Tip sheet and summaries Annals of Family Medicine March/April 2026
Original Research
Patients With Floaters or Flashes Could Face Higher Risk of Retinal Detachment
Background: Data from ophthalmology practices showed that experiencing newly emerging floaters in vision is more strongly associated with retinal tears than experiencing flashes. However, these associations have not been studied in primary care. In this study, researchers conducted a retrospective cohort study using electronic records from seven family practices in the Netherlands to examine whether patients presenting with floaters, flashes, or both had different risks of retinal detachment in primary care.
What They Found: Researchers reviewed 1,181 episodes of care between 2012 and 2021 involving adults with floaters or flashes. Retinal detachment occurred in 77 of these episodes. The absolute risk of retinal detachment was 6.1% among episodes with floaters alone, 4.7% among episodes with flashes alone, and 8.4% among episodes with both floaters and flashes. Episodes with new or recently changed acute floaters, more than 10 floaters, or floaters described as a cloud, haze, or curtain, showed higher relative risk compared with flashes alone. The most common final diagnoses were vitreous floaters without a specific disease diagnosis, posterior vitreous detachment, and migraine.
Implications: The study findings suggest that floaters, with or without flashes, are an important warning sign for retinal detachment.
Do Vitreous Floaters Predict Retinal Detachment? Retrospective Cohort Study in Primary Care
Floris A. van de Laar, MD, PhD, et al
Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
PRE-EMBARGO LINK (Temporary)
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Original Research
Clinical Trial Participants Prefer Community Paramedic Home Care Over Usual Care Pathways
Background: Researchers conducted a randomized clinical trial to test whether a program called Care Anywhere with Community Paramedics (CACP) could shorten or prevent hospital use. The study enrolled 240 adults receiving care through Mayo Clinic sites in Minnesota and Wisconsin. Study participants needed medical services that could be delivered by community paramedics at home but would have otherwise required hospital-based care. Participants were randomly assigned to receive either CACP care or usual care pathways. The primary outcome was days alive outside the hospital or emergency department within 30 days.
What They Found: The number of days alive outside the hospital or emergency department did not differ between groups. Participants receiving community paramedic care averaged 26.7 days, compared with 27.9 days for those receiving usual care. Rates of emergency department visits, unplanned hospitalizations, and death during the 30-day follow-up period also did not differ between groups. However, participants who received community paramedic care reported higher satisfaction with their care, and nearly all said they would recommend the program. Patients in both study groups preferred future care to be delivered in a home setting like the community paramedic program.
Implications: The CACP program, which enrolled highly complex patients with heterogeneous care needs, did not decrease 30-day acute care use compared with alternative usual care pathways, but it improved patient satisfaction and was preferred by most participants.
Effect of an Advanced Community Paramedic Program to Shorten or Prevent Hospitalizations: A Pragmatic, Point-of-Care, Randomized Clinical Trial
Rozalina G. McCoy, MD, MS, et al
University of Maryland Institute for Health Computing, North Bethesda, Maryland
PRE-EMBARGO LINK (Temporary)
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Original Research
Bleeding events largely outnumber thromboembolic events in patients with cancer during the last phase of life, most patients continue antithrombotic therapy
Background: Blood thinners can prevent strokes and blood clots, but they also increase bleeding risk. It is unclear whether patients with cancer continue to benefit from these medications during the final weeks of life. Researchers in the Netherlands examined blood thinner use and related events in people with cancer during this period using routine general practitioner (GP) records from 2018 to 2022. They analyzed data from 2,860 adults starting when the GP first registered palliative care and reviewed records until death or their last GP visit (median follow up period was about six weeks).
What They Found: Blood thinners were used by one third of the patients with cancer in the last phase of life. Only one in five patients discontinued treatment, usually shortly before death, with a median of eight days beforehand. The most recorded reason was the patient’s recognition of the final stage of life. Bleeding events were common in both groups. At least one bleeding episode occurred in 28.5% of patients taking blood thinners and in 22.0% of those not taking them. New blood clots were less common, with venous clots occurring in 3.1% of users and 3.0% of non-users. Arterial events such as stroke or heart attack were recorded in 2.5% and 1.9%, respectively. Bleeding was markedly under-recorded in diagnosis codes compared with manual review (3.7% coded vs 28.5% manually identified among users).
Implications: These findings provide a detailed picture of antithrombotic management in primary care near the end of life.
Antithrombotic Therapy Discontinuation, Bleeding, and Thromboembolic Events in Patients With Cancer During the Last Phase of Life: Insights From Primary Care Records
Denise Abbel, MSc, et al
Department of Medicine, section of Gerontology and Geriatrics, Leiden University Medical
Center, Leiden, The Netherlands
Department of Medicine, section of Thrombosis and Hemostasis, Leiden University Medical
Center, Leiden, The Netherlands
LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The
Netherlands
PRE-EMBARGO LINK (Temporary)
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Original Research
Isolation and Financial Hardship Linked With Lower Odds of Receiving Preventive Health Care in the U.S.
Background: Researchers analyzed data from the U.S. Behavioral Risk Factor Surveillance System, a national telephone survey, to better understand how social isolation and physical isolation intersect with material deprivation, including financial strain and inadequate health care access. The study examined six preventive services: COVID-19, flu and pneumococcal vaccination, and breast, cervical, and colorectal cancer screenings.
What They Found:
Implications: These findings suggest that financial hardship explains part of the relationship between isolation and preventive care use and highlight the importance of attending social and physical isolation alongside material needs when counseling patients about prevention.
