ ǀŝĂ ƐŽĐŝĂů ŵĞĚŝĂ ƉůĂƞŽƌŵƐ ƚŽ ŚĞůƉ ĐŽŶƚƌŽů ƚŚĞŝƌ ĐŚƌŽŶŝĐ ĚŝƐĞĂƐĞ Žƌ ƐĞƚ ŐŽĂůƐ ĂŶĚ ƚƌĂĐŬ ƉƌŽŐƌĞƐƐ ƚŽǁĂƌĚ achieving them. ^ŽĐŝĂů ŵĞĚŝĂ ĐĂŶ ĐƌĞĂƚĞ ǀŝƌƚƵĂů ĐŽŵŵƵŶŝƟĞƐ͕ some designed exclusively for physicians, ƐŽŵĞ ĨŽƌ ƉĂƟĞŶƚƐ ĂŶĚ ŽƚŚĞƌƐ ĨŽƌ ďŽƚŚ͘ DĂŶǇ ĚŽĐƚŽƌƐ ƵƐĞ ƐŽĐŝĂů ŵĞĚŝĂ ƚŽ ŶĞƚǁŽƌŬ͕ ĐŽŶŶĞĐƚ ƉƌŽĨĞƐƐŝŽŶĂůůǇ Žƌ ďƵŝůĚ ƚŚĞŝƌ ĐĂƌĞĞƌƐ ǁŝƚŚŝŶ ǀĂƌŝŽƵƐ ƐƉĞĐŝĮĐ ĨŽƌƵŵƐ͘ ^ŽŵĞ ƵƐĞ ƐŽĐŝĂů ŵĞĚŝĂ ƚŽ ĐƌŽǁĚƐŽƵƌĐĞ ĚŝĂŐŶŽƐĞƐ Žƌ ĂƐŬ ĨŽƌ ŐƵŝĚĂŶĐĞ ŽŶ ŚŽǁ ƚŽ ŵĂŶĂŐĞ ĐŚĂůůĞŶŐŝŶŐ ŵĞĚŝĐĂů ƉƌŽďůĞŵƐ Žƌ ƐƉĞĐŝĮĐ ĐĂƐĞƐ͘ KƚŚĞƌƐ ŚĂǀĞ ŽďƚĂŝŶĞĚ ĂĐĂĚĞŵŝĐ Žƌ ŝŶƐƟƚƵƟŽŶĂů ĂĚǀĂŶĐĞŵĞŶƚ͕ ĞŵƉůŽǇŵĞŶƚ Žƌ ŽƚŚĞƌ ůĞĂĚĞƌƐŚŝƉ ŽƉƉŽƌƚƵŶŝƟĞƐ ŝŶ ƉĂƌƚ ĚƵĞ ƚŽ their use of social media. ůƚŚŽƵŐŚ ƌĞĚƵĐŝŶŐ ďĂƌƌŝĞƌƐ ŚĂƐ ďĞĞŶ ŵĞŶƟŽŶĞĚ ĂƐ Ă ƉŽƚĞŶƟĂů ĚŽǁŶƐŝĚĞ ŽĨ ƐŽĐŝĂů ŵĞĚŝĂ ƵƐĞ͕ ďǇ ƚŚĞ ƐĂŵĞ ƚŽŬĞŶ͕ ƵƐĞ ŽīĞƌƐ ŶƵŵĞƌŽƵƐ ďĞŶĞĮƚƐ͘ dŚĞ ĚŝƌĞĐƚ ůŝŶĞ ŽĨ ĐŽŵŵƵŶŝĐĂƟŽŶ ďĞƚǁĞĞŶ ƉƌŽĚƵĐĞƌƐ ŽĨ ŚĞĂůƚŚ ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ĐŽŶƐƵŵĞƌƐ ŵĞĂŶƐ ŝŶĨŽƌŵĂƟŽŶ ĐĂŶ ďĞ ƋƵŝĐŬůǇ ĂŶĚ ĂĐĐƵƌĂƚĞůǇ ĚŝƐƐĞŵŝŶĂƚĞĚ͕ ŽŌĞŶ ŝŶ ƌĞĂů ƟŵĞ͘ DĂŶǇ ƉŚǇƐŝĐŝĂŶƐ Žƌ ŚĞĂůƚŚ ƐǇƐƚĞŵƐ ƵƐĞ ƐŽĐŝĂů ŵĞĚŝĂ ĨŽƌ ŵĂƌŬĞƟŶŐ ĂŶĚͬŽƌ ĐŽŵŵƵŶŝƚǇ ĞŶŐĂŐĞŵĞŶƚ͘ DŽƌĞ ƚŚĂŶ ϳϬ ƉĞƌĐĞŶƚ ŽĨ h^ ŚĞĂůƚŚ ĐĂƌĞ ŽƌŐĂŶŝǌĂƟŽŶƐ ƵƐĞ social media and perhaps more stunning, more ƚŚĂŶ ϴϬ ƉĞƌĐĞŶƚ ŽĨ ƉĂƟĞŶƚƐ ĂƐƐĞƐƐ ƉŽƚĞŶƟĂů physicians via social media prior to their visit. dŚĞ ĚŽĐƚŽƌͲƉĂƟĞŶƚ͕ Žƌ ŚĞĂůƚŚ ƐǇƐƚĞŵͲƉĂƟĞŶƚ ĐŽŶǀĞƌƐĂƟŽŶ ĐĂŶ ďĞŐŝŶ ďĞĨŽƌĞ ĂŶĚ ĞǆƚĞŶĚ ĂŌĞƌ ƚŚĞ ƚǇƉŝĐĂů ŚĞĂůƚŚ ĞŶĐŽƵŶƚĞƌ͘ ŽĐƚŽƌƐ͕ ƉĂƟĞŶƚƐ ĂŶĚ ĨĂŵŝůŝĞƐ ĐĂŶ ƌĞĂĐŚ ĞĂĐŚ ŽƚŚĞƌ ŝŶ ŶĞǁ ĂŶĚ ŝŶŶŽǀĂƟǀĞ ǁĂǇƐ ƚŽ ŚĞůƉ ŝŵƉƌŽǀĞ ƚŚĞ ŚĞĂůƚŚ ŽĨ ŽƵƌ ĐŽŵŵƵŶŝƟĞƐ͘ ^ĐŝĞŶƟĮĐ ĐŽŵŵƵŶŝƟĞƐ Žƌ ŐŽǀĞƌŶŵĞŶƚ ŝŶƐƟƚƵƟŽŶƐ ĐĂŶ ƉƵďůŝƐŚ ĂŶĚ distribute research and policy more easily via social media.

ƚŚĞ ŝŶĐŝĚĞŶĐĞ ĂŶĚ ƐĞǀĞƌŝƚǇ ƚŚƌŽƵŐŚŽƵƚ ƚŚĞ ǁŝŶƚĞƌ͘ WŚǇƐŝĐŝĂŶƐ ĐĂŶ ĂůƐŽ ĞǆƉƌĞƐƐ ǀŝĞǁƐ ŽŶ ƉƌŽƉŽƐĞĚ ĐŚĂŶŐĞƐ ƚŽ ŚĞĂůƚŚ ƉŽůŝĐǇ ĂŶĚ ŚŽǁ ƚŚĞǇ ŵĂǇ ĂīĞĐƚ ƉƌĂĐƟĐĞ ĂŶĚ ƉĂƟĞŶƚƐ͘ ^ŽĐŝĂů ŵĞĚŝĂ ĂĚǀŽĐĂĐǇ ĨŽƌ ƉĂƟĞŶƚƐ͕ ĚŽĐƚŽƌƐ ĂŶĚ ĐŽŵŵƵŶŝƚǇ ŚĞĂůƚŚ has rapidly progressed over the past several years. Many physicians ĐŽŶƟŶƵĞĚ ŽŶ ŶĞǆƚ ƉĂŐĞ х

We are looking for Family Medicine • Internal Medicine • Urgent Care Physicians

Set off for a partnership track in Southern California Come and join a well established, multi-specialty medical group of 250+ providers, first established in 1945 with continued growth.

Why Beaver Medical Group? Many people entrust their most valued possession — their good health — into the hands of our outstanding, committed physicians at Beaver Medical Group. We would like to extend a personal invitation to you to participate in a unique opportunity to combine professional excellence and camaraderie by joining us. You will love our competitive compensation plan, generous benefit package, vacation time, partnership track after 2 years, professional business account • Sign on bonus • medical insurance for family with Beaver HMO option • Relocation • Life insurance & disability insurance

BMGRecruiting@epiclp.com 909.335.4189

dƌĂĚŝƟŽŶĂů ƉƵďůŝĐ ŚĞĂůƚŚ ĂŶĚ ƉŽůŝĐǇ ĚŝƐĐƵƐƐŝŽŶƐ ĐĂŶ ďĞŶĞĮƚ ĨƌŽŵ ƉŚǇƐŝĐŝĂŶƐ͛ ƉƌĞƐĞŶĐĞ ŽŶ ƐŽĐŝĂů ŵĞĚŝĂ͘ WƵďůŝĐ ŚĞĂůƚŚ ĞŶƟƟĞƐ ĐĂŶ ƋƵŝĐŬůǇ ĚŝƐƐĞŵŝŶĂƚĞ ŝŶĨŽƌŵĂƟŽŶ ĂŶĚ ŵŽďŝůŝǌĞ ƐĞƌǀŝĐĞƐ during natural disasters or disease outbreaks, for ĞǆĂŵƉůĞ͕ ƚŚĞ ĞŶƚĞƌƐ ŽĨ ŝƐĞĂƐĞ ŽŶƚƌŽů ŽŌĞŶ ƵƐĞƐ ƚǁŝƩĞƌ ƚŽ ƉŽƐƚ ŽŶ ŝŶŇƵĞŶǌĂ ƚŽ ŵĞĂƐƵƌĞ California Family Physician Fall 2017

