UAFP Annual Member Dinner Page 10 Page 24 Putting into Practice: Implementing Chronic Pain Management Toolkit in Your Office STRONG MEDICINE FOR UTAH UTAH ACADEMY OF JOURNAL FamilyPhysicians
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STRONG MEDICINE FOR UTAH Participation by advertisers does not constitute endorsement by the UAFP. CONTENTSIssue 2 2021 © 2021 Utah Academy of Family Physicians | The newsLINK Group, LLC. All rights reserved. UAFP is published two times each year by The newsLINK Group, LLC for the UAFP, and it is the official publication for this association. The information contained in this publication is intended to provide general information for review and consideration. The contents do not constitute legal advice and should not be relied on as such. If you need legal advice or assistance, it is strongly recommended that you contact an attorney as to your specific circumstances. The statements and opinions expressed in this publication are those of the individual authors and do not necessarily represent the views of UAFP, its board of directors, or the publisher. Likewise, the appearance of advertisements within this publication does not constitute an endorsement or recommendation of any product or service advertised. UAFP is a collective work, and as such, some articles are submitted by authors who are independent of UAFP. While UAFP encourages a first-print policy, in cases where this is not possible, every effort has been made to comply with any known reprint guidelines or restrictions. Content may not be reproduced or reprinted without prior permission. For further information, please contact the publisher at 855.747.4003. The mission of the Utah Academy of Family Physicians: To improve the health of all Utahns by advocating for and serving the professional needs of family physicians. 6 24 UtahAFP.org | 4
UAFP Annual Member Dinner Page 10 Page 24 Putting into Practice: Implementing Chronic Pain Management STRONG MEDICINE FOR UTAH UTAH ACADEMY OF JOURNAL FamilyPhysicians 31 Executive Director’s Message 6 President’s Message 7 2021/2022 Utah Academy of Family Physicians Board of Directors 8 UAFP Annual Member Dinner 10 Member Spotlight: Ben Wilde, DO, FAAFP 14 Resident Spotlight: Lyly Tran, MD 16 Medical Student Spotlight: Alyssa Lolofie 19 Invest in Utah’s Health, Invest in Primary Care 21 Putting into Practice: Implementing Chronic Pain Management Toolkit in Your Office 24 Family Medicine Worth the Wait for GME Award Winner: Melanie Dance 28 The Beautiful Sound of Complaining 30 Utah Early Hearing Detection and Intervention Milestones 31 Are You Licensed Where Your Patient is Located? 33 Utah Early Hearing Detection and Intervention Milestones On the Cover: Jesse Spencer, MD Senior Medical Director, Family Medicine Intermountain Medical Group 5 |
Maryann Martindale The more we hear from our members, the better understanding we have of how to help and where to advocate. EXECUTIVE DIRECTOR’S MESSAGE In a survey we conducted two years ago, advocacy was named as one of the top priorities Utah members wanted from their academy. Advocacy is a critical component to the work we do at UAFP and it comes with great responsibility. We speak for our doctors who are busy treating patients, we speak for the students and residents who are learning and preparing for their careers in medicine, and we speak for our patients. When advocating on your behalf, I always ask myself three questions: • Will this promote or advance the practice of family medicine? • Will this help our physicians in their practices and professional journeys? • Will this improve or impact the health and wellness of our patients? The third Wednesday of every month and for 45 days from mid-January to early March, I participate in legislative hearings. I listen to proposed legislation and testimony and speak on behalf of our doctors. But there is so much more behind-the-scenes work that takes place. I recently had the opportunity to work with a legislator on a bill that, when passed, will provide an enhanced penalty when an act of violence is committed against a health care worker. By expanding enhancement from the previous emergency-only situation to all your offices, clinics, and your staff, we can give you more peace of mind that there is a greater deterrent to violence and harsh penalties should any still occur. It is a tragic side-effect of both the pandemic and the ever-growing contentious world we find ourselves in, but it is paramount that those of you providing care are protected. We also work proactively on ways to provide better health outcomes for patients by seeking funding and support for programs that will help educate patients with early onset diabetes, promote anti-tobacco initiatives, provide resources for our aging population and accessibility for our patients with disabilities, to name just a few. Family physicians care for the whole person from birth until death and it is incumbent on us to advocate for patients across the full spectrum of life. One of our primary focuses for the coming year is primary care and looking for ways, both legislatively Representation Matters and collaboratively, to increase the amount of money spent on primary care and prevention. It is no surprise that increasing primary care decreases overall health costs while increasing healthy outcomes, and we are busy educating legislators and stakeholders on ways to accomplish this. But, just as in all the work we do, our insight is only as good as our knowledge of what you need; what changes would benefit your practice and what initiatives could improve the health of your patients. I welcome input from you on issues you find important. I am here to listen and act on your behalf. The more we hear from our members, the better understanding we have of how to help and where to advocate. In this fast-moving world where a lot of voices are competing for attention, representation matters, and we work hard to be the best representation possible for our Utah family physicians. Maryann Martindale, center, testifying in a legislative committee meeting in February 2020. UtahAFP.org | 6
