Shouldn’t Family Doctors Treat Acute Illnesses?

John Hickner, Editor of The Journal of Family Medicine, in his July 23 editorial, takes issue with the more and more prevalent opinion that chronic disease management is the core of Family Medicine:

At times I fear that all the focus on prevention and chronic disease management, necessary as these are, distracts us from our most important work: meeting the immediate needs and concerns of our patients. The agenda of the office visit used to be exclusively the patients’. Now a visit—and our attention—is often split between their agenda and ours, which includes screening for this and that and exhorting patients to a healthier lifestyle whether they want it or not. I had one irate patient tell me, “Don’t put me on that scale again! I know I’m fat and if I want your help, I’ll ask for it.”

Overemphasis on prevention and chronic disease management, I fear, has caused many physicians to undervalue diagnosis and acute care. The sad result? In some practices, the schedule is so full of routine follow-ups that patients must go to an urgent care center or the ED for complaints that could be easily managed in a doctor’s office.

I did not go to medical school to be a health psychologist, even though my college major was psychology. I wanted to be a doctor, and I still do. I want to diagnose illness or wellness accurately and efficiently and help patients feel better—to offer reassurance to the worried well and the right treatments to those who are sick. The “number needed to treat” to listen carefully and provide reassurance and proper treatment to a patient with an acute complaint is one!

2 Comments to “Shouldn’t Family Doctors Treat Acute Illnesses?”

  1. I apologize if I should have contacted you about this a different way, but I don’t see a “contact me” feature to your blog so I thought I’d put it in a comment. (Please feel free to edit this comment or to contact me privately and tell me how to do differently in the future. Today I was alerted to this ( ) by the author’s blog feed. I would love to hear you comment on the article. Thanks.

  2. Chronic disease management is of course the core of family medicine – it’s what I do at least 60% of my working day. The rest is acute care, ER, prenatal, delivery and postpartum care, anaesthesia, surgical assisting, palliative care, nursing home visits (acute and chronic), etc. Ongoing care of chronic illness is our schtick – acute care of many common illnesses and as many add-ons as we wish to enjoy we make us ‘full service’ (or your favourite moniker) FPs.

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