Annals of Family Medicine最新文献

Purpose: Federal initiatives have encouraged collection of sexual orientation, gender identity, and differences of sex development data in national health surveys. Researchers use these data sets to identify health disparities faced by marginalized populations and shape primary care practices. We summarized the current state of sexual orientation, gender identity, and differences of sex development measures in federal health surveys to inform primary care researchers, outline gaps in data, and discussed their research implications.

Methods: We examined 10 large federal population-based health surveys and, using content analysis, summarized the composition and continuity of their sexual orientation, gender identity, and differences of sex development measures.

Results: Federal health surveys have longstanding measures of sexual orientation, with 4 having more than 10 years of data. Several surveys introduced gender identity questions over the last 2 years. Only 1 survey measured differences of sex development.

Conclusions: Federal surveys have robust sexual orientation measures, but more surveys including gender identity and differences of sex development (DSD)s are needed. The presence of sexual orientation and gender identity measures in these surveys could help identify primary care disparities among sexual and gender minority populations. Research using sexual orientation data benefits from standardization and continuity that has not yet been achieved for gender identity measures across these surveys. New federal restrictions may hamper further collection of sexual orientation and gender identity data. The absence of differences of sex development data places this population at risk of having their needs go unaddressed in primary care settings.

During the vulnerable, painful time around my diagnosis with a chronic illness, my physician shared with me a story from her own life. Her act of self-disclosure was profoundly impactful, reminding me that the gulf between myself and other people was not as vast as it felt. In this essay, I share my story and the conclusions I've drawn from it in the years since, using my tools as a philosopher and bioethicist. I explore what "patient-centered self-disclosure" might look like. I hope that these reflections might deepen our understanding of the intimacy and vulnerability of receiving medical care, and of the power of physician self-disclosure.

This narrative explores my experience as a family doctor deeply embedded in a rural community comprising 9 villages. The regional cemetery, a symbol of mortality, serves as a focal point for meditations on what it means to bear witness as a family doctor, depicting some of the joys and sorrows I have witnessed over the last quarter of a century serving this community. Grounded in the philosophy of "to cure-sometimes, to relieve-often, and to comfort-always," I underscore the importance of presence and compassion in family medicine, ultimately embracing mortality as a shared human journey that shapes both patients and their caregivers.

This study assessed changes in self-reported usual source of care (USC) across income groups and rural-urban settings after Affordable Care Act implementation, using 2010-2017 Medical Expenditure Panel Survey data. Multivariable regression estimated adjusted percentage changes in USC and reasons for lacking one. Usual source of care prevalence rose modestly (67% to 68%), with significant gains among low-income adults (+4.96% rural, +2.45% urban) and a small decline among urban high-income adults. Affordability-related barriers decreased, while accessibility and individual preference barriers increased. Findings suggest that insurance expansion alone may not ensure continuous care, especially given persistent non-financial access challenges.

My passion for geriatric medicine was inspired by the compassionate care I witnessed in my grandfather's clinic in Vijayanagar, Bangalore, India. His integral, empathetic approach to treating older adults profoundly shaped my own practice as a physician. This reflection explores pivotal moments in my journey to becoming a geriatrician, from my encounters with my grandfather's patients to applying his methods of sincere listening. Through this lens, I examine the challenges and rewards of maintaining empathy within the constraints of modern health care, while emphasizing the importance of preserving human connection.