Note: This is the first of three parts. Click here to access them all.
I am happy I get to write this blog post.
It falls on the occasion of my recertification as a diplomate of the American Board of Family Medicine. Before, during, and on completion of this milestone, I received many, many, questions like this:
Weren’t you already a doctor? I’m confused…. (Matthew Holt @boltyboy , via Facebook)
A lot of people are confused about how doctors grow and develop.
After the first big decision a doctor makes, to go to medical school, they next choose a specialty that they’ll train in and maintain certification in after training. The last two letters after our names can’t be taken away. Board certification can be.
When I entered medical school, I hoped to become a specialist in family medicine. When I left medical school, I hoped to become one, and then I became one, and I would do it again in a heartbeat.
I realized this every time I turned one of the 1000+ electronic pages in my review this year. I decided to go back in time to see where I came from.
What am I?
I’m not an internist. I’m not a pediatrician. I’m not an OB/Gyn. I’m not a surgeon. But I was trained by excellent ones.
I wasn’t created by doctors defined by a shallow knowledge of a lot of things.
I was created by doctors defined by deep knowledge of a whole person, focused on the relationship with family, community, society.
This psychological description of this “new” specialist from 1969 (“Specialist in family practice — prototype of a doctor“) is exceedingly relevant ( except for the gender pronouns, even this social movement was not perfect ):
- More concerned with people than things
- Views things holistically rather than as elements or parts
- More of a pathfinder than a traditionalist
- Sees medicine as a means to helping others, and by instinctive action makes others aware of his service orientation
- Views himself more as an “artist” in dealing with others and their problems – a healer rather than a “scientist” dealing with disease processes or malfunctioning organs, though he has great respect for the values of science. However, he sees it as a means to an end rather than an end in itself
- More concerned with his community as a whole than many of his colleagues because, to him, the community is the extension of his patient-family units and, in a sense, a “laboratory”. Also, because he is concerned with people and humanity, he is concerned with the success of the human organization
And their definition of role even has that phrase I like so much:
Accepts responsibility for his patients’ total health care, including the use of consultants, within the context of their environment – the family or comparable social unit an the community
There’s an official description of the specialty here, with its differentiating characteristic:
Family medicine is a three-dimensional specialty, incorporating (1) knowledge, (2) skill and (3) process. Although knowledge and skill may be shared with other specialties, the family medicine process is unique. At the center of this process is the patient-physician relationship with the patient viewed in the context of the family. It is the extent to which this relationship is valued, developed, nurtured and maintained that distinguishes family medicine from all other specialties.
One of the youngest
Family medicine is one of the youngest medical specialties, but it’s not the youngest – that title belongs to the specialty of medical genetics (1991). You can review the list here.
What’s important to note in the list is that the difference between family medicine and many of the other specialties is that this is a specialty that wasn’t created out of a requirement to harness new technology. It may have been created as a response to it.
In Part 2 of 3…a little bit more about who we are, where we came from, a specialty that is much a movement as a way of healing.
In the meantime, if you get a chance, check out these photographs of a family doctor, circa 1945, in Caring For America : The Story of Family Practice ( also featuring one of my heroes! Neil Calman, MD)