Study Smart Beats Study Hard

Keep your "nose to the grindstone" is the advice we often tell young people is an essential ingredient of learning difficult tasks. A joke captures the matter with the old bromide for success, "Keep your eye on the ball, your ear to the ground, your nose to the grindstone, your shoulder to the wheel: Now try to work in that position."

Over the years of teaching, I have seen many highly conscientious students work like demons in their study yet don't seem to learn as much as they should for all the effort they put in. Typically, it is because they don't study smart.

In an earlier post, I described a learning strategy wherein a student should spend short (say 15-20 minutes) of intense study followed immediately by a comparable rest period of "brain-dead" activity where they don't engage with intense stimuli or a new learning task. The idea is that during brain down-time the memory of just-learned material is more likely to be consolidated into long-term memory because there are no mental distractions to erase the temporary working memory while it is in the process of consolidation.

Now, new research suggests that too much nose-to-the-grindstone can impair learning. Margaret Schlichting, a graduate student researcher, and Alison Preston, an associate professor of psychology and neuroscience at the University of Texas tested the effect of mental rest with a learning task of remembering two sets of a series of associated photo pairs.  Between the two task sets, the participants rested and were allowed to think about whatever they wanted. Not surprisingly, those who used the rest time to reflect on what they had just learned were able to remember more upon re-test. Obviously, in this case, the brain is not really resting, as it is processing (that is, rehearsing) the new learning. But the brain is resting in the sense that new mental challenges are not encountered.

The university press release quotes the authors as saying, "We've shown for the first time that how the brain processes information during rest can improve future learning. We think replaying memories during rest makes those earlier memories stronger, not just impacting the original content, but impacting the memories to come." Despite the fact that this concept has been anointed as a new discovery in a prestigious science journal, the principle has been well-known for decades. I have explained this phenomenon in my memory books as the decades-old term of "interference theory of memory,"

What has not been well understood among teachers is the need to alter teaching practices to accommodate this principle. A typical class period involves teachers presenting a back-to-back succession of highly diverse learning objects and concepts. Each new topic interferes with memory formation of the prior topics. An additional interference occurs when a class period is disrupted by blaring announcements from the principal's office, designed to be loud to command attention (which has the effect of diverting attention away from the learning material). The typical classroom has a plethora of other distractions, such as windows for looking outside and multiple objects like animals, pictures, posters, banners, and ceiling mobiles designed to decorate and enliven the room. The room itself is a major distraction.

Then, to compound the problem, the class bell rings, and students rush out into the hall for their next class, socializing furiously in the limited time they have to get to the next class (on a different subject, by a different teacher, in a differently decorated classroom). You can be sure, little reflection occurs on the academic material they had just encountered.

The format of a typical school day is so well-entrenched that I doubt it can be changed. But there is no excuse for blaring loudspeaker announcements during the middle of a class period. Classrooms do not have to be decorated. A given class period does not have to be an information dump on overwhelmed students. Short periods of instruction need to be followed by short, low-key, periods of questioning, discussion, reflection, and application of what has just been taught. Content that doesn't get "covered" in class can be assigned as homework—or even exempted from being a learning requirement. It is better to learn a few things well than many things poorly. Indeed, this is the refreshing philosophy behind the new national science standards known as "Next Generation Science Standards."

Give our kids a rest: the right kind of mental rest.

Sources:

http://www.nextgenscience.org/

http://scicasts.com/neuroscience/2065-cognitive-science/8539-study-suggests-mental-rest-and-reflection-boost learning.

Schlicthing, M. L., and Preston, A. R. (2014). Memory reactivation during rest supports upcoming learning of related content. Proc. Nat. Acad. Science. Published ahead of print, Oct. 20.

Dr. Klemm's latest book, available at most retail outlets, is "Mental Biology. The New Science of How the Brain and Mind Relate" (Prometheus). See reviews at http://thankyoubrain.com

Let's get creative in how we provide health care to the poor

When I speak with colleagues about ways to provide primary care to the poor, they generally fall into one of two camps. The first camp, generally supporters of the Affordable Care Act, contends that the ACA's originally mandatory (but later ruled optional) expansion of Medicaid insurance eligibility and a temporary federally-funded increase in Medicaid fee-for-service rates to Medicare levels provided enough incentives to attract family physicians to patient-centered medical homes that primarily serve low-income patients. (Disclosure: about 15 percent of my current practice's patients have Medicaid.)

