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War appears to be an unfortunate fact of life for populations across the globe throughout recorded history. At this moment, major wars are occurring in Ukraine, Sudan, and the Middle [...], Wars and conflicts appear to be a fact of life for populations across the globe, often in places where family medicine functions as the backbone of the health care system. In these situations, family physicians are frequently called on to serve in expanded roles and are witnesses to the enormous mental and physical suffering of individuals, families, communities, and populations. This article examines the lessons family medicine can learn from current wars and other terrible conflagrations.

https://doi.org/10.1370/afm.3140 INTRODUCTION Despite evidence supporting the positive effects of workforce diversity on equity in scientific investigation and access to care, racial disparities are persistent in the composition of the US [...], PURPOSE Despite being key to better health outcomes for patients from racial and ethnic minority groups, the proportion of underrepresented in medicine (URiM) physicians remains low in the US health care system. This study linked a nationally representative sample of family physicians (FPs) with Medicaid claims data to explore the relative contributions to care of Medicaid populations by FP race and ethnicity. METHODS This descriptive cross-sectional study used 2016 Medicaid claims data from the Transformed Medicaid Statistical Information System and from 2016-2017 American Board of Family Medicine certification questionnaire responses to examine the diversity and Medicaid participation of FPs. We explored the diversity of FP Medicaid patient panels and whether they saw [greater than or equal to]150 beneficiaries in 2016. Using logistic regression models, we controlled for FP demographics, practice characteristics, and characteristics of the communities in which they practiced. RESULTS Of 13,096 FPs, Latine, Hispanic, or of Spanish Origin (LHS) FPs and non- LHS Black FPs saw more Medicaid beneficiaries compared with non-LHS White and non-LHS Asian FPs. The patient panels of URiM FPs had a much greater proportion of Medicaid beneficiaries from racial and ethnic minority groups. Overall, non-LHS Black and LHS FPs had greater odds of seeing [greater than or equal to]150 Medicaid beneficiaries in 2016. CONCLUSIONS These findings clearly show the critical role URiM FPs play in caring for Medicaid beneficiaries, suggesting physician race and ethnicity are correlated with Medicaid participation. Diversity in the health care workforce is essential for addressing racial health inequities. Policies need to address problems in pathways to medical education, including failures to recruit, nurture, and retain URiM students. Key words: health workforce diversity; Medicaid; racial health inequities

https://doi.org/10.1370/afm.3162 COLLEEN Running late in the middle of a busy morning, I found myself at the only window on our clinical suite. I was overwhelmed with the visits I'd just [...], Practicing family medicine is really hard; the emotional toll of sharing patients' distress, vulnerability, and trauma can build up and become overwhelming. A family physician experienced such a moment during one particularly complex morning. Feeling nearly ready to walk out of patient care, she reached out to the team nurse, who helped her get through the moment and re-engage with the waiting patients. Sharing vulnerability in the moment, and later reflecting and deciding to write about it shows the power of prioritizing teamwork in practice. Key words: family medicine; health care teams; relationships

I first met Sam as we jammed ourselves into my clinic room alongside his bike and most of his belongings. Perspiration dripped down his face after cycling across this northern [...], I am an anthropologist and family doctor who has the good fortune of working in northern California with colleagues who prioritize the social needs of our patients alongside medical ones. In the essay that follows, I share details from my patient Sam's (pseudonym) last 2 years of life to underscore how attending to social precarity cannot be fully achieved within our safety net institutions as they are currently structured. While we have strong evidence that addressing social needs as part of clinical care offers good return on investment, Sam's story makes visible the problems we face when attempting to address social determinants of health. After introducing a concept from the social sciences about rationales that underlie health care delivery, I call on primary care doctors to redefine the medical paradigm to remedy the disjointed logics of care that result in unnecessarily high financial and human costs. Key words: social needs assessment; housing first; homelessness; social determinants of health; vulnerable populations

Academic promotion to the Associate Professor and Professor rank has traditionally required external letters of review from colleagues who are not personally connected to the individual being considered for promotion [...]