Ä&#x201A;ĹśÄ&#x161; Ć&#x2030;Ĺ&#x161;Ç&#x2021;Ć?Ĺ?Ä?Ĺ?Ä&#x201A;Ĺś Ĺ?Ć&#x152;Ĺ˝ĆľĆ&#x2030;Ć? Ĺ&#x161;Ä&#x201A;Ç&#x20AC;Ä&#x17E; ĹľÄ&#x201A;Ä&#x161;Ä&#x17E; Ć?Ĺ?Ĺ?ĹśĹ?ÄŽÄ?Ä&#x201A;ĹśĆ&#x161; Ĺ?ĹľĆ&#x2030;Ä&#x201A;Ä?Ć&#x161; Ĺ˝Ĺś Ĺ&#x161;Ä&#x17E;Ä&#x201A;ĹŻĆ&#x161;Ĺ&#x161; Ć&#x2030;Ĺ˝ĹŻĹ?Ä?Ç&#x2021; Ä&#x201A;Ć&#x161; ĹŻĹ˝Ä?Ä&#x201A;ĹŻÍ&#x2022; Ć?Ć&#x161;Ä&#x201A;Ć&#x161;Ä&#x17E; Ä&#x201A;ĹśÄ&#x161; ĹśÄ&#x201A;Ć&#x;Ĺ˝ĹśÄ&#x201A;ĹŻ ĹŻÄ&#x17E;Ç&#x20AC;Ä&#x17E;ĹŻĆ? Ç Ĺ?Ć&#x161;Ĺ&#x161; Ć?Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A; Ä?Ä&#x201A;ĹľĆ&#x2030;Ä&#x201A;Ĺ?Ĺ?ĹśĆ? Ä&#x201A;Ć? Ä&#x201A; Ć?Ć&#x161;Ć&#x152;Ä&#x201A;Ć&#x161;Ä&#x17E;Ĺ?Ç&#x2021;Í&#x2DC; ^Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A; Ĺ&#x161;Ä&#x201A;Ć? Ć&#x2030;Ć&#x152;Ĺ˝Ç&#x20AC;Ĺ?Ä&#x161;Ä&#x17E;Ä&#x161; ĹśÄ&#x17E;Ç Ä&#x201A;ĹśÄ&#x161; ĆľĹśĆ&#x2030;Ć&#x152;Ä&#x17E;Ä?Ä&#x17E;Ä&#x161;Ä&#x17E;ĹśĆ&#x161;Ä&#x17E;Ä&#x161; Ä&#x201A;Ä?Ä?Ä&#x17E;Ć?Ć? Ć&#x161;Ĺ˝ Ä&#x17E;ĹŻÄ&#x17E;Ä?Ć&#x161;Ä&#x17E;Ä&#x161; Ĺ˝Ä¸Ä?Ĺ?Ä&#x201A;ĹŻĆ? Ä&#x201A;ĹśÄ&#x161; Ĺ?Ć? Ä&#x201A; Ć&#x2030;Ĺ˝Ç Ä&#x17E;Ć&#x152;Ä¨ĆľĹŻ Ć&#x161;Ĺ˝Ĺ˝ĹŻ Ä¨Ĺ˝Ć&#x152; Ä?Ĺ˝ĹľĹľĆľĹśĹ?Ć&#x161;Ç&#x2021; Ĺ˝Ć&#x152;Ĺ?Ä&#x201A;ĹśĹ?Ç&#x152;Ä&#x17E;Ć&#x152;Ć? Ĺ˝Ć&#x152; Ĺ?Ć&#x152;Ĺ˝ĆľĆ&#x2030;Ć? Ć&#x161;Ĺ˝ Ć?Ç Ä&#x201A;Ç&#x2021; Ć&#x2030;ĆľÄ?ĹŻĹ?Ä? Ĺ˝Ć&#x2030;Ĺ?ĹśĹ?Ĺ˝Ĺś Ä¨Ĺ˝Ć&#x152; Ç&#x20AC;Ä&#x201A;Ć&#x152;Ĺ?Ĺ˝ĆľĆ? Ä?Ä&#x201A;ĹŻĹŻĹ˝Ć&#x161; Ĺ?ĹśĹ?Ć&#x;Ä&#x201A;Ć&#x;Ç&#x20AC;Ä&#x17E; Ĺ˝Ć&#x152; Ć&#x2030;ĆľÄ?ĹŻĹ?Ä? opinion. The sky is the limit for social media use.

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Ç Ä&#x17E; Ć&#x2030;Ć&#x152;Ä&#x17E;Ć?Ä?Ć&#x152;Ĺ?Ä?Ä&#x17E;Í&#x2022; Ĺ?Ć&#x161; ĹľĆľĆ?Ć&#x161; Ä?Ä&#x17E; Ć&#x161;Ä&#x201A;ĹŹÄ&#x17E;Ĺś Ĺ?Ĺś Ć&#x161;Ĺ&#x161;Ä&#x17E; Ć&#x152;Ĺ?Ĺ?Ĺ&#x161;Ć&#x161; Ä?Ĺ˝ĹśĆ&#x161;Ä&#x17E;Ç&#x2020;Ć&#x161; Ä&#x201A;Ć&#x161; Ć&#x161;Ĺ&#x161;Ä&#x17E; Ć&#x152;Ĺ?Ĺ?Ĺ&#x161;Ć&#x161; Ć&#x;ĹľÄ&#x17E; Ä&#x201A;ĹśÄ&#x161; Ä?Ä&#x17E; ĆľĆ?Ä&#x17E;Ä&#x161; Ä?Ç&#x2021; Ä&#x201A; Ć&#x2030;Ĺ&#x161;Ç&#x2021;Ć?Ĺ?Ä?Ĺ?Ä&#x201A;Ĺś Ä&#x201A;Ç Ä&#x201A;Ć&#x152;Ä&#x17E; Ĺ˝Ä¨ Ĺ?Ć&#x161;Ć? Ć?Ĺ?Ä&#x161;Ä&#x17E; Ä&#x17E;ÄŤÄ&#x17E;Ä?Ć&#x161;Ć?Í&#x2DC; ĎÍ&#x2DC; DĹ˝Ć?Ć&#x161; Ć&#x2030;Ä&#x201A;Ć&#x;Ä&#x17E;ĹśĆ&#x161;Ć? Ä&#x201A;Ć&#x152;Ä&#x17E; Ĺ˝Ĺś Ć?Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A; Ä&#x201A;ĹśÄ&#x161; Ç Ä&#x201A;ĹśĆ&#x161; Ć&#x161;Ĺ˝ Ĺ?ĹśĆ&#x161;Ä&#x17E;Ć&#x152;Ä&#x201A;Ä?Ć&#x161; Ç Ĺ?Ć&#x161;Ĺ&#x161; Ć&#x2030;Ĺ&#x161;Ç&#x2021;Ć?Ĺ?Ä?Ĺ?Ä&#x201A;Ĺś Ç Ĺ&#x161;Ĺ˝ use and understand social media. ĎŽÍ&#x2DC; ^Ĺ˝Ä?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x17E;Ä&#x161;Ĺ?Ä&#x201A; Ć&#x2030;Ć&#x152;Ĺ˝Ä¨Ä&#x17E;Ć?Ć?Ĺ?Ĺ˝ĹśÄ&#x201A;ĹŻ Ä&#x17E;Ä&#x161;ĆľÄ?Ä&#x201A;Ć&#x;Ĺ˝ĹśÍ&#x2022; ĹľÄ&#x201A;Ć&#x152;ĹŹÄ&#x17E;Ć&#x;ĹśĹ?Í&#x2022; ĹśÄ&#x17E;Ć&#x161;Ç Ĺ˝Ć&#x152;ĹŹĹ?ĹśĹ? Ä&#x201A;ĹśÄ&#x161; 30

California Family Physician Fall 2017

BECOME AN INTEGRAL PART OF AN EXCITING YOUNG RESIDENCY PROGRAM!