The past year has been tough, and we all have fallen victim to one stressor or another: COVID, mandates, administrative burdens, misinformation, patients delaying screening measures, and limitations in access to care. Sometimes it may feel overwhelming. You might be asking yourself why you’re even practicing medicine when everyone is an expert in vaccines with a degree from Facebook University and a Master’s in “I did my own research.” We need you, your patients need you, your family needs you. At times it may not feel like it, but you make a difference in the lives of those around you, and we need you at your best. That’s why I want to talk about physician burnout. A lot has been said on burnout and how to keep it at bay. Often, we are encouraged to take a vacation, go on a retreat, or engage in self-care practices. For some, that’s great. For my colleagues facing physician and staff shortages, not so much. That’s not even mentioning the day-to-day roller coaster that is being a family physician. Recently, I was speaking to a patient of mine who was about to go on hospice. I had cared for her for over seven years, and she had just been diagnosed with metastatic lung cancer that had spread to her brain. She was telling me that her dying wish was to go rock hunting one more time in the hills of the state where she was born. We both knew that just wasn’t possible. It is excruciating to care for a patient in this situation. It is difficult not to break down and cry with them. But we do not because we are their support system. I got off the phone with her, silently acknowledging that this would likely be the last time we would have a conversation before she passes or is too weak to speak. I stared outside my office window and wondered how in the world I got involved in this job. I feel confident that many of you have had a similar experience. You probably handle these types of interactions in between telling a patient good news, making dinner plans with your spouse, and trying to convince a patient to get the COVID vaccine. Sometimes you can relate a bit too well to Elizabeth “Eliza” Schuyler and just feel “Helpless.” The 2021 AAFP FMX virtual conference contained an excelled burnout lecture by Dr. Corey Martin titled “The Science of Gratitude.” You can watch the lecture through the AAFP FMX On Demand right now; I’m happy to wait. Okay, fine, since I appreciate you taking the time to read this, I’ll give you a summary. Dr. Martin’s findings and recommendations can improve your mental health (he has data to back him up, and I can attest with my personal experience as well): 1. R andom Acts of Kindness: One simple act can improve your outlook for seven to 14 days! 2. T hree Good Things: Each night for at least two weeks, write down three good things that happened to you before you go to bed. 3. C all or text at least one person each day who is meaningful in your life, and tell them so. Dr. Martin’s presentation is a great one. I have worked on following his suggestions and have noticed an improvement in my overall well-being. Whether you follow these tips, take a trip to Disneyland, have a glass of wine, go for a run, or stop by your favorite burger joint, I encourage each of you to recognize when you’re feeling down and/or burned out and commit to some daily self-care time. Not only is this good for your mental and physical well-being, it’s good for the ones you love as well. So, what are you waiting for? Chad A. Spain, MD, FAAFP IG.: chad_spain_md_FAAFP chadspainmd@gmail.com PRESIDENT’S MESSAGE Chad A. Spain, MD, FAAFP 7 |
Shannon Baker, MD Craig Batty, DO John Berneike, MD Marlin Christianson, MD Zoe Cross, MD Amy de la Garza, MD Lynsey Drew, DO, FAAFP R. Tyler Hansen, DO Nicholas Hanson, MD Tiffany Ho, MD Bernadette Kiraly, MD Marlana Li, MD, FAAFP David Miner, MD José E. Rodríguez, MD, FAAFP Thea Sakata, MD Tyson Schwab, MD Sarah Scott, MD Kathy Shen, MD Kirsten Stoesser, MD, FAAFP Mark Wardle, DO, FAAFP AAFP Delegates and Alternates AAFP Delegate Jordan Roberts, MD AAFP Delegate Kirsten Stoesser, MD, FAAFP AAFP Alternate Delegate Benjamin Wilde, DO, FAAFP AAFP Alternate Delegate Saphu Pradhan, MD Family Medicine Residency Representatives McKay-Dee Family Medicine Residency Representative Dane Lyman, MD St. Mark’s Family Medicine Residency Representative Skyler Nguyen, MD University of Utah Family Medicine Residency Representative Laura Yeater, MD Utah Valley Family Medicine Residency Representative Daniel Payne, MD Medical Student Representatives Rocky Vista University – Southern Utah Nicholas Longe University of Utah Jen Christiansen Executive Committee At-Large 2021/2022 Utah Academy of Family Physicians Board of Directors Mission The mission of the Utah Academy of Family Physicians: To improve the health of all Utahns by advocating for and serving the professional needs of family physicians. Vision The vision of the American Academy of Family Physicians and the Utah Chapter: To transform health care to achieve optimal health for everyone. Thank you for your service to the UAFP Board! Interested in Becoming a Member of the UAFP Board in the Future? Contact us at boardchair@utahafp.org for more information. Saphu Pradhan, MD President Elect Chad Spain, MD, FAAFP President Isaac Noyes, MD Immediate Past President Michael Chen, MD Treasurer UtahAFP.org | 8
HUNTSMAN MENTAL HEALTH INSTITUTE CONSULTATION ACCESS LINK LINE TO UTAH PSYCHIATRY UTAH'S STATEWIDE PSYCHIATRIC CONSULATION SERVICE CALL-UP is a legislative funded program designed to address the limitednumber of psychiatric services in Utah and improve access to psychiatry consultations. The program serves primary care physicians throughout the state of Utah at no cost. HOW WE CAN HELP: • Consult on psychotropic medication questions • Optimize primary care providers’ ability and confidence to diagnose and treat mild to moderate mental health issues • Improve quality of care and health outcomes for patients by affording early interventions • Promote and improve behavioral health and physical health integration • Ensure appropriate referrals for individuals with serious health concerns CONSULT HOURS: 12:00 pm–4:30 pm, Monday through Friday (closed on holidays) 801 .587.3636 UOFUHEALTH.ORG/CALL-UP SCHEDULE A CONSULT