Presenters Zakary Newberry, Karl Clebak, MD, MHA, FAAFP, Joseph Wiedemer, MD, FAAFP, Jessica Parascando, Alexis Reedy-Cooper, MD, MPH, Robert Lennon, MD, FAAFP, JD, JD, Huamei [...], Context: As a result of the COVID-19 pandemic, interviews during the 2021 U.S. residency match were conducted virtually; a practice again recommended and repeated by many programs in 2022. The impact of transitioning to virtual interviews on match outcomes is not well studied. If not detrimental, continuing virtual interviewing in the future may be preferred by applicants and programs. Objective: To evaluate the impact of virtual interviews by comparing a baseline of in- person resident interviewing outcomes from 2016-2019 to virtual interviewing outcomes using data from the 2020-2022 virtual interview seasons in three Family Medicine (FM) residency programs. Study Design and Analysis: Retrospective cross-sectional analysis of National Residency Matching Program[R] data between 2016-2022. Aggregate in-person data (2016-2019) was compared to aggregate virtual data (2020-2022) for each program using chi-square, Fisher Exact test or 2-tailed t-tests to 95% confidence. Setting or Dataset: Three Pennsylvania FM residency programs affiliated with Penn State Health (PSH): the M.S. Hershey Medical center in Hershey, a three-year University-based program; the Mount Nittany Medical Center in State College, a three-year community-based university affiliated program; and Saint Joseph Hospital in Reading, a three-year community-based university affiliated program. Population Studied: FM residency applicants at three programs affiliated with PSH. Intervention/Instrument: Retrospective chart review. Outcome Measures: Fill rate, MD/DO ratio, average position on rank list, average distance from residency site to current and permanent address, and % URIM matched resident. Results: One program had significantly more unfilled positions during virtual recruitment (p=0.006); two had significant differences in the proportion of MD:DO matched applicants (p=0.001; p

Presenters Annie Phung, DO, Katherine Wright, PhD, MPH, Natalie Choi, [...], Context: The COVID-19 pandemic significantly affected both the 2021 and 2022 residency recruitment cycles. Many programs rapidly shifted their recruitment efforts to include a greater presence on social media (SoMe), assuming that applicants would use these avenues as supplemental sources of information. Objective: Our program sought to investigate the impact of SoMe from the perspective of applicants during the Family Medicine Virtual Match process. Study Design: Cross-sectional survey. Setting: Community Based University Affiliated Family Medicine Residency. Population Studied: Family medicine residency candidates selected to interview with our program. Intervention/Instrument: We gathered survey data through REDCap of interviewees to our residency program to assess social media use. We also acquired SoMe (Facebook, Instagram and Twitter) and google website analytics to obtain trends trafficking users to our official residency website. Outcome Measures: Survey items captured candidate preferences regarding recruitment. Facebook/Instagram "reach" and Twitter "impressions" were analyzed to evaluate SoMe engagement. Google analytics data were used to quantify sources of traffic. Results: n=55 completed the survey for a response rate of 28%. Participants indicated Instagram was most helpful in evaluating programs (45.5%, n=25), followed by Twitter (5.5%, n=3), and Facebook (3.6%, n=2). About half of participants stated they did not use SoMe to learn about programs at all (45.5%, n=25), whereas a fifth agreed or strongly agreed that SoMe played a vital role (21.7%, n=12). When residency website traffic was linked to SoMe analytics, we saw a small increase in activity with our program accounts after content generation, but this did not translate into increased website visits, our surrogate marker representing successful use of SoMe as a recruitment tool. Analysis of the traffic sources to our website revealed that Google was the greatest driver to our website, more than SoMe platforms. Outcomes: We expected candidates would utilize social media more than reported and increased SoMe content would increase website traffic. Though our findings are discordant with the previous studies, our data suggest SoMe is less significant in recruitment than we initially hypothesized. This was one of few studies aimed at the applicant experience, and further investigation is needed to better understand the different ways in which SoMe and other virtual platform.

MICHELLE'S STORY On August 5, 2019, Michelle, a long time patient of the University of Minnesota (UMN) Physicians Broadway Family Medicine (BFM) clinic, came in for an appointment soon after [...], Family medicine covers all ages and specializes in chronic disease management as well as acute care medicine. As the health of the population continues to grow in complexity, treating patients appropriately and efficiently is imperative to improving health outcomes and managing health care costs. Family medicine physicians are uniquely poised to provide this type of care. A patient story plus a look at the patients seen over the course of a day within a family medicine residency clinic explores the complexity of care and the ability of family medicine physicians to provide the necessary care. Taking a close look at who comes through our door on a particular day highlights 3 points: primary care physicians are seeing patients with an increasing complexity of needs, our society is witnessing an extreme increase in patients suffering with mental health problems and substance use disorders, and addressing social determinants of health must be part of the solution. Key words: delivery of health care; patient-centered care.