Faculty, Family Medicine Residency Rancho Mirage, CA

'KUGPJQYGT /GFKECN %GPVGT KP 4CPEJQ /KTCIG %CNKHQTPKC TGEGPVN[ YGNEQOGF KVU Ć&#x201A; HVJ class of residents and has a full 10-year ACGME accreditation. Eisenhower Medical Associates, Inc., a California Professional Corporation, is seeking to enhance its team of employed physicians to serve as Family Medicine Residency faculty members for the Eisenhower Medical Center Residency Program. Options include outpatient-only, inpatient-only, or combined inpatient and outpatient care responsibilities. You may precept family medicine residents in our outpatient center and/or supervise residents on our family medicine inpatient service. You will have protected time for curriculum management, resident advising, and scholarly work. $QCTF EGTVKĆ&#x201A; ECVKQP KP (COKN[ /GFKEKPG KU TGSWKTGF (CEWNV[ CECFGOKE CRRQKPVOGPVU CTG EQPĆ&#x201A; TOGF HTQO C PWODGT QH NQECN WPKXGTUKVKGU DCUGF WRQP GZRGTKGPEG CPF SWCNKĆ&#x201A; ECVKQPU 'KUGPJQYGT /GFKECN #UUQEKCVGU UGGMU ECPFKFCVGU YJQUG GZRGTKGPEG teaching, research, and community service has prepared them to contribute to our commitment to serving the Coachella Valley. 3WCNKĆ&#x201A; GF CRRNKECPVU KPENWFKPI TGEGPV TGUKFGPE[ ITCFWCVGU CTG GPEQWTCIGF VQ apply. Candidates should submit an electronic CV and statement of interest to Anne Montgomery, MD, MBA, Program Director, at amontgomery@emc.org with a copy to tdunn@emc.org. (QT SWGUVKQPU QT KPSWKT[ RNGCUG EQPVCEV /KEJGNNG *CTFKPI (/ 4GUKFGPE[ 2TQITCO Manager, at mharding@emc.org or 760-773-4504.

emc.org/GME

Social Media Do’s • Identify yourself and speak in the first person • Take responsibility and own your mistakes • Respect copyright • Be yourself • Add value and be accurate • Know your fellow SoMe individuals • Use best judgment • Be professional • Have Fun and learn

ϭ͘ Z͘ ,͘ ůůĂǁĂǇ͕ :͘ ŽƌĂů͕ ͘ dŽƉƉƐ͕ D͘ Topps - Exploring digital professionalism, WĂŐĞƐ ϴϰϰͲϴϰϵ ͮ WƵďůŝƐŚĞĚ ŽŶůŝŶĞ͗ Ϭϭ :ƵŶ ϮϬϭϱ͕ ŚƩƉ͗ͬͬĚǆ͘ĚŽŝ͘ŽƌŐͬϭϬ͘ϯϭϬϵͬϬϭϰϮϭϱ ϵy͘ϮϬϭϱ͘ϭϬϰϰϵϱϲ Ϯ͘ >ĞĨĞďǀƌĞ ͕ DĞƐŶĞƌ :͕ ^ƚŽƉǇƌĂ :͕ K͛EĞŝůů :͕ ,ƵƐĂŝŶ /͕ 'ĞĞƌ ͕ 'ĞƌĂŶĐŚĞƌ <͕ ƚŬŝŶƐŽŶ H, Harper E, Huang W, Cline DM, Social DĞĚŝĂ ŝŶ WƌŽĨĞƐƐŝŽŶĂů DĞĚŝĐŝŶĞ͗ EĞǁ ZĞƐŝĚĞŶƚ WĞƌĐĞƉƟŽŶƐ ĂŶĚ WƌĂĐƟĐĞƐ͕ : DĞĚ /ŶƚĞƌŶĞƚ ZĞƐ ϮϬϭϲ͖ϭϴ;ϲͿ͗Ğϭϭϵ͕ hZ>͗ ŚƩƉ͗ͬͬ ǁǁǁ͘ũŵŝƌ͘ŽƌŐͬϮϬϭϲͬϲͬĞϭϭϵ 3. Social Media and Health Care WƌŽĨĞƐƐŝŽŶĂůƐ͗ ĞŶĞĮƚƐ͕ ZŝƐŬƐ͕ ĂŶĚ ĞƐƚ WƌĂĐƟĐĞƐ͕ ͘ >ĞĞ sĞŶƚŽůĂ͕ ƵƚŚŽƌ ŝŶĨŽƌŵĂƟŽŶ͕ ĐŽƉǇƌŝŐŚƚ ĂŶĚ >ŝĐĞŶƐĞ ŝŶĨŽƌŵĂƟŽŶ͕ ŽƉǇƌŝŐŚƚ Ξ ϮϬϭϰ͕ DĞĚŝDĞĚŝĂ h^ ͕ /ŶĐ͘ ϰ͘ W d͘ ϮϬϭϰ :Ƶů͖ ϯϵ;ϳͿ͗ ϰϵϭͲϰϵϵ͕ ϱϮϬ͘ WD / ͗ WD ϰϭϬϯϱϳϲ͕ ^ŽĐŝĂů DĞĚŝĂ ĂŶĚ ,ĞĂůƚŚ ĂƌĞ WƌŽĨĞƐƐŝŽŶĂůƐ͗ ĞŶĞĮƚƐ͕ ZŝƐŬƐ͕ ĂŶĚ ĞƐƚ WƌĂĐƟĐĞƐ͕ ͘ >ĞĞ sĞŶƚŽůĂ ϱ͘ ^ŽĐŝĂů DĞĚŝĂ hƐĞ ŝŶ DĞĚŝĐĂů ĚƵĐĂƟŽŶ͗ ^ǇƐƚĞŵĂƟĐ ZĞǀŝĞǁ͕ ŚĞƐƚŽŶ͕ ŚƌŝƐƟŶĞ ͘ D ͖ &ůŝĐŬŝŶŐĞƌ͕ dĂďŽƌ ͘ D ͕ DW,͖ Chisolm, Margaret S. MD ϲ͘ ĐĂĚĞŵŝĐ DĞĚŝĐŝŶĞ͗ :ƵŶĞ ϮϬϭϯ Ͳ sŽůƵŵĞ ϴϴ Ͳ /ƐƐƵĞ ϲ Ͳ Ɖ ϴϵϯʹϵϬϭ͕ ĚŽŝ͗ ϭϬ͘ϭϬϵϳͬ D͘ϬďϬϭϯĞϯϭϴϮϴīĐϮϯ ϳ͘ ƐŽĐŝĂů ŵĞĚŝĂ ƉƌŝŵĞƌ ĨŽƌ ƉƌŽĨĞƐƐŝŽŶĂůƐ͗ digital dos and don’ts., Bernhardt JM, ůďĞƌ :͕ 'ŽůĚ Z^͕ ,ĞĂůƚŚ WƌŽŵŽƚ WƌĂĐƚ͘ ϮϬϭϰ DĂƌ͖ ϭϱ;ϮͿ͗ϭϲϴͲϳϮ͘

ƌ͘ DĐ ŽŶĂůĚ ƉƌĂĐƟĐĞƐ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ Ăƚ <ĂŝƐĞƌ WĞƌŵĂŶĞŶƚĞ͕ &ŽŶƚĂŶĂ͘

JOIN OUR TEAM! AVAILABLE PROVIDEROPPORTUNITIES IN FAMILY MEDICINE WHAT WE HAVE TO OFFER: • Salary based on experience • Sign on bonus and relocation assistance • 5 days of CME, $3,000 CME reimbursement and 10 paid holidays • Quarterly bonuses SACRAMENTO based on quality and productivity SAN FRANCISCO YOSEMITE • Cap Exempt and Offering Visa FRESNO Sponsorship • National Health Service Corp Scholar and Loan Recruitment eligible • Organizational HPSA (Health Provider Shortage Area) score of 16 • Many sites within 1 hour of Yosemite National Park, 2 hours from the San Francsico Bay Area, and Monterey • 30 sites located throughout the central valley of California SAN JOAQUIN COUNTY

STANISLAUS COUNTY

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CONTACT ME TO DISCUSS OUR AMAZING OPPORTUNITIES: Joshua Skunca, Director of Provider Recruitment jskunca@gvhc.org | Office: 209.384.6489 | Cell: 209.291.9750

PLEASE VISIT US AT www.gvhc.org

California Family Physician Fall 2017

311

No-see, no-handle needle No reconstitution required No need to dial a dose 1,2

TrulicityÂŽ (dulaglutide) is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) that is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes. Limitations of Use: Not recommended as first-line therapy for patients inadequately controlled on diet and exercise because of the uncertain relevance of rodent C-cell tumor findings to humans. Prescribe only if potential benefits outweigh potential risks. Has not been studied in patients with a history of pancreatitis; consider another antidiabetic therapy. Not for the treatment of type 1 diabetes mellitus or diabetic ketoacidosis. Not a substitute for insulin. Has not been studied in patients with severe gastrointestinal disease, including severe gastroparesis. Not for patients with pre-existing severe gastrointestinal disease.

Select Important Safety Information WARNING: RISK OF THYROID C-CELL TUMORS In male and female rats, dulaglutide causes a dose-related and treatment-duration-dependent increase in the incidence of thyroid C-cell tumors (adenomas and carcinomas) after lifetime exposure. It is unknown whether Trulicity causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of dulaglutide-induced rodent thyroid C-cell tumors has not been determined. Trulicity is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk of MTC with the use of Trulicity and inform them of symptoms of thyroid tumors (eg, mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Trulicity.

Please see Important Safety Information for Trulicity, including Boxed Warning about possible thyroid tumors including thyroid cancer, on following pages and accompanying Brief Summary of Prescribing Information. Please see Instructions for Use included with the pen.

Preparation2 •

Check the pen to be sure it is not expired, damaged, cloudy, discolored, or has particles in it

•

Choose an area for injection (abdomen or thigh), being sure to choose a different site (even within area) each week

The key administration steps

Disposal2

•

Uncap the pen

Place and unlock

Press and hold

Dispose of the pen in a closable punctureresistant container and not in household trash

Please review the full Instructions for Use with your patients to ensure they understand how to properly administer Trulicity. Select Important Safety Information • Trulicity is contraindicated in patients with a personal or family history of medullary thyroid carcinoma or in patients with Multiple Endocrine Neoplasia

syndrome type 2, and in patients with a prior serious hypersensitivity reaction to dulaglutide or to any of the product components. • Cases of medullary thyroid carcinoma (MTC) in patients treated with liraglutide, another GLP-1 RA, have been reported in the postmarketing period; the data

in these reports are insufficient to establish or exclude a causal relationship between MTC and GLP-1 RA use in humans. If serum calcitonin is measured and found to be elevated or thyroid nodules are noted on physical examination or neck imaging, the patient should be further evaluated.