The annual UAFP member meeting and dinner was held on September 17. It was our first indoor, in-person member event since the pandemic and staff went to great lengths to ensure safety protocols were in place while also providing a virtual option for those unable to attend in person. The evening kicked off with some comments from outgoing UAFP President, Dr. Isaac Noyes. Isaac has been a great example of leadership in action, always looking for ways the Academy can advance the practice of family medicine, especially during the pandemic. Awards are always a highlight of the evening, and this year was no exception. We included a new award from AAFP – Boundary Breakers – one given to two physicians from each state who provided exceptional service during the pandemic. Dr. Alana Jonat, Infection Prevention Specialist with Community Health Centers Inc., Stephen D. Ratcliffe Clinic, and Dr. Michele Goldberg, Medical Director with Fourth Street Clinic were both recognized this year for their outstanding efforts. The UAFP Family Medicine Champion of the Year Award was presented to Dr. Marc Babitz. This award is given to a person who advocates and champions the practice of family medicine. Dr. Babitz recently retired from the Utah Department of Health where he was a strong advocate, not only for family medicine, but for UAFP, providing wisdom and insight that helped guide our own advocacy efforts. And our annual UAFP Family Medicine Physician of the Year Award was presented to Dr. Kurt Rifleman, Medical Director with Midtown Community Health Centers. Dr. Rifleman is beloved by patients, colleagues, and community members and has served as an inspiring example of what it means to be a family physician to countless students and residents over the years. The meeting closed with comments from new UAFP President, Dr. Chad Spain. Dr. Spain inspired all to take pride in their work, to recognize the extraordinary responsibility family physicians have and to be mindful of the need to take care, personally. UAFP Annual Member Dinner UAFP Family Medicine Physician of the Year Dr. Kurt Rifleman with outgoing UAFP President Dr. Isaac Noyes Boundary Breaker award winner Dr. Michele Goldberg with new UAFP Incoming President Dr. Chad Spain UAFP Family Medicine Champion of the Year Award winner Dr. Marc Babitz Outgoing UAFP President Dr. Isaac Noyes with Incoming President Dr. Chad Spain Boundary Breaker award winner Dr. Alana Jonat with new UAFP Incoming President Dr. Chad Spain UtahAFP.org | 10
We were joined virtually by outgoing AAFP president, Dr. Ada Stewart. Her remarks were poignant and timely, and she was kind enough to let us share them with you: I am honored to bring you Greetings from the National Academy of Family Physicians. Wow, what a year I have had ... What an 18-plus months we have had! Who would have predicted I would be greeting you all virtually again? Thank you for giving me the opportunity. Throughout this public health emergency, your national academy has been here for you, providing updated information related to COVID-19, being the go-to resource for you, your practice, your patients and your community. Throughout it all, our membership continues to be strong – 133,500 members strong – and I thank you! The AAFP continues to advocate for you and address your priorities that include: 1. Reducing Administrative Burdens 2. A dvocating for Health care systems and payment models that value primary care 3. Increasing overall payment 4. And Protecting Family Physician’s interests with regard to nonphysician providers We continue advocacy efforts around financial relief, especially during this pandemic and stress, and the need to follow science. We continue to FIGHT FOR FAMILY MEDICINE. Just this week I joined the Group of Six representing over 590,000 frontline physicians to Advocate around Medicaid Parity, The Integration of Behavioral Health and Primary Care, the Need to Advert the End-of-Year Medicare Cuts to Physicians and Maternal Mortality, to name a few. As we advocate, one must recognize how COVID has definitely changed the way we advocate – writing numerous letters on behalf of our specialty, our members, patients, and communities, and meeting virtually, just as I am meeting with you this evening. But no matter what the method, the goal is still the same: “FIGHTING FOR FAMILY MEDICINE.” In May of 2021, AAFP praised the NASEM Report which recommends an increased investment in and access to high-quality primary care. The report, of which AAFP was one of the sponsors, stated “Primary care is the key to transforming health care in America.” Primary care is the only discipline of medicine where a greater supply is equated to better health outcomes, longer life expectancy and lower costs. NASEM’s report is the result of nearly 18 months of research and work to examine the role that primary care should play in the U.S. health care system. Its recommendations include: 1. P ay for primary care teams to care for people, not doctors to deliver services. 2. E nsure that high-quality primary care is available to every individual and family in every community. 3. T rain primary care teams where people live and work. 4. Design information technology that serves the patient, family, and interprofessional care team. 5. Ensure that high-quality primary care is implemented in the United States. With this report, we recognize it is time to change the conversation about primary care and finally deliver to the American people a health care system that prioritizes their health. That is why our organization, along with other key partners, came together to form Primary Care for America (primarycareforamerica. org), a collaboration focused on demonstrating the value of primary care, the need for increased primary care investment and the importance of innovation in primary care delivery and payment models. In coming together, we stated “We can’t wait another 50 years, or even another day, to deliver comprehensive, continuous and coordinated primary care to improve the health of all Americans.” This campaign will seek to educate policymakers, health care thought leaders, purchasers and employers and health care influencers on the value of primary care to individuals, communities, vulnerable populations and the health care system. One of the focuses is to position primary care as a solution to the major policy challenges, including health disparities and to increase the investment in primary care. As we look to transform healthcare and the future, we will continue to work hard to address diversity, Outgoing AAFP President Dr. Ada Stewart Member Dinner | Continued on page 12 11 |