There is plenty of evidence that low-income residents of states that chose to opt out of Medicaid expansion will be worse off than those in states that have expanded their programs. Not only do people whose incomes are at or lower than federal poverty levels have less access to acute and chronic care, they receive less preventive care and are more likely to be sicker and die sooner than if they had Medicaid coverage. In addition, the Robert Graham Center has projected that fewer primary care physicians will practice in states that do not expand their programs, exacerbating existing workforce shortages. A study published in the New England Journal of Medicine reported that after Medicaid fee-for-service payments for primary care visits rose in 2013 by an average of 73 percent, it was significantly easier for simulated Medicaid patients to schedule appointments with doctors. Unfortunately, the federal Medicaid pay increase expired at the end of 2014, and only 15 states plan to continue the increased rates.

Most encouraging is a recent study in JAMA Internal Medicine that examined the association between patient-centered medical home implementation and breast, cervical, and colorectal cancer screening. Not only was having more characteristics of a PCMH associated with higher screening rates in general, larger screening increases in PCMH practices that served patients with lower incomes and educational backgrounds considerably reduced screening disparities between the rich and the poor.

All good news, but is this momentum sustainable, and is it nearly enough? Not a chance, say my colleagues in the other camp. In 35 states and the District of Columbia, Medicaid fees have reverted to their previous embarrassingly low levels, and the Supreme Court will rule this summer whether doctors and hospitals can sue state Medicaid programs for paying fees that are typically less than the cost of providing care. It gets even worse: in my practice, a large Medicaid insurer paid us nothing for several months, then negotiated a lump settlement with our parent institution that required the insurer to only to pay 40 percent of what it actually owed. If our practice had to rely exclusively on Medicaid for cash flow, it's hard to see how we could keep our doors open. And low-income patients who earn between 138% and 400% of the federal poverty level and receive federal subsidies to purchase health insurance on the marketplaces often face several thousand dollar deductibles, making them pay out of pocket for everything except preventive care.

So family physicians and other primary care innovators are taking matters into their own hands. For example, the "Robin Hood" practice model is a viable solution for patients who remain uninsured or underinsured after the ACA. The most-read guest post of all time on this blog explained how a direct primary care model can benefit low-income patients. For those who worry that a $50 monthly fee for unlimited primary care could be too much for patients living paycheck to paycheck, a leading direct primary care practice in Washington State now serves thousands of Medicaid patients through a contract where regular monthly payments flow directly to the practice rather than passing through an administrative maze of insurance claims for individual visits. After being slow to recognize these types of practices or dismissing them as high-end "concierge care," the American Academy of Family Physicians now offers a variety of helpful resources on direct primary care.

Given these developments, it doesn't make sense to me for physicians and policy makers to squabble about the "best" way to provide health care to the poor or continue to pine for a pie-in-the-sky universal system for all. The U.S. health care environment has always been complicated, and is even more so nearly 5 years after passage of the ACA. Physicians who dedicate themselves and their practices to caring for underserved and vulnerable populations should be supported however they choose to do so, rather than rebuked for thinking outside of a politically correct health reform box. The more creativity we can bring to bear on this issue, the better.

Debating testosterone screening and therapy in older men

A good number of new patients to my practice are older men whose previous physicians have retired. More and more often, I've noticed while reviewing records from previous physicals that they have had their testosterone levels checked - usually without any documented rationale for doing so. In two Pro-Con editorials in the February 15th issue of American Family Physician, Drs. Joel Heidelbaugh and Adriane Fugh-Berman debate the merits and potential unintended consequences of screening for testosterone deficiency in older men. Dr. Heidelbaugh points out that observational studies have associated low serum testosterone levels with cardiovascular disease, cancer, impaired glucose tolerance, and metabolic syndrome. He further argues that symptoms of testosterone deficiency may be erroneously attributed to normal aging:

Although screening targets asymptomatic men, testosterone deficiency is unique because symptoms are not always well defined. This warrants casting a wider net to identify a treatable condition. Symptoms such as depression, fatigue, and inability to perform vigorous activity are related to low testosterone levels, whereas there is an inverse relationship between the number of sexual symptoms and testosterone levels.

On the other hand, Dr. Fugh-Berman raises concerns about overly aggressive marketing of testosterone supplements by pharmaceutical companies, such as online symptom surveys that seem designed to elicit "yes" answers from most older men.

These questions demonstrate how pharmaceutical companies use nonspecific symptoms to foster disease states and then convince physicians that these conditions are real. In this case, the disease state is marketed to consumers as Low T, and to physicians as late-onset hypogonadism.

