KANSAS CITY, MO--As family physicians sail the uncharted waters of the evolving health care system, they must be guided by a moral compass. This was the message of AAFP Past President James G. Jones, MD, last month to family practice residency directors.
"Sometimes the sailing will be rough, with the winds of change blowing at gale force straight at our bow. At other times, the wind will be at our stern pushing us along faster than we wanted to sail," he said in the Nicholas J. Pisacano, MD, Memorial Lecture at the Workshop for Directors of Family Practice Residencies June 9-11. "Let the set of your sails steer you in the direction of those values that made you unique."
Dr. Jones, executive director of the North Carolina Health Care Reform Commission, urged FPs to remain true to the principles defining family practice, including continuity of care, comprehensiveness, and accessibility.
He talked about the overwhelming changes occurring in the health care system, spurred by three factors: the cost of health care, the number of uninsured, and access-to-care problems.
"Any solution to these ... has family practice written all over it," said Dr. Jones, who founded the East Carolina University School of Medicine family medicine department. "It is becoming increasingly obvious to policy-makers and managed care CEOs that when it comes to the delivery of high-quality, cost-effective medicine, there is no substitute for the family physician."
Yet FPs must be wary not to make the fatal mistakes that the arrogant, overconfident Napoleon made at Waterloo, said Dr. Jones. He asked his audience to consider the following points.
Napoleon: His first mistake was to delay his plan of attack until the environment changed.
FPs: "We can never be caught in family medicine waiting around for the environment to change. I'm sick to death of doctors saying, `Well, we've always done it this way.' ... It's time for us to sharpen again those skills of adaptability that have made us unique."
Napoleon: He placed too much confidence in unreliable associates.
FPs: "I do not believe that we in family medicine, in the name of generalism, should expect the pediatricians and the internists to lead the charge. They are really not the answer to what is so badly needed in American medicine today. We must not shrink back from that responsibility."
Napoleon: He had an inappropriate, outdated battle formation.
FPs: "I urge you not to be afraid of the new [technology], but to try it. It's unthinkable that we would have residency programs that are not totally computerized; that we wouldn't have computerized records ... telemedicine, or a whole list of accesses to the information highway. I believe that's what our responsibility is."
Dr. Jones stressed that his purpose was not to "spoil the victory parade" for family practice--but to remind FPs that what should have been an easy victory for Napoleon destroyed him and his vast empire.
"You are America's finest--and as program directors and educators, you have a moral imperative to sustain the highest aspirations of the students and residents you teach," he said.
By Toya Hill, Associate Editor
FP Report, July 1996 headlines
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