Member Dinner | Continued from page 11 Your Academy with continue to be here for you, your patients, and your community. We will continue to work to preserve the sacred patient-physician relationship. We will continue to promote science. We will continue to be there for ALL our members. equity, and inclusion (DEI). And as we work to achieve this, we will continue to provide the necessary resources to help us all succeed in achieving health equity. I am grateful for our Academy, our diversity of minds, thoughts, ideas – because it just makes us who we are – we are family medicine. Remember: what we do is sacred – we make a difference in the lives of our patients, in our communities, in the boardroom, and in D.C. Thank you for all for all you do every day – thank you for your sacrifices. Contact our team for a free financial consultation. mark.pyper@wfa.com | (801) 453-7126 | http://www.courypypergroup.wfadv.com/ Are you on a path toward financial Independence? Wells Fargo Advisors is a trade name used by Wells Fargo Clearing Services, LLC, Member SIPC. Your Academy with continue to be here for you, your patients, and your community. We will continue to work to preserve the sacred patient-physician relationship. We will continue to promote science. We will continue to be there for ALL our members. UtahAFP.org | 12
Are you interested in having a piece featured in an upcoming edition of the UAFP Journal? We publish twice a year, in the spring and fall each year. Is there an issue area you are passionate about? Whether you want to write about physician wellness, practice improvements, rural medicine, or diversity, equity and inclusion – we want to hear from you! Please email Barbara Muñoz, UAFP program director, at munozb@utahafp.org with your idea and for more information. Calling all Authors! A Family Med Vacation Register Now at utahafp.org 13 |
First, a Little Bit About Dr. Wilde I grew up in rural Worland, Wyoming, the oldest of seven children. My wife and I met at the University of Wyoming and now have five children ranging in age from two to 16. Although most of my free time is spent engaging with my family and their interests, my personal interests include reading, playing the piano, and getting outdoors whenever possible. The Journey to Becoming a Physician I earned a B.S. in Health Sciences at the University of Wyoming. I attended medical school at Midwestern University – Arizona College of Osteopathic Medicine in Glendale, AZ. I stayed an extra year as a pre-doctoral teaching fellow of osteopathic manipulative medicine and then completed my residency with Southern Illinois University in Quincy, IL. Choosing Family Medicine How/when did you choose family medicine as your specialty? What are some of the aspects of family medicine that drew you to it? My father, a chiropractor, inspired my earliest interests in a career in medicine. I saw the positive impacts he had on his patients’ health and the way his patients appreciated him. This fascinated me. I noted, however, the limitations of a chiropractor’s scope of care and determined that I wanted to do so much more. I concluded that family medicine gave me the fullest potential to meet the wideranging needs of my patients. I appreciate that I am prepared to care for my patients medically, surgically, mentally and emotionally, in a wide variety of settings. Did you consider another specialty? If so, what made you ultimately choose family medicine? When I began medical school, I felt certain family medicine was for me. But when I started into my thirdyear clerkships, I found myself enjoying each specialty immensely. For a few months, my interests shifted first to ophthalmology and then to physical medicine and rehabilitation. Ultimately, the inherent variety of family medicine and the potential of long-term physician-patient relationships brought me back to family medicine. The Move to Southern Utah Prior to coming to Southern Utah, I practiced medicine in my childhood hometown in Wyoming, providing both inpatient and outpatient care, working in the emergency room, and sidelining sporting events. On arriving there, I was surprised by how quickly my family and I were embraced by the community and integrated into several events and service opportunities. The factor that finally persuaded me to leave my rural practice was the opportunity to teach future physicians at Rocky Vista University (RVU) in Ivins, UT. Teaching had long been a passion of mine, first recognized during my pre-doctoral teaching fellowship, and my position at RVU opened to me the door of academic medicine. In addition to my teaching and leadership roles at RVU, I have continued to care for patients at the Southern Utah Veterans Home, the Doctors Volunteer Clinic, and Intermountain InstaCares in the St. George area. Member Spotlight Ben Wilde, DO, FAAFP Family Disc Golf Teaching OMT 2020-21 UtahAFP.org | 14
Teaching Future Physicians What drew you to teaching? My teaching opportunities in the past, such as the predoctoral teaching fellowship, gave me the insight that teaching is highly rewarding for me. In many ways, I view my students’ academic successes and outcomes through the same lens I view my patients’ medical successes and outcomes. The “aha moments” students have as they learn new concepts and skills, accompanied by the gratitude they express, keep me coming back for more. It is also very satisfying to know that I am helping train up the next generation of excellent physicians. I have also found that teaching helps keep me honest about the medical care I provide my patients. When a student is by my side and is likely to ask why I have chosen a particular diagnosis or treatment, this creates in me a feeling of accountability and helps me ensure I am consistently using evidence-based best practices in my care. The point-of-care learning and discussion that so naturally takes place when precepting a student in the clinic is a preventive measure for me against complacency, apathy, and burnout. Plus, every time the student experiences something new, their excitement is palpable. This sincere enthusiasm reminds me of the great privilege and honor it is to be a physician. What do you enjoy about it, and are there challenges? One of the things I enjoy most about my career in academic medicine is the opportunity to innovate. I teach Ironman 2021 primarily in preclinical years one and two at RVU. The ways I studied and learned in school almost two decades ago are very different from how students study and learn today. The newer technology, including virtual reality and high-fidelity simulation, and online resources available to support their learning are fascinating. They allow us new ways to teach and structure the learning environment and process. One challenge related to this new technology is that often students face a “paradox of choice.” Faculty can be instrumental in helping students customize their use of learning materials without becoming overwhelmed by the sheer volume of choices available. What do you see happening with the future of medical schools, especially as it may relate to Utah? Multiple new medical schools have recently opened their doors in Utah, resulting in significantly