Of observed associations between low testosterone levels and chronic diseases, Dr. Fugh-Berman counters that "association does not prove causation, and there is no reliable evidence that testosterone treatment improves any chronic disease."

Last September, an advisory committee to the U.S. Food and Drug Administration considered the potential cardiovascular risks for testosterone therapy and voted to exclude men with age-related testosterone declines from indications for testosterone use and to support performing additional studies to clarify cardiovascular harms. Whether clinical practice will evolve to reflect a similar level of caution is unclear. A 2013 analysis of a health insurance database showed that 25% of men prescribed a testosterone supplement never had a testosterone level checked, while other men with apparently normal levels nonetheless received therapy. At a minimum, family physicians who prescribe testosterone supplements should heed the Choosing Wisely recommendation to avoid these unsupported practices.

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This post first appeared on the AFP Community Blog.

Visualize pleasant experience to sharpen your memory

Visualization of the information as it is while reading or listening can help boost the memorizing power. If this is something which is often overlooked this can be added to the mainframe of thinking.

Visualize some pleasant experiences that had recently. The visualization will be more effective if the person can get the sensations at the time, the feelings, the emotions, the smells, the sounds, the sights, the colors.

This will freshen the mind and make it easier to retain information.

Visualization which is used of imagination and memory, remembering, or imagining pleasant experiences activates many of the same sensory, motor, emotional and cognitive circuits that fired during the ‘real’ pleasant experience.
Visualize pleasant experience to sharpen your memory

Actual causes of death in the U.S.: not what you think

Any standard public health or medical school prevention text includes (or ought to include) some version of the figure below, which illustrates that the leading causes of death in the U.S. at the turn of the century (heart disease, cancer, stroke) were actually surrogates for what have come to be known as the actual causes of death: unhealthy behaviors such as tobacco use, poor diet, and physical inactivity.

The most effective preventive services that primary care clinicians provide, then, are not screening tests but counseling interventions that aim to change one or more of these behaviors for the better. Community-level initiatives such as tobacco-free restaurants and campuses, pedestrian-friendly cities, and increasing access to nutritious food sources play a critical role in changing health-related behaviors, too.

Unfortunately, the impact of behavioral or "lifestyle" approaches to prevention is likely to be limited by two factors: 1) even intensive interventions produce very modest benefits; and 2) behaviors don't exist in a vacuum, but are largely shaped by economic and social circumstances. Family medicine professor and former U.S. Preventive Services Task Force member Steven Woolf has published a number of studies showing that the risk of death is strongly associated with levels of college education and income; his research team at Virginia Commonwealth University worked with the Robert Wood Johnson Foundation to develop an interactive County Health Calculator that illustrates how many premature deaths could be avoided by eliminating educational and income disparities.

Researchers from Columbia University went a step further in 2011 by publishing the analysis "Estimated Deaths Attributable to Social Factors in the United States" in the American Journal of Public Health. Using estimates derived from the literature on social determinants of health and year 2000 mortality data, they found that the "actual" causes of death looked like this:

1) Low education: 245,000

2) Racial segregation: 176,000

3) Low social support: 162,000

4) Individual-level poverty: 133,000

5) Income inequality: 119,000

6) Area-level poverty: 39,000

Clearly, we know a great deal more about successful strategies for fighting clinical and behavioral causes of death than we do about social causes, some of which often appear intractable. But I could not agree more with the authors' conclusion that "these findings argue for a broader public health conceptualization of the causes of mortality and an expansive policy approach that considers how social factors can be addressed to improve the health of populations." The point being: poverty, discrimination, and low education aren't just social or political issues best left to non-clinicians - they're health issues, too.

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This post first appeared on Common Sense Family Doctor on August 26, 2011.

Common Sense Family Doctor: LIVE

Since I began blogging in July 2009, my posts have been featured in widely read blogs such as KevinMD.com, The Doctor Weighs In, The Health Care Blog, The Doctor Blog, and Gary Schwitzer's HealthNewsReview, as well as the websites of major national health and news outlets such as Proto Magazine, the Costco Connection, the New York Times, the Wall Street Journal, USA Today, and the Boston Globe. I also previously wrote the consumer health blog Healthcare Headaches for U.S. News and World Report.