Associations of Social and Physical Isolation With Material Deprivation and Inadequate Use of Preventive Care in the United States
Jacob Riegler, MD, MBA, MSBE, et al
Cambridge Health Alliance, Department of Internal Medicine, Cambridge, Massachusetts
Harvard Medical School, Cambridge, Massachusetts
Brigham and Women’s Hospital, Boston, Massachusetts
PRE-EMBARGO LINK (Temporary)
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Original Research
Primary Care Continuity Remained High in Community Health Centers Despite COVID-19 Disruptions
Background: Continuity of care — seeing one’s own primary care clinician for most visits — is a basic tenet of primary care. This study examined continuity trends from 2019 through 2023 in a national sample of community-based health centers spanning the period before, during, and after the COVID-19 pandemic. Researchers used OCHIN Epic electronic health record (EHR) data to measure continuity among patients using the Usual Provider of Care (UPC) index (the proportion of visits with a patient’s most frequently seen clinician). A score of 1 means all visits were with the same clinician.
What They Found: High rates of continuity were consistently observed over the five-year period: Among an annual average of 353,608 patients seen in an average of 186 community health centers, the median UPC score was 1 in each year. The average score dipped slightly in 2020 (0.822) at the start of the pandemic, then rebounded to levels slightly above the 2019 rate (0.825). In 2023, adults were more likely to have perfect continuity if they were older or had income above 138% of the Federal Poverty Line. Lower rates of continuity were associated with female gender, Hispanic ethnicity, Black/African American race, having multiple chronic conditions, telehealth use, and receiving care at large clinics. Among children, lower rates of continuity were associated with Hispanic ethnicity, telehealth use, and receiving care at high-volume clinics.
Implications: The high rates of continuity suggest that community health centers and their patients sustained strong patient-clinician relationships despite the disruptions of the COVID-19 pandemic and identify opportunities to improve continuity of care.
Continuity of Primary Care in Community Health Centers
Kurt C. Stange, MD, PhD, et al
Center for Community Health Integration, Departments of Family Medicine & Community
Health, Population and Quantitative Health Sciences, and Sociology, Case Western Reserve
University, Cleveland, Ohio
PRE-EMBARGO LINK (Temporary)
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Original Research
Care Team Continuity, Flexibility and Collaboration Benefits Whole-Person Care for Patients With Multiple Long-Term Conditions
Background: Research and policy have called for a shift toward whole-person primary care for people living with multimorbidity, defined as the presence of two or more chronic conditions. Researchers in the United Kingdom (UK) observed 25 general practitioner-patient consultations across five practices, and conducted six focus groups — four with 16 primary care staff members and two with eight patients and care staff members— to identify enablers and barriers to delivering tailored care.
What They Found: The researchers found that clinicians assess patients in context, allowing more time when possible, sometimes drawing on home visits or information from carers to understand how patients manage their conditions. Second, patients and caregivers develop management plans collaboratively, with both groups participating in decisions and coordinating across clinicians and services. Third, clinicians described developing new skills and confidence to move beyond disease-specific guidelines toward more holistic conversations about priorities and overall well-being. Clinicians said tailored care was easier when teams had continuity, flexibility and strong collaboration. Tailored care was harder when consultations were short, services were fragmented or care remained tightly structured around single-disease models.
Implications: The findings suggest that delivering whole-person care for patients with multimorbidity requires changes to how primary care is organized and practiced.
Person-Centred Multimorbidity Care in UK Primary Care: Identifying Changes to Practice
Molly Megson, MSc, et al
Hull York Medical School, University of Hull, Hull, United Kingdom
PRE-EMBARGO LINK (Temporary)
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Original Research
Study Explores Frameworks for Improved Indigenous Data Sovereignty
Background: In Canada, current approaches to managing health data do not always reflect principles of Indigenous data sovereignty, which emphasize Indigenous peoples’ rights to control how data about their communities are collected, used, and shared. This study examined how practice-based research and learning networks (PBRLNs) currently approach data governance and explored how Indigenous data sovereignty frameworks could apply. Researchers conducted a cross-sectional survey of leaders from Canadian PBRLNs and reviewed published frameworks describing Indigenous data sovereignty principles.
What They Found: Eleven of 15 Canadian PBRLN leaders responded to the survey. Although several networks reported having organizational or data governance policies, only one reported applying Indigenous data sovereignty principles. Most respondents were unsure whether their network did so. Respondents identified the importance of building knowledge of Indigenous data sovereignty within PBRLNs, having resources specifically dedicated to advance Indigenous data sovereignty, and understanding ways to do this. Common framework ideas included relational, collective benefits and action, respect for Indigenous ways of knowing and space for co-learning, relevance to communities and places, access to data, building capacity, and ethical sustainment.
Implications: Even though PBRLNs in Canada are not yet incorporating Indigenous data sovereignty principles, existing Indigenous governance frameworks provide guidance on how to begin.
Integrating Indigenous Data Sovereignty Principles Into Learning Health Systems: Survey of Canadian PBRLNs and Framework Analysis
Brianne Wood, PhD, et al
Dr. Gilles Arcand Centre for Health Equity, NOSM University, Thunder Bay, Ontario, Canada
Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario, Canada
PRE-EMBARGO LINK (Temporary)
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Original Research
Integrating Social Risk Alerts Into Primary Care Workflows May Improve Blood Pressure Control
Background: Screening for social risks has expanded in recent years. However, less is known about how integrating social risk information into clinical workflows influences patient outcomes. The study was conducted in the OCHIN network, a national consultancy for community health care organizations. Six clinics implemented the intervention; 44 clinics served as controls and were followed for 12 months.
What They Found: The intervention included electronic health record-integrated alerts identifying patients overdue for social risk screening and decision-support prompts to care teams. The alerts were for adults with uncontrolled hypertension, uncontrolled diabetes, or visit no-show rates of 50% or higher, with some alerts prompting clinicians to consider medication affordability and adherence barriers. Blood pressure control over time improved in both groups. The odds of blood pressure control increased over time in intervention clinics compared with control clinics. There was no statistically significant difference in blood sugar (Hemoglobin A1c) control between groups. Intervention clinics were significantly more likely to complete social risk screenings and document social risks using Z-codes.
