Personalized Care

It is much more important to know what sort of patient has a disease than what sort of disease a patient has.

Sir William Osler (1904)

In the 12th century, Maimonides said, "May I never see in the patient anything but a fellow creature in pain. May I never consider him merely a vessel of disease" (Friedenwald, 1917). If an intimate relationship with patients remains the primary concern of physicians, high-quality medical care will persist, regardless of the way it is organized and financed. For this reason, family medicine emphasizes consideration of the individual patient in the full context of her or his life, rather than the episodic care of a presenting complaint.

Family physicians assess the illnesses and complaints presented to them, dealing personally with most and arranging special assistance for a few. The family physician serves as the patients' advocate, explaining the causes and implications of illness to patients and families, and serves as an advisor and confidant to the family. The family physician receives great intellectual satisfaction from this practice, but the greatest reward arises from the depth of human understanding and personal satisfaction inherent in family practice.

Patients have adjusted somewhat to a more impersonal form of health care delivery and frequently look to institutions rather than to individuals for their health care; however, their need for personalized concern and compassion remains. Tumulty (1970) found that patients believe a good physician is one who shows genuine interest in them; who thoroughly evaluates their problem; who demonstrates compassion, understanding, and warmth; and who provides clear insight into what is wrong and what must be done to correct it.

Ludmerer (1999a) focused on the problems facing medical education in this environment:

Some managed care organizations have even urged that physicians be taught to act in part as advocates of the insurance payer rather than the patients for whom they care (p. 881). . . . Medical educators would do well to ponder the potential long-term consequences of educating the nation's physicians in today's commercial atmosphere in which the good visit is a short visit, patients are "consumers," and institutional officials speak more often of the financial balance sheet than of service and the relief of patients' suffering (p. 882).

Cranshaw and colleagues (1995) discussed the ethics of the medical profession:

Our first obligation must be to serve the good of those persons who seek our help and trust us to provide it. Physicians, as physicians, are not, and must never be, commercial entrepreneurs, gate closers, or agents of fiscal policy that runs counter to our trust. Any defection from primacy of the patient's well-being places the patient at risk by treatment that may compromise quality of or access to medical care. . . . Only by caring and advocating for the patient can the integrity of our profession be affirmed (p. 1553).

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