Like the vast majority of physicians who blog, I write in my spare time. I have never accepted advertising or paid web links on Common Sense Family Doctor, and the choices of topics for posts are my own and not influenced by financial or other conflicts of interest. In order to support the time I devote to blogging, and to encourage high-quality medical writing and clinical practice, I give lectures and workshops to medical and non-medical audiences on a variety of topics. These include the uses of social media in medicine and education, developing and implementing clinical guidelines, and the evidence supporting prevention recommendations. Here's a clip from a recent talk I gave at the National Press Foundation on cancer screening.



If you or your organization would like to invite me to speak, please send me an e-mail at linkenny@hotmail.com or Kenneth.Lin@georgetown.edu.

Past events:

2015

Choosing Wisely: Pearls for Primary Care Physicians
- District of Columbia Academy of Family Physicians

The Physician's Perspective on Consumer Health Technology
- International Consumer Electronics Show, Las Vegas, NV

2014

Cancer Screening: An Updated Primer for Journalists
- National Press Foundation's Cancer Issues 2014, Washington, DC

Lung and Bronchial Cancer
- American Academy of Family Physicians Assembly, Washington, DC

Policy and Funding for Preventive Care Programs
- Georgetown University Health Systems, Policy, and Public Health Elective

2013

CT Screening for Lung Cancer: Evaluating the Evidence
- National Capital Consortium Family Medicine Residency, Fort Belvoir, VA

Thinking Like An Editor
- Society of Teachers of Family Medicine Annual Spring Conference, Baltimore, MD

Politics of HIV Testing
- Georgetown University School of Medicine

Burnout Prevention for Healthcare Professionals
- Teaching Prevention 2013, Washington, DC

Evidence-Based Literature Searching: A Primer
- National Capital Consortium Family Medicine Residency, Fort Belvoir, VA

Less is More: New Approaches to Cancer Screening in Primary Care
- Primary Care Coalition of Montgomery County, Maryland

2012

Science and Public Policy in Conflict: PSA Screening
- Johns Hopkins University Bloomberg School of Public Health Fall Policy Seminar

Screening Mammography for Women in their 40s: Exploring the Controversy
- National Capital Area Regional Breast Healthcare Improvement Initiative

Why You Should Stop Screening Patients for Prostate Cancer
- Ephrata (PA) Community Hospital Grand Rounds

Identifying and Using Good Practice Guidelines
- Temple University School of Medicine Family Practice Board Review Course

2011

Cancer Screening: A Primer for Journalists
- National Press Foundation's Cancer Issues 2011, Washington, DC

What to Do When Screening Guidelines Conflict: HIV and Mammography
- Grand Rounds, Georgetown University Department of Family Medicine

Overdiagnosed: Making People Sick in the Pursuit of Health
- William J. Bicknell Lecture (panelist)
- Boston University School of Public Health

For Geeks and Geezers: With Social Media Skills You Can Change the World
- Family Medicine Education Consortium Northeast Region Meeting

Screening for Diabetes: What Does the Evidence Say?
- Spanish Catholic Center of Catholic Charities of Washington, DC

Don't Do It! Preventive Health Services That Harm More Than They Help
- District of Columbia Academy of Family Physicians

Using the Medical Literature to Make Decisions About Preventive Health Services
- Medical Library Association Annual Meeting

2008 - 2010

Medical Blogging and Other Professional Uses of Social Media
- Grand Rounds, Virginia Commonwealth University Internal Medicine

Spilling Ink: An Expert's Guide to Getting Your Work Published
- Society of Teachers of Family Medicine Annual Meeting

How Learning Cursive Might Improve Reading Efficiency and Hand-eye Coordination

When directing the writing by hand, the brain has to visually track rapidly changing positions of the pencil and control hand and finger movements. To learn such skills, the brain must improve its control over eye-movement saccades and the processing of visual feedback to provide corrective feedback. Both tracking and movement control require much more engagement of neural resources in producing cursive or related handwriting methods than in hand printing, because the movements are more complex and nuanced. Thus, learning cursive is a much greater neural activator, which in turn must engage much more neural circuitry than the less demanding printing.

The key to learning successful handwriting, whether cursive, italics, or calligraphy, is well-controlled visual tracking and high-speed neural responses to the corrective feedback. Scientists are now starting to study the mechanisms, but not yet in the context of education. Two recent reports, seemingly unrelated to each other or to cursive, examined visual tracking and found results that could have profound educational implications for both reading and hand-eye coordination training, as in learning to touch type.

