Becoming A Family Physician

Drawing on the expertise of a nationally recognized group of family practice educators affiliated with the University of California, Drs. Little and Midtling are able to present many specific examples on meeting the challenges of becoming a family physician. Also included are chapters that draw out the differences between inpatient and outpatient service, discuss the teaching of practice management, and touch on the impact of specialists in ethics and cross cultural communication on family practice teams. The concluding chapters examine how family physicians have survived in the "medical community", and examine the future of family practice.

Preceded by Textbook of family medicine / Ian R. McWhinney, Thomas Freeman. 3rd edition. 2009.

With family doctors increasingly overburdened, bureaucratized, and burned out, how can the field change before it's too late? Over the past few decades, as American medical practice has become increasingly specialized, the number of generalists—doctors who care for the whole person—has plummeted. On paper, family medicine sounds noble; in practice, though, the field is so demanding in scope and substance, and the health system so favorable to specialists, that it cannot be fulfilled by most doctors. In Searching for the Family Doctor, Timothy J. Hoff weaves together the early history of the family practice specialty in the United States with the personal narratives of modern-day family doctors. By formalizing this area of practice and instituting specialist-level training requirements, the originators of family practice hoped to increase respect for generalists, improve the pipeline of young medical graduates choosing primary care, and, in so doing, have a major positive impact on the way patients receive care. Drawing on in-depth interviews with fifty-five family doctors, Hoff shows us how these medical professionals have had their calling transformed not only by the indifferent acts of an unsupportive health care system but by the hand of their own medical specialty—a specialty that has chosen to pursue short- over long-term viability, conformity over uniqueness, and protectionism over collaboration. A specialty unable to innovate to keep its membership cohesive and focused on fulfilling the generalist ideal. The family doctor, Hoff explains, was conceived of as a powered-up version of the "country doctor" idea. At a time when doctor-patient relationships are evaporating in the face of highly transactional, fast-food-style medical practice, this ideal seems both nostalgic and revolutionary. However, the realities of highly bureaucratic reimbursement and quality-of-care requirements, educational debt, and ongoing consolidation of the old-fashioned independent doctor's office into corporate health systems have stacked the deck against the altruists and true believers who are drawn to the profession of family practice. As more family doctors wind up working for big health care corporations, their career paths grow more parochial, balkanizing the specialty. Their work roles and professional identities are increasingly niche-oriented. Exploring how to save primary care by giving family doctors a fighting chance to become the generalists we need in our lives, Searching for the Family Doctor is required reading for anyone interested in the troubled state of modern medicine.

"This guidebook systematically analyses the contribution of family medicine to highquality primary health care in addressing the challenges faced by current health systems, and provides options for moving forward. It serves as a pragmatic guide to potential strategies for putting in place family care teams which effectively contribute to health sec

Since the previous edition of Ian McWhinney's text was published in 1989, family medicine has assumed an increasingly important role in the modern health care system. The growth of managed care in The United States and of similar movements in other countries has made it more important than ever to define and conceptualize the discipline and to synthesize its body of knowledge and skills. The author brings to this task a lifetime's experience in family practice and academic family medicine. The first edition was widely acclaimed for its originality, depth of analysis, and elegant style. The book has now been extensively revised, while retaining its original structure. The first ten chapters are devoted, as before, to a conceptualization and description of the field, Much new material has been added on the patient-centered clinical method, illness narratives, the biological basis of family medicine, health promotion, the concept of risk, and the contribution of evidence-based medicine. Chapter 9 now includes an authoritative review of evidence-based preventive strategies. The five clinical chapters exemplify the application of basic principles in practice. These have all been updated with the results of new research. The chapters on the practice of family medicine cover such topics as home care, records and practiced management. The revisions of these reflect many changes that have occurred since the first edition. A new chapter on alternative (complementary) medicine fills the need for reliable information on this topic. The book has been designed to be read as a whole, with fundamental ideas forming a continuous thread which runs through all its sections.

Much is new in Family Medicine since the last edition of our textbook. For example, not only is the therapy of human immunodeficiency virus (HIV) disease and the acquired immunodeficiency syndrome (AIDS) much different than a few years ago; the epidemiol ogy of the disease has also changed and more than half of the family physicians in a rural state such as Oregon have already managed patients with HIV disease or AIDS. 1 There are new immunization recommendations for children and new antibiotics for the treatment of bacterial infections. Computers are bringing medical informatics and on-line consultation into office practice. Medicare physician payment reform is underway and the reality of rationing medical care has been recognized. There has been a recent increase in student interest in a family practice career,2 coincidental with a Council on Graduate Medical Education (COGME) recommendation that at least 50 percent of all residency graduates 3 should enter practice as generalists. Also there is increasing awareness of the need for a 4 Center for Family Practice and Primary Care at the National Institutes of Health. This all-new fourth edition is intended to present the scientific and practical basis of family medicine with special attention to what's new in family medicine. The emphasis is on how the physician provides continuing and comprehensive care for persons of all ages, with clinical content selected from the perspective offamily physicians. The format ofthe book, like the practice of family medicine, continues to change.