It was the one-week anniversary of George Floyd's death. I put my 4-year-old son to bed and walked out to the porch to water some hanging flowerpots in desperate need [...], As we have traversed the last 2 years of the COVID-19 pandemic juxtaposed against an increased awakening to the realities of racial inequities in society and health care, the grief of Black individuals and communities has largely been underrecognized. This reflective essay explores the grief experience of Blacks in the wake of continual losses and acknowledges the impact of racism in these losses. I speak from my experiences as a Black mother, survivor of sibling loss, and pediatric palliative care pediatrician to examine this complex issue and what the medical community can do to stand with Black patients and families in their grief experience. Key words: grief; community/public health; parental loss; systemic racism; African American health

The process of making universal guidelines (for diagnostic decision-making, drug regimens and patient management) relevant to local institutional and cultural settings is recognized as important to their implementation and uptake. [...], The process of adapting universal guidelines to local institutional and cultural settings is recognized as important to their implementation and uptake. However, clarity on what, why and how to adapt in an evidence-based manner is still somewhat elusive. Health providers in low and middle income country contexts often have to deal with widely present co-morbidities and social inequalities among pregnant women. Since neither of these problems finds adequate discussion within the usual guidelines, and given the continual pressures posed by resource scarcity, health providers respond through ad hoc adaptations inimical to maternal safety and equity. We argue for, and describe, a grounded process of systematic adaptation of available guidelines through the example of a handbook on maternal risks for primary care doctors and staff nurses. The systematic adaptation in this practical, action-oriented handbook builds on research for a long-standing community-based project on maternal safety and rights. It takes a case-based problem-solving approach. Reiterating guidelines and best practices in diagnostic decision-making and risk management, it indicates how these can respond to co-morbidities and social inequality via complex clinical cases and new social science information. KEY WORDS: Maternal health; best practices; guidelines; co-morbidity; social inequality; capacity building Il est reconnu que le processus d'adaptation des directives universelles aux milieux institutionnels et culturels locaux importe pour l'application et l'adoption de ces directives. Quoi adapter, pourquoi le faire et comment s'y prendre en se fondant sur les preuves sont toutefois des questions auxquelles il n'existe pas de reponses claires. Les personnels de sante des pays a faible revenu et a revenu intermediaire doivent souvent composer avec des comorbidites et des inegalites sociales largement repandues chez les femmes enceintes. Comme ces deux problemes sont insuffisamment abordes dans les directives habituelles, et devant les pressions continuelles exercees par la rarete des ressources, les personnels de sante repondent par des adaptations ponctuelles parfois contraires a la securite des meres et a l'equite. Nous promulguons et decrivons un processus bien rode d'adaptation systematique des directives disponibles en citant l'exemple d'un guide sur les risques maternels redige a l'intention des medecins de premier recours et des infirmieres de soins generaux. Les adaptations systematiques presentees dans ce guide pratique et pragmatique tirent parti de la recherche effectuee pour un ancien projet communautaire sur la securite et les droits des meres. Le guide emploie une methode de resolution de problemes au cas par cas. En repetant les directives et les pratiques exemplaires en matiere de decisions diagnostiques et de gestion des risques, le guide indique comment elles peuvent repondre aux comorbidites et aux inegalites sociales en les illustrant par des cas cliniques complexes et de nouvelles donnees de sciences sociales. MOTS CLES : sante maternelle; pratiques exemplaires; directives; comorbidite; inegalite sociale; renforcement des capacites

The Association of Departments of Family Medicine's (ADFM's) overall mission is to 'support academic departments of family medicine to lead and achieve their full potential in care, education, scholarship, and [...]