Visual targets are fixed by saccades. One theory is that the eyes scan the target with a linked series of saccades, in this case the changes in cursive letter structure as the letters are being rapidly formed. We already know that the brain predicts eye movements based on what they see at each saccade fixation. This is how our visual world is made stable, even though the eyes are flicking around; otherwise, the image would jitter back and forth constantly. This suggests that visual image representation is integrated rapidly over many successive saccades. The degree of tracking speed, accuracy, and prediction error must surely influence how well the letters are transcribed during handwriting. The corollary is that the better one learns to write by hand, the better the brain is learning how to track visually.

Scientists used to think that these predictions were the source of error in estimating the position of seen objects. In handwriting, for example, the brain would assess the shape of part of a letter as you draw it and predict how and where the next portion of the letter should be added. Learning how to optimize the drawing then would be a matter of learning how to reduce prediction errors.

However, a new study tested the hypothesis that if localization errors really are caused by faulty predictions, you would also expect those errors to occur if an eye movement, which has already been predicted in your brain, fails to take place at the very last moment in response to a signal to abort the eye movement. The investigators (Atsma et al. 2014) asked test subjects to look at a computer screen and tracked eye movement fixation on a very small ball that appeared at various random positions. During this task, the brain must correctly predict where the eyes have to move to keep the eye on the ball.

The experiment ended with one last ball on the screen, followed by a short flash of light near that ball. The person had to look at the last stationary ball while using the computer mouse to indicate the position of the flash of light. However, in some cases, a signal was sent around the time the last ball appeared, indicating that the subject was NOT allowed to look at the ball. In other words, the eye movement was cancelled at the last moment. The person being tested still had to indicate where the flash was visible.

Subjects did not make any mistakes in fixation on the light location during the abortion test, even though the brain had already predicted that it needed to fixate on the ball. Most mislocations occurred when the flash appeared at the moment the eye movement began. Thus, the errors seemed to be associated with neural commands for eye fixation, not with saccade predictions. The application for handwriting learning is that the neural circuits that control target fixation may be a major factor in learning how to write cursive well. Surely, these circuits would be responsive to training, though that was not done in this experiment. It would seem possible that these circuits might be trained via learning cursive to provide faster and more accurate visual tracking, which should have other benefits—as in reading.

A related study of visual tracking in monkeys reveals parallel processing during visual search (Shen and Paré. 2014). Recordings from neurons in the visual pathway during visual tracking of targets in a distracting field showed that in the untrained state, these neurons had indiscriminate responses to stimuli. However, with training the neuronal function evolved to predict where the moving target should be in advance of the actual saccade. Results also showed that more than half the neurons learned to predict where the next two eye movements (saccades) needed to be, which obviously suggests that accurate tracking can be accelerated without loss of information.

In short, learning cursive should train the brain to function more effectively in visual scanning. Theoretically, reading efficiency could benefit. I predict that new research would show that learning cursive will improve reading speed and will train the brain to have better hand-eye coordination. In other words, schools that drop cursive from the curriculum may lose an important learning-skills development tool. The more that students acquire learning skills, the less will be the need for "teaching to the test."

"Memory Medic's" latest books are 

Mental Biology (Prometheus) and Memory Power 101 (Skyhorse).

Sources:

Atsma, J. et al. (2014). No peri-saccadic mislocalization with abruptly cancelled saccades.
Journal of Neuroscience, 15 April 2014. ttp://www.jneurosci.org/content/34/16/5497.full.html

Shen, Kelly and Paré, Martin. 2014.  Predictive saccade target selection in superior colliculus during visual search. The Journal of Neuroscience, 16 April 2014, 34(16): 5640-5648; doi: 10.1523/JNEUROSCI.3880-13.2014

Once a Cesarean ... now, a vaginal delivery

A recent essay in the "Narrative Matters" section of Health Affairs by physician and health policy researcher Carla Keirns highlighted the challenges that even a highly educated, well-informed patient faces in achieving the desired outcome of a vaginal childbirth, especially if her pregnancy is classified as high risk. Dr. Keirns, whose pregnancy was complicated by "advanced maternal age" (40) and gestational diabetes, narrowly avoided a Cesarean delivery by obstetricians who often seemed to be "watching the clock" more than assessing her individual circumstances. She observed how the "Cesarean culture" of medical practice overshadows the ideal of shared decision-making about delivery preference:

I was naked and uncomfortable, had invasive lines in place, and hadn’t slept or eaten in three days. If a doctor I trusted, instead of one I didn’t know, had suggested a cesarean forty-eight hours into my labor induction, I might have agreed. If they had told me that my baby’s life or health was in jeopardy, I would have consented to anything. The vision of the empowered consumer, or even the autonomous patient, is laughable under these circumstances.

