The new family doc
Today's medical students will restore innovation to a traditional practice
The New Physician January-February 2012
by Zach OrtizVolume 61, Number 1
The stability of our future health care system will only be realized when a vibrant and efficient network of primary care physicians comprise its base. The United States spends twice what some other developed nations do on health care, yet it experiences a lower life expectancy and greater infant mortality. These disparities are attributable in part to the mere 35 percent of physicians practicing primary care in the United States, compared to the 50 percent of generalists practicing in other nations. This trend prevails despite overwhelming evidence that suggests patients with regular access to primary care experience fewer preventable emergencies, require fewer tests and spend less money for their care. A resurgence of medical student interest in primary care is necessary to address the crisis. This will be achieved by a new generation of family medicine physicians using proactive technological innovation in their practices to both enhance patient care and maintain relevance in a hyper-specialized medical climate.
Medical students experience their most formative training in hospital wards. This environment is considered the vanguard of patient care largely because of the ubiquitous use of technology. Students see $3,000 images of complex neuroanatomy available at the click of a button and surgeons excise tumor-laden masses with the latest in robotics.
By contrast, family medicine has been stifled by its relative lack of innovation. Family doctors of recent decades were hesitant to adopt electronic medical records (EMR) as they grappled with their financial and professional solvency. Those who took the plunge found themselves with "paper electronic charts" and never experienced the promised interoperability of the EMR. Students saw that family doctors were left isolated and too overwhelmed to navigate further bureaucracy and heavy patient volumes, all while struggling to repay debt, and students began to hold simultaneous and contradictory opinions of primary care: It is vitally important to our nation's health, and pursuing it will be detrimental to my professional and economic well-being.
The resulting stagnation of interest in primary care has fueled a vicious paradox: The country vitally needs family doctors and yet, because of an obsession with reactive innovations in medicine like the MRI, catheterization and DaVinci, does not want them.
But now, medical students who believe in the potential of family medicine will marshal in a new era of technology that staves off disease instead of fighting it. These innovators already envision themselves arriving in patient rooms with an iPad, ready to securely access their patient's last A1C values from a nationwide interoperable EMR. They will expertly bring up the appropriate guidelines while receiving images and reports from a recent ophthalmologic consult in real time. Even in rural or underserved offices, these clinicians will e-mail or text a summary of an individualized health care plan to the patient for his own reference. If a further review of guidelines from the American Academy of Family Physicians suggests a statin to reduce the patient's cardiac morbidity, the clinician will simply tap the screen to discuss these evidence-based guidelines with her patient, while updating charts and prescriptions accordingly.
In this new setting, family doctors will enjoy the same innovative thrust that drives cardiology and surgery, but with an emphasis on prevention, instead of reaction, to preventable diseases. Medical students will then be able to see themselves practicing the new family medicine, where the central bond between patient and practitioner is enhanced by innovation.
However, before these sweeping changes can become the new paradigm in family medicine, they must replace the frustrations that burdened the field for so long. Medical students who pursue this vision must remain steadfast in their charge to redefine family medicine, for it is only in leveraging the unrealized potential of contemporary technology that a new era of health will emerge in our country.
Zach Ortiz is a fourth-year at the University of Arizona College of Medicine-Phoenix.