America's patients need health care heroes. They want personal medical homes, but they are surrounded by a mushrooming number of subspecialists. They read that the quality of care is spiraling downward, and they see that the cost of care is billowing.
Future of Health Care
Change, Opportunities Await Students and Residents
By Leslie Champlin
• Kansas City, Mo.
8/10/2007
"Everything I know, I learned from my patients," says AAFP President Rick Kellerman, M.D., during opening ceremonies at the 2007 National Conference of Family Medicine Residents and Medical Students.
Enter medical students and family medicine residents. The future of America's health care, these aspiring and newly minted physicians must
-- and will -- come to the rescue, say AAFP President Rick Kellerman, M.D., of Wichita, Kan., and President-Elect Jim King, M.D., of Selmer, Tenn.
The nation is beginning to recognize its burgeoning need for primary care, and medical students and family medicine residents are launching their careers at a time of change and opportunity, Kellerman and King told participants at the 2007 National Conference of Family Medicine Residents and Medical Students here Aug 1-4.
"We need more family physicians" rather than more subspecialists, Kellerman said during opening ceremonies. Why? "Because people don't have just one disease. People don't have just diabetes. People don't have just hypertension," Kellerman said.
-- and will -- come to the rescue, say AAFP President Rick Kellerman, M.D., of Wichita, Kan., and President-Elect Jim King, M.D., of Selmer, Tenn.
The nation is beginning to recognize its burgeoning need for primary care, and medical students and family medicine residents are launching their careers at a time of change and opportunity, Kellerman and King told participants at the 2007 National Conference of Family Medicine Residents and Medical Students here Aug 1-4.
"We need more family physicians" rather than more subspecialists, Kellerman said during opening ceremonies. Why? "Because people don't have just one disease. People don't have just diabetes. People don't have just hypertension," Kellerman said.
"We care for the most complex patients in the system," AAFP President-Elect Jim King tells residents and students at the 2007 National Conference. "We deal with it all."
King agreed. He told attendees that his life as a family physician was an adventure. "Every time I go into my office, it's an adventure to determine what's on the other side of that door," he said in his conference greetings. "We care for the most complex patients in the system. They have diabetes, heart disease, hypertension. They're depressed, they don't like their mother-in-law and their dog just got run over. We deal with it all."
That translates into a growing need for family physicians who can address the whole patient, within the context of the family and the community that support or undermine that patient's health, said Kellerman.
More than 100 papers cited at the AAFP's Value of Family Medicine Web page confirm the need for primary care if the United States is to improve health care quality and outcomes. Among those papers, said Kellerman, are studies that demonstrate higher quality care, fewer disparities, greater equity and lower costs when patients have more access to primary care. Areas with an overabundance of subspecialists have higher costs and lower quality of care.
"That's counterintuitive," said Kellerman. "How could it be that with more specialty care, quality goes down?" The answer is that care that relies primarily on subspecialists becomes fragmented; duplicative tests and care are provided or needed tests and care are missed. However, "family physicians treat the whole person, and because of that, quality of care is better. It means we need to have a system that's more balanced" in its ratio of primary care to subspecialty services, said Kellerman.
The system must change. More studies are showing that there is an increasing shortage of family physicians and primary care services, while demand for comprehensive services increases because of an aging population with multiple health conditions, he said.
For those who choose to meet the need for more primary care, Kellerman offered bits of advice adapted from All I Really Need to Know I Learned in Kindergarten by Robert Fulghum.
"Everything I know, I learned from my patients," said Kellerman. "To quote William Osler, a family physician, 'Listen to your patients. They're telling you what's wrong with them.'"
From that first tenet flow all other aspects of good patient care, said Kellerman.
That translates into a growing need for family physicians who can address the whole patient, within the context of the family and the community that support or undermine that patient's health, said Kellerman.
More than 100 papers cited at the AAFP's Value of Family Medicine Web page confirm the need for primary care if the United States is to improve health care quality and outcomes. Among those papers, said Kellerman, are studies that demonstrate higher quality care, fewer disparities, greater equity and lower costs when patients have more access to primary care. Areas with an overabundance of subspecialists have higher costs and lower quality of care.
"That's counterintuitive," said Kellerman. "How could it be that with more specialty care, quality goes down?" The answer is that care that relies primarily on subspecialists becomes fragmented; duplicative tests and care are provided or needed tests and care are missed. However, "family physicians treat the whole person, and because of that, quality of care is better. It means we need to have a system that's more balanced" in its ratio of primary care to subspecialty services, said Kellerman.
The system must change. More studies are showing that there is an increasing shortage of family physicians and primary care services, while demand for comprehensive services increases because of an aging population with multiple health conditions, he said.
For those who choose to meet the need for more primary care, Kellerman offered bits of advice adapted from All I Really Need to Know I Learned in Kindergarten by Robert Fulghum.
"Everything I know, I learned from my patients," said Kellerman. "To quote William Osler, a family physician, 'Listen to your patients. They're telling you what's wrong with them.'"
From that first tenet flow all other aspects of good patient care, said Kellerman.
- While you're listening, sit down.
- Warm your stethoscope and "that goo that you use with sonograms," said Kellerman.
- Wash your hands, and let your patients see you doing so.
- Touch your patient, "even if it's to shake their hands," said Kellerman. "If you do an examination on your patient and you take their history and you haven't touched him, you haven't done a complete exam."
- When you have trouble communicating with patients, perhaps it's you -- not the patient -- who needs to change.
- At the end of the day -- particularly a tough day -- thank your nurses and staff. "The way you act is the way they act," he said. "The way you treat your nurses and staff is how they treat your patients."