Yes, I think I can do this

In a study, 99% of patients reported that overall, the Trulicity Pen was easy or very easy to use3

•

Patients with type 2 diabetes who were naïve to self-injection and injecting others (n=214) participated in a phase 3b, multicenter, open-label, single-arm, outpatient study on the safe and effective use of the Trulicity single-dose pen

•

The primary objective was to achieve a final injection success rate (proportion of patients who successfully complete injection) significantly greater than 80%

•

Patients were trained at baseline on proper self-injection technique with the pen

•

Final injection (4th weekly injection) success was observed in 99.1% [95% CI: 96.6% to 99.7%] (n=209) of patients (primary objective met). Success determined by evaluation of patients’ ability to accurately complete each step in the sequence of drug administration

•

After the final self-injection, patients completed a 12-item ease of use module (secondary endpoint). 209 (99%) out of 210 patients reported that overall, the single dose pen was “easy” or “very easy” to use

To see how Trulicity can help your patients start injectable therapy, visit Trulicity.com/yesican

*Patient will need additional assistance from their healthcare professional as well as to review the full Instructions for Use included with the Trulicity Pen. Please see Important Safety Information for Trulicity, including Boxed Warning about possible thyroid tumors including thyroid cancer, on following pages and accompanying Brief Summary of Prescribing Information. Please see Instructions for Use included with the pen.

Important Safety Information WARNING: RISK OF THYROID C-CELL TUMORS In male and female rats, dulaglutide causes a dose-related and treatmentduration-dependent increase in the incidence of thyroid C-cell tumors (adenomas and carcinomas) after lifetime exposure. It is unknown whether Trulicity causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of dulaglutideinduced rodent thyroid C-cell tumors has not been determined.

Severe Gastrointestinal Disease: Use of Trulicity may be associated with gastrointestinal adverse reactions, sometimes severe. Trulicity has not been studied in patients with severe gastrointestinal disease, including severe gastroparesis, and is therefore not recommended in these patients.

Trulicity is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk of MTC with use of Trulicity and inform them of symptoms of thyroid tumors (eg, mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Trulicity.

The most common adverse reactions (excluding hypoglycemia) reported in ≥5% of Trulicity-treated patients in placebo-controlled trials (placebo, Trulicity 0.75 mg, and Trulicity 1.5 mg) were nausea (5.3%,12.4%, 21.1%), diarrhea (6.7%, 8.9%,12.6%), vomiting (2.3%, 6.0%,12.7%), abdominal pain (4.9%, 6.5%, 9.4%), decreased appetite (1.6%, 4.9%, 8.6%), dyspepsia (2.3%, 4.1%, 5.8%), and fatigue (2.6%, 4.2%, 5.6%).

Trulicity is contraindicated in patients with a personal or family history of MTC or in patients with MEN 2, and in patients with a prior serious hypersensitivity reaction to dulaglutide or any of the product components. Risk of Thyroid C-cell Tumors: Cases of MTC in patients treated with liraglutide, another GLP-1 receptor agonist (GLP-1 RA), have been reported in the postmarketing period; the data in these reports are insufﬁcient to establish or exclude a causal relationship between MTC and GLP-1 RA use in humans. If serum calcitonin is measured and found to be elevated or thyroid nodules are noted on physical examination or neck imaging, the patient should be further evaluated. Pancreatitis: Has been reported in clinical trials. Observe patients for signs and symptoms including persistent severe abdominal pain. If pancreatitis is suspected, discontinue Trulicity promptly. Do not restart if pancreatitis is conﬁrmed. Consider other antidiabetic therapies in patients with a history of pancreatitis. Hypoglycemia: The risk of hypoglycemia is increased when Trulicity is used in combination with insulin secretagogues (eg, sulfonylureas) or insulin. Patients may require a lower dose of the sulfonylurea or insulin to reduce the risk of hypoglycemia. Hypersensitivity Reactions: There have been postmarketing reports of serious hypersensitivity reactions (eg, anaphylactic reactions and angioedema) in patients treated with Trulicity. Instruct patients who experience symptoms to discontinue Trulicity and promptly seek medical advice. Use caution in a patient with a history of angioedema or anaphylaxis with another GLP-1 receptor agonist as it is unknown whether they will be predisposed to anaphylaxis with Trulicity. Renal Impairment: In patients treated with GLP-1 RAs, there have been postmarketing reports of acute renal failure and worsening of chronic renal failure, sometimes requiring hemodialysis. A majority of reported events occurred in patients who had experienced nausea, vomiting, diarrhea, or dehydration. In patients with renal impairment, use caution when initiating or escalating doses of Trulicity and monitor renal function in patients experiencing severe adverse gastrointestinal reactions.

PP-DG-US-1091

09/2017

Macrovascular Outcomes: There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with Trulicity.

Gastric emptying is slowed by Trulicity, which may impact absorption of concomitantly administered oral medications. Use caution when oral medications are used with Trulicity. Drug levels of oral medications with a narrow therapeutic index should be adequately monitored when concomitantly administered with Trulicity. In clinical pharmacology studies, Trulicity did not affect the absorption of the tested, orally administered medications to a clinically relevant degree. Pregnancy: Limited data with Trulicity in pregnant women are not sufficient to determine a drug-associated risk for major birth defects and miscarriage. Based on animal reproduction studies, there may be risks to the fetus from exposure to dulaglutide. Use only if potential benefit justifies the potential risk to the fetus. Lactation: There are no data on the presence of dulaglutide in human milk, the effects on the breastfed infant, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for Trulicity and any potential adverse effects on the breastfed infant from Trulicity or from the underlying maternal condition. Pediatric Use: Safety and effectiveness of Trulicity have not been established and use is not recommended in patients less than 18 years of age. Please see Brief Summary of Prescribing Information, including Boxed Warning about possible thyroid tumors including thyroid cancer, on following pages. Please see Instructions for Use included with the pen. DG HCP ISI 06FEB2017 Trulicity® is a registered trademark owned or licensed by Eli Lilly and Company, its subsidiaries, or affiliates. Trulicity is available by prescription only. Other product/company names mentioned herein are the trademarks of their respective owners. References 1. Trulicity [Instructions for Use]. Indianapolis, IN: Lilly USA, LLC. 2. Trulicity [Prescribing Information]. Indianapolis, IN: Lilly USA, LLC. 3. Matfin G, Van Brunt K, Zimmermann AG, et al. Safe and effective use of the once weekly dulaglutide single-dose pen in injection-naïve patients with type 2 diabetes. J Diabetes Sci Technol. 2015;9(5):1071-1079.

Trulicity® (dulaglutide) Brief Summary: Consult the package insert for complete prescribing information. WARNING: RISK OF THYROID C-CELL TUMORS • In male and female rats, dulaglutide causes a dose-related and treatment-duration-dependent increase in the incidence of thyroid C-cell tumors (adenomas and carcinomas) after lifetime exposure. It is unknown whether Trulicity causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of dulaglutide-induced rodent thyroid C-cell tumors has not been determined. • Trulicity is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk of MTC with use of Trulicity and inform them of symptoms of thyroid tumors (eg, mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Trulicity.

Trulicity and other suspected medications and promptly seek medical advice. Use caution in a patient with a history of angioedema or anaphylaxis with another GLP-1 receptor agonist because it is unknown whether such patients will be predisposed to anaphylaxis with Trulicity. Renal Impairment: In patients treated with GLP-1 receptor agonists, there have been postmarketing reports of acute renal failure and worsening of chronic renal failure, which may sometimes require hemodialysis. Some of these events were reported in patients without known underlying renal disease. A majority of reported events occurred in patients who had experienced nausea, vomiting, diarrhea, or dehydration. Because these reactions may worsen renal failure, use caution when initiating or escalating doses of Trulicity in patients with renal impairment. Monitor renal function in patients with renal impairment reporting severe adverse gastrointestinal reactions. Severe Gastrointestinal Disease: Use of Trulicity may be associated with gastrointestinal adverse reactions, sometimes severe. Trulicity has not been studied in patients with severe gastrointestinal disease, including severe gastroparesis, and is therefore not recommended in these patients. Macrovascular Outcomes: There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with Trulicity. ADVERSE REACTIONS

Risk of Thyroid C-cell Tumors: In male and female rats, dulaglutide causes a dose-related and treatment-duration-dependent increase in the incidence of thyroid C-cell tumors (adenomas and carcinomas) after lifetime exposure. Glucagon-like peptide (GLP-1) receptor agonists have induced thyroid C-cell adenomas and carcinomas in mice and rats at clinically relevant exposures. It is unknown whether Trulicity will cause thyroid C-cell tumors, including MTC, in humans, as the human relevance of dulaglutide-induced rodent thyroid C-cell tumors has not been determined. One case of MTC was reported in a patient treated with Trulicity. This patient had pretreatment calcitonin levels approximately 8 times the upper limit of normal (ULN). Cases of MTC in patients treated with liraglutide, another GLP-1 receptor agonist, have been reported in the postmarketing period; the data in these reports are insufficient to establish or exclude a causal relationship between MTC and GLP-1 receptor agonist use in humans. Trulicity is contraindicated in patients with a personal or family history of MTC or in patients with MEN 2. Counsel patients regarding the potential risk for MTC with the use of Trulicity and inform them of symptoms of thyroid tumors (eg, a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Trulicity. Such monitoring may increase the risk of unnecessary procedures, due to the low test specificity for serum calcitonin and a high background incidence of thyroid disease. Significantly elevated serum calcitonin value may indicate MTC and patients with MTC usually have calcitonin values >50 ng/L. If serum calcitonin is measured and found to be elevated, the patient should be further evaluated. Patients with thyroid nodules noted on physical examination or neck imaging should also be further evaluated. Pancreatitis: In Phase 2 and Phase 3 clinical studies, 12 (3.4 cases per 1000 patient years) pancreatitis-related adverse reactions were reported in patients exposed to Trulicity versus 3 in non-incretin comparators (2.7 cases per 1000 patient years). An analysis of adjudicated events revealed 5 cases of confirmed pancreatitis in patients exposed to Trulicity (1.4 cases per 1000 patient years) versus 1 case in non-incretin comparators (0.88 cases per 1000 patient years). After initiation of Trulicity, observe patients carefully for signs and symptoms of pancreatitis, including persistent severe abdominal pain. If pancreatitis is suspected, promptly discontinue Trulicity. If pancreatitis is confirmed, Trulicity should not be restarted. Trulicity has not been evaluated in patients with a prior history of pancreatitis. Consider other antidiabetic therapies in patients with a history of pancreatitis. Hypoglycemia with Concomitant Use of Insulin Secretagogues or Insulin: The risk of hypoglycemia is increased when Trulicity is used in combination with insulin secretagogues (eg, sulfonylureas) or insulin. Patients may require a lower dose of sulfonylurea or insulin to reduce the risk of hypoglycemia in this setting. Hypersensitivity Reactions: There have been postmarketing reports of serious hypersensitivity reactions (e.g., anaphylactic reactions and angioedema) in patients treated with Trulicity. If a hypersensitivity reaction occurs, the patient should discontinue

