What’s in a name?
I was just finishing up with a patient, a retired social worker named Paul, when I noticed he was looking at the plaques on my wall. “Your certificates say you’re a family physician,” he said. “What’s the difference between that and a general practitioner?”
The question took me aback. No patient had ever asked me that before. In fact, no patient had ever asked me where I went to medical school, where I trained, what number I graduated in my class or any of the things that we doctors think are important. “Well, Paul,” I began, “in family medicine we try to take care of the whole family and give comprehensive care to all family members.”
“So, you take care of all of your patients’ families?” he asked.
“Not always,” I said. “Some patients still take their kids to a pediatrician and their spouses might go to an internist or another family physician. But we’re concerned about the family unit, we ask about it and we treat people in the context of what we know about their families.”
“OK,” Paul said, “Do you have intensive training in family dynamics?”
Now I was beginning to wonder about the name myself. I had had some training in family dynamics before going to medical school, but I was no expert. Paul continued, “I would imagine that your specialty self-selects for people-oriented, intuitive, caring physicians, but how do family physicians’ training programs advance their knowledge about families? Do they study family life-cycles and parenting styles? Do they learn how to provide family counseling or deal with families that become dysfunctional?”
Paul didn’t want to put me on the defensive but reminded me that he had spent his entire career as a family counselor and objected to the arbitrary use of the term “family.” He said, “If your new moniker doesn’t reflect who you are and what you do better than your old one, then perhaps you should go back to being called general practitioners. Besides, most people still think of you all as GPs, don’t they?”
“Sad, but true,” I thought.
After Paul left my office, I decided to contact some of my colleagues to get their input and find out whether today’s residents are getting more training in family dynamics and therapy than my generation did. Don, who recently retired from 25 years in academic family medicine, confirmed my hunch to a degree. “The old GP programs were only two years and many residents left after just one. The idea behind the FP residency was to expand the training to three years and include the psychosocial aspects of patient care. In our program, we stressed continuity. Our clinics weren’t run like urgent-care centers. Patients would see the same resident over and over again. We would often videotape encounters and play them back later for the resident’s edification. We also had a psychologist on staff who taught family dynamics,” he explained. “As for the GP or FP designation, I don’t care what we’re called. It’s what we do that’s important.”
My itinerant FP buddy Jeff had this to say: “I don’t think there is much difference between FPs and GPs except two extra years of training and honing skills. My residency program offered a few noon conferences about family issues, but most of what I learned about the psychosocial model was taught to me in medical school. I agree that we should change the name of the specialty because it doesn’t make sense.”
Sharon, a newly minted residency graduate who spent a week in my office learning practice management, responded as well. “In our program, we spent one afternoon a month with our staff psychologist discussing various psychosocial issues, presenting complicated patients and discussing videos of interviewing techniques. We also had a couple of lectures per year focused on family dynamics, spousal abuse or related issues. I’ve heard of other FP programs that use the Balint method to discuss psychosocial issues, usually referred to as the ‘touchy-feely afternoon.’”
When Paul returned a week later for his follow-up visit, I briefed him on my findings. He grew pensive for a minute and then said, “I’m sorry, Sandy, but the more I think about it the more incongruous your nomenclature seems.” He went on to comment on how every other specialist’s designation defines his or her practice: pediatricians take care of children, hematologists take care of blood disorders, ENTs take care of ear, nose and throat problems, and so on. “The name family medicine implies a special knowledge of families that your training hours do not support,” he said. “If you’re going to call yourselves family physicians, you should be specialists in family issues. You may be jacks of all other trades, but you should be masters of this one.”
“Regardless of what you call yourself, you’re still my doctor,” Paul continued. “I like you because you listen to me, you’re nonjudgmental, you’re always there and you really care.”
“So in other words,” I said, “I guess we’re kind of like family.”
Editor’s note: What do you think? Do you believe the name “family physician” describes what you do? How would you defend the name? Send comments to firstname.lastname@example.org.