A Time for Reflection and a Time for Action

PRESIDENT’S MESSAGE to Members

By Dr. David Rinehart 2019–2020 NCAFP President

~ 2020 TODAY ~

The past several months, and especially the past several weeks, have caused all of us to focus on societal and healthcare issues that are challenging and at times uncomfortable, embarrassing, frustrating, and intolerable. We have witnessed a sweeping pandemic that has made us feel inadequate, sometimes helpless, and sometimes personally vulnerable. Inequities and disparities in healthcare and in our communities have been made apparent and obvious. We have witnessed horrific videos of brutality, violence, and racism against our Black community members. We struggled to identify, fight against, and understand our own implicit biases. We ask ourselves about how we might help each other find the right direction on the moral compass to rid our society of the inequities of opportunity, disparities of outcome, and racism that exists. There has been much to think about.

As we reflect, we are also swept up in the swirling current that calls for action. It does not seem like the right time to wring our hands and form another task force. We are called to be healers, and our communities have deep wounds and serious disease that require active treatment.

We must act first by becoming informed and humble. We need to spend time learning about and under-

Dr. Rinehart attended the University of Virginia and earned his BA in 1978 (Phi Beta Kappa) and his MD in 1982 (Alpha Omega Alpha). He completed his residency in Family Medicine at Charlotte Memorial Hospital in 1985 and was recognized as a national Mead Johnson Outstanding Resident. Dr. Rinehart has enjoyed 34 years of community-based Family Medicine practice with South Point Family Practice in Belmont, NC, 22 years as an independent group practice and 12 years as part of CaroMont Health. Dr. Rinehart lives in Belmont with his wife of 40 years and has three grown children and two grandchildren.

standing the implicit biases we all harbor, speak with and read about people and cultures that are not of our own experience. We must try to see the world through the perspective of another person to further develop our own. We must continue to uncover and quantify disparities as we work to better understand the social determinants of health. These social determinants must be prominent and explicit in our thinking as we advocate for health equity.

We are trained to focus on family, on community, and on our environment as determinants of health. Let us support community groups such as mental health agencies, faith-based groups, literacy councils, housing agencies, food banks, youth and senior programs, childcare agencies and others as they provide threads that together weave the fabric of a healthy community.

Some of us will heed the call to be leaders and prominent voices in the struggle to bring equity in justice to our laws, policies, and systems of healthcare. Many will join in advocacy for just housing, just wages, equal educational opportunity, and equal healthcare access.

See ‘Reflection’ on Page 6

NCAFP STATEMENT AGAINST RACISM AND DISCRIMINATION

The North Carolina Academy of Family Physicians has a long-held belief, reflected in policy, that discrimination for any reason is unacceptable. Considering recent events, it is clear that our state and nation have a long way to go before discrimination and racism have finally ended. Family physicians across North Carolina and our country are grieving with and for their communities. One of our past presidents, Dr. Karen Smith, attended the memorial service for Mr. George Floyd in his home county, Hoke County, in southeastern North Carolina. We join with all our members in speaking out against discrimination and institutional racism.

To reiterate AAFP’s position, the NCAFP considers racism a public health crisis. The elimination of health disparities will not be achieved without first acknowledging racism’s contribution to health and social inequalities. This includes inequitable access to quality health care services. Our members see the negative health outcomes of racism in their patients who are often at an increased risk of heart disease, stroke, diabetes, low birth weight, premature birth, and infant mortality. And we have seen it in the incidence of COVID-19 in minority populations in our state. As of early July, 33 percent of the COVID-19 related deaths in North Carolina had occurred in the African American community, a significant and disproportionate number compared to the population of our state.

The mission of our organization centers around providing our current and future members the tools to provide exceptional care to their patients and communities. We know that social determinants of health matter. We support family physicians in their efforts to actively dismantle implicit racist and discriminatory practices in their institutions and their communities. Here are some ways you can take action personally:

Challenge Bias and Racism: If you see something, say something. Conversations matter, even if it’s one person and one conversation at a time, whether it’s your friends, your family, or your co-workers.

