Key Points

• The rewards in family medicine come from knowing patients intimately over time and sharing their trust, respect, and friendship, as well as from the variety of problems encountered in practice that keep the family physician professionally stimulated and challenged.

• The American Board of Family Practice was established in

1969 and changed its name to the American Board of Family Medicine in 2004. It was the first specialty board to require recertification every 7 years to ensure ongoing competence of its diplomates.

• The American Academy of Family Physicians (AAFP) began as the American Academy of General Practice in 1947 and was renamed in 1971.

• Primary care is the provision of continuing, comprehensive care to a population undifferentiated by gender, disease, or organ system.

• The most challenging diagnoses are those for diseases or disorders in their early, undifferentiated stage, when there are often only subtle differences between serious disease and minor ailments.

• The family physician is the conductor, orchestrating the skills of a variety of health professionals that may be involved in the care of a seriously ill patient.

• The most cost-effective health care systems depend on a strong primary care base. The United States has the most expensive health care system in the world but ranks among the worst in overall quality of care because of its weak primary care base.

• The greater the number of primary care physicians in a country, the lower is the mortality rate and the lower the cost.

The family physician provides continuing, comprehensive care in a personalized manner to patients of all ages, regardless of the presence of disease or the nature of the presenting complaint. Family physicians accept responsibility for managing an individual's total health needs while maintaining an intimate, confidential relationship with the patient.

Family medicine emphasizes continuing responsibility for total health care—from the first contact and initial assessment through the ongoing care of chronic problems. Prevention and early recognition of disease are essential features of the discipline. Coordination and integration of all necessary health services (minimizing fragmentation) and the skills to manage most medical problems allow family physicians to provide cost-effective health care.

Family medicine is a specialty that shares many areas of content with other clinical disciplines, incorporating this shared knowledge and using it uniquely to deliver primary medical care. In addition to sharing content with other medical specialties, family medicine emphasizes knowledge from areas such as family dynamics, interpersonal relations, counseling, and psychotherapy. The specialty's foundation remains clinical, with the primary focus on the medical care of people who are ill.

The curriculum for training family physicians is designed to represent realistically the skills and body of knowledge that the physicians will require in practice. This curriculum is based on an analysis of the problems seen and the skills used by family physicians in their practice. The randomly educated primary physician has been replaced by one specifically prepared to address the types of problems likely to be encountered in practice. For this reason, the "model office" is an essential component of all family practice residency programs.

©2011 Elsevier Ltd, Inc, BV

DOI: 10.1016/B978-1-4377-1160-8.10001-6

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