Clinical Studies Experience: Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in practice. Pool of Placebo-controlled Trials: These data reflect exposure of 1670 patients to Trulicity and a mean duration of exposure to Trulicity of 23.8 weeks. Across the treatment arms, the mean age of patients was 56 years, 1% were 75 years or older and 53% were male. The population in these studies was 69% White, 7% Black or African American, 13% Asian; 30% were of Hispanic or Latino ethnicity. At baseline, the population had diabetes for an average of 8.0 years and had a mean HbA1c of 8.0%. At baseline, 2.5% of the population reported retinopathy. Baseline estimated renal function was normal or mildly impaired (eGFR ≥60mL/min/1.73 m2) in 96.0% of the pooled study populations. Adverse Reactions in Placebo-Controlled Trials Reported in ≥5% of Trulicity-Treated Patients: Placebo (N=568), Trulicity 0.75mg (N=836), Trulicity 1.5 mg (N=834) (listed as placebo, 0.75 mg, 1.5 mg): nausea (5.3%, 12.4%, 21.1%), diarrheaa (6.7%, 8.9%, 12.6%), vomitingb (2.3%, 6.0%, 12.7%), abdominal painc (4.9%, 6.5%, 9.4%), decreased appetite (1.6%, 4.9%, 8.6%), dyspepsia (2.3%, 4.1%, 5.8%), fatigued (2.6%, 4.2%, 5.6%). (a Includes diarrhea, fecal volume increased, frequent bowel movements. b Includes retching, vomiting, vomiting projectile. c Includes abdominal discomfort, abdominal pain, abdominal pain lower, abdominal pain upper, abdominal tenderness, gastrointestinal pain. d Includes fatigue, asthenia, malaise.) Note: Percentages reflect the number of patients that reported at least 1 treatment-emergent occurrence of the adverse reaction. Gastrointestinal Adverse Reactions: In the pool of placebo-controlled trials, gastrointestinal adverse reactions occurred more frequently among patients receiving Trulicity than placebo (placebo 21.3%, 0.75 mg 31.6%, 1.5 mg 41.0%). More patients receiving Trulicity 0.75 mg (1.3%) and Trulicity 1.5 mg (3.5%) discontinued treatment due to gastrointestinal adverse reactions than patients receiving placebo (0.2%). Investigators graded the severity of gastrointestinal adverse reactions occurring on 0.75 mg and 1.5 mg of Trulicity as “mild” in 58% and 48% of cases, respectively, “moderate” in 35% and 42% of cases, respectively, or “severe” in 7% and 11% of cases, respectively. In addition to the adverse reactions ≥5% listed above, the following adverse reactions were reported more frequently in Trulicity-treated patients than placebo (frequencies listed, respectively, as: placebo; 0.75 mg; 1.5 mg): constipation (0.7%; 3.9%; 3.7%), flatulence (1.4%; 1.4%; 3.4%), abdominal distension (0.7%; 2.9%; 2.3%), gastroesophageal reflux disease (0.5%; 1.7%; 2.0%), and eructation (0.2%; 0.6%; 1.6%). Pool of Placebo- and Active-Controlled Trials: The occurrence of adverse reactions was also evaluated in a larger pool of patients with type 2 diabetes participating in 6 placebo- and active-controlled trials evaluating the use of Trulicity as monotherapy and add-on therapy to oral medications or insulin. In this pool, a total of 3342 patients with type 2 diabetes were treated with Trulicity for a mean duration 52 weeks. The mean age of patients was 56 years, 2% were 75 years or older and 51% were male. The population in these studies was 71% White, 7% Black or African American, 11% Asian; 32% were of Hispanic or Latino ethnicity. At baseline, the population had diabetes for an average of 8.2 years and had a mean HbA1c of 7.6-8.5%. At baseline, 5.2% of the population reported retinopathy. Baseline estimated renal function was normal or mildly impaired (eGFR ≥60 ml/min/1.73 m2) in 95.7% of the Trulicity population. In the pool of placebo- and active-controlled trials, the types and frequency of common adverse reactions, excluding hypoglycemia, were similar to those listed as ≥5% above. Other Adverse Reactions: Hypoglycemia: Incidence (%) of Documented Symptomatic (≤70 mg/dL Glucose Threshold) and Severe Hypoglycemia in Placebo-Controlled Trials: Add-on to Metformin at 26 weeks, Placebo (N=177), Trulicity 0.75 mg (N=302), Trulicity 1.5 mg (N=304), Documented symptomatic: Placebo: 1.1%, 0.75 mg: 2.6%, 1.5 mg: 5.6%; Severe: all 0. Add-on to Metformin + Pioglitazone at 26 weeks, Placebo (N=141), Trulicity 0.75 mg (N=280), Trulicity 1.5 mg (N=279), Documented symptomatic: Placebo: 1.4%, 0.75 mg: 4.6%, 1.5 mg: 5.0%; Severe: all 0. Add-on to Glimepiride at 24 weeks, Placebo (N=60), Trulicity 1.5 mg (N=239), Documented symptomatic: Placebo: 1.7%, 1.5 mg: 11.3%; Severe: all 0. Add-on to Insulin Glargine with or without Metformin at 28 weeks, Placebo (N=150), Trulicity 1.5 mg (N=150), Documented symptomatic: Placebo: 30.0% 1.5 mg: 35.3%; Severe: Placebo: 0% 1.5 mg: 0.7%. Hypoglycemia was more frequent when Trulicity was used in combination with a sulfonylurea or insulin. In a 78-week clinical trial documented symptomatic hypoglycemia occurred in 39% and 40% of patients when Trulicity 0.75 mg and 1.5 mg, respectively, was co-administered with a sulfonylurea. Severe hypoglycemia occurred in 0% and 0.7% of patients when Trulicity 0.75 mg and 1.5 mg, respectively, was co-administered with a sulfonylurea. Documented

Trulicity® (dulaglutide)

INDICATIONS AND USAGE Trulicity® is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Limitations of Use: Not recommended as a first-line therapy for patients who have inadequate glycemic control on diet and exercise because of the uncertain relevance of rodent C-cell tumor findings to humans. Prescribe Trulicity only to patients for whom the potential benefits outweigh the potential risk. Has not been studied in patients with a history of pancreatitis. Consider other antidiabetic therapies in patients with a history of pancreatitis. Should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. It is not a substitute for insulin. Has not been studied in patients with severe gastrointestinal disease, including severe gastroparesis. Not recommended in patients with pre-existing severe gastrointestinal disease. CONTRAINDICATIONS Do not use in patients with a personal or family history of MTC or in patients with MEN 2. Do not use in patients with a prior serious hypersensitivity reaction to dulaglutide or to any of the product components. WARNINGS AND PRECAUTIONS