Implications: This trial adds evidence that integrating social risk information into primary care workflows may be associated with modest improvements in hypertension control.
Social Risk–Informed Decision Support and Blood Pressure Control in a Primary Care Cluster R
andomized Controlled Trial
Brenda M. McGrath, PhD, et al
OCHIN, Inc, Portland, Oregon
EARLY ACCESS
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Research Brief
Lonely Patients May Feel Misunderstood By Their Doctor and Less Confident Managing Their Health
Background: Loneliness is increasingly recognized as a health concern and has been linked to poorer physical and mental health. Researchers surveyed 2,673 adult patients from a primary care practice in Ontario, Canada. Participants completed the three-item UCLA Loneliness Scale and answered questions about aspects of their care experience. Statistical models examined whether loneliness was associated with patients’ ratings of these experiences.
What They Found: People who felt lonely reported worse experiences with their health care in almost every area measured. Compared to people who didn't feel lonely, those who felt lonely were less likely to say their clinician listened carefully or understood them. They were also less likely to feel that their care was coordinated, that someone followed up to make sure needed care was received, and that they felt confident managing their health. Loneliness was not associated with reports about the timeliness of access to a clinician.
Implications: These findings suggest that loneliness may shape how patients experience interpersonal aspects of primary care, such as communication and support.
Association Between Loneliness and Patient Experience in a Primary Health Care Setting
Walter P. Wodchis, PhD, et al
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Institute for Better Health, Trillium Health Partners, Ontario, Canada
PRE-EMBARGO LINK (Temporary)
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Methodology
Joint Display Method for Patient Surveys Reveals Deeper Insights Into Patient Satisfaction
Background: Many patient surveys include both numerical ratings and written comments, responses that are frequently analyzed separately, which can limit what researchers learn from the data. This report demonstrates a method for analyzing survey ratings and open-text comments together. Researchers used survey data from Alberta, Canada’s Long COVID Interprofessional Outpatient Program (IPOP), which provided multidisciplinary care for adults with COVID-19 infection and symptoms lasting at least 12 weeks.
What They Found: A total of 360 surveys were completed by 306 patients across three IPOP clinics. Overall satisfaction scores were high, with the following results::
Implications: For this long COVID program evaluation, pairing satisfaction scores with open-text comments gave a fuller view of patient experience than scores alone.
When High Scores Hide Realities: Enhancing Patient Survey Data Through Joint Display
Meaghan Brierley, PhD, et al
Health Systems Knowledge and Evaluation, Acute Care Alberta, Edmonton, Alberta, Canada
PRE-EMBARGO LINK (Temporary)
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Innovations In Primary Care
Chaplain Support at Primary Care Buprenorphine Clinic Addresses Mental Health Needs of Patients
Medication treatment with buprenorphine is widely used for opioid use disorder. Yet many people early in recovery experience emotional distress, social isolation, and difficulty finding meaning or rebuilding relationships. This report describes a team-based buprenorphine clinic within an academic family medicine residency practice that incorporated a clinically trained chaplain into patient care. The weekly half-day clinic began seeing patients in June 2022 and, by October 2025, had conducted 236 visits with 48 unique patients. Care is delivered by family medicine clinicians, nursing staff, and a chaplain trained in recovery coaching. During visits, the chaplain provides a psychologically safe space for conversation, supports patients in telling their stories, and works with them to identify “recovery capital,” or personal strengths and resources that may support recovery. Chaplain encounters also focus on how patients interpret their experiences and on emotional or spiritual distress related to substance use. Clinic staff reported that collaboration between medical and spiritual care providers produced more detailed patient histories and shared learning within the care team. As of October 2025, eight patients had achieved at least 12 months of sobriety—the clinic’s general benchmark for success—and were transitioned back to their primary care physician for ongoing medication and recovery management. Other patients are continuing to receive care through the clinic.
Leveraging the Role of Chaplaincy to Enhance Care for Patients With Opioid Use Disorder
April D. Newton, PT, DPT, PhD, et al
School of Medicine, Indiana University, Indianapolis, Indiana
PRE-EMBARGO LINK (Temporary)
There will be an accompanying episode of the Annals of Family Medicine podcast with Dr. Seth Hunter and Chaplain Dustin Hite available Tuesday, March 24, 2026, at 10am ET here
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Innovations in Primary Care
Innovative Panel Management Strategy Benefits Patients Who Need More Intensive Primary Care
Primary care panel sizes are often determined without detailed data on patient complexity, which can strain access to care and contribute to clinician burnout. Geisinger Health System used Charlson Comorbidity Health Analytics (CCHA) and Needs-Based Segmentation (NBS) tools to support complexity-based panel management across 45 primary care clinics serving more than 350,000 patients. CCHA estimates the likelihood of high health care costs or unplanned utilization based on chronic conditions, while NBS groups patients by their level of ambulatory care need. These tools were integrated into the electronic health record to assign each patient a CCHA score and NBS category. Using this information, Geisinger clinicians first decided how long visits should be and how often patients with more complex conditions should be seen. Researchers from the University of Chicago then used optimization modeling to test how scheduling factors—such as visit duration, visit frequency, and appointment types—could inform panel size. Using these tools allowed the health system to shift from scheduling appointment length based on patient age to scheduling based on clinical complexity. This approach helped focus limited resources, reduce variability in care, and prioritize continuity and visit frequency for patients who may benefit from more intensive primary care.
