Every fall, when I go to the AAFP's FMX conference, one session is at the top of my must-attend list: Dr. Frank Domino's insightful and funny take on the “top 10” updates from the literature.¹ Keeping up with the literature is important, but it's hard to find time for it. When I come across an interesting article, I often send it to myself with plans to review it later, but I rarely do. So, to prevent my unread list from getting too long, I present part of it here in “Domino” fashion.

1. News flash: Elite medical schools produce fewer primary care physicians.

We can file this article² in the “Well, that makes sense” folder. Given a projected shortfall of primary care physicians over the next decade, it might sound concerning that the medical schools producing the highest percentage of primary care physicians are all osteopathic schools located mostly in the South and Midwest while those producing the lowest percentage are mostly “elite” East Coast allopathic schools. But considering the high cost of care in some of those coastal communities³ and the high cost of education at elite schools, is any of this surprising? No.

2. If you give people access to primary care, they use us.

In this study,⁴ Medicare enrollment was associated with a 14% increase in primary care usage. But it didn't result in an increase in visits to mental health providers. The authors seemed perplexed by this, but I'm not. Good luck finding a mental health provider who will see your patient in a timely manner and do more than throw atypical anti-psychotics at them. Also, we manage mental health in primary care!

3. Facebook makes us irritable.

How many times have you found yourself scrolling through social media and thinking, “Wow, I feel great!” Hardly ever, right? This study⁵ found that frequent use of social media was directly correlated with “irritability,” defined as answering yes to any of the following statements: “I have been grumpy,” “I have been feeling like I might snap,” or “Other people have been getting on my nerves.” I feel personally validated by this study.

4. Almost half of older adults will develop dementia.

This study⁶ estimated that overall lifetime risk of developing dementia after age 55 is 42%. The rates are even higher in women, Black adults, and APOE ε4 carriers. I find this incredible. With new medications coming, dementia care will look different in the future, but at what cost?⁷

5. The new term for skin ulcer is “skin failure,” distinct from pressure ulcer.

The thought behind this is interesting.⁸ If you've done hospice care, you have likely seen a patient with a “Kennedy” ulcer — skin breakdown primarily over the sacral area in the last few days of life. This can happen even with proper nursing care and skin protection. It's a complex interplay of physiology, nutrition, and comorbidities. If we acknowledge that the skin is an organ system, it follows that at some point we will see “skin failure.”

Interestingly, the original term for skin ulcer was “decubitus ulcer,” coined by Jean-Martin Charcot (the father of neurology), who attributed it to a “blockage of neurotrophic factors delivered through a neural network.”⁹ It was Florence Nightingale who pointed out that these ulcers were caused by pressure on the area.

Now that I've knocked a few articles off my list, I'd love to hear what's on yours. And if you attend FMX this year, I'll save you a seat at Dr. Domino's session.