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Friday Aug 03, 2018

Why Am I a Family Physician? Because FPs Are the 'Real Docs'

"Why don't you become a real doc?"

[the real deal stamped in red]

I was asked that question more than once back in my medical school days. My answer was always, "I am. I'm going to be a family doctor."

Times have changed, but in many ways, the questions put before today's medical students are the same. As the associate dean of my clinical campus, I hear them often. Students tell me they hear the same stories when they visit the home campus: "You are too smart to be a family doc," or "With your Step scores, you can do better than that."

Better? What could be better than being a family doc, having no limits on whom you can serve and what you can do? What could be better than rounding in the hospital early in the morning -- starting the day off in the newborn nursery, then seeing new parents in the maternity wing, all before visiting children in the pediatric wing?

Too smart? We need the brightest students to go into family medicine because family doctors care for the whole patient regardless of age or gender, handle all the organ systems and manage complex cases. We put the patient at the center of that care and are the experts about what's best for them. Our patients come from complicated family systems and live in the complicated communities we serve. They are whole people who often need more than medicine alone to become well. They need family medicine.

We are the "real docs."

In family medicine, you do primary care and more. You go see your patient who just had their gall bladder removed after you made the initial diagnosis and sent them to the surgeon.

You take care of the patient in the intensive care unit with sepsis and the patient who has not stopped smoking and is in for a flare of COPD.

What other branch of medicine allows you to do all that?

My time in outpatient clinic never felt like work to me. I was visiting with my friends (my patients) and helping them with their chronic issues or dealing with something new that came up. I enjoyed giving talks in my diabetes group meetings and assigning homework for the next meeting. I love the challenge of taking on different medical issues in each exam room. It is demanding work, but it is satisfying, as well. We help people on a daily basis.

These are the reasons I went into family medicine. But I worry that the love of practice is waning for some of us. As more and more of us are being employed by hospital systems, we are seeing our scope of practice narrowing. At the same time, hospitalists have elbowed us out of many hospitals, where we should be the ones seeing our patients. In fact, it is the relationship between doctor and patient that keeps patients out of the hospital.(www.nytimes.com)  

Systems expect us to refer patients instead of taking care of issues we can and should be handling ourselves, and time constraints do not always allow us to find out why a patient is not taking their meds as they should. We do not have the time to dig deeper into the social determinants that affect a patient's health when payment systems are pushing us to see more patients. This pressure leads us to gather less information, which leaves the real problems in patient care not dealt with.

All this stands in the way of why I went into family medicine.

What is the answer? There are differing opinions, any one of which could be right for a given individual physician. But what about the profession as a whole?

We need to get back to our core beliefs. I personally believe in the Family Physicians' Creed,  which says,

"I am a family physician,
one of many across this country.

This is what I believe:
You, the patient,
are my first professional responsibility,
whether man, woman or child,
ill or well,
seeking care, healing or knowledge.

You and your family deserve
high-quality, affordable health care,
including treatment, prevention
and health promotion.

I support access to health care for all.

The specialty of family medicine
trains me to care for the whole person
physically and emotionally, throughout life,
working with your medical history and family dynamics,
coordinating your care with other physicians when necessary.

This is my promise to you."

I could not say it any better. We need to embrace that creed. We need to live that creed. We need to stress to the public, payers and legislative leaders that we are the answer to our nation's health care crisis.

We need them to recognize the way to save lives and save money at the same time is to invest in family medicine. We are the answer everyone is looking for.

We are the real doctors we were asked to be.

Leonard Reeves, M.D., is a member of the AAFP Board of Directors.

The Family Physicians' Creed is printed with permission of the American Academy of Family Physicians, Copyright 1994 AAFP.

Posted at 01:06PM Aug 03, 2018 by Leonard Reeves, M.D.

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