Tuesday, April 3, 2012

The most difficult specialty in medicine

Family Medicine.

Are you surprised at my answer? Here are my 5 top reasons, see if you disagree by the end.

1. Breadth of knowledge. 
General practitioners like to say they care for patients from "womb to tomb". It's impressive. Knowing pediatrics, preventive medicine, all specialties, geriatrics, end of life care. On any given day in the clinic I would see cases that spanned the entire first two years of medical school.

2. Early infancy of disease processes.
It's easy for the specialist to look back and say, how did the PCP miss this? The tough part of primary care is that you see disease in it's early phases, often before the easy hallmarks become apparent. It's really difficult to diagnose some diseases in their early phases.

3. Behavior change.
We all know how to stay healthy: diet, exercise, sleep, joy in our life, avoid stress, good relationships, no evils like smoking, alcohol or drugs. Easy eh? These are the things that GPs deal with every day, they are in the trenches trying to improve health care in the U.S.

4. Keeping pace with changes across medicine.
How many studies and policy changes occur every year? How do you decide which ones to follow, to change your management of patient care? Keeping up with the NY Times controversies, from cancer screening to statin side effects to HPV vaccines and contraception -a frontline doc needs to stay on top of the headlines and have a critical take to inform their patients.

5. Current structure of healthcare delivery.
GPs bare the brunt of the disaster that is currently known as American health care delivery. They're also going to be the area of medicine most transformed in my life time, no doubt about it. Change is hard.

PS. Family medicine, general practitioner, primary care provider, pediatrician, general internist are all generalists, first line doctors who help keep America healthy.

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