What it feels like to be one (a family doctor)
The first secretary of the American Academy of Family Physicians said his contribution was to:
give prestige and dignity to the general practitioners. They had been discriminated against for years, and were considered nobodies among medical organizations.
There’s an undercurrent in our history of wanting respect, which manifests today as a kind of underdog feeling.
(and maybe it’s a little ironic that within medicine, a profession that commands such respect in society, there are feelings of disempowerment – we have a lot in common with our patients)
Artist Regina Holliday (@ReginaHolliday) captured this so well in my first Walking Gallery jacket, maybe more than she realizes (she tends to do that), when she created a piece called “Shoot the Moon.” . Regina wrote in her blog post about the jacket
No great change is possible without the chance of great failure.
In medicine, this is the kind of choice that people like me made when we chose family medicine. We made it willingly.
Meeting another family physician in a room of doctors or any room is like finding another American in Europe.
Meeting a member of the community who learns that I am a family doctor almost always gets a genuine smile.
We are conditioned to have unlimited curiosity because we can’t limit the depth of our interest in any topic or person.
We study the art and the science (and we hang out with artists :)).
We know as doctors that when we talk people listen. We know as family doctors that when we listen, people talk, and we love that. A lot.
We’re all necessary – every specialty, every clinician
I have the interesting (and quite awesome actually) niche experience of training as a family physician in (a) a multi specialty medical group (b) in a non-profit integrated care delivery system that was (c) created and is governed by patients as a health care cooperative
What I know good health care to be means that:
- I reject any notion that sub or other specialists are a problem or at cross purposes with myself, other primary care physicians, or our patients
- I see family physicians as integrators and collaborators across all the specialties, our patients, families, community, society
- I don’t see family physicians as the exclusive bearers of the social movement or mission driven flag in medicine
The question that I got (from my advisor in medical school who was an internist) when I decided to do a residency in emergency medicine (1977-1980) was. “why don’t you do an internal medicine residency? You can always work in an ER.” There was strongly conveyed sense of the illegitimacy the the specialty. I wound up sitting for the 2nd or 3rd offering of the boards (and have now recertified 3 times (q 10 years)).
Here I want to say that I’ve recognized in this review that family medicine is unique; its values are not exclusive. I’ll expound on it more below, but first:
Good news about technology and the decade of the patient
I came across these quotes, across the generations of doctors, that express a kind of defiance, mixed with fear, about the role of the physician in the era of an enabled patient.
It may be that computers will soon diagnose better than doctors. But the facts fed to computers will still have to be the result of intimate, individual recognition of the patient. (From A Fortunate Man, 1965)
Family physicians will become more in demand and more clearly a center point of an efficiently operating health care system, says Robert Graham, MD….he discounts predictions that patients of the future will become their own doctors with little diagnostic computers (Robert Graham, MD, Executive VP of AAFP, 1997)
In 2013, I can put their fears to rest, thanks to the exploration of colleagues like Susannah Fox ( @susannahfox ) – (see: The relationship with Health Professionals in the era of social media | Ted Eytan, MD ) and the work of Edelman and the Health Barometer (see: Edelman Health Barometer 2011 – Doctor most credible source of health information | Ted Eytan, MD), and just being alive in health care.
The decade of the patient is only going to make you, compassionate, caring, curious, doctor, even more important in people’s lives. All you have to do is keep listening.
Why you should care
I’m not writing these posts so that people care about the story of family medicine over any other specialty. Instead, I hope people care about the stories of all physicians as much as physicians care about the stories of their patients and their families. I would like people to care that the calling of every physician and specialist is genuine and meaningful.
One of the lost opportunities I see so often when people work with doctors is that they stop at, “What do you do?” instead of continuing on to “Why do you do it?”
Try that latter question with any physician, regardless of specialty. You’ll (a) probably get more than 3 blog posts of narrative (b) be very impressed (c) find out you have a lot in common.
Thanks again to all the people who expressed curiosity about what this is, the people who came before me, and American Board of Family Medicine and the American Board of Medical Specialties who are with us today.