What Is Family Medicine?

Going into medicine from a suburban community in the northeast, I never really knew exactly what family medicine was as a specialty. I had heard of it before, but did not see it in action until going to undergraduate school in the middle of Pennsylvania. It was there when I began to understand that family physicians could do a little bit of everything...

But what really is family medicine? I needed an exact definition... as one to memorize for an exam.

Before medical school began, I went to Honduras with a group of family physicians and general internists. It was there where we delivered 2 babies, sutured small wounds, treated rare infectious diseases, helped children in an orphanage, and provided acute and chronic care to people of all ages and stages. This is not something I experienced in my suburban community in the northeast. Family physicians providing comprehensive care in obstetrics, treating obscure infectious disease, all while taking care of pediatric and geriatric patients? What IS this specialty??

I searched for the truth early on in medical school - a difficult task considering I go to a school in a large city in the northeast. It was here where I learned that family medicine physicians were very undervalued, overlooked, overworked, and underfunded. Although competent in all areas, family physicians mostly taught public and community health, physical exam skills, and patient communication skills... interesting since family physicians also provided care in all of the other subject areas during the first two years of medical school, but did not give lectures in any of the core content areas. (sidebar - I would argue that the entire family medicine faculty had better presentation and communication skills than several of the proceduralists that lectured us.)

Later on during my clinical years, I traveled to family medicine conferences, networking with a variety of family physicians throughout the country. I have also spent time on a number of clinical rotations in family medicine away from the big cities, traveling to the subrural community 45 minutes away as well as venturing to the south for an away elective. It is amazing how different family physicians practice depending on the location and proximity to specialist-driven care.

One of my future colleagues, a family physician in the rural midwest, practices in a small community located more than an hour away from most of the specialists located in an academic center within a small city. He does full-scope family medicine, providing full scope care in obstetrics, performs C-Sections, colposcopy and gynecological care, performs colonoscopy, ultrasound, helps in the emergency department, rounds on patients in the hospital/taking call, takes house calls, and by the way, sees patients in the typical northeast fashion - outpatient practice. He does all of this mainly because it is too much of a hassle for the patients and specialists to get together at the specialty-driven academic center located over an hour away. Is this family medicine?

My conclusion is that you cannot really define family medicine.

Another family medicine colleague said that you, as the family physician, are defined by the needs of your patients.

Furthermore, we are defined by the number of specialists required to refer to in order to practice proper defensive medicine when involved in a malpractice case when asked

"'x' specialist was located in close proximity as an 'expert' for 'y' condition. Why did you choose to follow evidence-based medicine instead of referring your patient to 'x' specialist to follow the same evidence-based medicine?"

When it comes down to it, a family physician can do whatever they want to do, as long as they are flexible in their location for practice and are providing services that others are not willing to practice within that given area. The most important thing to remember is knowing when to refer to that academic center - inconveniently located in an area that already has at least 2 other of its kind within walking distance.