My audacious goal for family medicine

I have a BHAG (Big Hairy Audacious Goal).

I want people to hear “family medicine” and know that it refers to a medical specialty dedicated to providing relationship-based, patient-centered health care.

I want people to know that family docs take care of a lot of complicated, challenging diseases – and not usually in isolation.  Our patients have high blood pressure, complications from type 2 diabetes, congestive heart failure, depression, chronic kidney disease, emphysema, anxiety, asthma, and coronary artery disease, to name a few; treating each of those conditions individually is nothing like treating them in relation to each other.

I want people to know that I trained for three years to become an expert in my specialty.  During my family medicine residency, I learned about providing preventive care.  I learned how to treat a multitude of acute problems – colds, fractures, lacerations, rashes, etc.  I learned how to deliver babies, resuscitate victims of cardiac arrest, and drop a central line into a coding patient.  I can take off your moles, skin tags, and warts.  I can remove your ingrown toenail and treat your acne.  I can obtain your pap smear, discuss your birth control options, and treat your STDs.

I want people to know that I can care for your kid and your grandparent.  I routinely counsel teens about sex, drugs, and rock ‘n’ roll.  I am comfortable in offices, hospitals, maternity wards, newborn nurseries, intensive care units, nursing homes, and even patients’ homes.

I want people to know that family medicine residents learn about using the best medical evidence and the latest medical technology to guide decision-making conversations with patients. They can intelligently sift through the tremendous reams of medical studies that are published daily to pull out the information most relevant to their patients.

I want people to know that those residents learn how to work within a healthcare team.  Nurses, medical assistants, pharmacists, care managers, social workers, administrative staff – it takes all of us to provide outstanding care.  These incredibly important people are my hands, eyes, and ears into the thousands of little tasks that must get done every day in the office and at the hospital.

I want people to know that no medical specialty is as devoted to medical education as family medicine.  The Society of Teachers of Family Medicine holds an annual meeting devoted solely to medical student education.  We are one of only a handful of medical specialties with an entire fellowship (post-residency training) devoted to faculty development – training the next generation of academic family medicine teachers, researchers, and leaders.

Lastly, I want people to know that family docs do everything that they do in the context of our patients’ belief systems, families, and communities.  Our specialty is the only one that mandates dozens of hours of educational time during residency about the doctor-patient relationship.  How to help folks quit smoking/over-eating/whatever, how to tell someone that the biopsy did show cancer, how to mediate family disagreements about end-of-life wishes – this behavioral instruction is just as important to a family medicine resident as the pathophysiology, treatment, and prevention of disease.*

If you’re not a family doc, I bet you didn’t know all of those things.  And the blame for that truth lies squarely with us as family docs.  Frankly, other specialties have been better than us at promoting themselves.  You all likely know what a dermatologist or a cardiologist is, even if you’re not working in the medical field. Family docs can learn a lot from how other specialties have advanced the interests of their patients by advancing their specialty’s cause; it’s something we have failed to recognize the importance of until now.

Because of that failure, family medicine is not understood – and thus not valued – by the public, by politicians, by health plan administrators, and by too many of the other people who make decisions about health care in this country.

We need to show them what family medicine is all about.

My BHAG is to share family medicine with the people who don’t know about us yet. I hope that this blog does that in some small way; certainly, many of the family medicine bloggers and tweeters out there are doing it in a bigger way.

But, I don’t think that’s enough.  We need more.  We need an #FMRevolution.  I have to believe that there’s something even bigger, hairier, and more audacious that we could do.  I wish that I knew just what that that big, hairy, audacious thing was. Fortunately, though, I am but one of many.

It will take all of us to get the chorus of family medicine to echo across our nation.

Jennifer Middleton is a family physician who blogs at The Singing Pen of Doctor Jen.

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  • http://www.facebook.com/profile.php?id=100001222357028 Stephen Anthony

    This is a great article. I’m with you – MS2 here.
    I think it would a great idea to encapsulate this message in a 30 second Public Service Announcement and broadcast it around the nation. – a great way to set the image of Family Physicians and PCPs.   So many people have no idea of skillsets and thinks everything is just referred. A PSA would be a great way to let the truth be known.

  • Penni Sadlon

    Dr. Jen, 

    I’m a supporter of your BAHG (although, I don’t get the hairy part?).  As a RN (30 yrs exp), I was trained from day one to provide holistic assessment of my patient in coordination with the primary attending MDs diagnoses and treatment plans.  Treating the whole person, whole family, whole environment is the correct paradigm.  Specialty care is needed, but in context of the whole. 

  • http://www.facebook.com/beau.ellenbecker Beau Ellenbecker

    I prefer the term Family Medicine Specialist….its my new lingo

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    Ever see the movie “Doc Hollywood” where the doc has this patient with, I can’t exactly remember now, it was either an “obvious” heart attack or “obvious” appendicitis. Michael J. Fox calls the patient’s regular doctor, who said some crazy thing about giving him a bottle of Coke……”Give him a co-cola”.

    Michael J. Fox thought the doc was some ignorant fool. Big argument. Then the patient gets a coke, has a big belch or something and goes home feeling fine. Old family doc says he does it all the time.

    I had a Quality Assurance complaint against me from my hospital. Lady comes in with chest pain, they’re ready to sart the million-dollar workup, I overrode some orders and sent her home. Staff was upset….actually I didn’t know they were so worked up until I got the QA.

    Real simple, I knew her for five years, and she does this every time she has a fight with her boyfriend. I knew about the fight the day before, having seen her in my office. I showed them five years of the same thing, with million-dollar workups all over town (but not yet at my hospital)……all negative.

    Saw her in the office the next day, all made up, sweetness and light, and no chest pain.

    QA committee was fine with report. I suppose it could be the one time where there really was a heart attack.

    She didn’t need a co-cola though.

  • http://twitter.com/chasedave Dave Chase

    The BHAG that a rapidly increasing number of family medicine docs are taking as we speak is converting as high a percentage as possible of their patients to Direct Primary Care — see “The Primary Care Doc Fix is In” from a few days ago – http://www.kevinmd.com/blog/2011/12/primary-care-doc-fix.html. Patients win. Doctors win. Gov’t wins. Even the smart insurance companies realize they can have higher satisfaction/retention when they couple DPC with a catastrophic policy. They are able to make money in that model. As mentioned in that article, there’s an ecosystem of service providers, technology companies, etc. that are ready to serve this growing segment as it moves from leading edge into the mainstream. Read the piece for more. Email me if you want some data that backs up the points made above and in that piece.