Charlson Comorbidity Health Analytics (CCHA) and Needs-Based Segmentation (NBS): A Strategy for Managing Primary Care Panel Complexity
Bobbie Johannes, PhD, MPH, et al
Department of Population Health Sciences, Geisinger College of Health Sciences, Danville, Pennsylvania
PRE-EMBARGO LINK (Temporary)
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Innovations In Primary Care
Family Medicine Practice Redesigns Patient Dismissal Process
Clinicians at an academic family medicine practice in upstate New York serving more than 25,000 patients revised their patient dismissal process after a review found that all immediate dismissals during a six-month period involved Black patients, who represent about 36% of the practice population. The clinic replaced the expedited dismissal approach with a structured review process led by an interdisciplinary Practice Concerns Review Committee. Rather than defaulting to warning letters or dismissal, the new approach centers patient engagement, shared problem solving, collaborative planning, and early intervention. Strategies include offering one-time clinician changes and scripting communications while equipping the team with tools for boundary setting and difficult conversations. The authors compared behavior-concern referrals reviewed during a six-month pre-intervention period (January–June 2021) with the same six-month period after implementation (January–June 2023). Referrals declined from 87 to 24. No immediate dismissals occurred in the later period, and no racial disproportionality was observed. The redesign created time for team reflection and more consistent responses while dismissal remained an option for threats of violence or repeated concerns.
A Team-Based Approach to Fair and Patient-Centered Dismissals in Family Medicine
Traci C. Terrance, PhD, LCSW, et al
University of Rochester Medical Center, Rochester, New York
PRE-EMBARGO LINK (Temporary)
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Editorial
Family Medicine is Uniquely Poised to Address the Growing Loneliness Epidemic
A 2023 U.S. Surgeon General’s Advisory on Loneliness and Isolation highlighted its link to premature mortality, likening its health impact to smoking up to 15 cigarettes a day. The authors argue that family medicine is uniquely poised to address the growing loneliness epidemic because the specialty is grounded in continuous, comprehensive, and relationship-centered care for individuals, families, and communities across their lifespan. The authors highlight two studies published in this issue of Annals of Family Medicine regarding loneliness and isolation and call for implementing interventions and evidence-based screening tools that capture the multiple dimensions of loneliness and in primary care.
Loneliness in Primary Care Patients—From Understanding the Risk to Actionable Clinical Priority
Sebastian T. Tong, MD, MPH
Brennan Keiser, MSW
Department of Family Medicine, University of Washington, Seattle, Washington
PRE-EMBARGO LINK (Temporary)
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Essay
Family Physician Describes the Joys and Challenges of Extended Partial Parental Leave “Dad Days”
In this essay, a family physician describes how academic medicine can promote better work–life harmony for physician parents. After reviewing institutional policy and planning carefully, the author proposed and was granted a year of partial parental leave, consisting of two “dad days” each week. The arrangement allowed the author to bond more deeply with his newborn child, share domestic responsibilities and strengthen his marriage. His personal life was enriched by the arrangement, but he also describes professional trade-offs, including missed meetings, delayed work, and reduced continuity for patients. Drawing on research about paid parental leave, he argues that academic medicine should support flexible parental leave policies so physicians can meet family needs without leaving academia or reducing their work effort.
Dad Days: The Joys and Challenges of Extended Partial Parental Leave
Brandon H. Hidaka, MD, PhD
Department of Family Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin
PRE-EMBARGO LINK (Temporary)
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Essay
Listening to a Patient Led This Physician to Rare Diagnosis of Tick-Borne "Cave Fever” Illness
In this essay, a family physician describes a teenage patient whose illness first appeared to be a routine viral infection. Her fever improved but returned twice over the following weeks, once with joint pain and a rash, while laboratory results remained nearly normal. Concerned, the physician revisited the patient’s history and recalled Sir William Osler’s advice: “Listen to the patient. They are telling you the diagnosis.” The patient then mentioned leading children on a hike through caves in the Judean Lowlands, where ticks carrying Borrelia persica live. The exposure explained the recurring fevers. The author illustrates how careful listening and local knowledge can reveal patterns others might easily miss.
Listen to the Patient—She is Telling You the Diagnosis
Ruth Kannai, MD
Siaal Research Center for Family Medicine and Primary care, Department of Family Medicine, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
PRE-EMBARGO LINK (Temporary)
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Essay
Genetic Test Seemed to Explain Child’s Short Stature, But Family Testing Told a Different Story
In this essay, a pediatrician reflects on a case in which a genetic variant (1q21.1 deletion) appeared to explain a child’s short stature, but family testing later contradicted that interpretation. For example, some short relatives lacked the deletion, while a taller cousin carried it. The patient’s response to growth hormone pointed to treatable growth hormone deficiency, not a genetic syndrome. The experience led the author to reconsider how genomic results are interpreted and communicated and realize “how quickly precision can seduce us into premature closure.” After that visit, the author changed three aspects of practice. When ordering genomic tests, the author emphasizes uncertainty during pre-test counseling and explains that genetic findings may require family testing before their meaning is clear. When reviewing results with families, the author begins with the child—their growth, energy, school, play—before discussing the genetic report. The author also begins practicing “delabeling,” removing diagnoses that no longer fit the evidence and explaining to families why a previous label is being revised.
Diagnoses Live in Relationships: Bedside Sense in the Age of Precision Medicine
Chunlin Wang, MD, et al
The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
PRE-EMBARGO LINK (Temporary)
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Essay
Small Rituals of Patient Attention Help Maintain Presence in Care
The author, a medical student at the All India Institute of Medical Sciences in New Delhi, India, argues that small intentional rituals help preserve humanity and presence in clinical care, especially in high-pressure medical environments. Through several patient encounters, the author describes how ordinary clinical acts such as handwashing, listening, adjusting a blanket, and staying with a grieving patient can become rituals of attention that anchor clinicians and patients in moments of care. The author presents these rituals not as distractions from medical work but instead as practices that prevent detachment and maintain compassionate care.