increased numbers of medical students training in hospitals and clinics across the state. Although the schools will innovate and use technology to train their students, nothing can really take the place of in-person face-to-face learning under the guidance of a mentor physician. Utah physicians now have more of an opportunity than ever to mentor and teach students, specifically family medicine, to inspire them to take a closer look at this important and rewarding specialty. Some Thoughts on the Future of Family Medicine How do we as a country/state ensure that there will be enough family physicians to meet the demand? In my opinion, future interest in careers in family medicine must start with early outreach to students in their high school, undergraduate, and medical school years. The students need to see family physicians leading and having a positive impact at the one-on-one individual level, strengthening communities, and engaging with state and national policy. I believe the best and brightest of the students belong in family medicine, where they can make the greatest difference. With that mindset, I try to model a high standard of excellence in my teaching and leadership so students see and understand the degree of influence family physicians can have. How can we encourage more people to pursue family medicine rather than a higher-paying specialty? We must celebrate family medicine freely and effectively. I often have the chance to counsel students as they are choosing their medical specialty. I note that family physicians gain a large breadth of knowledge across multiple body systems, medical conditions and treatments. We also enjoy the privilege of acquiring a depth of knowledge in any system and condition of our choosing. The flexibility and variety afforded by a career in family medicine are unparalleled by any other specialty. I then remind them that, as a physician, they will be well compensated no matter what specialty they choose. Therefore, they should choose the medical specialty they enjoy the most, recognizing that their future happiness is more closely tied to their daily satisfaction than the money they will make. 15 |
The little bit of your story from the biography on the University of Utah family medicine residency site seems to only scratch the surface of what appears to be an amazing journey to medical school. Can you share a bit more of your story of that journey? Oh man, My Story. It certainly has been long and convoluted. I grew up in low socio-economic and culturally diverse neighborhoods where English was spoken only by young children. I lived with my aunt in southern California for a few years as a baby until my mom could take me back to northern California, where I was born. We lived off food stamps and charity. My mom knew the tiniest bit of English; basically, she learned English with me once I started school. With her middle school education, she did her darndest to keep me ahead in math during elementary school and made me keep up my Vietnamese literacy. My brother (six years younger with a different dad) and I moved every year, around December/January, so I was perpetually the new kid in the middle of the year. I ended up going to four different high schools as well. Part of that was my own stupidity; I was a struggling teen, angry I had to straddle two cultures, so I rebelled. It didn’t help that I moved so often and didn’t have a stable support system. Not knowing me or my situation, the counselors often passed me over regarding wellness checks. I last lived with my mom when I was 14 and lived with other family members until I was 18. After high school, I somehow got accepted into a university. However, being the stupid teen I was, I allowed the acceptance to lapse and ended up going to a community college for the next few years. I struggled during that period, too, though I held several part-time jobs: at a restaurant, Big 5 Sporting Goods, Good Guys (an electronics store,) PetSmart, and Sears. By the time I should have graduated from university, I became so mad at myself after four years of not completing anything. So I bribed myself: complete community college, and the end goal would allow me to go snowboarding all winter if I passed all my classes by the end of the year. I tried asking counselors at the community college for advice on redirecting my path to medical school, and I got a lot of, “maybe you should try for something easier.” For both mental and financial support, I asked to move back in with part of my family. (The group I had been living/hanging with the past few years was not supportive of my goals.) The University of California San Diego finally accepted me. During my three years there, I became very involved with a volunteer clerkship program that provided prehealth students clinical exposure in what was basically a CNA-type role. I ended up as the assistant director of the ICU division, where I coordinated various ICU volunteers, the training I piloted, and acted as liaison between the program and the hospital directors and staff. That position ultimately morphed into many meetings and paperwork and less one-on-one interaction with patients that I craved. I loved teaching but missed patient care. I slowly transitioned into being a private caregiver for various patients, who were sometimes difficult but also absolutely lovely. I had several traumatic brain injury Resident Spotlight Lyly Tran, MD UtahAFP.org | 16
(TBI) patients, some with different kinds of dementia, and some with multiple sclerosis (MS). I usually had one to two patients at a time. I supplemented that work with being a food delivery person and worked as a nanny and housekeeper. Those were some wild days and hectic schedules. I loved it. I loved my patients but wanted to go to medical school and keep moving forward. I did not get any interviews the first time I inquired, so I applied for a postbaccalaureate to help “prove” I was ready for medical school. I busted my butt and made amazing friends at the University of California Davis’ postbaccalaureate program, geared toward pre-medical students from underserved and underrepresented groups. My boyfriend (now husband) stayed in San Diego and a long-distance relationship was hard, but we video chatted every day before the pandemic made it a thing! After postbaccalaureate, I returned to San Diego and resumed the previous work schedule while applying to medical school. During the next cycle, I finally got in. OH NO, NOW WHAT DO I DO?