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Am Fam Physician. 2001;63(7):1295-1296

to the editor: The patient information handout entitled, “When You Have Chronic Unexplained Medical Problems,”1 poses the questions to readers: “Do I need an operation?” “ Don't I need to see a ‘specialist’?”

In answer to the question, the handout states, “Your family doctor will know you well and will know if you need an operation or if you should see a ‘specialist’.”

In response to this handout, [I want to clarify that…] when a patient comes to see me they are seeing a specialist. [I feel that… ] they are getting the kind of specialty care they need and deserve. If they need to be referred to a consulting specialist, I will arrange for that.

The literature is full of misleading identities for family physicians. We are called PCPs, generalists and probably other not-so-nice acronyms. Remember the old “LMD” despairingly referred to on rounds at medical school?

I am a specialist, and my area of expertise is exactly what most patients need most of the time. Help me make this point by calling me a specialist when appropriate and emphasizing my special expertise in ambulatory medicine when giving information to patients.

editor's note: Dr. Baum's points are well taken. The American Academy of Family Physicians (AAFP) has a policy regarding the use of the “specialist” designation for family practice physicians: AAFP defines a “specialist” in family practice as a physician who meets at least one of the following three criteria:

  1. Current board certification by the American Board of Family Physicians(ABFP); or

  2. Successful completion of an Accreditation Council for Graduate Medical Education (ACGME)-approved family practice residency program, or a three-year American Osteopathic Association (AOA)approved postgraduate family practice residency program; or

  3. Maintenance of eligibility requirements for active membership in the AAFP.

At AAFP, we are certainly sensitive to the points made by Dr. Baum. For example, as a matter of AFP style, we do not refer to family physicians (or any physician for that matter) as simply a “provider.” And we certainly consider our family physician readers specialists in family practice.

The patient information handout that Dr. Baum refers to mentions “your family doctor” sending you [their patient] to see a “specialist.” As used here, the term “specialist” is used in its more colloquial sense—that of a subspecialist in a given field. I think the context of the handout makes it clear that the family physician is the one in charge of the patient's care. And, certainly, it is not intended to disparage the skills or specialty status of family physicians. Being a practicing family physician myself, I can assure Dr. Baum that AFP will remain vigilant in promoting the ideals of our specialty.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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