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symptomatic hypoglycemia occurred in 85% and 80% of patients when Trulicity 0.75 mg and 1.5 mg, respectively, was co-administered with prandial insulin. Severe hypoglycemia occurred in 2.4% and 3.4% of patients when Trulicity 0.75 mg, and 1.5 mg, respectively, was co-administered with prandial insulin. Heart Rate Increase and Tachycardia Related Adverse Reactions: Trulicity 0.75 mg and 1.5 mg resulted in a mean increase in heart rate (HR) of 2-4 beats per minute (bpm). The long-term clinical effects of the increase in HR have not been established. Adverse reactions of sinus tachycardia were reported more frequently in patients exposed to Trulicity. Sinus tachycardia was reported in 3.0%, 2.8%, and 5.6% of patients treated with placebo, Trulicity 0.75 mg, and Trulicity 1.5 mg, respectively. Persistence of sinus tachycardia (reported at more than 2 visits) was reported in 0.2%, 0.4%, and 1.6% of patients treated with placebo, Trulicity 0.75 mg and Trulicity 1.5 mg, respectively. Episodes of sinus tachycardia, associated with a concomitant increase from baseline in heart rate of ≥15 beats per minute, were reported in 0.7%, 1.3%, and 2.2% of patients treated with placebo, Trulicity 0.75 mg, and Trulicity 1.5 mg, respectively. Immunogenicity: Across four Phase 2 and five Phase 3 clinical studies, 64 (1.6%) Trulicitytreated patients developed anti-drug antibodies (ADAs) to the active ingredient in Trulicity (ie, dulaglutide). Of the 64 dulaglutide-treated patients that developed dulaglutide ADAs, 34 patients (0.9% of the overall population) had dulaglutide-neutralizing antibodies, and 36 patients (0.9% of the overall population) developed antibodies against native GLP-1. The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, the incidence of antibodies to dulaglutide cannot be directly compared with the incidence of antibodies of other products. Hypersensitivity: Systemic hypersensitivity adverse reactions sometimes severe (eg, severe urticaria, systemic rash, facial edema, lip swelling) occurred in 0.5% of patients on Trulicity in the four Phase 2 and Phase 3 studies. Injection-site Reactions: In the placebo-controlled studies, injection-site reactions (eg, injection-site rash, erythema) were reported in 0.5% of Trulicity-treated patients and in 0.0% of placebo-treated patients. PR Interval Prolongation and Adverse Reactions of First Degree Atrioventricular (AV) Block: A mean increase from baseline in PR interval of 2-3 milliseconds was observed in Trulicity-treated patients in contrast to a mean decrease of 0.9 millisecond in placebo-treated patients. The adverse reaction of first degree AV block occurred more frequently in patients treated with Trulicity than placebo (0.9%, 1.7%, and 2.3% for placebo, Trulicity 0.75 mg, and Trulicity 1.5 mg, respectively). On electrocardiograms, a PR interval increase to at least 220 milliseconds was observed in 0.7%, 2.5%, and 3.2% of patients treated with placebo, Trulicity 0.75 mg, and Trulicity 1.5 mg, respectively. Amylase and Lipase Increase: Patients exposed to Trulicity had mean increases from baseline in lipase and/or pancreatic amylase of 14% to 20%, while placebotreated patients had mean increases of up to 3%. Postmarketing Experience: Anaphylactic reactions have been reported during post-approval use of Trulicity. Because these events are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency or establish a causal relationship to drug exposure. DRUG INTERACTIONS Trulicity slows gastric emptying and thus has the potential to reduce the rate of absorption of concomitantly administered oral medications. Caution should be exercised when oral medications are concomitantly administered with Trulicity. Drug levels of oral medications with a narrow therapeutic index should be adequately monitored when concomitantly administered with Trulicity. In clinical pharmacology studies, Trulicity did not affect the absorption of the tested, orally administered medications to any clinically relevant degree. USE IN SPECIFIC POPULATIONS Pregnancy: Risk Summary Limited data with Trulicity in pregnant women are not sufficient to determine a drug associated risk for major birth defects and miscarriage. Based on animal reproduction studies, there may be risks to the fetus from exposure to dulaglutide during pregnancy. Trulicity should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. In pregnant rats administered dulaglutide during organogenesis, early embryonic deaths, fetal growth reductions, and fetal abnormalities occurred at systemic exposures at least 14-times human exposure at the maximum recommended human dose (MRHD) of 1.5 mg/week. In pregnant rabbits administered dulaglutide during organogenesis, major fetal abnormalities occurred at 13-times human exposure at the MRHD. Adverse embryo/fetal effects in animals occurred in association with decreased maternal weight and food consumption attributed to the pharmacology of dulaglutide. Lactation: Risk Summary There are no data on the presence of dulaglutide in human milk, the effects on the breastfed infant, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for Trulicity and any potential adverse effects on the breastfed infant from Trulicity or from the underlying maternal condition. Pediatric Use: Safety and effectiveness of Trulicity have not been established in pediatric patients. Trulicity is not recommended for use in pediatric patients younger than 18 years. Geriatric Use: In the pool of placebo- and active-controlled trials, 620 (18.6%) Trulicity-treated patients were 65 years of age and over and 65 Trulicity-treated patients (1.9%) were 75 years of age and over. No overall differences in safety or efficacy were detected between these patients and younger patients, but greater sensitivity of some older individuals cannot be ruled out. Hepatic Impairment: There is limited clinical experience in patients with mild, moderate, or severe hepatic impairment. Therefore, Trulicity should be used with caution in these patient populations. In a clinical pharmacology study in subjects with Trulicity® (dulaglutide)

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varying degrees of hepatic impairment, no clinically relevant change in dulaglutide pharmacokinetics (PK) was observed. Renal Impairment: In the four Phase 2 and five Phase 3 randomized clinical studies, at baseline, 50 (1.2%) Trulicity-treated patients had mild renal impairment (eGFR ≥60 but <90 mL/min/1.73 m2), 171 (4.3%) Trulicity-treated patients had moderate renal impairment (eGFR ≥30 but <60 mL/min/1.73 m2) and no Trulicity-treated patients had severe renal impairment (eGFR <30 mL/min/1.73 m2). No overall differences in safety or effectiveness were observed relative to patients with normal renal function, though conclusions are limited due to small numbers. In a clinical pharmacology study in subjects with renal impairment including end-stage renal disease (ESRD), no clinically relevant change in dulaglutide PK was observed. There is limited clinical experience in patients with severe renal impairment or ESRD. Trulicity should be used with caution, and if these patients experience adverse gastrointestinal side effects, renal function should be closely monitored. Gastroparesis: Dulaglutide slows gastric emptying. Trulicity has not been studied in patients with pre-existing gastroparesis. OVERDOSAGE Overdoses have been reported in clinical studies. Effects associated with these overdoses were primarily mild or moderate gastrointestinal events (eg, nausea, vomiting) and non-severe hypoglycemia. In the event of overdose, appropriate supportive care (including frequent plasma glucose monitoring) should be initiated according to the patient’s clinical signs and symptoms. PATIENT COUNSELING INFORMATION See FDA-approved Medication Guide • Inform patients that Trulicity causes benign and malignant thyroid C-cell tumors in rats and that the human relevance of this finding has not been determined. Counsel patients to report symptoms of thyroid tumors (eg, a lump in the neck, persistent hoarseness, dysphagia, or dyspnea) to their physician. • Inform patients that persistent severe abdominal pain, that may radiate to the back and which may (or may not) be accompanied by vomiting, is the hallmark symptom of acute pancreatitis. Instruct patients to discontinue Trulicity promptly, and to contact their physician, if persistent severe abdominal pain occurs. • The risk of hypoglycemia may be increased when Trulicity is used in combination with a medicine that can cause hypoglycemia, such as a sulfonylurea or insulin. Review and reinforce instructions for hypoglycemia management when initiating Trulicity therapy, particularly when concomitantly administered with a sulfonylurea or insulin. • Patients treated with Trulicity should be advised of the potential risk of dehydration due to gastrointestinal adverse reactions and take precautions to avoid fluid depletion. Inform patients treated with Trulicity of the potential risk for worsening renal function and explain the associated signs and symptoms of renal impairment, as well as the possibility of dialysis as a medical intervention if renal failure occurs. • Inform patients that serious hypersensitivity reactions have been reported during postmarketing use of Trulicity and other GLP-1 receptor agonists. If symptoms of hypersensitivity reactions occur, patients must stop taking Trulicity and seek medical advice promptly. • Advise patients to inform their healthcare provider if they are pregnant or intend to become pregnant. • Prior to initiation of Trulicity, train patients on proper injection technique to ensure a full dose is delivered. Refer to the accompanying Instructions for Use for complete administration instructions with illustrations. • Inform patients of the potential risks and benefits of Trulicity and of alternative modes of therapy. Inform patients about the importance of adherence to dietary instructions, regular physical activity, periodic blood glucose monitoring and HbA1c testing, recognition and management of hypoglycemia and hyperglycemia, and assessment for diabetes complications. During periods of stress such as fever, trauma, infection, or surgery, medication requirements may change and advise patients to seek medical advice promptly. • Each weekly dose of Trulicity can be administered at any time of day, with or without food. The day of once-weekly administration can be changed if necessary, as long as the last dose was administered 3 or more days before. If a dose is missed and there are at least 3 days (72 hours) until the next scheduled dose, it should be administered as soon as possible. Thereafter, patients can resume their usual once-weekly dosing schedule. If a dose is missed and the next regularly scheduled dose is due in 1 or 2 days, the patient should not administer the missed dose and instead resume Trulicity with the next regularly scheduled dose. • Advise patients treated with Trulicity of the potential risk of gastrointestinal side effects. • Instruct patients to read the Medication Guide and the Instructions for Use before starting Trulicity therapy and review them each time the prescription is refilled. • Instruct patients to inform their doctor or pharmacist if they develop any unusual symptom, or if any known symptom persists or worsens. • Inform patients that response to all diabetic therapies should be monitored by periodic measurements of blood glucose and HbA1c levels, with a goal of decreasing these levels towards the normal range. HbA1c is especially useful for evaluating long-term glycemic control.

