People are often surprised to learn that family physicians take care of infants and children as well as adults. I guess this is truly poor marketing on our part because I think it’s one of the things we do best! A large part of caring for a child is the relationship with the child’s parents and/or extended family. By caring for the whole family, we family doctors have an advantage. For example, if I know Mrs. Jones very well and I know that she doesn’t get rattled easily, I will take it pretty seriously when I hear that she is upset about her newborn son’s illness. If I know that a grandparent or parent is struggling with a severe medical problem, I’ll understand the stress the family is under. I may decide that we can handle a child’s illness over the phone because an office visit would be an incredible inconvenience at such a difficult time. Family doctors are uniquely trained to establish a partnership with the parents and the whole family. We consider this to be an integral part of the care of a child.
Some people still wonder if we have as much training as a pediatrician. In fact, we do train alongside pediatricians. The difference is that our training is more broad, and encompasses the care of adults as well. Many disease processes cross from childhood to adulthood and have similar underlying mechanisms and treatment options, so this is really not as difficult as it may seem. Family doctors are trained to care for all the major illnesses that affect children, and know when to recognize the signs of something rare and/or potentially life-threatening. When the problem is out of our realm of expertise, we refer to the same specialists as pediatricians.
Many people don’t really understand the training of family doctors because things have changed a great deal since the days of the old “general practitioner.” Many years ago, any physician who graduated from medical school could begin in general practice. Doctors who wanted to specialize (cardiology, hematology, etc.) went on for more training. With an explosion of medical knowledge and technology, it has become unrealistic to think that someone could learn everything s/he needs to know after four years of medical school. For this reason, the specialty of family practice was born over 30 years ago. Family practitioners must complete a 3 year residency after medical school and undergo board examinations every 7-10 years to maintain certification by the Board of Family Medicine. A family physician’s training is just as rigorous as many of the specialists’ training, but the end result is a knowledge base that is more broad than a specialist’s, but not as deeply focused in one specific area. The goal is to be trained to manage the common medical problems that are responsible for approximately 90% of all office visits, and to recognize the signs of the other 10%, so we know when and where to refer patients. We plan to refer if we encounter a problem that is rare, does not respond to standard treatment, or requires a procedure that we have not been trained to perform. Family medicine residents spend time training in general adult medicine, pediatrics, obstetrics and gynecology, dermatology, orthopedics, psychiatry, etc. Again, during each of these rotations, our focus is learning to diagnose and manage the most common problems. And if my experience is typical, we undergo greater scrutiny than our colleagues training in internal medicine, pediatrics, etc. Why? For some reason, the attending physicians in the other specialties like to grill the family medicine residents more than their own residents! We are always kind of the “ugly duckling” as we rotate through their departments. As a family medicine resident, I learned pretty quickly that I had better know my stuff or I’d get skewered by the attending physician during rounds.
Family physicians are also trained to practice “patient-centered”care. This means that we focus on the wants, needs, and unique issues of the individual patient, not just the textbook protocols. We actually receive additional training in this area. We are well-versed in providing comprehensive care because during training we are expected to manage ALL of the patient’s medical problems, not just the issues of one organ system. We are also taught to involve patient’s families in these care decisions. A physician caring for a child needs to have a partnership with the parents, so their unique perspective is considered when establishing a plan. This is true of many adult patients and their family members as well.
Even though the old “general practitioner” has gone the way of the telegraph and horse and buggy, today’s family practitioners strive to continue the tradition of strong patient relationships, continuity, and compassion, as we care for families in the era of modern medicine. Our training has become more intense and our knowledge base larger, but our values are the same. Putting the patient and family first is our top priority. In an age when medical care can be fragmented and impersonal, we feel that a family physician offers patients of all ages, from newborns to seniors, the best possible care.
Shari S. Phillips, M.D.
Your Lake Norman Physician