- I never envisioned anything beyond getting accepted; it had been my end goal for so long, but now I was a full decade older than most of my school peers. Yikes. But once again, I busted my butt. All credit goes to my nowhusband who was all things a good partner should be: supportive, motivating, would not let me wallow too long in self-hatred, would not let me get lazy, made me put on real pants, made me coffee for all those exam days, and reminded me to talk about things other than school/ medicine once in a while to make me feel like a person. And I did it – I completed medical school at Michigan State in Grand Rapids and made even more fantastic and lifelong friends. I also got married, and we started our family during this time. Whew. Adulthood, here I am, I made it. What are some factors that influenced your decision to become a doctor and pursue family medicine? I was drawn to providing medical care as a kid because every human being at some point needs help, and one of the most basic ways to provide that help is through medical care. My disadvantaged upbringing and experiences as an adult give me a unique perspective and connection with my intended patient population. I felt the most significant impact I can make as a physician is with people who share the same roots. When starting medical school, I still had a limited understanding of the various specialties. I knew that patients in underserved communities like mine often come to the emergency department (ED) as their source of primary care, so I looked first into emergency medicine and primary care. This quickly evolved into a strong passion for family medicine. The breadth of problems, age span, and the option of doing procedures appealed to my need for variety. It is essential to me that as a holisticminded physician, I can address physical health along with emotional and mental health, particularly in underserved communities where it may be challenging to make it to even one appointment consistently. This also fosters a stronger longitudinal relationship with the patient, as my team and I would be their “home base,” whether or not they need additional specialists. As relationships grow, I have more opportunities to counsel, educate, and provide preventative care and health maintenance. During clinical rotations, my favorite moments were spread out: the different outpatient clinics addressing prevention and chronic conditions counseling, complex cases in the operating room, completely unpredictable days in psych (where I worked with chronic mental health patients with schizophrenia and bipolar disorder), and the ever-changing ED. Luckily for me, family medicine is a specialty that allows me to continue to have all these different experiences (this is what I jokingly refer to as my “professional FOMO”). What was it that drew you to apply for residency at the University of Utah? How has your experience been there? I previously applied to medical school here, mainly because we love winter sports and have a few friends out here. I decided to check it out for residency as well for similar reasons. There were several things I was specifically looking for in a residency and a few things that surprised me about Utah. I definitely wanted a blend of academic and community medicine, strong relationships with other residencies in the area, and strong obstetrics. What I was also looking for but was pleasantly surprised by in Utah was so much diversity (way more than expected,) a large refugee population, and transgender health care. What ultimately tipped the scales was the resident relationships and focus on resident wellness. The residents genuinely seemed to like each other, had such amazing things to say about each other and the residents we interact with from other programs. This program had the best quality of life focus of all the residencies I was seriously considering. We were now a family of three, so I had to consider the Resident Spotlight | Continued on page 18 17 |
STRONG MEDICINE FOR UTAH quality of life for my family as well. While there are certainly days when I’m not loving being a resident, I am incredibly grateful to be here and absolutely feel like I made the right decision to come here. In your biography on the University of Utah site, you also mention that your interest areas include education advocacy for disadvantaged youth and their parents, being a high school student medical interest mentor, and working with immigrant and other underserved populations. What does putting those interests into practice look like for you? Yeah! I grew up in immigrant and low SES communities, so that’s always been “home” to me. I always participate in things geared toward disadvantaged families because I came from one, and I REALLY wish that I had crossed paths with more professionals growing up. My cousins and I are the first ones to finish high school and go to college. I’m the first one to receive an advanced degree, so there was no way to ask anyone in our family for any kind of guidance about school (other than “go to it!”). Being from a low SES background and fighting that, and now having studied all about it, I understand and feel the struggle from many different angles. I try to reach out to families; the young kiddos to get them excited, the teens to try to bring them back from the dumb decisions they’re making, and parents to help educate and break the cycle. I’ve been the kid with food stamps, with thrift stores and knock-off clothes. I received corporal punishment for most of my childhood (mom is from the old country, which is how she was raised). I’ve briefly been in the foster system and fought viciously to stay with my baby brother every single minute. I’ve been the truant, smoked cigarettes for 14 years, and participated in over-drinking and illicit substances. But I also finally graduated not only from high school but college. And incredibly, also medical school – and I am now a doctor. It took me years, but I successfully quit smoking. I found an absolute saint, we got married, and now we have an almost 2-year-old who is way too smart for our sanity. Somehow along the way, I cut out all the deviant habits and behaviors and forced myself to evaluate what kind of person I wanted to be, with a lot of mental and emotional support from my brother and my husband. These are the stories and struggles that I can share with my mentees, peers, and patients. I think it’s important to know that you can keep trying, even if you’ve messed up over and over, and trying won’t always work but when it does it’s worth it. If you talked to young adults considering medicine as a