Storylines of family medicine VI: ways of being-in the office with patients.

is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VI: ways of being-in the office with patients', authors address the following themes: 'Patient-centred care-cultivating deep listening skills', 'Doctor as witness', 'Words matter', 'Understanding others-metaphor and its use in medicine', 'Communicating with patients-making good use of time', 'The patient-centred medical home-aspirations for the future', 'Routine, ceremony or drama?' and 'The life course'. May readers better appreciate the nuances of patient care through these essays.

Program Outcomes and Health Care Utilization of People Experiencing Homelessness and Substance Use Disorder after Transitional Care Program Engagement.

People experiencing homelessness (PEH) have a high prevalence of mental illness and substance use disorder (SUD) and substantial acute and chronic disease burden. Transitional care and medical respite programs facilitate a safe transfer for PEH from the acute care to community setting. Many medical respite programs practice harm reduction strategies that can increase the opportunity for positive program outcomes for PEH with SUD.

The Face of God Revealed.

Many years have passed since I visited Donny in the hospital, where he was admitted with a newly diagnosed and terminal lung cancer. Despite years of separation, his wife Rose took him back into her home and cared for Donny at the end of his life. In the months after his death, I learned more about their relationship; Donny's drinking and infidelities, the emotional and verbal abuse that Rose put up with.

Medical Student Leadership Development through a Business School Partnership Model: A Case Study and Implementation Strategy.

Background: There is an ongoing call for leadership development in academic health care and medical students desire more training in this area. Although many schools offer combined MD/MBA programs or leadership training in targeted areas, these programs do not often align with medical school leadership competencies and are limited in reaching a large number of students.

Methods: The Leadership Initiative (LI) was a program created by a partnership between a School of Medicine (SOM) and Business School with a learning model that emphasized the progression from principles to practice, and the competencies of self-awareness, communication, and collaboration/teamwork.

What is My Value as a Doctor?

A weekly habit of viewing my performance data led me to question the value of my doctoring. I tried to answer this quandary in my head for months, but it was a patient encounter that revealed what I had been searching for. As a doctor I am bound to the care of another, especially when disease, disability, or injury create any space between a patient and their personhood.

Evaluating the care provision of a community-based serious-illness care program via chart measures.

Background: Although quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model.

Methods: Retrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 (n = 159).

Peak Performance: A Communications-Based Leadership and Teamwork Simulation for Fourth-Year Medical Students.

Background: Medical education has traditionally been rooted in the teaching of health and disease processes, with little attention to the development of teamwork and leadership competencies.

Objective: In an era of value-based health care provided by high-functioning teams, new approaches are needed to develop communication, leadership, and teamwork skills for medical students.

Design: We designed and piloted a simulation-based educational activity called that linked a workbook, which focused on self-reflection on communication and leadership skills, with professional coaching.

Palliative Care in a Community-Based Serious-Illness Care Program.

Although community-based serious-illness care (CBSC) is an innovative care model, it is unclear to what extent CBSC addresses palliative care needs, particularly for those patients near death. To evaluate palliative care services of a CBSC program. Retrospective chart reviews.

The Impact of a Community-Based Serious Illness Care Program on Healthcare Utilization and Patient Care Experience.

Objective: Healthcare organizations are expanding community-based serious illness care programs to deliver care for homebound patients. Programs typically focus on home-based primary care or home-based palliative care, yet this population may require both services. We developed and evaluated a primary and palliative care program serving seriously ill older adults, called the Reaching Out to Enhance the Health of Adults in Their Communities and Homes (REACH) program.

Implementing Lean in Academic Primary Care.

Background: Lean is emerging as a quality improvement (QI) strategy in health care, but there has been minimal adoption in primary care teaching practices. This study describes a strategy for implementing Lean in an academic family medicine center and provides a formative assessment of this approach.

Methods: A case study of the University of North Carolina Family Medicine Center that used the Consolidated Framework for Implementation Research to guide a formative evaluation.

The Mid-Career Demon.

For several months I have been trying to tag a greyness that has shaded my doctoring. I was not burned out but uncovered the desert experience of mind and soul known as acedia, which is called the noonday demon because it vexes those in the mid-stages of life. Grappling with the noonday demon has upended all of my assumptions about the workings of hope in the practice of medicine.

Primary Care of Adults with Intellectual and Developmental Disabilities.

Most adults with intellectual and developmental disabilities receive care through primary care providers in their communities. An interdisciplinary approach that incorporates home- and community-based services is effective and can be facilitated by care managers in a medical home model. Preventive services should follow established guidelines as in the general population with some modifications, including regular monitoring of weight and height.

Enriching Patient-Centered Medical Homes Through Peer Support.

Peer supporters are recognized by various designations-community health workers, promotores de salud, lay health advisers-and are community members who work for pay or as volunteers in association with health care systems or nonprofit community organizations and often share ethnicity, language, and socioeconomic status with the mentees that they serve. Although emerging evidence demonstrates the efficacy of peer support at the community level, the adoption and implementation of this resource into patient-centered medical homes (PCMHs) is still under development. To accelerate that integration, this article addresses three major elements of peer support interventions: the functions and features of peer support, a framework and programmatic strategies for implementation, and fiscal models that would support the sustained viability of peer support programs within PCMHs.

A method to determine the impact of patient-centered care interventions in primary care.

Objective: The implementation of patient-centered care (PCC) innovations continues to be poorly understood. We used the implementation effectiveness framework to pilot a method for measuring the impact of a PCC innovation in primary care practices.

Methods: We analyzed data from a prior study that assessed the implementation of an electronic geriatric quality-of-life (QOL) module in 3 primary care practices in central North Carolina in 2011-2012.

Embedding care management in the medical home: a case study.

Introduction: Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach.

Methods: A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation.

Development and preliminary testing of the quality of spiritual care scale.

Context: The provision of spiritual care is considered a key element of hospice and palliative care, but there is a paucity of empirically developed quality-of-care measures in this domain.

Objectives: To describe the development and reliability and validity of the Quality of Spiritual Care (QSC) scale in family caregivers.

Methods: We conducted analyses of interviews conducted that included the QSC scale with family members of residents who died in long-term care settings taken after the resident had died.