Confronting Complacency in the Face of Calamity: Mobilizing for the Home Front War Against Diabetes

by Dean Schillinger, MD


Please see the recent thoughtpiece in the Journal of Endocrinology and Diabetes.

Their Values and Ours

By Alicia Fernandez, MD

A really important Perspective piece was published recently in the NEJM, and I am proud to say that one of our colleagues, Margot Kushel, was senior author. 

Science and Public Health on Trial

by Dean Schillinger, MD

Our purpose in writing this piece was to alert the scientific, clinical, and public health communities about the outcome of the landmark decision regarding warning notices on advertisements for sugar sweetened beverages (SSBs) and explain its legal underpinnings. We also wanted to show this as an exemplar of how industry-misappropriated scientific language and scientific methods to hijack science and public health and obfuscate scientific truth and introduce controversy regarding associations between their products (in this case SSBs) and health harms (in this case obesity, diabetes, and tooth decay). Finally, we wanted to highlight the importance of such policy efforts for improving the health of at-risk populations, including children, ethnic minorities, and individuals with limited health literacy.

Click below to read the full JAMA viewpoint:

http://jama.jamanetwork.com/article.aspx?articleID=2542158

Citizen Engagement in Precision Public Health

By Courtney Lyles, PhD and Kirsten Bibbins-Domingo, MD, PhD

At the Precision Public Health Summit held this week at UCSF (sponsored by the Bill and Melinda Gates Foundation and the White House Office of Science, Technology, and Policy: see), we were inspired by many great discussions and ideas.  While the field is still figuring out how to define and conceptualize the core elements of “precision public health,” a broad interpretation that is relatively simple and straightforward includes:  a discipline for using the best methodologies and datasets to tailor interventions (from medical screenings and treatments, to community wellness and prevention programs, to science-informed advocacy and policy) that better meet the needs and priorities of local communities and individuals. 

Digital literacy and what it means for healthcare

by Courtney Lyles, PhD

Should healthcare organizations be taking a major role in increasing the overall digital literacy of their patients? 

In my last post I talked about how most patients in our health system, the SFHN, want to use the internet to manage their health care and health, but don’t have the proficiency they need to be able to do so. I wanted to take that idea one step further. If our patients often can look something up on Google but don’t know how to use an email account (which is often required for signing up to access your electronic health record online) – should we be providing them with basic technology classes?  The answer I keep coming back to is “yes,” and here are a few reasons why:

Partnerships to Prevent Violence: ARISE

By Leigh Kimberg, MD

Each day, an overwhelming majority of our patients arrive in clinic wishing that their healthcare providers would ask them questions about how their personal relationships affect their health and, more specifically, whether an intimate partner, family member or other person has hurt or threatened them.  And, despite the requirement by the Affordable Care Act that all women and girls be offered interpersonal violence (IPV) (intimate partner violence and sexual assault) screening, brief counseling and referral, healthcare providers and healthcare systems have not institutionalized this practice.  “Aspire to Realize Improved Safety and Empowerment” (ARISE), a partnership program newly funded by the Office of Women’s Health in the US Department of Health and Human Services, will fully institutionalize these life-saving practices in the San Francisco Health Network primary care system.

“Where Can This Person Go?”: A Plea for the Expansion of Medical Respite Services

 

by Soraya Azari, MD

While recently working in the hospital I was often asked by my interns and medical students: “so where can this person go?”  An example: a 53 year old homeless man, wheelchair-bound from prior injuries, who had his wheelchair stolen during an assault, which led to pneumonia and hospitalization.  He quickly improved with intravenous antibiotics, was medically stable, and no longer met criteria for inpatient hospitalization.  So then the question is where should he go? 

Connecting the dots: Health information technology expansion and health disparities

By Courtney Lyles, PhD, Dean Schillinger, MD and Urmimala Sarkar, MD, MPH

Check out our newest essay in PLOS Medicine outlining how health technology could be better designed and implemented to meet the needs of diverse patient populations:

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001852

Making Older Homelessness a Never Event

by Margot Kushel, MD

On April 2, Bevan Dufty, (@BevanDufty) the director of the HOPE program (Housing Opportunity, Partnerships and Engagement) for San Francisco (aka the official responsible for addressing homeless services and outcomes), posted the following message to his 4500 followers on twitter: “86-year old staying @ECS_SF Next Door Polk/Geary shelter needs help walking/feeding small dog. Without dog, client likely returns to street.”

The future is already here, it just not very evenly distributed.

By Courtney Lyles, PhD

The title of this blog post is a quote by science fiction author William Gibson (who coined the phrase many years ago, by the way).  And I think it is spot on in a number of ways.  It is clear that so many seemingly futuristic technologies have already been developed: from using your smartphone to passively track your activity and mood, to the development of a sensor to test blood glucose through the skin without drawing blood.  But the reality that is so clear to us working in the safety net is that most of these tools are not distributed to those who need it most, and sometimes even only make their way to our settings after they become somewhat obsolete in the tech space.