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2009.01228.x Byline: Renata Kokanovic (1), Carl May (2), Christopher Dowrick (3), John Furler (4), Danielle Newton (4), Jane Gunn (4) Keywords: depression; East Timorese; Vietnamese; family doctors; Australia Abstract: Abstract Recent critiques of depression have contested its coherence as a concept and highlighted its performance in medicalising distress. Studies of depression in a cross-cultural context have focused on language and belief systems as technical barriers to practice that need to be overcome in enacting depression work. This paper seeks to locate culture within the broader socio-structural context of depression care in general practice. The paper draws on interviews with five general practitioners (GPs), and 24 patients from Vietnamese and East Timorese backgrounds who predominantly have left their home as refugees. Each had been diagnosed with depression or prescribed antidepressants. These patients gave accounts of distress deeply embedded within, and inseparable from, lives fraught with frightening pre-migration experiences, traumatic escape and profound dislocation and alienation in their new 'home'. Fragmented lives were contrasted with the nourishing social fabric of homes left behind. GP participants were involved in a process of engaging with a profoundly communal and structural account of emotional distress while defending and drawing on an individualised notion of depression in performing their work and accounting for the pain presented to them. Author Affiliation: (1)Department of Sociology, Monash University, Melbourne, Australia (2)Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne (3)Division of Primary Care, University of Liverpool (4)Primary Care Research Unit, Department of General Practice, The University of Melbourne, Australia Article note: Address for correspondence: Renata Kokanovic, Department of Sociology, School of Political and Social Inquiry (PSI), Faculty of Arts, Monash University, Victoria 3800, Australia, e-mail: renata.kokanovic@arts.monash.edu.au

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.10.065 Byline: David A. Kenny (a), Wemke Veldhuijzen (b), Trudy van der Weijden (b), Annie LeBlanc (c), Jocelyn Lockyer (d)(e), France Legare (f), Craig Campbell (g) Abstract: Doctor-patient communication is an interpersonal process and essential to relationship-centered care. However, in many studies, doctors and patients are studied as if living in separate worlds. This study assessed whether: 1) doctors' perception of their communication skills is congruent with their patients' perception; and 2) patients of a specific doctor agree with each other about their doctor's communication skills. A cross-sectional study was conducted in three provinces in Canada with 91 doctors and their 1749 patients. Doctors and patients independently completed questions on the doctor's communication skills (content and process) after a consultation. Multilevel modeling provided an estimate of the patient and doctor variance components at both the dyad-level and the doctor-level. We computed correlations between patients' and doctors' perceptions at both levels to assess how congruent they were. Consensus among patients of a specific doctor was assessed using intraclass correlation coefficient (ICC). The mean score of the rating of doctor's skills according to patients was 4.58, and according to doctors was 4.37. The dyad-level variance for the patient was .38 and for the doctor was .06. The doctor-level variance for the patient ratings was .01 and for the doctor ratings, .18. The correlation between both the patients' and the doctors' skills' ratings scores at the dyad-level was weak. At the doctor-level, the correlation was not statistically significant. The ICC for patients' ratings was .03 and for the doctors' ratings .76. Overall, this study suggests that doctors and their patients have a very different perspective of the doctors' communication skills occurring during routine clinical encounters. Author Affiliation: (a) Department of Psychology, University of Connecticut, Storrs, CT, United States (b) Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands (c) Research Center, HA[acute accent]pital Saint-Francois d'Assise, Centre Hospitalier Universitaire de Quebec, Quebec, Canada (d) Continuing Medical Education & Professional Development, University of Calgary, Calgary, Alberta, Canada (e) Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (f) Universite Laval, Department of Family Medicine and Emergency Medicine, Faculty of medicine, Campus Universitaire, Quebec City, Quebec, G1K 7P4, Canada (g) Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.07.041 Byline: Thomas Niederkrotenthaler (a)(b), Benedikt Till (c), Nestor D. Kapusta (d), Martin Voracek (e), Kanita Dervic (f)(g), Gernot Sonneck (a)(h) Abstract: This study aimed to investigate whether the risk of increased suicide occurrence after reports on suicide is associated with the social characteristics of the reported suicides and whether this varies with similarity between the reported suicides and suicides in the population. We collected reports on all 179 individual suicides named in the 13 largest Austrian nationwide newspapers from 1996 to 2006. Information on social status and sociodemographic characteristics of the reported suicides, on certainty of labelling the death as a suicide, and on the suicide methods applied were extracted from the articles. We conducted logistic regression analyses, with the increase of post-report suicides within 28 days after the reports as dependent variable. In model 1, the increase of suicides that matched the reported individual suicide with regard to age group, sex and suicide method was used as outcome variable. In model 2, the increase of suicides that were different from the reported suicide with regard to these characteristics was the outcome. In model 3, the post-report increase of total suicides was the dependent variable. Celebrity status of the reported suicide, age of the reported suicide between 30 and 64 years, and definitive labelling as a suicide were associated with an increased risk of a post-report increase of similar suicides; criminality (i.e. the individual was reported as suspected or convicted of crime) of the reported suicide was associated with a lower risk of a post-report increase. In dissimilar suicides, none of the variables was associated with a post-report increase of suicides. Celebrity status of the reported suicide was the only predictor of a post-report increase of total suicides. The findings support the hypothesis that social variables of reported suicides impact the risk of post-report copycat behaviour. Evidence of copycat effects seemed to be strongest in suicides that were similar to the respective model with regard to age group, sex, and suicide method. Author Affiliation: (a) Medical University of Vienna, Center for Public Health, Department of Medical Psychology, Severingasse 9, 1090 Vienna, Austria (b) Medical University of Vienna, Center for Public Health, Department of General Practice and Family Medicine, Wahringerstra[beta]e 13a, 1090 Vienna, Austria (c) University of Vienna, Department of Communication, Vienna, Austria (d) Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, Vienna, Austria (e) University of Vienna, School of Psychology, Department of Basic Psychological Research, Vienna, Austria (f) Medical University of Vienna, Department of Child and Adolescent Psychiatry, Vienna, Austria (g) United Arab Emirates University, Faculty of Medicine and Health Sciences, Department of Psychiatry, United Arab Emirates (h) Ludwig-Boltzmann Institute for Social Psychiatry, Vienna, Austria

