There is a group of folks who write about Family Medicine and occasionally write to each other. In the “writing to each other” category, a concern was raised about our inability to tell our story. Many who are true believers in the power of the family physician bemoan the reality that the narrative built around family medicine is not compelling. Or at least not as compelling as the ones built around emergency room physicians who have lots of extracurricular activities (ER), internists who use drugs while engaged in direct patient care (House) or medical students with a lot of free time on their hands (Grey’s Anatomy). So the question went out to the group: what is the dramatic arc around care delivered by family physicians and how can it be packaged and sold? My thoughts on the subject are as follows:

Personally, I don’t want to see a cult of personality around Family Physicians any more than I wanted to see one around a drug addled diagnostician or any other physician being lionized (although I understand the title “Allen Perkins, Great Family Doc” is available). Like pilots flying airplanes, good physicians are necessary but not sufficient to improve the health of America. Many of these physicians, by temperament, must be Family Docs. Our training is very much lagging behind the needs of our country so these “Family Docs” are not just trained in Family Medicine (my specialty) but are commonly trained as Pediatricians, and in Internal Medicine, and may be trained in a number of other specialties. As we do not have a tool yet to measure “Family Physicianess” we have found proxies such as satisfaction and the practice’s performance on certain markers. These docs can also be found by their patient’s stories, often told, is a variation of “I love my doctor because…” which does not make for good drama.

We physicians are clearly complicit in the bloated, inefficient system we have today. Those practicing “primary care” (FM, Peds, and IM) are less complicit as a group than those in other specialties and subspecialties but we are all clearly complicit. Atul Gawande has done a good job of finding stories which illustrate our system problems and has also identified those Family Docs (many of whom were trained in Family Medicine) who are marching down a different path even though it makes for dense reading. I salute him for doing so and look forward to the television show (or more likely the mini-series).

Citizen engagement in their own health is necessary but not sufficient for improving the health of America. Our investment in public health has been woefully inadequate as a nation and our unwillingness to more broadly define public health has allowed the health care system to soak up money from every other aspect of society and move it into the medical industrial complex under the guise of “improving health.” For example,

The recent approval by Medicare of the prostate cancer drug sipuleucel-T (Provenge), which will cost an estimated $93,000 for treatment to increase life expectancy by 4 months, is an example of a very expensive service contributing to health care inflation.

Instead, a patient saying, “I went for a walk with my neighbors yesterday, today, and will do so tomorrow on the path that cost $90,000 and was paid for by the city” is not sexy but it is needed to change the direction of our country. Necessary but hard to develop a dramatic arc to sell.

The interaction between the Family Doc (in the broad sense as identified in the first paragraph) and the pluripotential patient in a setting where health is improved as a consequence of a lot of lifestyle and appropriate pharmacology with only necessary interaction within the broader system is where we need to be. Anyone got a story?

Advertisements