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It is not surprising to see my colleague and former co-resident of forty years so cogently unearth the soft underbelly of the modern American Health Care conundrum. While so much in the science of medicine has changed over the course of the forty years of our careers, so little has occurred to recognize the failings outlined by Dr. Stange. The obsession with technologies, high-cost cures and therapies, and scientifically unproven treatments has created a top-down system which diminishes caring, compassionate and preventive care. The same challenges wrought the recognition of the specialty of Family Medicine and the establishment of the ABFM in 1969.
A recent letter published in JAMA (1) which states “The “old style family physician,” formerly the ideal example of medical practitioner who was family councilor and comforter as well as omnimedical adviser, is passing. Several most interesting articles have appeared which have emphasized his worth to the community, regretted his gradual disappearance, and suggested means of bringing him back; but he is the victim of human limitations, and in the “time honored” sense cannot “come back,” because medical science has made it impossible.…” highlights the uphill battle faced by those of us who would join Dr. Stange in his proposed mission.
Although I do echo the sentiment of his proposal to “focus family medicine on delivering the highest quality personal doctoring for the number of people for whom that is feasible, and let the resulting growing demand drive the needed systemic changes”, it has always been the very nature of family physicians to strive to provide the highest quality personal care while at the same time attend to the needs of those in dire need. It is, however, unlikely that those devoted to this noble specialty can steel themselves to abandon those in their communities sufficiently to shake the foundation of the current medical system.
We must once again focus all of our energies on empowering the students and residents to recognize the value and lifelong benefits of crafting this new model of “sophisticated health care” and provide them opportunities to make that choice. Once they recognize that Family Medicine can offer models with financial security, sustainable lifestyles and professional satisfaction they will increasingly choose careers in the specialty. The great weapon, our “family doctorness” lit the torch 50 years ago and must now carry us forward into a new era of higher quality, patient-centric health care built on a foundation of well-trained, capable, satisfied family physicians.
(1) The Problem of Preventive Medicine:In Practice and in Medical Education
March 31, 1923 | JAMA. 1923;80(13):885- 890.