Archive

Perspectives in Primary Care features writing from practitioners, activists, and community members representing organizations, practices, and institutions across the United States and around the world.

Comprehensive Sex Education as Violence Prevention

It’s #SexEdForAll month, yet most people still believe sex education is just about sex. But it’s so much more than that. As a young woman from rural Appalachia, I’m well aware that until people learn what sex education truly is, it won’t be widely accepted in our society. That’s why I created the Sexuality ...

Saving Lives Slowly

Today, I am saving lives slowly. This is less satisfying than the days I am in full personal protective equipment (PPE) for hours in our new urgent care respiratory isolation unit. The unit was converted over the course of a weekend in the early days of the COVID-19 pandemic from what used to be our billing department, now with new linoleum and exam beds where carpet and desks used to be. In the isolation unit, it is easy to feel I am doing something vital, instead of this strange new disconnect of seeing my patients on the 3x5 inch screen of my cellphone, struggling to connect both ...

Abortion During the COVID-19 Pandemic

The 1973 Roe v. Wade United States (US) Supreme Court case resulted in the historic decision that the US Constitution protects a person’s liberty to choose to have an abortion in private consultation with one’s clinician. Since that time patients and medical providers have had to continue to fight for access to abortion throughout this country. In the years since Roe v. Wade, over 1,000 abortion ...

Contraception During the COVID-19 Pandemic

We know that many barriers to accessing safe, equitable, and effective contraception exist at individual, institutional, and societal levels. These include things such as lack of insurance, inability to get a timely appointment, difficulty taking time off from work or childcare, and required (but not evidence-based) pelvic exams or other pre-requisites. Unfortunately, the COVID-19 pandemic is heightening many of these existing ...

Reflections on COVID-19, the Climate Crisis, Environmental Justice and Health Equity

We are living in an unprecedented time in which an unimaginable global pandemic has upended our way of life. Our current public health crisis is the kind of dramatic disruption that worries many climate advocates as our planet continues to warm. Climate change has and will continue to increase the frequency of natural disasters, the spread of infectious diseases and displacement for people around the world. The United Nations has made clear in their Intergovernmental Panel on Climate Change 2018

Pediatric Health Amidst the COVID-19 Pandemic

While knowledge of COVID-19 transmission and its clinical manifestations is rapidly expanding, many questions remain unanswered regarding the effects of this pandemic on children. Research suggests that most children develop mild illness with COVID, and the development of severe disease is generally limited to infants and patients with pre-existing medical conditions (e.g. cardiovascular disease, chronic lung disease, immunosuppression). ...

Protecting Those Who Protect Us

Health care workers, including residents, have stepped into the breach of the COVID-19 pandemic, and they have done so at great personal cost. We know that ICU physicians, emergency room physicians, nurses, and nursing home health aides have died in unprecedented numbers. At least one surgical resident is known to have died from COVID-19, and it is likely there are others as well. We also know that caring for patients with COVID-19 creates fear and anxiety among health care workers, leading to both burnout and disability, and a demand for hazard pay. And we know that approximately

Experiencing Rural Family Medicine During the COVID-19 Pandemic

I arrived in Valdez, Alaska in mid-February as a visiting third year medical student and was quickly immersed in full-scope Family Medicine. I was learning in a myriad of settings: seeing patients in clinic for routine primary care, evaluating a trauma in the emergency room, assisting with vaginal and cesarean deliveries, and rounding on inpatients in the 11-bed critical access hospital. Six Family Medicine physicians provide comprehensive care here in a town of 4,000 residents, more than 300 road miles from the next hospital, in a census area where the population density is 0.3 persons ...

“Some New Kind of Infection or Plague:"  The 1918 Flu Pandemic & COVID-19

A humbling sense of medical uncertainty. Tensions between public health concerns versus economic consequences for shuttered businesses. Public recognition of heroic healthcare workers, especially nurses. Concern over the standards used to gauge therapeutic efficacy. Even homemade masks. Such tensions and tropes of course color our contemporary experience of the COVID-19 pandemic, but they likewise appeared throughout the 1918 influenza pandemic ...

Immigrant Health, COVID-19, and the Duty to Care

Three months ago, the novel coronavirus arrived in the Boston area. It struck first in wealthy communities of international business travelers and exchange students, then spread quickly to the low-income and immigrant neighborhoods of their housekeepers and personal care attendants. Fear in communities of privilege led to early characterizations of COVID-19 as a disease that doesn’t discriminate. But the disease’s case rate in Chelsea, MA (majority Latinx, poor and working-class) is now

In Times of Crisis, Family Medicine Rises to the Challenge

We are all looking forward to the day when COVID-19 no longer dominates the news cycle, nor our lives. The ongoing conversations about treatment, improving preparedness, and how we move forward are vital and must continue. However, I would like to make a quick aside to these discussions and share why I am grateful for my Family Medicine training. A crisis is not a common time for gratitude, and I admit that I have felt plenty of despair during this pandemic. All the same a recurring thought keeps coming to me that provides me with some comfort: “I was trained really, really well.” My ...

HMS Family Medicine Alumni Spotlight: Kelsey Leonardsmith

The Harvard Home for Family Medicine builds upon the growing community of HMS family medicine students, residents, and attendings engaged in family medicine education, research, and mentorship opportunities. While most of our more active participants are based within the Harvard system, our Harvard Medical School students often graduate to residencies further afield. In this series, we’re thrilled to spotlight what some of our recent HMS Family Medicine students have gone on to achieve.

Caring for Women Who are Homeless During COVID-19

We doctors don’t like to feel helpless. It’s a real comeuppance when we are faced with an unknown entity so vast, so consuming of resources, and so perplexing even to the giants of medicine. And devastating. Robbing lives too soon. Stealing goodbyes and last hugs. I’ve been here before. The emergence of HIV/AIDS happened during my residency. Thousands of young gay men died from opportunistic infections. It was years before they identified the virus and discovered treatment regimens that contained—and still haven’t cured—that virus. I remember standing in the ...

The Coronavirus Does Discriminate: How Social Conditions are Shaping the COVID-19 Pandemic

Part of this developing crisis is very well known: On December 31, 2019, Chinese officials reported a cluster of pneumonia cases in Wuhan and identified the novel coronavirus as the causative agent on January 7, 2020. This novel coronavirus spread rapidly, and on March 11, 2020, the

Boston MedFlight Playing a Vital Role in New England’s COVID-19 Response

Boston MedFlight is a 501(c)(3) nonprofit organization that for 35 years has provided critical care transport to patients in need by air and ground. We care for more than 4,700 patients annually, including the most critically ill and injured infants, children and adults. As a nonprofit, our organization provides over $4 million in free and unreimbursed care to patients in need with little or no medical insurance. We have always served as the link between community hospitals and larger tertiary care facilities. Now, as our region and our nation face the COVID-19 pandemic, ...

A Second, Silent Pandemic: Sexual Violence in the time of COVID-19

What happens when “safer-at-home” doesn’t apply to everyone? NOTE: The term sexual violence refers to crimes like sexual assault, rape, and sexual abuse, which can be perpetrated by anyone. Domestic violence includes emotional, physical, and/or sexual harm by a current or former intimate partner. Research into the specific types of violence ...