career, why would you tell them to consider family medicine? The hugs. Just kidding, we live in COVID times. I love family medicine because there are so many ways for you to mold it to exactly what you love and help the patients for whom you feel the most passion. You can choose inpatient, outpatient, or a combo. You see every human in residency, but you can choose which population you want to work with afterward, whether you want to focus on geriatrics, women’s health, sports medicine, or a billion other directions. There are procedures you can do if you like that. And, you get to learn a bit of everything! The relationships with patients take time, but it’s so gratifying to follow someone over the years, be their medical advocate, and watch them progress in managing whatever conditions they struggle with. You also get to take a step back and look at the whole patient, rather than just one aspect of them, and you have an opportunity to help any human being. The relationships with patients take time, but it’s so gratifying to follow someone over the years, be their medical advocate, and watch them progress in managing whatever conditions they struggle with. You also get to take a step back and look at the whole patient, rather than just one aspect of them, and you have an opportunity to help any human being. Resident Spotlight | Continued from page 17 visit utahafp.org UtahAFP.org | 18
Student Spotlight Alyssa Lolofie Medical A Bit about Alyssa My name is Alyssa Lolofie. I’m a Samoan American medical student at the University of Utah. I grew up in Murray/Holladay with my parents and my sister, Kali. As a child and teen, I danced hula, which I appreciate now because I learned about and stayed connected with my culture. I went to the University of Utah and earned a B.S. in Biomechanical Engineering with a minor in Chemistry. I was always interested in science and knew that I also wanted a career where I could work with people; medicine is the best mix of both. These days, keeping up with my hobbies is hard because I feel like I’m always so busy with school, but when I have time, I like to spend it with my friends and family, bake, and travel. I’ll have more time this winter, so I’m thinking about re-learning how to ski since I haven’t skied in almost 20 years. The Path to Medicine I was always interested in science, but my interest in medicine developed later in my teens. Science and mathematics were fun; there was always something more to learn and discover. What I knew about science told me that careers included researching things in a room all by myself or very few people, and I wanted to talk to people. So, I kept looking and found that medicine was a great combination of science and human interaction, and I decided that becoming a physician was the job for me. In high school, I took a class called “the block” – a combination of math and physics – and each year, I expanded on what we learned. By my senior year of high school, I took combined AP Calculus II and AP Physics A/B. The teachers for this class were so supportive of me and pushed me to continue pursuing science in college. Their intervention and support helped me apply for scholarships (like ACCESS for Women in Mathematics and Science) that would shape my education. During college, I had the opportunity to research in a lab at the Moran Eye Center. I found out quickly that basic science research was fun but lonely, and actually sitting in a room doing research by myself was not for me. While science is fun, working with people is more important for me. At the University of Utah, I enjoyed applying science to medicine with a degree in Biomedical Engineering. Still, after I graduated, I wasn’t sure that I wanted to do more school. I took a few years off, continued to work as a research assistant, and volunteered weekly at the Hope Clinic. (The Hope Clinic is a free medical clinic for uninsured and lowincome patients in Midvale, UT, fully staffed by volunteers.) The providers at this clinic are also volunteers, but it wasn’t just the medical care they provide that was so impressive to me. They’re donating time each week to see patients, educate pre-medical students, and create a deeper connection with the communities they are serving. I found my love for medicine again and felt ready to go back to school. Medical School at the University of Utah I grew up in Utah, with a lot of my family around, and when it came time to apply to medical school, I didn’t want to leave. My Polynesian community and the community I had made for myself as a pre-medical Medical Student | Continued on page 20 19 |
student are very important to me, and I liked the idea of getting to do medical school close to home. Overall, I’ve enjoyed my time at the University of Utah School of Medicine. I found many great and lasting friendships, built community within my class and the School of Medicine as a whole, and found my voice in advocating for medical students of color. As co-president of the Family Medicine Interest Group and Pacific Islander Medical Student Association, I created safe places and a feeling of community among the student body. Choosing Family Medicine I came into medical school thinking about family medicine but wanted to keep an open mind throughout the process. However, in my third year of medical school, I started with pediatrics and loved it! I did rural family medicine and loved it! I enjoyed psychiatry, neurology, and internal medicine. Surgery was fun, but I knew that general surgery wasn’t for me by the end of my first six-hour surgery. Mid-way through my third year, I was pretty positive that I wanted to pursue family medicine and was excited to do the parts of family medicine I enjoyed as a family medicine physician. I love full-spectrum medicine and want to work with a community where the families and I are a team! Often when people start seeing a doctor, it ’s a family medicine physician. These doctors are first in line to meet with patients, create lasting and trusting relationships, and start a conversation about their health. The increase in medical students going into family medicine is important because for the general public, finding one good doctor they can relate with, trust to go to for medical advice, and to help them become invested in their own health is so important. Creating relationships with my patients, working together to treat or prevent chronic disease, and being a part of a community is why I was drawn to family medicine. Having worked with so many different health care providers (not just