From Rush to Ritual: Restoring the Sacred in Daily Care
Vangipuram Harshil Sai
All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, India
PRE-EMBARGO LINK (Temporary)
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END
Patients With Floaters or Flashes Could Face Higher Risk of Retinal Detachment
Background: Data from ophthalmology practices showed that experiencing newly emerging floaters in vision is more strongly associated with retinal tears than experiencing flashes. However, these associations have not been studied in primary care. In this study, researchers conducted a retrospective cohort study using electronic records from seven family practices in the Netherlands to examine whether patients presenting with floaters, flashes, or both had different risks of retinal detachment in primary care.
What They Found: Researchers reviewed 1,181 episodes of care between 2012 and 2021 involving adults with floaters or flashes. Retinal detachment occurred in 77 of these episodes. The absolute risk of retinal detachment was 6.1% among episodes with floaters alone, 4.7% among episodes with flashes alone, and 8.4% among episodes with both floaters and flashes. Episodes with new or recently changed acute floaters, more than 10 floaters, or floaters described as a cloud, haze, or curtain, showed higher relative risk compared with flashes alone. The most common final diagnoses were vitreous floaters without a specific disease diagnosis, posterior vitreous detachment, and migraine.
Implications: The study findings suggest that floaters, with or without flashes, are an important warning sign for retinal detachment.
Do Vitreous Floaters Predict Retinal Detachment? Retrospective Cohort Study in Primary Care
Floris A. van de Laar, MD, PhD, et al
Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
PRE-EMBARGO LINK (Temporary)
_____________________________________________________________________________
Original Research
Clinical Trial Participants Prefer Community Paramedic Home Care Over Usual Care Pathways
Background: Researchers conducted a randomized clinical trial to test whether a program called Care Anywhere with Community Paramedics (CACP) could shorten or prevent hospital use. The study enrolled 240 adults receiving care through Mayo Clinic sites in Minnesota and Wisconsin. Study participants needed medical services that could be delivered by community paramedics at home but would have otherwise required hospital-based care. Participants were randomly assigned to receive either CACP care or usual care pathways. The primary outcome was days alive outside the hospital or emergency department within 30 days.
What They Found: The number of days alive outside the hospital or emergency department did not differ between groups. Participants receiving community paramedic care averaged 26.7 days, compared with 27.9 days for those receiving usual care. Rates of emergency department visits, unplanned hospitalizations, and death during the 30-day follow-up period also did not differ between groups. However, participants who received community paramedic care reported higher satisfaction with their care, and nearly all said they would recommend the program. Patients in both study groups preferred future care to be delivered in a home setting like the community paramedic program.
Implications: The CACP program, which enrolled highly complex patients with heterogeneous care needs, did not decrease 30-day acute care use compared with alternative usual care pathways, but it improved patient satisfaction and was preferred by most participants.
Effect of an Advanced Community Paramedic Program to Shorten or Prevent Hospitalizations: A Pragmatic, Point-of-Care, Randomized Clinical Trial
Rozalina G. McCoy, MD, MS, et al
University of Maryland Institute for Health Computing, North Bethesda, Maryland
PRE-EMBARGO LINK (Temporary)
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Original Research
Bleeding events largely outnumber thromboembolic events in patients with cancer during the last phase of life, most patients continue antithrombotic therapy
Background: Blood thinners can prevent strokes and blood clots, but they also increase bleeding risk. It is unclear whether patients with cancer continue to benefit from these medications during the final weeks of life. Researchers in the Netherlands examined blood thinner use and related events in people with cancer during this period using routine general practitioner (GP) records from 2018 to 2022. They analyzed data from 2,860 adults starting when the GP first registered palliative care and reviewed records until death or their last GP visit (median follow up period was about six weeks).
What They Found: Blood thinners were used by one third of the patients with cancer in the last phase of life. Only one in five patients discontinued treatment, usually shortly before death, with a median of eight days beforehand. The most recorded reason was the patient’s recognition of the final stage of life. Bleeding events were common in both groups. At least one bleeding episode occurred in 28.5% of patients taking blood thinners and in 22.0% of those not taking them. New blood clots were less common, with venous clots occurring in 3.1% of users and 3.0% of non-users. Arterial events such as stroke or heart attack were recorded in 2.5% and 1.9%, respectively. Bleeding was markedly under-recorded in diagnosis codes compared with manual review (3.7% coded vs 28.5% manually identified among users).
Implications: These findings provide a detailed picture of antithrombotic management in primary care near the end of life.
Antithrombotic Therapy Discontinuation, Bleeding, and Thromboembolic Events in Patients With Cancer During the Last Phase of Life: Insights From Primary Care Records
Denise Abbel, MSc, et al
Department of Medicine, section of Gerontology and Geriatrics, Leiden University Medical
Center, Leiden, The Netherlands
Department of Medicine, section of Thrombosis and Hemostasis, Leiden University Medical
Center, Leiden, The Netherlands
LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The
Netherlands
PRE-EMBARGO LINK (Temporary)
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Original Research
Isolation and Financial Hardship Linked With Lower Odds of Receiving Preventive Health Care in the U.S.
Background: Researchers analyzed data from the U.S. Behavioral Risk Factor Surveillance System, a national telephone survey, to better understand how social isolation and physical isolation intersect with material deprivation, including financial strain and inadequate health care access. The study examined six preventive services: COVID-19, flu and pneumococcal vaccination, and breast, cervical, and colorectal cancer screenings.
What They Found:
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Among 281,582 adults, 31.9% reported social isolation and 8.2% reported physical isolation, with the two types of isolation often overlapping; Researchers found that 63.9% of physically isolated individuals were socially isolated vs. 29.0% of those who were not physically isolated. Both types of isolation were more common among lower-income adults and declined steadily as income increased. Both forms of isolation were associated with material deprivation. For example, 82.1% of physically isolated adults, compared with 30.9% of those who did not report physical isolation, experienced hardship, including food insecurity, trouble paying housing or utility bills, and potential utility shutoff.
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In unadjusted analyses, both forms of isolation were associated with lower odds of receiving most preventive health services. After adjusting for socioeconomic factors, many of these associations became smaller or were no longer statistically significant.
