The news surrounding family physicians isn't always positive, and FPs need to know how to discuss negative stories with their patients and how to get them involved.
Richard Roberts, MD, JD, of Madison, WI, says he's rarely had patients ask him about studies portraying family physicians in a negative light.
"But with the recent onslaught of these studies, I would expect to talk about it more often," says Dr. Roberts, who's been in practice for 14 years. "As family physicians, we need to remember that our patients can vote with their feet. Just the fact that they are in our offices asking about these studies means they trust us and they're feeling us out about our reaction to the stories."
Recent articles in major magazines and newspapers have focused on study results that seem to question family physicians' training in diagnosing heart disease, performing Pap smears, and treating depression.
When confronted by a patient about negative stories, a doctor should follow some basic steps, says Dr. Roberts, speaker of the AAFP Congress of Delegates.
"First, don't get defensive," he says. "Most of these studies don't even measure important things. It's like testing whether a police officer can buckle or unbuckle her holster instead of whether she can shoot straight."
Second, talk to your patients about what they've read or heard about the study.
"Ask them what they think," Dr. Roberts says. "Our patients know we don't know it all. But because we're trained to treat the whole person through their whole lives, our patients trust us and believe in us more than they do a subspecialist they only see once or twice. As family physicians, we know there is more to medicine than just lifting the hood and tinkering with a couple of parts."
Third, enlist the patient as your ally.
"If they seem to feel particularly strongly about the situation, encourage them to respond to the magazine or television story by writing a letter," Dr. Roberts says. "Invite them to let their opinions be known."
FPs need to expect questions on negative stories, says Dr. Roberts.
"With the health care system still evolving, there will only be more of these studies with negative results," he says. "Right now we are a culture with 150,000 excess subspecialists and 30 percent too many hospital beds. We're facing too many doctors with too high prices, and the system won't handle it. Doctors are facing layoffs as the fat gets squeezed from the system. So they're coming up with studies like these to justify their practices and their specialties."
The studies may be flawed in various ways. They may draw clinical conclusions from economic research; they may use small samples; they may compare ambulatory primary care to tertiary care.
Dr. Roberts says the negative publicity will probably continue until the health care system gets straightened out.
"There is and will be lots of anger, frustration, and worry," he says. "But family physicians need to remember that in the court of public opinion, your best allies will be your patients."
By Leigh Anne Bathke, Associate Editor