Margot Savoy, MD, MPH
I never got up the courage to say it out loud to the senior physician leader who had declared he was now officially my mentor. Not exactly the way I usually start off a mentor-mentee relationship, but my leadership coach said be curious and go with it.
We met for my semiannual check-in. I came prepared to share what progress I had made over the past months since we last met and had some goals I wanted to get his advice on. He started with “How have things been going?” and within the first 30 seconds he had interrupted me and taken over the conversation. Over the next 45 minutes I never got more than a sentence in before he started talking again. He wrapped up by telling me what I needed to work on before our next meeting while escorting me out of his office. (I have to say, if that is how we make patients feel during office visits, shame on us!) It was an unsatisfying encounter leaving me feeling disappointed, frustrated, and angry.
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Sarina Schrager, MD, MS
The debate about work-life balance seemingly has a life of its own. Every few months there is a new book or blog with the answers. I have two issues with the concept of work-life balance and its meaning in my life. First, most discussion of work-life balance implies that the life part is good, and the work part is bad. We all work too much, so don’t have enough time for “life.” Our conversation revolves around how to do more in less time, how to hire out chores that we don’t enjoy, how to not feel guilty about being away from home. My issue is that this black and white, good and bad, is just not reality. I spent a lot of time training to be a physician. It is a big part of who I am. There are lots of parts of my job that I love to do. It is not inherently bad. In fact, when I am happy at work, I am happier at home and in my life.
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Joseph Scherger, MD, MPH
Many educators are lamenting today that the scope of family medicine is shrinking.
They refer to fewer family physicians working in hospitals and doing procedures. Warren Newton, MD, MPH, chair of the American Board of Family Medicine, recently sent out a letter expressing this concern. Such a grave outlook is dangerous to our specialty at a time when we are struggling to motivate medical students to go in to family medicine.
I think just the opposite. Family medicine today is more complex and expansive in some ways than ever before. Sure, fewer of us are delivering babies and doing hospital medicine, but family medicine is first and foremost a primary care specialty. Primary care is expanding and becoming far more complex in this new age of medical homes and the advanced use of information systems.
The Willard Report that set the stage for the transition from general practice to family medicine called for the creation of a new primary physician. That doctor would be the personal physician to individuals and their families. It is that personal physician role that is the essence of our specialty. New models of primary care, from concierge medicine to team-oriented medical homes to populations of patients, are deeply complex and expansive.
What do I mean? Prevention became part of primary care in the 1970s and continues to expand. Primary prevention includes all efforts to prevent disease, and since lifestyle causes 50% or more of disease, motivational counseling toward lifestyle change is a new and vital part of being a personal physician. Secondary prevention is the early detection of disease and knowing and applying all aspects of the US Preventive Services Task Force recommendations requires good information systems and skills. Tertiary prevention is the prevention of complications of chronic disease and is far more complex than when I finished residency 30 years ago.
Chronic illness drives about 75% of all health care costs so effective management of these problems is vital to our health care system. The routine visit of a type 2 diabetic patient is far more complex than before and requires much more time. Acute problems are still a major part of family medicine and if we are available to our patients online, we can manage or coordinate care much more efficiently. Relationship-centered care calls on us to know our patients well and provide the counseling services our patients need to deal with what life brings to them, attending to the biopsychosocial and spiritual dimensions of illness.
So, let’s stop this talk about the scope of practice of family medicine shrinking. I am grateful to have more time to take a deep dive with my patients and be their personal physician with much greater complexity and effectiveness than ever before. Let’s train our residents to do the same and show off this rewarding specialty to our students. What can be better than being a family physician?