Hello! Welcome back to The Friday Sign Out - a newsletter for primary care physicians and advanced practice providers.

I hope everyone is having a great July so far. We spent the July 4th holiday weekend at a lake house in Michigan. It was full of boat rides, tubing (the kids’ first time and my first time in > 6 years - wow, my arms were sore lol), hot dogs, s’mores, sparklers and fireworks. We ran the Firecracker 7k race on July 4th and I like to believe this offset all the chips consumed in the days prior! 😆 It was back to reality this week with clinic in full swing. Needless to say, I’m ready for the weekend.

Here’s what I’ve been reading and thinking about this week.

In the News

This study from The Annals of Internal Medicine compared intermittent fasting and calorie-restriction to a control group over 12 months. The resulting weight loss was comparable and not statistically significant in either group.

My patients are often asking if intermittent fasting is the right approach when it comes to weight loss. My reply usually includes an explanation on how approaches to weight loss vary as our bodies are unique and the same method does not work for everyone. This study supports the advice to try different tactics and see what works and feels good for you and your body!

In Your Practice

If you use dot phrases in your notes, get ready to copy and paste! If you don’t use dot phrases, I highly recommend incorporating them into your practice. They make it easy to repeat phrases or explanations we use often in practice, especially when communicating to your staff and patients. Here is one I use for incidental hyperkalemia, courtesy of the AAFP:

“Please advise patient these labs are OK except potassium is a little high. The potassium level is very sensitive to how the blood is handled, so it can often be artificially elevated. However, if it is truly elevated, it can cause significant problems. Please ask the patient to recheck this potassium blood test within the next week. The test does not need to be fasting. An order will be waiting in the lab.”

I also have an altered version of this saved for direct communication with the MyChart-savvy patient.

In Your Heart

I found myself reflecting on my role as a PCP recently after a conversation with a non-medical friend. She was navigating an uncertain medical issue and found herself somewhat unmoored, not sure where to turn next. Should she research a new specialist, try a new diet, or turn to a google search? After a little more back and forth, I was able to guide her in setting up a step-by-step plan. Start with this test and this specialist, ask these questions and then move to this next step if needed, etc.

This plan came together naturally for me, almost intuitively. I’m sure you can relate as a PCP - this is what we do. We are able to pull back and use a wide-angled lens to see more of the picture, to see what lies on the fringes. We can then confidently decide how to proceed - ruling out life-threatening urgent issues while addressing the most bothersome, worrisome symptoms for each of our patients in a stepwise manner.

In my conversation with my friend, I realized that this does not come easily to most people, especially those who do not work in healthcare. Our current healthcare system can leave patients disconnected, isolated and unsure where to turn next.

Enter, the PCP!

I often tell patients I’m their quarterback. Turn to me for guidance, consultation and leadership. I will help you navigate the system and when something doesn’t work, we will try again, and again if needed.

When you’re having a tough day as a PCP and the messages are many and the paperwork stack is high, remember - our patients need brilliant, kind, compassionate “quarterbacks”.

PCPs, you are invaluable. Keep up the good work.

Have a wonderful weekend!

Ashley