Implications: These findings suggest that financial hardship explains part of the relationship between isolation and preventive care use and highlight the importance of attending social and physical isolation alongside material needs when counseling patients about prevention.
Associations of Social and Physical Isolation With Material Deprivation and Inadequate Use of Preventive Care in the United States
Jacob Riegler, MD, MBA, MSBE, et al
Cambridge Health Alliance, Department of Internal Medicine, Cambridge, Massachusetts
Harvard Medical School, Cambridge, Massachusetts
Brigham and Women’s Hospital, Boston, Massachusetts
PRE-EMBARGO LINK (Temporary)
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Original Research
Primary Care Continuity Remained High in Community Health Centers Despite COVID-19 Disruptions
Background: Continuity of care — seeing one’s own primary care clinician for most visits — is a basic tenet of primary care. This study examined continuity trends from 2019 through 2023 in a national sample of community-based health centers spanning the period before, during, and after the COVID-19 pandemic. Researchers used OCHIN Epic electronic health record (EHR) data to measure continuity among patients using the Usual Provider of Care (UPC) index (the proportion of visits with a patient’s most frequently seen clinician). A score of 1 means all visits were with the same clinician.
What They Found: High rates of continuity were consistently observed over the five-year period: Among an annual average of 353,608 patients seen in an average of 186 community health centers, the median UPC score was 1 in each year. The average score dipped slightly in 2020 (0.822) at the start of the pandemic, then rebounded to levels slightly above the 2019 rate (0.825). In 2023, adults were more likely to have perfect continuity if they were older or had income above 138% of the Federal Poverty Line. Lower rates of continuity were associated with female gender, Hispanic ethnicity, Black/African American race, having multiple chronic conditions, telehealth use, and receiving care at large clinics. Among children, lower rates of continuity were associated with Hispanic ethnicity, telehealth use, and receiving care at high-volume clinics.
Implications: The high rates of continuity suggest that community health centers and their patients sustained strong patient-clinician relationships despite the disruptions of the COVID-19 pandemic and identify opportunities to improve continuity of care.
Continuity of Primary Care in Community Health Centers
Kurt C. Stange, MD, PhD, et al
Center for Community Health Integration, Departments of Family Medicine & Community
Health, Population and Quantitative Health Sciences, and Sociology, Case Western Reserve
University, Cleveland, Ohio
PRE-EMBARGO LINK (Temporary)
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Original Research
Care Team Continuity, Flexibility and Collaboration Benefits Whole-Person Care for Patients With Multiple Long-Term Conditions
Background: Research and policy have called for a shift toward whole-person primary care for people living with multimorbidity, defined as the presence of two or more chronic conditions. Researchers in the United Kingdom (UK) observed 25 general practitioner-patient consultations across five practices, and conducted six focus groups — four with 16 primary care staff members and two with eight patients and care staff members— to identify enablers and barriers to delivering tailored care.
What They Found: The researchers found that clinicians assess patients in context, allowing more time when possible, sometimes drawing on home visits or information from carers to understand how patients manage their conditions. Second, patients and caregivers develop management plans collaboratively, with both groups participating in decisions and coordinating across clinicians and services. Third, clinicians described developing new skills and confidence to move beyond disease-specific guidelines toward more holistic conversations about priorities and overall well-being. Clinicians said tailored care was easier when teams had continuity, flexibility and strong collaboration. Tailored care was harder when consultations were short, services were fragmented or care remained tightly structured around single-disease models.
Implications: The findings suggest that delivering whole-person care for patients with multimorbidity requires changes to how primary care is organized and practiced.
Person-Centred Multimorbidity Care in UK Primary Care: Identifying Changes to Practice
Molly Megson, MSc, et al
Hull York Medical School, University of Hull, Hull, United Kingdom
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Original Research
Study Explores Frameworks for Improved Indigenous Data Sovereignty
Background: In Canada, current approaches to managing health data do not always reflect principles of Indigenous data sovereignty, which emphasize Indigenous peoples’ rights to control how data about their communities are collected, used, and shared. This study examined how practice-based research and learning networks (PBRLNs) currently approach data governance and explored how Indigenous data sovereignty frameworks could apply. Researchers conducted a cross-sectional survey of leaders from Canadian PBRLNs and reviewed published frameworks describing Indigenous data sovereignty principles.
What They Found: Eleven of 15 Canadian PBRLN leaders responded to the survey. Although several networks reported having organizational or data governance policies, only one reported applying Indigenous data sovereignty principles. Most respondents were unsure whether their network did so. Respondents identified the importance of building knowledge of Indigenous data sovereignty within PBRLNs, having resources specifically dedicated to advance Indigenous data sovereignty, and understanding ways to do this. Common framework ideas included relational, collective benefits and action, respect for Indigenous ways of knowing and space for co-learning, relevance to communities and places, access to data, building capacity, and ethical sustainment.
Implications: Even though PBRLNs in Canada are not yet incorporating Indigenous data sovereignty principles, existing Indigenous governance frameworks provide guidance on how to begin.
Integrating Indigenous Data Sovereignty Principles Into Learning Health Systems: Survey of Canadian PBRLNs and Framework Analysis
Brianne Wood, PhD, et al
Dr. Gilles Arcand Centre for Health Equity, NOSM University, Thunder Bay, Ontario, Canada
Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario, Canada
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Original Research
Integrating Social Risk Alerts Into Primary Care Workflows May Improve Blood Pressure Control
Background: Screening for social risks has expanded in recent years. However, less is known about how integrating social risk information into clinical workflows influences patient outcomes. The study was conducted in the OCHIN network, a national consultancy for community health care organizations. Six clinics implemented the intervention; 44 clinics served as controls and were followed for 12 months.