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.04.022 Byline: Anne MacFarlane, Zhanna Dzebisova, Dmitri Karapish, Bosiljka Kovacevic, Florence Ogbebor, Ekaterina Okonkwo Abstract: This paper focuses on the work involved for service users in arranging and negotiating the use of informal interpreters from their social networks for general practice consultations. The data are drawn from a participatory learning and action research study, carried out in the west of Ireland. Qualitative data were gathered using a peer researcher model from a 'hard to reach' community of Serbo-Croat and Russian refugees and asylum seekers (n =26). The findings elucidate that there is a tension for service users between the experienced benefits of having a trusted friend/family member present to act as their interpreter and the burden of work and responsibility to manage the language barrier. Participants emphasize that, for them, the use of informal interpreters can be inadequate and problematic and can leave them worried, frustrated and with experiences of error and misdiagnosis. Overall, they state a clear preference for the use of professional, trained interpreters in general practice consultations which is currently unavailable to them in routine Irish general practice consultations. Author Affiliation: National University of Ireland, Galway, Ireland Article Note: (footnote) [star] This research was funded by a Health Research Board Health Services Research Fellowship (2002-2005) for Anne MacFarlane. Thank you to all research participants, the research steering group and the Galway Refugee Support Group. Thanks to Tomas de Brun, Eileen Green, Mary O'Reilly-de Brun, Hans-olaf Pieper and Carrie Singleton, for comments on drafts of this paper and to Breda Kelleher and Denis Murphy for assistance with its preparation.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.02.014 Byline: Richard Layte (a), Anne Nolan (a), Hannah McGee (b), Ann O'Hanlon (b) Abstract: In the Republic of Ireland, approximately 30% of the population ('medical card patients') are entitled to free general practice services. Eligibility is determined primarily on the basis of an income means test. The remaining 70% of the population ('private patients') must pay the full cost of all general practitioner (GP) consultations. From July 2001, all those over 70 years of age are also entitled to a medical card, regardless of income. This change in the pricing of GP services in the Republic of Ireland in 2001 provides a natural experiment that allows for an examination of the influence of economic incentives on GP visiting behaviour. The purpose of this paper is to examine whether this change in pricing for GP care for those over 70 years of age in Ireland led to an increase in the utilisation of GP services among this group. Using data from two nationally representative surveys of the population over the age of 65 before and after the policy change, difference-in-difference two-step models of GP visiting behaviour are estimated. The results indicate that, while there is some limited evidence in favour of an increase in the probability of seeking GP care among those over 70 years of age after the policy change, there is no significant effect on the frequency of visits. Differences in the incentives facing both patients and GPs after the policy change can explain the latter result. Author Affiliation: (a) Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, Ireland (b) Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland Article Note: (footnote) [star] We thank other Healthy Aging Research Programme (HARP) staff and Steering Group members who contributed in this overall research programme: Ms. Rebecca Garavan, Ms Maja Barker, Dr Anne Hickey, Dr Ronan Conroy, Dr. Frances Horgan, Ms Karen Morgan, Dr. Emer Shelley (at RCSI); Ms. Claire Donnellan, Dr. David Hevey & Professor Desmond O'Neill (at TCD); Dr. Vivienne Crawford, Mr John Dinsmore and Professor Bob Stout (at QUB). We thank Professor James Williams (ESRI) and Dr. Donal McDade (Social and Market Research) for coordinating community interviews in the Republic and Northern Ireland respectively. We also sincerely thank research participants for their time and cooperation.

