The Family Physician in Practice

The advent of family medicine has led to a renaissance in medical education involving a reassessment of the traditional medical education environment in a teaching hospital. It is now considered more realistic to train a physician in a community atmosphere, providing exposure to the diseases and problems most closely approximating those she or he will encounter during practice. The ambulatory care skills and knowledge that most medical graduates will need cannot be taught totally within the tertiary medical center. The specialty of family practice emphasizes training in ambulatory care skills in an appropriately realistic environment, using patients representing a cross section of a community and incorporating those problems most frequently encountered by physicians practicing primary care.

The lack of relevance in the referral medical center also applies to the hospitalized patient. Figure 1-4 places the health problems of an average community in perspective. In any given month, 800 people experience at least one symptom. Most of these people are managed by self-treatment, but 217 consult a physician. Of these, eight are hospitalized, but only one goes to an academic medical center. Patients seen in the medical center (with most cases used for teaching) represent atypical samples of illness occurring within the community. Students exposed to patients in only this manner develop an unrealistic concept of the types of medical problems prevalent in society and particularly those composing primary care. It focuses their training on knowledge and skills of limited usefulness in later practice. Medical schools should accept the responsibility of providing health care for a defined population, and the dean's office should ensure that the curriculum is congruent with the health needs of that population.

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