Sunday, August 26, 2012

Family Medicine: Superhero Needed

I still remember the excitement I had when Robert Rakel, MD, Chairman of Family Medicine at the University of Iowa (and, eventually, editor of one of the top two texts in the field of Family Medicine) spoke at the National Rural Health Annual Meeting in Detroit in 1974 to medical students attending the meeting.  He introduced the relatively new specialty of Family Medicine with a charismatic presentation which included the Kerr-White diagram, showing that almost no-one who gets sick goes to a university hospital for their diagnosis and treatment.  They were going to Family Physicians.  They still do.

We are America's specialty:  A group of generalists who relate to patients regardless of their problem or need.  Family Doctors are doing well at taking care of much of America.  I'm still proud to be a Family Physician after more than 170,000 patient encounters, but things are changing.

I'm worried about Family Medicine now.  We need 30 % of medical students to select our specialty in order to have enough of a workforce to care for an aging population and to prevent premature demise from preventable or treatable diseases.

An over-emphasis on numbers is leading to increasing patient dissatisfaction with their care.  An  over-emphasis on money is leading to "Market Medicine", ethically insensitive business practices that lean toward profits instead of patients.  An over-emphasis on technology is leading to overuse of expensive technology instead of efforts to balance "High Tech" with "High Touch".  The money that follows the over-emphasis seems to pull medical students away from Family Medicine.

Bob Rakel, who was sometimes referred to as "The Rakel of OZ" was like a Superhero to me.  Family Medicine could use a Superhero to "fight for truth, justice and the American way of life", or at least the patient-physician relationship.  Be on the lookout for a masked someone with a big "FM" on their Superhero shirt.  We need them.

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