Hey, Doc what is this Family Practice thing?

03/17/2009 at 6:22 AM Leave a comment

Or as some would ask, are you a pediatrician or what?

Family Practice is a new specialty, created around 1970 or so. Before then you were either a general practitioner or a specialist, such as a pediatrician, Internist, etc. To be a General Practitioner it only took one year after medical school. You did your year of internship and you hung out your shingle.

However it became quite evident that the scope of medicine was exploding and that one year after med school was hardly sufficient, yet you had to choose between adults and kids. so a group of far sighted GP’s formed Family Practice. It required three years of post grad training, just like the other specialties and formalized a great amount of general medical education. Now you could still be a generalist and see patients from birth to death.

But more than that there is a philosophical difference. It is a focus on the entire family across all diseases and includes the psychological and social dimension. Some of us would add the spiritual/creative dimension (not necessarily religious ). And there was a push towards training and treating people where they lived, in the outpatient world.

Before this the vast amount of training was inpatient. After all that was were the sick people were. That was were the serious diseases were. But the vast number of people that go to a doctor are seen in an outpatient setting. Family Practice formalized training in that setting. The skill set for out patient is distinct from the inpatient. The diseases are milder but similar to inpatient but the ways of handling them are worlds apart. As a crude example, for a pneumonia patient in the hospital, you would write and order 

Keflex 500 mg one QID sign it and sure enough that patient would get one dose of the antibiotic four times a day. This is without having to talk to the patient whatsoever.

In an outpatient setting, you need to inform the patient of the diagnosis, the importance of taking the medicine. Then you need to make it possible for her to be compliant. Giving a medicine that is dosed four times a day is asking for failure. There are no reliable nurses to give them their pill. You have to convince the patient to finish the medicine. On top of that you need to educate them when to call back, what to look out for, and hopefully what not to do ( mixing meds with alcohol, or extra precautions against pregnacy if they are on BCP (birth control pills))

These are not inconsequential skills and they take time and effort and good teachers to learn them. Before FP I suppose they learned it from senior partners and as they went along.

Unfortunately FP had ( has?) a poor country bumkin status in the halls of medicine. It also doesnt help that along with Peds it is among the lowest paying specialties. In a world that desperately needs more generalists my class of 172 sent 8 to FP. I was repeatedly told I was wasting my life, I should just decide whether to do: adults or kids and choose accordingly.

Fortunately for me I had drunk the kool aid way before this. I have been dyed in the wool FP since first year in Med School. Absolutely the right choice for me. I love the kids, but love taking care of the parents, grandparents, great grandparents and now the kids of the first children I took care of when I started.

There wasn’t even a second choice for me ( well actually I might have chosen sports medicine if pushed- but that again crosses many age lines.)

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Entry filed under: How things work.

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