Nutrition and the Tax Code

By Hilary Seligman, MD & Marydale Debor, JD

On December 31, 2014, the Internal Revenue Service issued the long-awaited final ruling implementing Section 501 (r) of the Patient Protection and Affordable Care Act of 2010 (ACA). This section of the Internal Revenue Code deals with the conditions hospitals must meet in order to retain their nonprofit health status.  In an exciting development, this new code directs attention to the elimination of “root causes of disease,” especially among medically underserved, minority, and vulnerable populations.

Martin Luther King Day, 2015

By Margaret Wheeler, MD

For this Martin Luther King Jr. Day, in the fiftieth anniversary year of the Voting Rights Act and the Selma to Montgomery March, it is hard not to draw comparisons between those days and ours.  

How Can Non-English Speaking Patients 'Meaningfully Use' Patient Portals?

By Neda Ratanawongsa, MD, MPH

 “For Spanish press 1, for Cantonese press 2, for Mandarin press 3, for Taishanese press 4, for Vietnamese press 5 …” 

My exam room phone doesn’t have enough buttons for all the languages I need to serve my patients.   In a typical clinic session, I use an interpreter for half of my clinic visits and phone calls to patients.   It is this amazing linguistic and cultural diversity that drew me to be a primary care provider at the General Medicine Clinic.

The Center of the Storm: Homelessness and Health

by Margot Kushel, MD

As the Bay Area is deluged with the biggest rainstorm in a decade, most of the region’s schools were cancelled and many workplaces allowed for flexibility, so that people could stay safe and dry in their homes. Churches and homeless service agencies opened their doors to provide temporary shelter for members of our community who are homeless. But the storm of the decade was another blow to those who have already been struck by the perfect storm of rising housing prices, loss of support for affordable housing, and lack of availability of living wage jobs for those without specialized skills.  

Ebola and Immigrant Fears

by Alicia Fernandez, MD

Here is a thought experiment:  Imagine that Thomas Duncan, the unfortunate Texas Ebola patient, had been undocumented in addition to uninsured when he presented to a private hospital in Dallas.

Be sure to consider the impact on his decision making in seeking health care.  Now, imagine the media response.  Imagine the impact on policy makers.

Hold those thoughts.

Insights from mainstream media

By Robert Brody, MD

People Magazine is an unusual source for a blog such as this - we are more likely to comment on articles in more academic journals.  But I believe the following from People.com about a young woman, a UCSF patient, who had to leave California for another state to get the care she wanted, and especially the video in which she tells the story herself, is a powerful reminder about work that still needs to be done to make patient-centered end of life care in the form of death with dignity legal and accessible in this state.

http://www.people.com/article/Brittany-Maynard-death-with-dignity-compassion-choices

Leaving No One Behind: The International Day of Older Persons

By Anna Chodos, MD, MPH

I am wondering if Mr. Rose knows that today is the UN’s 24^th celebration of the International Day of Older Persons (IDOP). The theme is “Leaving No One Behind: Promoting a Society for All.”

He does not talk to many people in a given day.  He lives on his own in a single-room occupancy (a bed and a small bathroom) in one of the many housing units for low-income adults in San Francisco.  At 75, he is one of its oldest residents.  When I visited him there for a home medical visit, he showed me his small fridge full of microwave pizzas and orange soda, which is what he can buy from the drug store near him.  He has difficulty walking, so he gets what he can from the nearest place that sells food.  He is fiercely independent so has refused help from a city in-home support worker that could help him with shopping.  And he said he did not have any friends or family who could help out.  But, he said, he did not feel lonely.

The war at home against diabetes disparities

by Dean Schillinger, MD

During the recent decade-long Iraq and Afghanistan wars, 1,500 US soldiers lost a limb in combat. This tragedy was widely covered in the media and helped mobilize efforts to reduce exposure to threats in the Near East theatre, expedite troop withdrawals, and improve rehabilitation services for veterans. In that same period of time, over 1.5 million US residents suffered amputations as a result of Type 2 diabetes (DM2). While the number of amputations occurring on the home front as a result of DM2 exceeds that of the overseas front by a factor of 1,000, there is little public awareness of this war being waged at home. While clinicians, patients and families fight thousands of life- and limb-threatening battles on a daily basis, there is scant evidence that the US clinical and scientific community has truly mobilized for a public health war against DM2.

Innovations in Safety Net Primary Care - Specialty Care Collaboration

 

by Neda Ratanawongsa, MD

When my 4-year old asked me why I was staying at work last Tuesday evening, I told him, “To learn about how doctors can work together to take care of people.” 

I’m a primary care provider at the General Medicine Clinic at SFGH. Although I wish I could provide my patients with all of their care within my clinic’s walls, I rely on colleagues in medical and surgical specialties to help care for my patients’ concerns around diabetes, heart disease, arthritis, broken bones, and eyes.  When my patients and I need that help, I want the same quick access to specialists’ advice that my in-laws receive in their health networks. However, safety net health systems often experience long wait times for visits because there is such a high need for specialty clinics with limited appointment slots.  The referral system can also be confusing to patients because of communication barriers; over half of my patients speak a language other than English as their first language and have limited health literacy.  

Denti-Cal Benefits Return to California - Hooray!!

A friend who is a social worker recently informed me that Medi-Cal is reinstating coverage for dental services in the state of California. As a primary care doctor in an urban safety net hospital, all I can say is "HOORAY!!"