Eli Lilly and Company, Indianapolis, IN 46285, USA US License Number 1891 Copyright © 2014, 2015, Eli Lilly and Company. All rights reserved. Additional information can be found at www.trulicity.com DG HCP BS 10FEB2017 Trulicity® (dulaglutide)

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evp forum

Susan Hogeland, CAE

What Does the Future Hold for ACA? The theme of this issue of California Family Physician is the ĐǇďĞƌ ǁŽƌůĚ ŽĨ ŵĞĚŝĐŝŶĞ͕ ďƵƚ /͛ŵ ŶŽƚ ŐŽŝŶŐ ƚŽ ǁƌŝƚĞ ĂďŽƵƚ ƚŚĂƚ͘ KƚŚĞƌƐ ŵƵĐŚ ŵŽƌĞ ŬŶŽǁůĞĚŐĞĂďůĞ ĂďŽƵƚ ƚŚĞ ƚŽƉŝĐ ǁŝůů ŚĂŶĚůĞ ŝƚ ǀĞƌǇ ǁĞůů͘ dŚĞ ďƵƌŶŝŶŐ ƉůĂƞŽƌŵ ŝƐƐƵĞ ƚŽĚĂǇ ĨŽƌ ĨĂŵŝůǇ ŵĞĚŝĐŝŶĞ͕ ĂŶĚ͕ ŝŶĚĞĞĚ͕ ĨŽƌ ƚŚĞ ĐŽƵŶƚƌǇ͕ ŝƐ ƚŚĞ ĨƵƚƵƌĞ ŽĨ ƚŚĞ īŽƌĚĂďůĞ ĂƌĞ Đƚ ; Ϳ͘ /ƚ ŝƐ ŵǇ ƐƚƌŽŶŐ ŚŽƉĞ ŝƚ ƐƵƌǀŝǀĞƐ ůŽŶŐ ĞŶŽƵŐŚ ĨŽƌ ƚŚŝƐ ĂƌƟĐůĞ ƚŽ ĂƉƉĞĂƌ ŝŶ ƉƌŝŶƚ ďĞĐĂƵƐĞ͕ ĂƐ ǁĂƐ ƚŚĞ ĐĂƐĞ ǁŝƚŚ DĞĚŝĐĂƌĞ ŝŶ ƚŚĞ ƉĂƐƚ͕ ƚŚĞ ƉƵďůŝĐ ŽŶůǇ ƌĞĂůŝǌĞƐ ŝƚ ůŽǀĞƐ ƐŽŵĞƚŚŝŶŐ ǁŚĞŶ Ă ƚŚƌĞĂƚ ůŽŽŵƐ ƚŽ ƚĂŬĞ ŝƚ ĂǁĂǇ͘ Before the Republican-dominated House and Senate tried to ƌĞƉĞĂů ƚŚĞ ͕ ƉŽůůƐ ŝŶĚŝĐĂƚĞĚ Ă ŶĞĂƌůǇ ϱϬͲϱϬ ƐƉůŝƚ ďĞƚǁĞĞŶ ƚŚĞ ůŝŬĞ ŝƚͬůŽǀĞ ŝƚ ĨŽůŬƐ ĂŶĚ ƚŚĞ ŚĂƚĞ ŝƚͬƌĞƉĞĂů ŝƚ ĨŽůŬƐ͕ ǁŝƚŚ ƚŚĞ ůĂƩĞƌ ƐůŝŐŚƚůǇ ĂŚĞĂĚ ĨŽƌ Ă ƐĞǀĞƌĂů ǇĞĂƌƐ͘ tŚŝůĞ ƚŚĞ ĨĂǀŽƌĂďůĞ ǀ͘ ƵŶĨĂǀŽƌĂďůĞ ǀŝĞǁ ƐƉůŝƚ ŶŽǁ ŝƐ ϱϮ ƉĞƌĐĞŶƚ ƚŽ ϯϵ ƉĞƌĐĞŶƚ͕ Ă <ĂŝƐĞƌ &ĂŵŝůǇ &ŽƵŶĚĂƟŽŶͲƌĞůĞĂƐĞĚ ƉŽůů ŝŶ ĞĂƌůǇ ƵŐƵƐƚ ĨŽƵŶĚ Ă ůĂƌŐĞ majority of the public, including half of Republicans and Trump ƐƵƉƉŽƌƚĞƌƐ͕ ƐĂǇ ƚŚĞ ĚŵŝŶŝƐƚƌĂƟŽŶ ŶŽǁ ƐŚŽƵůĚ ƚƌǇ ƚŽ ŵĂŬĞ ƚŚĞ īŽƌĚĂďůĞ ĂƌĞ Đƚ ǁŽƌŬ͘

ŬŶŽǁƐ ǁŚĂƚ ĂĚǀĞƌƐĞ ƐĞůĞĐƟŽŶ ŝƐ ĂŶĚ ŝƚƐ ĂīĞĐƚ ŽŶ Ă ŚĞĂůƚŚ ƉůĂŶ͕ ƵůƟŵĂƚĞůǇ͘ Ǉ ƚŚĞ ƐĂŵĞ ƚŽŬĞŶ͕ ŝĨ ƚŚĞ ĚŵŝŶŝƐƚƌĂƟŽŶ ĐŚŽŽƐĞƐ ƚŽ ŐŽ ƚŚĞ ͞ĚĞĂƚŚ ďǇ Ă ƚŚŽƵƐĂŶĚ ĐƵƚƐ͟ ƌŽƵƚĞ ĂŶĚ ĞůŝŵŝŶĂƚĞ ĐŽƐƚͲ sharing subsidies, remove various taxes that support the ACA, fail ƚŽ ĞŶĨŽƌĐĞ /Z^ ƌƵůĞƐ ŽŶ ƉĞŶĂůƟĞƐ ĨŽƌ ĨĂŝůŝŶŐ ƚŽ ƉƵƌĐŚĂƐĞ ĐŽǀĞƌĂŐĞ͕ ƐƚŽƉ ƉƌŽŵŽƟŶŐ ƐŝŐŶͲƵƉƐ Žƌ ĐŽŶƟŶƵĞ ƚŽ ƐĐĂƌĞ ƚŚĞ ĚĂǇůŝŐŚƚƐ ŽƵƚ of the health insurance industry, jeopardizing stability, the result may be the same – not just death of an industry, but literally ĚĞĂƚŚƐ ŽĨ ƚŚŽƵƐĂŶĚƐ ŽĨ ŵĞƌŝĐĂŶ ĐŝƟǌĞŶƐ ƵŶĂďůĞ ƚŽ ŽďƚĂŝŶ Žƌ ĂīŽƌĚ ŚĞĂůƚŚ ĐĂƌĞ ĐŽǀĞƌĂŐĞ͘ /Ŷ ŚŝƐ ƵŐƵƐƚ ͞/Ŷ ƚŚĞ dƌĞŶĐŚĞƐ͟ ďůŽŐ͕ &W ^ĞŶŝŽƌ sŝĐĞ WƌĞƐŝĚĞŶƚ͕ ĚǀŽĐĂĐǇ͕ WƌĂĐƟĐĞ ĚǀĂŶĐĞŵĞŶƚ ĂŶĚ WŽůŝĐǇ ^ŚĂǁŶ DĂƌƟŶ ƋƵŽƚĞĚ &W͛Ɛ ůĞƩĞƌ ƚŽ ^ĞŶĂƚĞ ůĞĂĚĞƌƐ DĐ ŽŶŶĞůů ĂŶĚ ^ĐŚƵŵĞƌ͗ ͞/ƚ ŝƐ ƟŵĞ ƚŽ ŵŽǀĞ ďĞǇŽŶĚ ŽƵƌ ĐƵƌƌĞŶƚ ŚĞĂůƚŚ ĐĂƌĞ ĚĞďĂƚĞ ƚŚĂƚ ŝƐ ĨŽĐƵƐĞĚ ŽŶ ƌĞƉĞĂůŝŶŐ ŵĂũŽƌ ƉŽƌƟŽŶƐ ŽĨ ĐƵƌƌĞŶƚ ůĂǁ ĂŶĚ ƐĞĞŬ ďŝƉĂƌƟƐĂŶ ƉŽůŝĐŝĞƐ ƚŚĂƚ ďƵŝůĚ ŽŶ ŽƵƌ ĐŽůůĞĐƟǀĞ ƐƵĐĐĞƐƐĞƐ͕ ĂĚĚƌĞƐƐ ongoing challenges, and improve our health care system for ĐƵƌƌĞŶƚ ĂŶĚ ĨƵƚƵƌĞ ĐŝƟǌĞŶƐ͘͟

dŚĞ ƐƵƌǀĞǇ ĞǀĞŶ ĨŽƵŶĚ ƚŚĂƚ ŵŽƐƚ ZĞƉƵďůŝĐĂŶƐ ĂƌĞ ͞ĚŝƐĂƉƉŽŝŶƚĞĚ͟ ďƵƚ ŶŽƚ ͞ĂŶŐƌǇ͟ ƚŚĂƚ ƌĞƉĞĂů ĂŶĚ ƌĞƉůĂĐĞ ůĞŐŝƐůĂƟŽŶ ĨĂŝůĞĚ͘ ŝŐŚƚ ŝŶ ϭϬ ŵĞƌŝĐĂŶƐ ;ϳϴ ƉĞƌĐĞŶƚͿ ƐĂǇ ƚŚĞ ĚŵŝŶŝƐƚƌĂƟŽŶ ƐŚŽƵůĚ ĚŽ ǁŚĂƚ ŝƚ ĐĂŶ ƚŽ ŵĂŬĞ ƚŚĞ ĐƵƌƌĞŶƚ ŚĞĂůƚŚ ĐĂƌĞ ůĂǁ ǁŽƌŬ͕ ŝŶĐůƵĚŝŶŐ ϱϮ ƉĞƌĐĞŶƚ ŽĨ ZĞƉƵďůŝĐĂŶƐ ĂŶĚ ϱϭ ƉĞƌĐĞŶƚ ŽĨ WƌĞƐŝĚĞŶƚ dƌƵŵƉ͛Ɛ ƐƵƉƉŽƌƚĞƌƐ͕ ĂůƚŚŽƵŐŚ ƚŚĞ ůĂƩĞƌ ƐƵƉƉŽƌƚ ͞ŚĂƌĚďĂůů͟ ŶĞŐŽƟĂƟŶŐ ƚĂĐƟĐƐ ƚŚĂƚ ĐŽƵůĚ ĨƵƌƚŚĞƌ ĚĞƐƚĂďŝůŝǌĞ ƚŚĞ ŝŶƐƵƌĂŶĐĞ ŝŶĚƵƐƚƌǇ͘ / Ăŵ ŚĂƉƉǇ ƚŽ ƐĂǇ ƐŽŵĞ ďŝƉĂƌƟƐĂŶ ĞīŽƌƚƐ ƚŽ ĂĚĚƌĞƐƐ ƚŚĞ ŇĂǁƐ ĂƌĞ ďĞŐŝŶŶŝŶŐ ƚŽ ƚĂŬĞ ƐŚĂƉĞ ŝŶ ƚŚĞ ^ĞŶĂƚĞ͘ WĂƌƟƐĂŶ ƌĂŶĐŽƌ ƉƌĞǀĞŶƚĞĚ ƐƵĐŚ ĞīŽƌƚƐ ĨƌŽŵ ďĞŝŶŐ ƵŶĚĞƌƚĂŬĞŶ ƉƌĞǀŝŽƵƐůǇ͕ ĂŶĚ͕ ŽĨ ĐŽƵƌƐĞ͕ ƚŚĞƌĞ͛Ɛ ŶŽ ŐƵĂƌĂŶƚĞĞ ƚŚĞǇ ǁŝůů ǁŽƌŬ ŶŽǁ͘

