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Research ArticleReflections

Family Medicine’s Identity: Being Generalists in a Specialist Culture?

Howard F. Stein
The Annals of Family Medicine September 2006, 4 (5) 455-459; DOI: https://doi.org/10.1370/afm.556
Howard F. Stein
PhD
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  • Please Think Family
    Roy J. Gerard
    Published on: 25 October 2006
  • Evolution of our Identity
    Susan H McDaniel
    Published on: 23 October 2006
  • The Role of a Generalist
    Elaine H. Menard
    Published on: 18 October 2006
  • Family Medicine: Identity Consolidation?
    Kathy A. Zoppi
    Published on: 11 October 2006
  • Generalists are special too!
    Randall Longenecker
    Published on: 08 October 2006
  • Thoughts on Identity Formation
    Virginia A Aita
    Published on: 04 October 2006
  • Generalists and specialists.
    Bery J. Engebretsen MD
    Published on: 03 October 2006
  • Published on: (25 October 2006)
    Page navigation anchor for Please Think Family
    Please Think Family
    • Roy J. Gerard, East Lansing Michigan

    Dr. Stein's article is quite refreshing. I wish had his wisdom and gift for words. In 1980 at the STFM meeting in Boston I stated to the general audience "There is no Family In Family Practice" Today I ask the question "Where is the Family in Family Medicine?" In the Future of Family Medicine report, "A seeming paradox is that while the discipline of family medicine places the concept of the family as central to the...

    Show More

    Dr. Stein's article is quite refreshing. I wish had his wisdom and gift for words. In 1980 at the STFM meeting in Boston I stated to the general audience "There is no Family In Family Practice" Today I ask the question "Where is the Family in Family Medicine?" In the Future of Family Medicine report, "A seeming paradox is that while the discipline of family medicine places the concept of the family as central to the discipline, this attribute does not appear to be viewed in that way by many family physicians. For example,in the FFM research only 59% of family physicians mentioned family as important to the practice of family medicine. This finding suggests the need to redefine the focus on the family in broader terms, because the notion of the family is variable and in flux." I am having a problem with this: we could change the name, drop the name "Family", use the word "General"; it seems I have been there. Meanwhile, other primary disciplines seem to have found the Family. For example, AAP Policy Statement:

    "Drawing on several decades of work with families,pediatricians,other health care professionals and policy makers the American Academy of Pediatrics provides a definition of family-centered care. In pediatrics, family centered care is based on the understanding that the family is the child's primary source of strength and support. Further,this approach to care recognizes that perspectives and information provided by families, children and young adults are important in clinical decision making."

    Without question I feel that Family oriented, Family Centered care is the essence of Family Medicine

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (23 October 2006)
    Page navigation anchor for Evolution of our Identity
    Evolution of our Identity
    • Susan H McDaniel, Rochester NY, USA

    Howard Stein’s article, “Family Medicine’s Identity: Being Generalists in a Specialist Culture?”, is a call to consciousness for those of us in primary care. Dr Stein reminds us that we must not push ideology or politics in the evolving development of our identity. We also must not dump our values in our attempt to survive, for ethical reasons and because that may have paradoxical effects. For those of us interested...

    Show More

    Howard Stein’s article, “Family Medicine’s Identity: Being Generalists in a Specialist Culture?”, is a call to consciousness for those of us in primary care. Dr Stein reminds us that we must not push ideology or politics in the evolving development of our identity. We also must not dump our values in our attempt to survive, for ethical reasons and because that may have paradoxical effects. For those of us interested in the effect of relationships on health, we must continue to study what is and isn’t true in this regard. Similarly, we must define and operationalize a pragmatic, biopsychosocial, family-oriented model of care for Family Medicine.

    Susan H McDaniel PhD Professor of Psychiatry & Family Medicine Associate Chair, Department of Family Medicine U of Rochester School of Medicine & Dentistry Rochester NY

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (18 October 2006)
    Page navigation anchor for The Role of a Generalist
    The Role of a Generalist
    • Elaine H. Menard, Rochester, USA

    I have a dinosaur of an insurance plan that does not require referrals from my FP. So, if I choose or feel I need to see a specialist, then I go to see the specialist without awaiting a referral. A long time ago I utilized that option for either family members or for me.

    That attitude changed when I found my current family practitioner. A generalist or family practitioner is important in many ways. Unless the p...

    Show More

    I have a dinosaur of an insurance plan that does not require referrals from my FP. So, if I choose or feel I need to see a specialist, then I go to see the specialist without awaiting a referral. A long time ago I utilized that option for either family members or for me.

    That attitude changed when I found my current family practitioner. A generalist or family practitioner is important in many ways. Unless the physician is an idiot or complete incompetent, an individual wants to see the same person when they get sick or have continuing complaints. An individual wants someone who remembers family history and medical history. An FP can act as a gateway in helping to prevent unnecessary or expensive tests. They also have the opportunity to engender trust when sensitivity is required for certain referrals in mental health issues.

    Being a generalist should be just as celebrated as the choice to become an opthamalogist. Perhaps more activism on the part of Family Practitioners would help change the attitudes of those who just don't understand the concept of generalization.

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (11 October 2006)
    Page navigation anchor for Family Medicine: Identity Consolidation?
    Family Medicine: Identity Consolidation?
    • Kathy A. Zoppi, Indianapolis IN USA

    Dr. Stein's comments about family medicine and its identity crisis are timely and needed. While it is a very difficult time for family medicine educators, who see student and resident interest shifted toward specialties, it is likewise wonderful to witness patients' own loyalties to the concept of generalism that is the core of family medicine. In an academic center, no other specialty can lay claim to the teaching,...