Support Your Colleagues: Minority physicians remain under-represented in medicine and face their own unique obstacles in the workplace. Start by supporting them.

Educate Yourself: Take some time to learn about our country’s history with racism, and the impacts that we still see today. Even if you already know a lot, we can always learn more. Here’s one North Carolina resource, The Racial Equity Institute - www.racialequityinstitute.com, to get you started.

The NCAFP will continue to use our organization’s platform and voice to advance the conversation and act against racial injustice.

As AAFP previously said, it is incumbent upon all of us to engage in an honest discussion about how to ensure that health outcomes and personal safety are not determined by the color of a person’s skin. We stand ready to continue this conversation at both the local and state level.

David A. Rinehart, MD, FAAFP NCAFP President, and on behalf of the NC Academy of Family Physicians Board of Directors

REFLECTION from page 4 But the first and most important call to action for each one of us is in our daily patient care. When that exam room door closes, and we are face-to-face with a patient, this is when we as family physicians will practice true and honest health equity. We

Health Equity Resources –

THE AAFP EVERYONE PROJECT

The AAFP EveryONE Project is designed to help family physicians take action and confront health disparities head on. The project focuses on providing family physicians and their practice teams with education and resources, advocating for health equity, promoting workforce diversity, and collaborating with other disciplines and organizations to advance health equity. As part of the project, the AAFP developed a toolkit to help family physicians address social determinants of health in their practices and communities, to improve their patients’ lives and help them thrive in a multitude of ways. Some of the resources in the toolkit include:

Implicit Bias Training Materials on practice leadership for health equity Social needs screening tools for patients Health Equity issue briefs and more

Search for the “EveryONE Project” at www.AAFP.org.

will see that patient, regardless of their skin color, age, gender, culture, or ethnicity, as a valuable person and not as a member of a stereotyped group. We will embrace and celebrate their differences. We

CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES IN HEALTH CARE (CLAS) STANDARDS

From 2006 through the summer of 2011, the NCAFP Foundation undertook an extensive grant-funded initiative to reduce health disparities in our state. One of the key components of the grant was to teach primary care physicians about the federal Culturally and Linguistically Appropriate Services (CLAS) standards. During the grant, physician knowledge and implementation of the standards increased greatly. For example, the percentage of surveyed members that had a process to resolve conflicts and patient complaints that included simple forms in preferred languages increased by nearly 50 percent. The grant also included numerous clinical presentations with specific information about health disparities in various disease states. Since that time, the federal government has updated and revised the CLAS standards and developed additional materials. This information can be found at www.thinkculturalhealth.hhs.gov, and includes:

will learn some of the story of their life, their fears and successes, their goals and their relationships. We will see them as valuable members of an inclusive community of equally important persons.

We will care for them. We will care about them. We are family physicians.

A Physician’s Practical Guide to Culturally Component Care – updated online educational program.

• An overview of the CLAS Standards

• Information on Health Care and Civil Rights

Health Equity Resources and more.

Executive Officers President President-Elect

David R. Rinehart, MD Jessica Triche, MD Secretary/Treasurer Dimitrios “Takie” P. Hondros, MD Immediate Past President Alisa C. Nance, MD, RPh Executive Vice President Gregory K. Griggs, MPA, CAE

At-Large Directors

Talia M. Aron, MD

Elizabeth B. Baltaro, MD

Jewell P. Carr, MD

Garett R. Franklin, MD

Shauna L. Guthrie, MD, MPH

Brian McCollough, MD

Mark McNeill, MD

Ying Vang, MD

Academic Position Mark L. Higdon, DO (Novant FMR)

Resident Director Elizabeth Ferruzzi, MD (Novant)

Resident Director-Elect Clayton Cooper, MD, MBA (Duke)

Student Director Katelyn Turlington (WFSOM)

Student Director-Elect Hannah Smith (ECU)

AAFP Delegates & Alternates

AAFP Delegate AAFP Delegate AAFP Alternate AAFP Alternate Michelle F. Jones, MD Karen L. Smith, MD Richard W. Lord, Jr., MD, MA Robert L. Rich, Jr., MD

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