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1741-3729.2008.00503.x Byline: Lenna Ontai (**), Yoshie Sano (**), Holly Hatton (**), Katherine J. Conger (**) Keywords: family structure; health; parenting; social support Abstract: Abstract: Parenting confidence can be undermined by the presence of frequent or persistent health problems, particularly for people living in rural communities that have limited access to adequate health care. However, little is known about how minor health problems in the family impact parenting. The current study examined single and coresident mothers' parent confidence in relation to family health problems and parental support in a sample of 303 low-income, rural mothers with young children from 14 states. Results show that the presence of family health problems was negatively associated with parent confidence. For coresident mothers, there was an indirect relationship through perceived parental support. Article note: (**) Lenna Ontai is an assistant specialist in Cooperative Extension in the Department of Human and Community Development at the University of California, Davis, One Shields Avenue, Davis, CA 95616 (lontaigrz@ucdavis.edu). Yoshie Sano is an assistant professor in the Department of Human Development at the Washington State University-Vancouver, 14204 NE Salmon Creek Avenue, Vancouver, WA 98686 (yoshie_sano@vancouver.wsu.edu). Holly Hatton is a PhD Candidate in the Department of Human and Community Development at the University of California, Davis, One Shields Avenue, Davis, CA 95616 (hnpong@ucdavis.edu). Katherine J. Conger is an assistant professor of the Department of Human and Community Development at the University of California, Davis, One Shields Avenue, Davis, CA 95616 (kjconger@ucdavis.edu).

Primary health care (PHC) is a systems perspective for examining the provision of essential health care for all. A multidisciplinary collaborative approach to health care delivery is associated with effective delivery and care providers' enrichment. Yet data regarding multidisciplinary practice within PHC are limited. The purpose of this exploratory qualitative descriptive study was to better understand team-based PHC practice in the US. Aims included (a) describing nursing faculty involvement in PHC, (b) analyzing ways that multidisciplinary work was enacted, and (c) recommending strategies for multidisciplinary PHC practice. After institutional review board (IRB) protocol approval, data collection occurred by: (a) surveying faculty/staff in a Midwestern nursing college (N = 94) about their PHC practice, and (b) interviewing a purposive sample of nursing faculty/staff identified with PHC (n = 10) and their health professional collaborators (n = 10). Survey results (28% return rate) were summarized, interview notes were transcribed, and a systematic process of content analysis applied. Study findings show team practice is valued because health issues are complex, requiring different types of expertise: and because teams foster comprehensive care and improved resource use. Mission, membership attributes, and leadership influence teamwork. Though PHC is not a common term, nurses and their collaborators readily associated their practice with a PHC ethos. PHC practice requires understanding community complexity and engaging with community, family, and individual viewpoints. Though supports exist for PHC in the US, participants identified discord between their view of population needs and the health care system. The following interpretations arise from this study: PHC does not explicitly frame health care activity in the US, though some practitioners are committed to its ethics; and, teamwork within PHC is associated with better health care and rewarding professional experience. Nurses integrate PHC in multiple roles and are experts at aspects of PHC teamwork. Keywords: USA; Primary health care; Multidisciplinary; Teamwork; Nurses

