A Real Family Doc

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What is a real family doctor?  I can probably write pages about that.  Actually, you would know that if you had ever read this blog.   That being said, I think all family docs have their own preferences and some are better at certain procedures or areas of illness than others.  The spread of differences seem to be getting wider, however.  The most recent editorial by the head cheese at the Journal of Family Practice got heated over this issue:

Not long ago, I had a conversation with a colleague—a residency director and family physician—about the unique contributions family doctors make to health care. He believes FPs are best trained to provide chronic disease care and address prevention. And he’s proud that his program trains residents in motivational interviewing to guide patients to healthy behaviors and adherence to medications and recommended screening tests.

I agree that these health-coaching skills are important for FPs and that we should strive to nudge our patients toward healthier lifestyles. But is that the heart of family medicine? I don’t think so.

I was dismayed by the fact that my colleague did not mention caring for people who are sick: those who have aches and pains and those who just don’t feel well and need careful evaluations that could lead to a diagnosis of cancer—or to the realization that the symptoms are related to psychological distress.

At times I fear that all the focus on prevention and chronic disease management, necessary as these are, distracts us from our most important work: meeting the immediate needs and concerns of our patients. The agenda of the office visit used to be exclusively the patients’. Now a visit—and our attention—is often split between their agenda and ours, which includes screening for this and that and exhorting patients to a healthier lifestyle whether they want it or not. I had one irate patient tell me, “Don’t put me on that scale again! I know I’m fat and if I want your help, I’ll ask for it.”

Overemphasis on prevention and chronic disease management, I fear, has caused many physicians to undervalue diagnosis and acute care. The sad result? In some practices, the schedule is so full of routine follow-ups that patients must go to an urgent care center or the ED for complaints that could be easily managed in a doctor’s office.

I did not go to medical school to be a health psychologist, even though my college major was psychology. I wanted to be a doctor, and I still do. I want to diagnose illness or wellness accurately and efficiently and help patients feel better—to offer reassurance to the worried well and the right treatments to those who are sick. The “number needed to treat” to listen carefully and provide reassurance and proper treatment to a patient with an acute complaint is one!  My beliefs about family medicine are reflected in the contents of JFP. We publish articles about chronic illness, prevention, and acute care in a balanced fashion. Family physicians need to be triple threats, not health psychologists.

Yes, this is what our residency programs are cranking out – doctors who can’t treat an acute illness.   Unbelievable.  Why?  Because a lot of FP directors got caught up in the quality crap and were hooked.   They now teach future doctors not to meet the immediate needs of our patients.   They teach them to meet the needs of administrators, insurance companies and the government.   It’s so sad.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “A Real Family Doc

  1. Gerald A. Shubs, M.D.
    September 29, 2013 at 2:56 pm

    As you have written and bemoaned for years, the insurance companies (and managed “cost” companies and pharmaceutical managed carve-outs) control the practice of medicine. In my case, as a psychiatrist in a community mental health center, the term “prescriber” has usurped “doctor” and “physician.” There has been more and more of a blurring of identities, so that a physician’s assistant and other “physician extenders” are CONSIDERED “psychiatrists.” As far as I am concerned, my role is as a physician, who evaluates and treats and cares and controls the treatment. Physicians should be supervising these people, no matter what their level of competence. The medical schools are more concerned (so I have been informed by someone on a medical school admission committee) with admitting technically-proficient, very bright research-oriented people. Life experiences are not as much as a factor, if they ARE a factor, in becoming a medical student than are algorithms and shallow expectations. Dr. Farrago, you and I are too old-fashioned or just-plain OLD to spend so much time on the EHR/EMR than on patients. It is getting worse, as the government and insurance companies mine the data to look for what they consider improper use of medications. They mine the data to weed us out.

    • T
      October 2, 2013 at 2:31 pm

      Have you ever considered being a Naturopath? There’s many different types of ‘holistic’ doctors.
      I expect you know it’s not quackery.
      I use a Chiropractor, and a Knesiologist. Obviously, insurance doesn’t cover that- gotta keep Big Pharma happy.
      But they’ve people I know and me a great deal of good.

      No insurance BS? Then you’re your own boss.

      Just a thought.

  2. Sir Lance-a-lot
    September 28, 2013 at 7:53 pm

    Which is why I sometimes feel as though I’m practicing better family medicine working in an urgent care than I would stuck under a mountain of EMR “paperwork” and behind a schedule of follow-ups in a “regular” office.

    I see people all the time who tell me that they come to us when they feel bad because their doctors only want to see them when they’re well, and people whose lengthy histories of subtle complaints I elicit, who tell me they never told them to their doctor because “he doesn’t listen to me.”

    It’s frankly depressing as hell.

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