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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.
'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.
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 issue of Gastroenterology Clinics of North America is on Gastrointestinal Motility Disorders. GI motility disorders are common reasons for patients to see gastroenterologists. Knowledge of the pathophysiology, evaluation and treatment of these disorders is important to appropriately care for patients with gastrointestinal motility disorders in clinical practice. The chapters of this issue will discuss key aspects of gastrointestinal motility disorders focusing on how they relate to practicing gastroenterologists and other health care providers. Current knowledge in the area as well as evolving concepts from clinical investigations and translational research from basic sciences will be discussed. The rapid explosion of new technology used in the evaluation of patients will be covered.
Doctors Pierre Pluye and Roland Grad, internationally recognized experts in the fields of knowledge translation and health information studies, along with bestselling author and journalist Julie Barlow, take readers behind the scenes to show how online information is affecting self-care and primary health care in medicine, nursing, and pharmacy. Based on fifteen years of in-depth interviews and research, Look It Up! provides essential tips for patients and clinicians to administer and receive the best possible primary health care, while avoiding the perils of unguided self-diagnosis. This book shows how, by dint of an inquiring mind and a smartphone, rapid and accurate acquisition of knowledge keeps primary care clinicians up to date. It also shows how people can determine whether a test is more beneficial than harmful, and how information helps resolve disagreements and improve collaboration with patients and families, and among doctors, pharmacists, and nurses. In the age of easily accessible online information, clinicians have to think differently about how they work. Organized around numerous real clinical stories, Look It Up! is an illuminating and lively guide to improving patient care.
Health care and medicine are dependent upon a close interaction with social sciences and professions in order to effectively treat patients. Athough medicines have becoming more and more targeted in recent times, it is the recovery of the patient which is the true test of the system whether it be in a hospital setting or within a daily societal setting. Such interactions may be psychological or interactions with social organisations essential to phase the patient back into society. This book presents new issues, experiences and research in the field from around the globe.
Job Search Sucks! If you are looking for work, will be looking for work, or have given up on the whole job hunting experience, you will know how true that is. But, if you want work, you gotta do the job search thing, so why not get a laugh or two and some great advice along the way? Read it all? Heard it all? Don't be so sure. Being fired is a horrible experience. A layoff may sound less brutal, but in reality its just a firing in camouflage; you are still being given the boot, only with benefits (sometimes). Just as crappy is having to reenter the workforce after an accident or illness has shattered your confidence, maybe even stolen your ability to do a job you loved and were good at. Or you have just graduated and have no clue what you really want to do with your life or who is going to hire you without experience. Whatever your story, the fact is, some horrific, brutal, or crappy event has forced you to look for work. You just might find a new idea or two in this frank and funny look at what we all know to be trueJob Search Sucks!
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.