Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VIII: clinical approaches', authors address the following themes: 'Evaluation, diagnosis and management I-toward a working diagnosis', 'Evaluation, diagnosis and management II-process steps', 'Interweaving integrative medicine and family medicine', 'Halfway-the art of clinical judgment', 'Seamless integration in family medicine-team-based care', 'Technology-uncovering stories from noise' and 'Caring for patients with multiple long-term conditions'. May readers recognise in these essays the uniqueness of a family medicine approach to care.
Family Practice , Integrative Medicine , Humans , Physicians, Family , Clinical Reasoning , Technology
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VI: ways of being-in the office with patients', authors address the following themes: 'Patient-centred care-cultivating deep listening skills', 'Doctor as witness', 'Words matter', 'Understanding others-metaphor and its use in medicine', 'Communicating with patients-making good use of time', 'The patient-centred medical home-aspirations for the future', 'Routine, ceremony or drama?' and 'The life course'. May readers better appreciate the nuances of patient care through these essays.
Drama , Family Practice , Humans , Physicians, Family , Metaphor , Patient-Centered Care
Family medicine is a champion of human-focused health care in the context of lasting relationships. What do humans need-those who seek care and those who offer it? Respect, understanding, and kindness. Without it, more money, more ancillary personnel, more time-saving technology cannot lift us from the profession's doldrums. The author believes that the deep desire to be of help to others can be rekindled in an office culture where the humanity in all of us is honored.
Population Health , Humans , Delivery of Health Care
Professionalism is what professionals do to connect, contribute, and give back to their profession. We often picture it on a grand and spot-lit stage: the white coat ceremony, graduation oath, diplomas on the wall, and resumes on file. But it is in the crucible of everyday practice that a different image emerges. The icon of the heroic and duty-bound physician morphs into a kind of family portrait. Here we stand on a stage built by our forebears, lean against our colleagues, and look to the community where our work is fulfilled.
Physicians , Professionalism , Humans
Continuity of care has long held a hallowed place in the halls of family medicine. Indeed, it is one of the 4 pillars of an ideal family practice, along with first contact, comprehensive, and coordinated care. But what does it mean to the patient, the doctor, and our sense of identity and purpose? And why, in recent years, has it receded from the discourse of family medicine values? This author suggests that continuity is an expression of the value we place on human relationships, a contract of sorts with the people we care for both inside and outside the office. Such relationships are not lightly discarded, for they serve us best in the long haul when our own sense of identity and purpose is tested and worn.
Internship and Residency , Physicians , Continuity of Patient Care , Family Practice/education , Humans , Physician-Patient Relations
After 3 decades in private practice, I joined the faculty of a nearby residency program. Like most family medicine residencies, it follows a curriculum that my physician father would have recognized: heavy emphasis on inpatient medicine; short shrift to continuity care. Despite a changing marketplace, there is still a disconnect between how we train graduates (for full spectrum care) and where they end up (in ambulatory practices). Is our identity disappearing? I contend that the primary and indispensable duty of a residency program is to model professional values and prepare residents to live and work in sustainable communities. Though the scope of practice will vary, family physicians still pride themselves in putting the needs of their patients at its center.
Faculty, Medical/psychology , Family Practice/education , Internship and Residency , Scope of Practice , Curriculum/standards , Education, Medical, Graduate , Humans , Physicians, Family/standards , Surveys and Questionnaires
At the end of the Second World War, the US birth rate peaked at nearly 27 births per 1,000 population-a rate unparalleled in the previous 3 decades, and one that would not be repeated. That Boomer generation is now retiring. How do those of us caught in the wave feel about stepping back? Who will step in to replace us? And how will we replace the loss of purpose and fulfillment that comes from a career in medicine? A lengthening life expectancy has challenged many of us to consider the "second act" to our adult life. This essay describes the emotional turbulence of ending one career and contemplating the next.
Physicians, Family/psychology , Retirement/psychology , Humans , Personal Satisfaction
Although the American health care system seems forever in flux, the young doctors who enter it provide one constant: their desire to help others. How will this desire express itself in an evolving marketplace? This letter is a reassurance that meaning and purpose can still be found in caring for others and investing in their worthy lives.
Career Choice , Physicians, Family/education , Humans , Physician-Patient Relations
The culture of medicine is rapidly changing. The majority of primary care physicians are now employed, and the decisions that govern us are made farther and farther from the point of care. Our sense of well-being is threatened less by the demands of clinical practice than it is by the emptiness of our job: we have forgotten who we are working for, or working with, or why we are working at all. The solution lies in creating the kind of practice environment that we advocate for in each of our patients' lives.
Attitude of Health Personnel , Career Choice , Family Practice , Burnout, Professional , Humans , Job Satisfaction , Workforce
We often experience time as a commodity-in excess for those who suffer; in scarcity for those who minister to them. But it is also a teacher, a tool, and a generous yardstick for measuring one's career-if we take the time to reflect on it. This is an essay about time and timing as a doctor negotiates the practice of medicine.
Family Practice/methods , Physician-Patient Relations , Physicians, Family/psychology , Primary Health Care/methods , Humans , Time Factors
