By Amy Cline
The practice of the physician has evolved from the early days of having a town doctor provide all of the medical care to every age range. These general practitioners treated children with chicken pox, performed surgery, eased the pain of dying seniors and delivered babies. For many years, these generalists provided the only medical care available. These all-purpose physicians are now known as family practice physicians.
As the medical field has grown it has become impractical for every physician to have the latest training due to the advanced medical knowledge and technology required. Today, physicians have begun to limit their practice to specific, defined specialties. In the 20 years that followed the second World War, specialties and sub-specialties have increased immensely leaving the generalists practice dwindling. This resulted in a public outcry due to shortages of physicians who could provide comprehensive care for every member of their family.
Thus began the reorientation of medicine back to personal, primary care. Ironically, the concept of the "generalist "was reborn with the establishment of family medicine as medicine's twentieth specialty.
Not unlike other specialties, family medicine incorporates skill, knowledge and finally process in their practices. Knowledge and skill are shared with all specialties, it is the "process" that sets family medicine apart from the rest. The patient-physician relationship in this process is unique in that the patient is viewed in the context of the family, not individual. Because this is unique to only a family practice job, it separates the specialty from all other physician jobs in medicine.
The family physician functions as the gatekeeper for the patient's entry into the health care system. Because he or she functions as the healthcare system's point of first contact, the family medicine physician is in a unique position to form a bond with the patient. The family physician's job is both personal and comprehensive, and not limited by their patient's age, sex, or type of problem - be it biological, behavioral or social.
This relationsip allows the family physician to base the patient's care on knowledge of the family and the community while focusing on disease prevention and health promotion. Should the patient need to be referred the family physician refers their patient to a specialist or caregiver, but will remain the overall coordinator of the patient's health care. This system prevents confusion and mistakes in both the outpatient and inpatient settings.
The family physician serves as the patient's advocate in dealing with other medical professionals, third party payers, employers and the world at large. As such, the family medicine physician serves as a governor over rising healthcare costs.
Family physicians generally share a core of knowledge, however, these skills and knowledge can vary by geographic areas and socioeconomic factors. A good example of this would be the difference between the skills and knowledge used by a family physician practicing in an inner city may vary greatly from those used by a family physician with a rural practice.
The patient-physician relationship is central to the family medicine job and distinguishes family practice from other specialties. To sum it up, the family practice job today is rooted in the historical traditions keeping the specialty patient-focused and unbound by age, sex or malady.
