Suzanne Leonard Harrison, MD
People are talking about domestic violence. Finally.
One good thing that has emerged from the media attention with domestic violence and the NFL is that people are talking about it. During the week following release of the Ray Rice video it was all over the national news, making it easy to engage both men and women in conversations about domestic violence. While the video was playing on a television in a Texas airport, I asked a young man what he thought about it. He looked directly at me and said, “I don’t think you want to know what I think.” After I assured him I did, he shared some very negative remarks about men who perpetrate violence against women. The significance for me was that it was easy to engage a man I had never met in a meaningful conversation about domestic violence. The National Domestic Violence Hotline experienced an 84% increase in calls in the days following release of the video. Perhaps we finally entered an era when the silence has ended. I sincerely hope so.
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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?