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2006.06.005 Byline: Ludwien Meeuwesen (a), Johannes A.M. Harmsen (b), Roos M.D. Bernsen (c), Marc A. Bruijnzeels (d) Keywords: Medical communication; Intercultural communication; General practice; Interethnic differences; Immigrants; Health care; The Netherlands Abstract: The aim of this study was to gain deeper insight into relational aspects of the medical communication pattern in intercultural consultations at GP practices in the Netherlands. We ask whether there are differences in the verbal interaction of Dutch GPs with immigrant and Dutch patients. Data were drawn from 144 adult patient interviews and video observations of consultations between the patients and 31 Dutch GPs. The patient group consisted of 61 non-Western immigrants (Turkish, Moroccan, Surinamese, Antillean, Cape Verdian) and 83 Dutch participants. Affective and instrumental aspects of verbal communication were assessed using Roter's Interaction Analysis System (RIAS). Patients' cultural background was assessed by ethnicity, language proficiency, level of education, religiosity and cultural views (in terms of being more traditional or more modern). Consultations with the non-Western immigrant patients (especially those from Turkey and Morocco) were well over 2min shorter, and the power distance between GPs and these patients was greater when compared to the Dutch patients. Major differences in verbal interaction were observed on the affective behavior dimensions, but not on the instrumental dimensions. Doctors invested more in trying to understand the immigrant patients, while in the case of Dutch patients they showed more involvement and empathy. Dutch patients seemed to be more assertive in the medical conversation. The differences are discussed in terms of patients' ethnic background, cultural views (e.g. practicing a religion) and linguistic barriers. It is concluded that attention to cultural diversity does matter, as this leads to different medical communication patterns. A two-way strategy is recommended for improving medical communication, with implications for both doctor and patient behavior. Author Affiliation: (a) Interdisciplinary Social Science Department, Research School for 'Psychology and Health', Utrecht University, Utrecht, The Netherlands (b) Department of General Practice, Erasmus MC Rotterdam, The Netherlands (c) United Arab Emirates University, Department of Community Medicine, Al Ain, United Arab Emirates (d) Department of Health Policy and Management, Erasmus MC Rotterdam, The Netherlands

Public health asks of systems science, as it did of sociology 40 years ago, that it help us unravel the complexity of causal forces in our varied populations and the ecologically layered community and societal circumstances of public health practice. We seek a more evidence-based public health practice, but too much of our evidence comes from artificially controlled research that does not fit the realities of practice. What can we learn from our experience with sociology in the past that might guide us in drawing effectively on systems science?

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.05.028 Byline: Sara Arber (a), John McKinlay (b), Ann Adams (c), Lisa Marceau (b), Carol Link (b), Amy O'Donnell (b) Keywords: Gender; Ageism; Health inequalities; Primary care; Decision-making; UK/US; Randomised experiment Abstract: Numerous studies examine inequalities in health by gender, age, class and race, but few address the actions of primary care doctors. This factorial experiment examined how four patient characteristics impact on primary care doctors' decisions regarding coronary heart disease (CHD). Primary care doctors viewed a video-vignette of a scripted consultation where the patient presented with standardised symptoms of CHD. Videotapes were identical apart from varying patients' gender, age (55 versus 75), class and race, thereby removing any confounding factors from the social context of the consultation or other aspects of patients' symptomatology or behaviour. A probability sample of 256 primary care doctors in the UK and US viewed these video-vignettes in a randomised experimental design. Gender of patient significantly influenced doctors' diagnostic and management activities. However, there was no influence of social class or race, and no evidence of ageism in doctors' behaviour. Women were asked fewer questions, received fewer examinations and had fewer diagnostic tests ordered for CHD. 'Gendered ageism' was suggested, since midlife women were asked fewest questions and prescribed least medication appropriate for CHD. Primary care doctors' behaviour differed significantly by patients' gender, suggesting doctors' actions may contribute to gender inequalities in health. Author Affiliation: (a) Department of Sociology, Centre for Research on Ageing and Gender, University of Surrey, Guildford, Surrey GU2 7XH, UK (b) New England Research Institutes, Watertown, MA 02172, USA (c) Centre for Primary Health Care Studies, University of Warwick, Coventry CV4 7AL, UK

I was introduced to family medicine at a young age. In fact, some of my earliest memories include running through our doctor's house trying to avoid my vaccine injections. Perhaps [...]

As protests rock the U.S. following the death of George Floyd at the hands of a Minneapolis, Minn., police officer, physician organizations are adding their voices to groups seeking to [...]