Primary care – a lousy term

I remember when I was a 3rd year medical student doing my pediatrics rotation. The chief resident (who coincidentally was a girl who was a year or two beind me in high school who I was friends with), asked me what specialty I was planning on going into. When I told her family medicine, she replied “Oh Sam, don’t do that. You are far too smart for family medicine.”

when I was a 4th year med student and doing a rotation in the E.R. the head guy there asked me what specialty I was planning on going into.

I told him I was leaning toward family medicine.

He looked at me and asked “Are you going into family med because you’re really stupid or because you’re really smart?”

In response to my confused look he explained, “Becomming a family medicine doctor is easy. You don’t have to be very smart at all. It’s about the least competitive residency to get into that there is. Almost any moron can become a family medicine doc.

You can be the dumbest guy in your class and be a family medicine doc. To be a truly good family medicine doc however, you better be the smartest guy in your class. ”

My experience as a family medicine doctor seems to support the ER guys description more than that of my friend in pediatrics.

I think your description of people’s general reaction to the term “primary care” is unfortunately pretty accurate.

People have a false impression that primary care docs are not very bright and that the work they do is somehow much easier to competently handle than that of the sub-specialists.

My question to you is “What terminology do you propose to replace the term Primary Care?”

Will changing the name get us any more respect? I doubt it. I get all the respect in the world from anyone who knows me personally and none at all from most who don’t. The AAFP has their “We specialize in you” campaign which is charming but hasn’t changed attitudes as far as I can tell.

How about Comprehensive Medicine. Sounds good to me but pretty sure to miff someone by being too pretentious.

I call myself bean because I am very good for you, a great value and am almost always underrated and underappreciated by the outside observer. “Beans, beans, good for your heart… and I am!

like ‘ i’ll do a resident in a complex care.’

Primary care docs provide care across the spectrums of:
Person (age, gender, severity of illness, organ system, etc.)
Place (office, hospital, SNF, airplane, family get-together)
Time (longitudinal, not to mention the nights/eves/weekends/holidays)

How about
Multidimensional Care
Polydimensional Care (sounds nerdy)
Multi-oriented care
Full Spectrum Care
Whole Person Care (sounds crunchy)

I still think the old fashioned term ‘generalist’ makes the most sense (like a general contractor.) ‘Primary care’ is too difficult a concept…many lay people don’t understand the differences between levels of care (like tertiary, etc) and the term ‘family medicine’ is too limited in todays world where everything is not about the nuclear family… for instance the ‘family values’ term is often used by many groups to discriminate against gays, etc…. the use of ‘family’ here is often just a dirty word bringing to mind all the prejudices those people harbor.

Name doesn’t matter. I remember “Doctors for Adults” from my parent organization. Pffftt. My relatives still ask me when I will be done being an Intern (Practicing IM X 10 years).
My partners and I haven’t given a name yet to the ultimate obstruction of a turd rolling downhill. This doesn’t keep us from showering up each morning and coming in to work.

Well Dr. Kranky, it is hard to understand how it works if you’re not familiar with it. But its hard to argue with all the outcomes studies that show over and over again what good pimary care adds. Study after study shows lower mortality, lower costs, fewer disparities, etc. when you have more of us. There are dozens of articles, but probably the best are from Barbara Starfield out of Johns Hopkins. Here is one of her more recent articles if you want to read about the evidence. The specialist haven’t been able to show similar results and neither can the nurse practitioners.

http://www.fammed.tulane.edu/news/Contrib%20of%20PC%20to%20health%20systems%20starfield%20milbk%20qurt%202005.pdf

Isn’t the term “holistic care” associated with “primary care”? I think it would make a good substitution.

Gee. Reading this article brought back a whole bag of emotions I felt at the start of this year as I began considering medicine and doing research into the field of primary care (family medicine in particular). I was impressed by the roles primary care physicians play in the health care process. In the midst of my research, I happened to come across several articles referencing studies indicating the range of benefits an adequate supply of primary care physicians provides to communities (as DB and Dr. Bob mention). In short, I was pleased that such a profession exists and I even entertained the thought of going to medical school to become a family physician.

However, I couldn’t help but note a several articles expounding the problems facing primary care. To make a long story short, after a few internet searches, and hours poured over reading medical blogs by (real, live :]) practitioners, I am not having serious thoughts in considering family medicine or medicine at all…

Well, I still have three more years (or less, accounting for prerequisite courses and testing), so I guess there’s still enough time to reflect and consider. I’ll certainly be attentive to what changes (if at all) the presidency will bring.

- DP

A rose is a rose is a rose…
By any other name we still
Do what we do or don’t.

And if I AM the smartest
The best of the brightest,
Would the patient know?

Or care when what we sell
Is “care” which means pleasing
The always-right customer.

FM/IM/PC are stuck in a system
Where selling services drives
The fee for service bottom line.

And we sell sno cones, not
Seven course meals with
Wine and cigars.

Rose flavored sno cones.

It does not matter what term you use for “primary care”. IM/FP/Peds are now dying fields for phsicians. The NBME has recently agreed to develop board certification exams for nurse practitioners – http://online.wsj.com/article/SB120710036831882059.html?mod=todays_us_personal_journal
This means that the distinction between board certified physicians in primary care and board certified doctor NPs. The midlevels will take over primary care IMHO.