physicians) and getting to emulate the way they connect with their patients makes me proud to be going into family practice. The Critical Importance of a More Diverse and Inclusive Physician Workforce On a recent rotation, I saw a name with Polynesian origins on a list of new admits, and I felt a sense of excitement for the workday. I walked into the room to see a smiling middle-aged man whose foot was covered with a bandage, underneath which he had a diabetic ulcer. As we connected over our shared culture, I explained the pathophysiology behind the formation of his ulcer, the importance of controlling his diabetes, and the necessity of continued follow-up care. The patient was going to be discharged later that morning, and upon leaving, he said, “The next time we see each other, we’ll go eat.” I left with a warm, contented feeling: sharing a meal is how Polynesians show love for one another. And this interaction solidified my interest in family medicine – connecting with patients and helping them understand their illness, with the knowledge that in doing so, I am strengthening the health of a community. The role of professional physician associations to ensure a more diverse workforce is tough to determine, but I also think it’s an important question to ask. Right now, educating current family practice providers and health care workers on diversity and cultural practices in their patients is essential to help increase patient satisfaction. Having a provider who understands where you’re coming from is important in making patients feel included as members of their health care team. Programs with the ability to help students of color, students from historically excluded and lower-income populations should be cognizant of their privilege and work to create pipelines or educational opportunities for these students early in their academic careers. One mentor from medical school actually did not know that becoming a physician was a career option for him until he was well into college. Sadly, this is the case for many other students that come from ethnically diverse backgrounds. Programs that teach these students about science and medicine in K through 12 can help them know that they can pursue careers in health care and often encourage them to continue their education after high school. Medical Student | Continued from page 19 UtahAFP.org | 20
Putting into Practice: Implementing Chronic Pain Management Toolkit in Your Office The Centers for Disease Control and Prevention guidelines state: An estimated 20% of patients presenting to physician offices with non-cancer pain symptoms or pain-related diagnoses (including acute and chronic pain) receive an opioid prescription. Chronic pain has been variably defined but is defined within this guideline as pain that typically lasts more than three months or past the time of normal tissue healing. Chronic pain can be the result of an underlying medical disease or condition, injury, medical treatment or condition, injury, medical treatment, inflammation, or an unknown cause. Physicians report multiple barriers to appropriately managing chronic pain, including lack of time, training, increased scrutiny on opioid prescribing, and fear of patients developing opioid use disorder. In addition to these concerns, several studies have reported increased physician burnout in the management of chronic pain from a lack of patient self-management skills. From Carole Upshur, EdD, and colleagues in “Primary Care Provider Concerns about Management of Chronic Pain in Community Clinic Populations”: “Despite the unfavorable reports about pain education and low satisfaction with pain treatment, PCPs did not identify provider expertise and health system factors (e.g., difficulty of diagnosis, lack of evidence-based guidelines) as the most important obstacles to treating patients with chronic pain. Instead, patient compliance and behavioral factors were rated as more problematic.” Using a systematic evaluation in chronic pain management, including implementing the resources found in the American Academy of Family Physician’s (AAFP) chronic pain management toolkit, allows for physical, mental, and functional evaluation of patients who suffer from chronic pain. After completing a thorough evaluation, a physician can determine appropriate medication and additional treatments and therapies that can be taken to improve selfmanagement skills. In March 2014, AAFP launched the Chronic Pain Toolkit, giving physicians multiple resources in one location that are easily accessed and downloaded. The Chronic Pain Toolkit is divided into five sections: • Pain Assessment gives an overview of appropriate strategies and diagnostic tools used to support chronic pain assessment in patients. • Functional and Other Assessments discuss supporting tools and methods for the diagnostic assessment of functional activity and other coexisting conditions, including the patient’s emotional and mental health, quality of life, and other psychosocial factors. • Pain Management provides details on strategies and considerations for effective management of acute and chronic pain. • Opioid Prescribing covers the prescribing of opioids as it relates to the treatment of chronic pain and includes information and resources on safe prescribing practices, risk mitigation and monitoring, opioid conversion and tapering tools, and specific resources for patients. • Opioid Use Disorders: Prevention, Detection and Recovery offers a brief overview along with resources in support of opioid use disorder prevention, recognition and assessment, and treatment and recovery. Application Determining which patients are appropriate for evaluation is key. The more inclusive the application of the pain management toolkit within a physician’s practice allows for clearer guidelines for staff and improves patient safety. Avoid common misperceptions that short-acting opioids or morphine milliequivalents (MME) less than 90 can be excluded from pain management evaluation because the patient is deemed lower risk. Protocols should be clear and nondiscriminatory, including all patients meeting the criteria for chronic pain. Barriers to Implementation Often cited as barriers for not managing chronic pain are the lack of time or familiarity with resources provided, patient behaviors, and increasing scrutiny over controlled substance prescribing. Overcoming these barriers can improve adherence and patient safety. By Darlene Petersen, MD, and Brian Hunsicker UtahAFP.org | 24
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