Mar-Apr 2013 Table of Contents

THE LAST WORD

The Relational Soul of Family Medicine



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It's time to focus on what you do best.

Fam Pract Manag. 2013 Mar-Apr;20(2):40.

As a counselor, family therapist, and teacher who works with family physicians and residents, I often get to observe what I believe is the essence, or soul, of family medicine – relationship. Unfortunately, as you probably know all too well, certain pressures in health care today seem to be putting the specialty at risk of losing its relational soul. What's a family physician to do?

Although you may not be able to radically change the environment in which you practice, I believe you can change your attitude and your effectiveness within that environment by focusing on your strengths – the 10 As of family medicine:

1. Alliance with the patient against disease and the vulnerability it brings. Even well-functioning patients are susceptible to feeling overwhelmed when disease or accidents befall them. Family physicians are natural allies with their patients in the trenches where pain and confusion reside.

2. Attentiveness to the total person. Financial burdens, family conflicts, life transitions, community and housing situations, and so on can have a significant impact on patients' health and wellness. Paying attention to these life experiences gives family physicians a more comprehensive view of the patient's situation and creates opportunities for intervention or support.

3. Acceptance of the patient. Every person needs a place of acceptance, one that is free from judgment. The exam room should be a place where patients can discuss any topic with trust and confidentiality.

4. Accountability. While family physicians are accepting of patients, they also need to challenge them at times. Destructive habits and behaviors cannot be ignored. Because of their relationship with the patient, family physicians can address difficult issues and offer accountability and motivation.

5. Availability and continuity over the life cycle. Family physicians, more than any other professionals except perhaps clergy, are with the individual through all phases of life. What a privilege this is, but also what a responsibility!

6. Authenticity. Being honest and genuine is something patients count on from their family physician. Authenticity affects so many aspects of the patient relationship, from providing candid and helpful feedback to ensuring transparent and ethical approaches to care.

7. Affirmation. Some patients rarely, if ever, receive affirmation. Knowing their patients' struggles and efforts, family physicians find ways to encourage their patients as they work toward positive goals and behaviors.

8. Awareness of what is going on beyond the overt disease. Family physicians understand that medicine is more than biological knowledge; it includes sensitivity to biopsychosocial issues as well.

9. Anticipation of the life pathway and possible difficulties and obstacles. Anticipatory guidance about what is coming next in life and what patients can do to prepare can reduce their pain and confusion. Anticipating the good and providing hope wherever possible is also important.

10. Advocacy in a fragmented, broken system. Now more than ever, patients need an advocate in the health care system. Family physicians have been fulfilling this role for years without recognition or reimbursement for it, but there are signs that payment for care coordination activities is slowly becoming a reality.

With today's time, reimbursement, and productivity pressures, you may sometimes feel that you're barely holding things together. Focusing on these 10 factors will help you protect your relational soul as a family physician.

About the Author

Dr. McBride is director of behavioral medicine at Floyd Medical Center's Family Medicine Residency in Rome, Ga. He is a credentialed pastoral counselor and licensed family therapist.

Author disclosure: no relevant financial affiliations disclosed.

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