THE FAMILY DOCTOR’S PIVOTAL ROLE--
Once upon a time there was a GENERAL PRACTITIONER who
took care of the FAMILY. Sutured lacerations, treated colds, took out the
appendix and delivered babies. This GP was understandably the FAMILY DOCTOR.
As medicine became more detailed and intricate
doctors started to specialize, and when the GP or Family Doctor needed help
s/he referred the patient to the Specialist or asked the Specialist to see
hospitalized patients, or asked the specialist to assist in surgery. Also the GP did lots of stuff in the office.
Specialists and Family Doctors conformed to a strict
protocol of manners.
The patient was under the Care of the Family Doctor. That was
understood.
The Specialist was there to help out.
The Specialist did not discuss the case with the referred patient.
Instead the Specialist
said “I will communicate with your physician and s/he will bring you up to date
on what can be done”.
Referred patients were returned to the
family doctor, never referred to other specialists.
Thus the Family Doctor played a pivotal role in the
care of the patient, refereeing procedures deemed unnecessary and in a position
to exert some cost control. Indigent individuals were often seen free.
The advantage of this ethic was that the Family
Doctor, familiar with the family, its medical history and social circumstances
was positioned to manage its medical problems and guide patients through the
medical process.
As medicine became more specialized the scope of
General Practice was reduced accordingly. The GP /FP now referred to as the
Family Doctor still performed many Specialty Office Procedures and continued as
family counselor and friend.
With the advent of HMOs, physician panels and
litigation flourished. The “Family
Doctor/Practitioner” became the “Primary Care Doctor” limited to, referring,
writing prescriptions and practicing Preventive Medicine. Specialists like it
or not became de facto Family Doctors and the Ombudsman role of the Family
Practitioner went into abeyance.
Retrieving the Family Doctor and putting
responsibilities back where they belong could be achieved by encouraging the
formation and distribution of Primary Care Medical Centers throughout the
country.
This
would assure every citizen of Primary Care Medicine,
Decongest
emergency rooms,
Create
a market for Term Health Insurance
Tort
Reform would be evaded Litigation because physicians would be (albeit indirectly)
government employees and law suits
would be defended by the office of the Attorney General.