American Family Physician's February 1st issue featured a review article on counseling and complications of Cesarean delivery and a concise summary of the American Academy of Family Physicians' updated clinical practice guideline on planned vaginal birth after Cesarean (VBAC). The review article, authored by Drs. Jeffrey Quinlan and Neil Murphy, noted that Cesareans represent nearly one-third of all deliveries in the U.S., with the most common indications being elective repeat Cesarean delivery (30%) and dystocia or failure to progress (30%).

Once a woman has had one Cesarean delivery, she faces considerable pressure from the medical system to choose repeat Cesarean deliveries in subsequent pregnancies. A 2014 article in The Atlantic explained why the dictum "once a Cesarean, always a Cesarean" increasingly holds true despite good evidence that planned VBAC is safe for, and desired by, most women. After the American College of Obsetricians and Gynecologists (ACOG) published guidelines in 1996 (later challenged by the AAFP) recommending that in-house surgical teams be "immediately available" during planned VBAC, many hospitals stopped allowing women to attempt labor after a Cesarean. Even though ACOG now acknowledges that there is no evidence that hospitals with fewer resources have worse maternal or neonatal outcomes from planned VBAC, these restrictive institutional policies have remained in place.

After our first child was born by Cesarean section, my wife, who is also a family physician. proceeded to have three consecutive uncomplicated vaginal deliveries after the age of 35. To change the culture of medicine to support this kind of outcome, and to reduce the overall frequency of Cesarean deliveries, patients, physicians, and hospitals must advocate for aligning medical protocols with the best evidence and putting mothers and babies back at the center of care.

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This post first appeared on the AFP Community Blog.

Project C.A.R.E.S. offers an innovative solution

It's rare that an article published in Business Insider "goes viral" in my Twitter and Facebook networks, but "Why Your Doctor Always Keeps You Waiting," by family physician Sanaz Majd, touched a raw nerve among friends and colleagues. In the article, Dr. Majd described "a day in the life of Dr. Tardy," a caring, competent family doctor who "doesn't like to take any shortcuts when it comes to patient care" and always seems to be running late. This hypothetical physician's typical half-day schedule consists of seeing patients in 20-minute time slots regardless of how much time they really need. The patients' complaints are the norm for a primary care practice: diabetes, heartburn, high blood pressure, depression, upper respiratory infections. By the end of the morning, Dr. Tardy is running more than a hour late.

By the time Dr. Tardy ends her morning, she is scheduled to see her first patient of the afternoon. It's a relief to reset the schedule once again, but this means that not only does she not have a break in the day (which doesn't really bother Dr. Tardy), but she also has no time for returning patient messages, reviewing lab results, or refilling prescriptions. This means tacking on about 2 hours at the end of her day to complete these tasks after her jam-packed afternoon schedule. And this is a typical morning for a primary care physician in the United States. Are you tired yet?

Keep in mind that the typical family doctor adheres to this grueling schedule most days of the week and earns a small fraction of a subspecialist's or hospital executive's salary, and it is unsurprising that despite a growing shortage of primary care physicians, family and general internal medicine residency programs struggle to recruit U.S. medical graduates to fill their existing slots, much less expand to meet anticipated future demand.

How to make a family medicine career more appealing and sustainable is a big project with a long-term horizon. But what can we do right now to reduce patients' waiting times while we wait for our current health system to transform into something resembling sanity? One of my residents, Dr. Troy Russell, is tackling the problem of redundant medical history taking with an innovative solution called Project C.A.R.E.S. (Communities Aided by Research and Education Solutions). In brief, he proposes to provide patients at with automated check-in kiosks that can transfer self-reported health history information directly into their electronic medical records, and measure the effect of this intervention on waiting times and patient satisfaction. If this pilot project is successful, it could inspire other underserved health clinics across the country to do the same. Please read more about the project and consider helping him and his team reach their 30-day fundraising goals to make this idea a reality.

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UPDATE 2/10/15 - Possibly due to the widespread interest that Dr. Russell's social media campaign generated in Project C.A.R.E.S., Fort Lincoln Family Medicine Center's parent institutions have agreed to fund this project internally. The private fundraising campaign has been suspended, and all donations to date will be refunded.