What They Found: The intervention included electronic health record-integrated alerts identifying patients overdue for social risk screening and decision-support prompts to care teams. The alerts were for adults with uncontrolled hypertension, uncontrolled diabetes, or visit no-show rates of 50% or higher, with some alerts prompting clinicians to consider medication affordability and adherence barriers. Blood pressure control over time improved in both groups. The odds of blood pressure control increased over time in intervention clinics compared with control clinics. There was no statistically significant difference in blood sugar (Hemoglobin A1c) control between groups. Intervention clinics were significantly more likely to complete social risk screenings and document social risks using Z-codes.
Implications: This trial adds evidence that integrating social risk information into primary care workflows may be associated with modest improvements in hypertension control.
Social Risk–Informed Decision Support and Blood Pressure Control in a Primary Care Cluster R
andomized Controlled Trial
Brenda M. McGrath, PhD, et al
OCHIN, Inc, Portland, Oregon
EARLY ACCESS
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Research Brief
Lonely Patients May Feel Misunderstood By Their Doctor and Less Confident Managing Their Health
Background: Loneliness is increasingly recognized as a health concern and has been linked to poorer physical and mental health. Researchers surveyed 2,673 adult patients from a primary care practice in Ontario, Canada. Participants completed the three-item UCLA Loneliness Scale and answered questions about aspects of their care experience. Statistical models examined whether loneliness was associated with patients’ ratings of these experiences.
What They Found: People who felt lonely reported worse experiences with their health care in almost every area measured. Compared to people who didn't feel lonely, those who felt lonely were less likely to say their clinician listened carefully or understood them. They were also less likely to feel that their care was coordinated, that someone followed up to make sure needed care was received, and that they felt confident managing their health. Loneliness was not associated with reports about the timeliness of access to a clinician.
Implications: These findings suggest that loneliness may shape how patients experience interpersonal aspects of primary care, such as communication and support.
Association Between Loneliness and Patient Experience in a Primary Health Care Setting
Walter P. Wodchis, PhD, et al
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Institute for Better Health, Trillium Health Partners, Ontario, Canada
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Methodology
Joint Display Method for Patient Surveys Reveals Deeper Insights Into Patient Satisfaction
Background: Many patient surveys include both numerical ratings and written comments, responses that are frequently analyzed separately, which can limit what researchers learn from the data. This report demonstrates a method for analyzing survey ratings and open-text comments together. Researchers used survey data from Alberta, Canada’s Long COVID Interprofessional Outpatient Program (IPOP), which provided multidisciplinary care for adults with COVID-19 infection and symptoms lasting at least 12 weeks.
What They Found: A total of 360 surveys were completed by 306 patients across three IPOP clinics. Overall satisfaction scores were high, with the following results::
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45% of respondents reported being very satisfied with their most recent visit
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29% were satisfied
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11% were neutral
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8% were unsatisfied
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7% were very unsatisfied
Implications: For this long COVID program evaluation, pairing satisfaction scores with open-text comments gave a fuller view of patient experience than scores alone.
When High Scores Hide Realities: Enhancing Patient Survey Data Through Joint Display
Meaghan Brierley, PhD, et al
Health Systems Knowledge and Evaluation, Acute Care Alberta, Edmonton, Alberta, Canada
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Innovations In Primary Care
Chaplain Support at Primary Care Buprenorphine Clinic Addresses Mental Health Needs of Patients
Medication treatment with buprenorphine is widely used for opioid use disorder. Yet many people early in recovery experience emotional distress, social isolation, and difficulty finding meaning or rebuilding relationships. This report describes a team-based buprenorphine clinic within an academic family medicine residency practice that incorporated a clinically trained chaplain into patient care. The weekly half-day clinic began seeing patients in June 2022 and, by October 2025, had conducted 236 visits with 48 unique patients. Care is delivered by family medicine clinicians, nursing staff, and a chaplain trained in recovery coaching. During visits, the chaplain provides a psychologically safe space for conversation, supports patients in telling their stories, and works with them to identify “recovery capital,” or personal strengths and resources that may support recovery. Chaplain encounters also focus on how patients interpret their experiences and on emotional or spiritual distress related to substance use. Clinic staff reported that collaboration between medical and spiritual care providers produced more detailed patient histories and shared learning within the care team. As of October 2025, eight patients had achieved at least 12 months of sobriety—the clinic’s general benchmark for success—and were transitioned back to their primary care physician for ongoing medication and recovery management. Other patients are continuing to receive care through the clinic.
Leveraging the Role of Chaplaincy to Enhance Care for Patients With Opioid Use Disorder
April D. Newton, PT, DPT, PhD, et al
School of Medicine, Indiana University, Indianapolis, Indiana
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There will be an accompanying episode of the Annals of Family Medicine podcast with Dr. Seth Hunter and Chaplain Dustin Hite available Tuesday, March 24, 2026, at 10am ET here
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Innovations in Primary Care
Innovative Panel Management Strategy Benefits Patients Who Need More Intensive Primary Care
Primary care panel sizes are often determined without detailed data on patient complexity, which can strain access to care and contribute to clinician burnout. Geisinger Health System used Charlson Comorbidity Health Analytics (CCHA) and Needs-Based Segmentation (NBS) tools to support complexity-based panel management across 45 primary care clinics serving more than 350,000 patients. CCHA estimates the likelihood of high health care costs or unplanned utilization based on chronic conditions, while NBS groups patients by their level of ambulatory care need. These tools were integrated into the electronic health record to assign each patient a CCHA score and NBS category. Using this information, Geisinger clinicians first decided how long visits should be and how often patients with more complex conditions should be seen. Researchers from the University of Chicago then used optimization modeling to test how scheduling factors—such as visit duration, visit frequency, and appointment types—could inform panel size. Using these tools allowed the health system to shift from scheduling appointment length based on patient age to scheduling based on clinical complexity. This approach helped focus limited resources, reduce variability in care, and prioritize continuity and visit frequency for patients who may benefit from more intensive primary care.
