Good health care doesn't focus on a single organ system. It doesn't focus on a single disease. It doesn't stop with the patient in the exam room. It envelops the organ, the disease, the patient, the family and the community.
And family medicine is at the center of all of these, said David Satcher, M.D., Ph.D., former U.S. Surgeon General and current director of the Center of Excellence on Health Disparities at Morehouse School of Medicine, Atlanta.
From Single Disease to Entire Community
Family Physicians Tie Together All Elements of Health Care
By Leslie Champlin
• Kansas City, Mo.
8/9/2007
Residents and students cue up behind Samuel Crane, left, a medical student at the University of South Florida, Tampa, for a chance to visit with family physician and former U.S. Surgeon General David Satcher, M.D., Ph.D.
"Primary care doesn't start with disease. It doesn't start with illness," said Satcher during the Aug. 2 Stephen J. Jackson Memorial Lecture at the National Conference of Family Medicine Residents and Medical Students here. "It starts with health, but sometimes we lose track of that."
Family physicians form the foundation of the health care system because they are the specialists who see undifferentiated patients with health concerns that must be identified before any other subspecialty service can be provided.
"Family physicians see patients who have not been worked up yet," said Satcher. "They don't come with a diagnosis. They've got to be worked up from scratch."
Family medicine also connects the community, the environment and mental health to physical health, said Satcher. He pointed to the 1854 cholera epidemic in England, which came to a halt after generalist physician John Snow asked his patients about their food and drinking water. He realized that the patients who got sick had drunk from the same contaminated pump on Broad Street.
Snow could have launched a communications or legislative campaign about the pump, "but what he did was remove the handle from the Broad Street pump," said Satcher. "And that was the end of the cholera epidemic."
The moral? "We will never solve our health care problems by just caring for patients in the office," he said. "We need to find out what's going on in the community."
Likewise, America's patients need physicians who can identify and help treat mental illness, according to Satcher.
Western medicine made a grave error when it separated body from mind. As a result, patient care -- and patients -- have suffered, according to Satcher. But family physicians can mend the rift by incorporating mental health services into routine medical care and reducing the stigma of mental illness.
"Did you know that less than 50 percent of patients referred by primary care doctors (for mental health services) keep their appointments?" Satcher asked. "There's a message there when we send them away" for psychiatric follow-up.
Twenty percent of Americans suffer from a diagnosable mental illness, and 80 to 90 percent of those conditions can be successfully treated, according to Satcher. But stigma prevents half of adults and two-thirds of children with mental disorders from seeking help.
"There was a time when cancer was stigmatized" in the way that mental illness is today, said Satcher. "Nobody wanted you to know somebody in the family had cancer. Over time, it became clear that you could save lives (with diagnosis and treatment). If we had that message in primary care -- that we can diagnose and treat mental disorders -- we could … go a long way to destigmatize mental disorders."
The need will rise as society continues to cope with disasters -- the Oklahoma City bombing, 9/11, Hurricane Katrina, the Minneapolis bridge collapse -- and the fallout from the battlefield, Satcher said.
"Because of the nature of this war and the greater number of women involved in Iraq, we're seeing much more posttraumatic stress disorder," said Satcher. "(These patients) are going to need help, or they will end up the new generation of homeless on the street or people dumped in jails."
Family physicians form the foundation of the health care system because they are the specialists who see undifferentiated patients with health concerns that must be identified before any other subspecialty service can be provided.
"Family physicians see patients who have not been worked up yet," said Satcher. "They don't come with a diagnosis. They've got to be worked up from scratch."
Family medicine also connects the community, the environment and mental health to physical health, said Satcher. He pointed to the 1854 cholera epidemic in England, which came to a halt after generalist physician John Snow asked his patients about their food and drinking water. He realized that the patients who got sick had drunk from the same contaminated pump on Broad Street.
Snow could have launched a communications or legislative campaign about the pump, "but what he did was remove the handle from the Broad Street pump," said Satcher. "And that was the end of the cholera epidemic."
The moral? "We will never solve our health care problems by just caring for patients in the office," he said. "We need to find out what's going on in the community."
Likewise, America's patients need physicians who can identify and help treat mental illness, according to Satcher.
Western medicine made a grave error when it separated body from mind. As a result, patient care -- and patients -- have suffered, according to Satcher. But family physicians can mend the rift by incorporating mental health services into routine medical care and reducing the stigma of mental illness.
"Did you know that less than 50 percent of patients referred by primary care doctors (for mental health services) keep their appointments?" Satcher asked. "There's a message there when we send them away" for psychiatric follow-up.
Twenty percent of Americans suffer from a diagnosable mental illness, and 80 to 90 percent of those conditions can be successfully treated, according to Satcher. But stigma prevents half of adults and two-thirds of children with mental disorders from seeking help.
"There was a time when cancer was stigmatized" in the way that mental illness is today, said Satcher. "Nobody wanted you to know somebody in the family had cancer. Over time, it became clear that you could save lives (with diagnosis and treatment). If we had that message in primary care -- that we can diagnose and treat mental disorders -- we could … go a long way to destigmatize mental disorders."
The need will rise as society continues to cope with disasters -- the Oklahoma City bombing, 9/11, Hurricane Katrina, the Minneapolis bridge collapse -- and the fallout from the battlefield, Satcher said.
"Because of the nature of this war and the greater number of women involved in Iraq, we're seeing much more posttraumatic stress disorder," said Satcher. "(These patients) are going to need help, or they will end up the new generation of homeless on the street or people dumped in jails."