Dƌ͘ DĂƌƟŶ ĂĚĚĞĚ͗ ͞dŚĞ ƉƌŽƉŽƐĞĚ ƐĞƚ ŽĨ ƉŽůŝĐŝĞƐ ŽƵƚůŝŶĞĚ ŝŶ ŽƵƌ ůĞƩĞƌ ĂƌĞ ǁĞůůͲƉŽƐŝƟŽŶĞĚ ƚŽ ŝŶĐƌĞĂƐĞ ĂĐĐĞƐƐ ƚŽ ĂīŽƌĚĂďůĞ ĂŶĚ meaningful health care coverage for all Americans. They place ĂŶ ĞŵƉŚĂƐŝƐ ŽŶ ĞƐƚĂďůŝƐŚŝŶŐ ƉƌŝŵĂƌǇ ĐĂƌĞ ĂƐ ƚŚĞ ĨŽƵŶĚĂƟŽŶ ŽĨ ŽƵƌ ŚĞĂůƚŚ ĐĂƌĞ ƐǇƐƚĞŵ Ăƚ ƚŚĞ ŝŶĚŝǀŝĚƵĂů ĂŶĚ ƉŽƉƵůĂƟŽŶ ůĞǀĞůƐ͘ They promote increased payment for family physicians, especially in the public insurance programs. We also have been mindful ƚŽ ƉƌŽŵŽƚĞ ƉŽůŝĐŝĞƐ ƚŚĂƚ ďĞŐŝŶ ƚŽ ƌĞŵŽǀĞ ƚŚĞ ĮŶĂŶĐŝĂů ďĂƌƌŝĞƌƐ ŵĂŶǇ ŝŶƐƵƌĞĚ ŝŶĚŝǀŝĚƵĂůƐ ĞǆƉĞƌŝĞŶĐĞ ĚƵĞ ƚŽ ŚŝŐŚ ĚĞĚƵĐƟďůĞƐ ĂŶĚ ĐŽͲƉĂǇƐ͘ &ŝŶĂůůǇ͕ ǁĞ ŝŶƚƌŽĚƵĐĞĚ Ă ŶĞǁ ƉƌŽƉŽƐĂů ƚŚĂƚ ǁŽƵůĚ ĂůůŽǁ ŝŶĚŝǀŝĚƵĂůƐ ďĞƚǁĞĞŶ ƚŚĞ ĂŐĞƐ ŽĨ ϱϱ ĂŶĚ ϲϰ ǁŚŽ ƉƵƌĐŚĂƐĞ ƚŚĞŝƌ insurance on the individual market to purchase that coverage ƚŚƌŽƵŐŚ Ă DĞĚŝĐĂƌĞ ĚǀĂŶƚĂŐĞ ƉůĂŶ͘͟

dŚŝƐ ƉŽůů ĂŶĚ ŽƚŚĞƌƐ ůŝŬĞ ŝƚ ƐĞŶĚ Ă ĐůĞĂƌ ŵĞƐƐĂŐĞ͗ ŵĂŬĞ ƚŚĞ ǁŽƌŬ ĂŶĚ ůĞƚ͛Ɛ ŵŽǀĞ ŽŶ͘ Ɛ ƚŚĞ ĨĞůůŽǁ ŽŶ ^ĂƚƵƌĚĂǇ EŝŐŚƚ >ŝǀĞ ƵƐĞĚ ƚŽ ƐĂǇ ĂďŽƵƚ ƚŚĞ ĞĐŽŶŽŵǇ ĂŌĞƌ ƚŚĞ ϮϬϬϴ ƌĞĐĞƐƐŝŽŶ͗ ͞:ƵƐƚ &/y ŝƚ͊͟ /ƚ͛Ɛ ďĞĞŶ &W͛Ɛ͕ &W͛Ɛ ĂŶĚ ŵŽƐƚ ŽĨ ŽƌŐĂŶŝǌĞĚ ŵĞĚŝĐŝŶĞ͛Ɛ ƉŽƐŝƟŽŶ ƚŚĂƚ ƚŚĞ ŵĞƌŝƚĞĚ ƐƚƌŽŶŐ ƐƵƉƉŽƌƚ ďĞĐĂƵƐĞ ŝƚ ĚƌĂŵĂƟĐĂůůǇ ĞǆƉĂŶĚĞĚ ĂĐĐĞƐƐ͕ ďƵƚ ĚĞĮŶŝƚĞůǇ ŚĂĚ ŇĂǁƐ ƚŚĂƚ ŶĞĞĚĞĚ ƚŽ ďĞ ĂĚĚƌĞƐƐĞĚ͘ Ƶƚ ŚŽǁ ƚŚĞ ,ŽƵƐĞ ŽĨ ZĞƉƌĞƐĞŶƚĂƟǀĞƐ ŵĂũŽƌŝƚǇ ĐŽƵůĚ ŝŐŶŽƌĞ ƚŚĞ ďĂƐŝĐ ƉƌŝŶĐŝƉůĞƐ ŽĨ ĞĐŽŶŽŵŝĐƐ ǁŚĞƌĞ health insurance is concerned is beyond me. Every physician

dŚĞ ƉƵďůŝĐ ƐĞĞŵƐ ǁĞůů ĂǁĂƌĞ͕ ƚŽŽ͕ ŽĨ ƚŚĞ ŝŵƉůŝĐĂƟŽŶƐ ŽĨ ƉƌŽďůĞŵƐ ŝŶ ƚŚĞ ŝŶƐƵƌĂŶĐĞ ƉůĂŶ ŵĂƌŬĞƚ ĨŽƌ ƚŚĞŝƌ ŽǁŶ ĐŽǀĞƌĂŐĞ͕ ǁŚĞƚŚĞƌ ŝŶ Žƌ ŽƵƚ ŽĨ ĐŽǀĞƌĂŐĞ ʹ ϲϬ ƉĞƌĐĞŶƚ ƐĂǇ ͞ŝŶƐƵƌĞƌƐ͛ ĚĞĐŝƐŝŽŶƐ ŶŽƚ ƚŽ ƐĞůů ŝŶƐƵƌĂŶĐĞ ƉůĂŶƐ ŝŶ ĐĞƌƚĂŝŶ ŵĂƌŬĞƚƉůĂĐĞƐ ǁŝůů ĂīĞĐƚ ĞǀĞƌǇŽŶĞ ǁŝƚŚ ŝŶƐƵƌĂŶĐĞ͖ ϲϬ ƉĞƌĐĞŶƚ ĂůƐŽ ďĞůŝĞǀĞ ƚŚĂƚ ͞ƚŚĞŝƌ ĨĂŵŝůǇ ǁŝůů ďĞ ŶĞŐĂƟǀĞůǇ ĂīĞĐƚĞĚ ďǇ ƌŝƐŝŶŐ ƉƌĞŵŝƵŵƐ ŝŶ ƚŚĞ ŵĂƌŬĞƚƉůĂĐĞƐ͘͟ ƚ ǁŚŽŵ ǁŝůů ǀŽƚĞƌƐ ďĞ ĂŶŐƌǇ ŝŶ ϮϬϭϴ ŝĨ ƚŚŽƐĞ ĨĞĂƌƐ ĐŽŵĞ ƚƌƵĞ ŝŶ ƚŚĞ ĂďƐĞŶĐĞ ŽĨ ƌĞĂů ĞīŽƌƚƐ ƚŽ ŝŵƉƌŽǀĞ ƚŚĞ ͕ ƐƵĐŚ ĂƐ ǁŚĂƚ &W ŚĂƐ ƉƌŽƉŽƐĞĚ͍

California Family Physician Fall 2017

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Toni Brayer, MD Board of Governors

MIEC has just announced $11 Million in dividends* to be distributed to policyholders in 2017

Committed to serving the Medical Professional Liability Needs of Physicians in California! MIEC Mission: Provide our policyholders and local medical communities with the exemplary service and support they deserve! By providing vastly superior Professional Liability coverage to our members, coupled with unmatched service & support, MIEC has never lost sight of its mission and the associations that support the medical community. MIEC is proud to support physicians, and organized medicine in California! MIEC has been proudly serving the Medical Professional Liability Insurance needs of physicians in California for more than 40 years. Added value: Q Owned by the physicians we protect Q No profit motive, dividend policy* Q Specialized local claims staff Q Local Northern California claims office Q Supports organized medicine in California

For more information or to submit an application: www.miec.com Call 800.227.4527 Email underwriting@miec.com * On premiums at $1/3 million limits. Future dividends cannot be guaranteed.

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