Charlson Comorbidity Health Analytics (CCHA) and Needs-Based Segmentation (NBS): A Strategy for Managing Primary Care Panel Complexity
Bobbie Johannes, PhD, MPH, et al
Department of Population Health Sciences, Geisinger College of Health Sciences, Danville, Pennsylvania
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Innovations In Primary Care
Family Medicine Practice Redesigns Patient Dismissal Process
Clinicians at an academic family medicine practice in upstate New York serving more than 25,000 patients revised their patient dismissal process after a review found that all immediate dismissals during a six-month period involved Black patients, who represent about 36% of the practice population. The clinic replaced the expedited dismissal approach with a structured review process led by an interdisciplinary Practice Concerns Review Committee. Rather than defaulting to warning letters or dismissal, the new approach centers patient engagement, shared problem solving, collaborative planning, and early intervention. Strategies include offering one-time clinician changes and scripting communications while equipping the team with tools for boundary setting and difficult conversations. The authors compared behavior-concern referrals reviewed during a six-month pre-intervention period (January–June 2021) with the same six-month period after implementation (January–June 2023). Referrals declined from 87 to 24. No immediate dismissals occurred in the later period, and no racial disproportionality was observed. The redesign created time for team reflection and more consistent responses while dismissal remained an option for threats of violence or repeated concerns.
A Team-Based Approach to Fair and Patient-Centered Dismissals in Family Medicine
Traci C. Terrance, PhD, LCSW, et al
University of Rochester Medical Center, Rochester, New York
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Editorial
Family Medicine is Uniquely Poised to Address the Growing Loneliness Epidemic
A 2023 U.S. Surgeon General’s Advisory on Loneliness and Isolation highlighted its link to premature mortality, likening its health impact to smoking up to 15 cigarettes a day. The authors argue that family medicine is uniquely poised to address the growing loneliness epidemic because the specialty is grounded in continuous, comprehensive, and relationship-centered care for individuals, families, and communities across their lifespan. The authors highlight two studies published in this issue of Annals of Family Medicine regarding loneliness and isolation and call for implementing interventions and evidence-based screening tools that capture the multiple dimensions of loneliness and in primary care.
Loneliness in Primary Care Patients—From Understanding the Risk to Actionable Clinical Priority
Sebastian T. Tong, MD, MPH
Brennan Keiser, MSW
Department of Family Medicine, University of Washington, Seattle, Washington
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Essay
Family Physician Describes the Joys and Challenges of Extended Partial Parental Leave “Dad Days”
In this essay, a family physician describes how academic medicine can promote better work–life harmony for physician parents. After reviewing institutional policy and planning carefully, the author proposed and was granted a year of partial parental leave, consisting of two “dad days” each week. The arrangement allowed the author to bond more deeply with his newborn child, share domestic responsibilities and strengthen his marriage. His personal life was enriched by the arrangement, but he also describes professional trade-offs, including missed meetings, delayed work, and reduced continuity for patients. Drawing on research about paid parental leave, he argues that academic medicine should support flexible parental leave policies so physicians can meet family needs without leaving academia or reducing their work effort.
Dad Days: The Joys and Challenges of Extended Partial Parental Leave
Brandon H. Hidaka, MD, PhD
Department of Family Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin
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Essay
Listening to a Patient Led This Physician to Rare Diagnosis of Tick-Borne "Cave Fever” Illness
In this essay, a family physician describes a teenage patient whose illness first appeared to be a routine viral infection. Her fever improved but returned twice over the following weeks, once with joint pain and a rash, while laboratory results remained nearly normal. Concerned, the physician revisited the patient’s history and recalled Sir William Osler’s advice: “Listen to the patient. They are telling you the diagnosis.” The patient then mentioned leading children on a hike through caves in the Judean Lowlands, where ticks carrying Borrelia persica live. The exposure explained the recurring fevers. The author illustrates how careful listening and local knowledge can reveal patterns others might easily miss.
Listen to the Patient—She is Telling You the Diagnosis
Ruth Kannai, MD
Siaal Research Center for Family Medicine and Primary care, Department of Family Medicine, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Essay
Genetic Test Seemed to Explain Child’s Short Stature, But Family Testing Told a Different Story
In this essay, a pediatrician reflects on a case in which a genetic variant (1q21.1 deletion) appeared to explain a child’s short stature, but family testing later contradicted that interpretation. For example, some short relatives lacked the deletion, while a taller cousin carried it. The patient’s response to growth hormone pointed to treatable growth hormone deficiency, not a genetic syndrome. The experience led the author to reconsider how genomic results are interpreted and communicated and realize “how quickly precision can seduce us into premature closure.” After that visit, the author changed three aspects of practice. When ordering genomic tests, the author emphasizes uncertainty during pre-test counseling and explains that genetic findings may require family testing before their meaning is clear. When reviewing results with families, the author begins with the child—their growth, energy, school, play—before discussing the genetic report. The author also begins practicing “delabeling,” removing diagnoses that no longer fit the evidence and explaining to families why a previous label is being revised.
Diagnoses Live in Relationships: Bedside Sense in the Age of Precision Medicine
Chunlin Wang, MD, et al
The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Essay
Small Rituals of Patient Attention Help Maintain Presence in Care
The author, a medical student at the All India Institute of Medical Sciences in New Delhi, India, argues that small intentional rituals help preserve humanity and presence in clinical care, especially in high-pressure medical environments. Through several patient encounters, the author describes how ordinary clinical acts such as handwashing, listening, adjusting a blanket, and staying with a grieving patient can become rituals of attention that anchor clinicians and patients in moments of care. The author presents these rituals not as distractions from medical work but instead as practices that prevent detachment and maintain compassionate care.
From Rush to Ritual: Restoring the Sacred in Daily Care
Vangipuram Harshil Sai
All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, India
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