    Show More

    Dr. Stein's comments about family medicine and its identity crisis are timely and needed. While it is a very difficult time for family medicine educators, who see student and resident interest shifted toward specialties, it is likewise wonderful to witness patients' own loyalties to the concept of generalism that is the core of family medicine. In an academic center, no other specialty can lay claim to the teaching, modeling, and clinical care of ALL members of a family. Often, the contributions of family medicine to the care of underserved populations are notable. But family medicine has struggled in its desire to appear and act like one of the "other" specialties while simultaneously clinging to its origins in generalism. If our political structure, like England's, were to endorse the speciality of generalism as a prerequisite for further training, would family medicine be in a different place, politically and emotionally?

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (8 October 2006)
    Page navigation anchor for Generalists are special too!
    Generalists are special too!
    • Randall Longenecker, Bellefontaine, Ohio, United States

    Excellent exploration of the tensions inherent in discussions around the future of Family Medicine! It would be a tragedy if we as family physicians abandoned our heritage as generalists, as adaptable lifelong learners (ever the novice), all in pursuit of recognition as experts. I for one heartily embrace generalism and our systemic, integrative function within the house of medicine.

    Competing interests:   Non...

    Show More

    Excellent exploration of the tensions inherent in discussions around the future of Family Medicine! It would be a tragedy if we as family physicians abandoned our heritage as generalists, as adaptable lifelong learners (ever the novice), all in pursuit of recognition as experts. I for one heartily embrace generalism and our systemic, integrative function within the house of medicine.

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (4 October 2006)
    Page navigation anchor for Thoughts on Identity Formation
    Thoughts on Identity Formation
    • Virginia A Aita, Omaha, Nebraska, USA

    Howard Stein's article, "Family Medicine's Identity: Being Generalists in a Specialist Culture?" brings to mind a number of important distinctions for those practicing and teaching family medicine. After exploring conflicting notions of identity in the culture of family medicine, he concludes by advocating a practical approach to identity formation through self-reflective and compassionate day-to-day work. Such a view i...

    Show More

    Howard Stein's article, "Family Medicine's Identity: Being Generalists in a Specialist Culture?" brings to mind a number of important distinctions for those practicing and teaching family medicine. After exploring conflicting notions of identity in the culture of family medicine, he concludes by advocating a practical approach to identity formation through self-reflective and compassionate day-to-day work. Such a view is sound and likely to lead to serving patients, their families and others in ways that are meaningful and helpful, which seems the point. Trying to categorize the discipline's identity in a more presumptive manner may be a futile endeavor as it does not account for the process of identity formation which is an inductive, experiential, on-going process in which individuals will diverge. This is, however, not to say that it does not matter how character and identity are informed. Thoughtful, reflective practice is as critical for practitioner's identity formation as is compassion for patient and family healing. Stein's article reminds us of the importance of the individual journey to practice identity, as well as the courage one must have to live by one's convictions despite conflicting forces within the environment. Given this perspective, Stein implicitly invites those who mentor students and care for patients and families to consider how our own individual and collective identities have shaped the culture of family medicine.

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (3 October 2006)
    Page navigation anchor for Generalists and specialists.
    Generalists and specialists.
    • Bery J. Engebretsen MD, Des Moines, IA

    I have been Board Certified by the ABFM since the initial exam. But somewhere in the ‘70s I began to tell people I was a generalist, not a specialist, albeit somewhat quietly, not wishing to offend. I feel quite comfortable in this view of my profession, feeling that medicine (and the world for that matter) need generalists to see the forest AND the trees, at the same time, and how they are connected. That ‘60s thinki...

    Show More

    I have been Board Certified by the ABFM since the initial exam. But somewhere in the ‘70s I began to tell people I was a generalist, not a specialist, albeit somewhat quietly, not wishing to offend. I feel quite comfortable in this view of my profession, feeling that medicine (and the world for that matter) need generalists to see the forest AND the trees, at the same time, and how they are connected. That ‘60s thinking that being a bit off the beaten path is a good thing, has never left me. I applaud Dr Stein's continued work to allow us to look at ourselves.

    Competing interests:   None declared

    Show Less
    Competing Interests: None declared.
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The Annals of Family Medicine: 4 (5)
The Annals of Family Medicine: 4 (5)
Vol. 4, Issue 5
1 Sep 2006
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Family Medicine’s Identity: Being Generalists in a Specialist Culture?
Howard F. Stein
The Annals of Family Medicine Sep 2006, 4 (5) 455-459; DOI: 10.1370/afm.556

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Family Medicine’s Identity: Being Generalists in a Specialist Culture?
Howard F. Stein
The Annals of Family Medicine Sep 2006, 4 (5) 455-459; DOI: 10.1370/afm.556
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  • Article
    • Abstract
    • THE STRUGGLE FOR IDENTITY
    • COMPETING IDENTITY MODELS IN FAMILY MEDICINE
    • FAMILY MEDICINE CULTURE AND IDENTITY IN THEORY AND OPERATION
    • A HISTORY OF CONFLICT
    • WHAT’S IN A NAME?
    • INSIDE AND OUTSIDE: FAMILY MEDICINE’S PROBLEMATIC BOUNDARIES
    • FAMILY MEDICINE AS CULTURAL REALITY, FAMILY MEDICINE AS METAPHOR
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  • Cancer Survivorship Care Roles for Primary Care Physicians
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  • Refutation: La medecine familiale est-elle une specialite?: OUI
  • Rebuttal: Is family medicine a specialty?: YES
  • On TRACK: Challenges and Insights
  • In This Issue: Capacity for Caring and Generating New Knowledge
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More in this TOC Section

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