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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.
Ask for a definition of primary care, and you are likely to hear as many answers as there are health care professionals in your survey. Primary Care fills this gap with a detailed definition already adopted by professional organizations and praised at recent conferences. This volume makes recommendations for improving primary care, building its organization, financing, infrastructure, and knowledge baseâ€"as well as developing a way of thinking and acting for primary care clinicians. Are there enough primary care doctors? Are they merely gatekeepers? Is the traditional relationship between patient and doctor outmoded? The committee draws conclusions about these and other controversies in a comprehensive and up-to-date discussion that covers: The scope of primary care. Its philosophical underpinnings. Its value to the patient and the community. Its impact on cost, access, and quality. This volume discusses the needs of special populations, the role of the capitation method of payment, and more. Recommendations are offered for achieving a more multidisciplinary education for primary care clinicians. Research priorities are identified. Primary Care provides a forward-thinking view of primary care as it should be practiced in the new integrated health care delivery systemsâ€"important to health care clinicians and those who train and employ them, policymakers at all levels, health care managers, payers, and interested individuals.
This easy-to-use reference helps practitioners quickly diagnose common skin disorders and determine appropriate treatment options. More than 500 fullcolor images speed diagnosis by showing the reader distinguishing characteristics of each disorder, as well as providing clear comparisons between similar looking conditions. Features of the text include fornulary tables of leading topical agents and preparations by brand name, as well as patient handouts in English and Spanish. Basic derm rologic procedures are presented in a simple, easyto-understand format, making this guide an invaluable reference for office surgery. The Second Edition features new, larger photos, more patient handouts, and new material on several disorders. Also included is an expanded basic procedures section with new and more detailed procedures and more illustrations and photos of necessary equipment.
This 2006 volume provides a comprehensive discussion of communication between doctors and patients in primary care consultations. It brings together a team of leading contributors from the fields of linguistics, sociology and medicine to describe each phase of the primary care consultation, identifying the distinctive tasks, goals and activities that make up each phase of primary care as social interaction. Using conversation analysis techniques, the authors analyze the sequential unfolding of a visit, and describe the dilemmas and conflicts faced by physicians and patients as they work through each of these activities. The result is a view of the medical encounter that takes the perspective of both physicians and patients in a way that is both rigorous and humane. Clear and comprehensive, this book will be essential reading for students and researchers in sociolinguistics, communication studies, sociology, and medicine.
Through ninety-five in-depth interviews with primary care physicians (PCPs) working in different settings, as well as medical students and residents, Practice Under Pressure provides rich insight into the everyday lives of generalist physicians in the early twenty-first centuryùtheir work, stresses, hopes, expectations, and values. Timothy Hoff supports this dialogue with secondary data, statistics, and in-depth comparisons that capture the changing face of primary care medicineùlarger numbers of younger, female, and foreign-born physicians.
How patients heal doctors In Patients and Doctors, physicians from around the world share stories of the patients they'll never forget, patients who have changed the way they practice medicine. Their thoughtful reflections on a variety of themes--from suffering to humor to death--help us to understand the experience of doctoring, in all its ordinary and extraordinary aspects. In settings as diverse as Slovenia and Sweden, Cambodia and New Jersey, we learn what makes the healer feel graced with insight or scarred with misadventure. In Washington State, we anguish with patient and doctor alike when a young resident removes a screw from a little boy's foot; on the Israeli-Jordanian border, a woman goes into labor just as the air-raid sirens signal the beginning of the Gulf War. These compelling accounts remind us what is at stake in doctoring, reinforcing the value of stories in the teaching and practice of medicine: to calm, to validate, and to illuminate the human experience. "These stories illustrate humane physicians at their best."--Sharon Kaufman, author of The Healer's Tale
A family orientation in health care can provide a wider understanding of illness and a broader range of solutions than the classic biomedical model. This volume thus offers practical guidance for the physician who would like to take greater advantage of this resource. The result is a readable guide, structured around step-by-step protocols that are vividly illustrated with case studies drawn from the authors extensive experience at the University of Rochester School of Medicine.
Because of changes in the health care system, the hospital has become less suitable as the primary focus of graduate medical education for primary care physicians. However, the current system of financing health care education and services makes it difficult to accomplish the needed shift to training in primary care ambulatory settings. This book suggests ways of lowering financial barriers to primary care training in ambulatory settings.
Designed for today's busy family physicians, Dermatology for the Primary Care Provider is an easy-to-use reference covering the diagnosis and management of commonly seen dermatologic conditions. It provides practical, everyday guidance for quick reference at the point of care, including management pitfalls, clinical warning signs, specific treatment recommendations, and much more. Packed with need-to-know information, this unique resource is invaluable both when you are confident in your diagnosis and need guidance on next steps, or when you need step-by-step assistance on initial management in the absence of a definitive diagnosis. Highlights common management pitfalls, how to rule out acutely dangerous entities, and clinical warning signs requiring urgent referral. Provides specific treatment recommendations including which level of therapy is necessary, clear instructions on how to prescribe, and what to watch for. Includes numerous treatment algorithms throughout, as well as a differential diagnosis overview list in every chapter with cross-references to the corresponding page. Contains helpful information on patient education as well as answers to commonly asked patient questions. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.