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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.
Next in Line is the first book to examine the doctor-patient relationship in the context of its new environs, in particular the impact of efficiency-driven innovation and retail-care models on physician mindsets and the patient experience. The overall picture is one of lowered expectations -- a transactional, impersonal, and institutionally-limited incarnation of the medical bedside that leaves all parties underwhelmed and overstressed.
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.
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.
'McWhinney's Textbook of Family Medicine' is one of the seminal texts in the field, defining the principles and practices of family medicine as a distinct field of practice. The fourth edition presents six new clinical chapters of common problems in family medicine.
Heirs of General Practice is a frieze of glimpses of young doctors with patients of every age—about a dozen physicians in all, who belong to the new medical specialty called family practice. They are people who have addressed themselves to a need for a unifying generalism in a world that has become greatly subdivided by specialization, physicians who work with the "unquantifiable idea that a doctor who treats your grandmother, your father, your niece, and your daughter will be more adroit in treating you." These young men and women are seen in their examining rooms in various rural communities in Maine, but Maine is only the example. Their medical objectives, their successes, the professional obstacles they do and do not overcome are representative of any place family practitioners are working. While essential medical background is provided, McPhee's masterful approach to a trend significant to all of us is replete with affecting, and often amusing, stories about both doctors and their charges.
A veteran physician shares his opinion on the state of health care in America and what needs to be done to change it. In an age where uncertainty rules the day, Dr. Rob Tenery explains how health care has evolved into a $2.6 trillion enterprise. He does this with carefully researched histories and a series of challenging and thought-provoking commentaries on the most important issues of the day. Dr. Tenery’s book focuses on a time when doctors and patients worked together to determine the best course of treatment—solutions now being ceded to large corporations and the federal government. He relates, as only a physician can, the challenges, fulfillment, and ethical dilemmas of caring for patients and making the best decisions for their health and well-being. Whether contemplating what doctors can do when nothing can be done, or thinking about the state of the medical profession, his insights are based on real-life experiences with his patients and colleagues. Dr. Tenery brings a perspective and a set of values gained from his father and grandfather, who, together with the author, represent over a century of caring for patients. This book gives you the opportunity to step into the shoes of a dedicated third-generation physician and to see the changing nature of health and medical care through his eyes. This physician of over thirty-seven years is sharing his collected writing for a better understanding of why medicine is a profession and not just another business.
Finding Family: My Search for Roots and the Secrets in My DNA is the highly suspenseful account of an adoptee trying to reclaim the biological family denied him by sealed birth records. This fascinating quest, including the author's landmark use of DNA testing, takes readers on an exhilarating roller-coaster ride and concludes with a twist that rivals anything Hollywood has to offer. In the vein of a classic mystery, Hill gathers the seemingly scant evidence surrounding the circumstances of his birth. As his resolve shores up, the author also avails of new friends, genealogists, the Internet, and the latest DNA tests in the new field of genetic genealogy. As he closes in on the truth of his ancestry, he is able to construct a living, breathing portrait of the young woman who was faced with the decision to forsake her rights to her child, and ultimately the man whose identity had remained hidden for decades. Finding Family offers guidance, insight, and motivation for anyone engaged in a similar mission, from ways to obtain information to the many networks that can facilitate adoption searches. The book includes a detailed guide to DNA and genetic genealogy and how they can produce irrefutable results in determining genetic connections and help adoptees bypass sealed records and similar stumbling blocks.