When Theodore Phillips, MD, was growing up, his surgeon father often got phone calls during supper. Typically, the calls were from general practitioners who said their patients needed surgery.
His father would say to his mother, "I've got to go to the hospital." She'd ask if he had to go immediately. Sometimes he'd say no, he could trust the GP's diagnosis and could tell the nurses how to begin caring for the patient. But other times his father would say, "I've got to leave right away. The doctor says it's appendicitis; I can rule that out."
From the dinner phone calls, the young Ted Phillips identified GPs who became his role models. He was in general practice from 1962 to 1969, six of those years in Sitka, AK. "I couldn't find anybody to come and join me, and I got talked into getting involved in teaching," he says. He taught family medicine, chaired the new family medicine department at the University of Washington in Seattle, and served as associate dean and acting dean of the UW medical school.
Then, surprising himself and his academic colleagues, Dr. Phillips returned to community-based practice. From 1989 to 1994, he worked on Lopez Island, WA, where he now lives in retirement.
Dr. Phillips says a generalist is both a part of the community and the sanctioned healer in the community. "GPs were firmly imbedded in the community they served. I didn't have that at the university," he says. "In the teaching setting, you saw patients coming in the door, and they went out the door, and you had to really work if you were going to get any kind of knowledge of who they were outside the door."
When Dr. Phillips was starting the UW department, visiting friends from Alaska--a minister and his wife--asked what he was doing. He said he and others were going to add new elements to the training of general practitioners such as understanding human behavior and emphasizing the family.
"Wait a minute," said the minister. "That's not why we went to see you as a doctor. We went because we knew you'd know something about my brain tumor. We went because, when our son got hit in the head with a club, you could sew up his head. What's happened to that?"
Dr. Phillips acknowledged he went into medicine to do general practice, to be a community physician.
He contends general practice and family practice are the same, and he opposed the name change.
"We gave up some of our generalist heritage in the name change from general to family practice," says Dr. Phillips. "The consequence is the current battle over who speaks for generalism in medicine. I don't know whether the generalist specialties are going to come together and we will once again have a single generalist, or whether we'll continue to fractionate generalism, with the multiple approaches we now have--and the rest of the world does not have."
Furthermore, Dr. Phillips says, "We made a mistake in denying accreditation to any residency that did not include major surgery training. That was the end of support for family practice from Harvard, which had one of the first family practice residencies, and some of the eastern medical schools that have since stayed out of the game."
He still reflects on his friend's question. He reminds family physicians not to forget their heritage.
And he's glad he spent the last five years of his career as a general practitioner. "It was important to do," he says, "to prove to myself I'm still the person I was. Then I could retire."