Where I Practice: On the Spaces of Family Medicine

Abstract

In this essay, the author explores 3 distinct "spaces" that have helped him metaphorically map the nature of his work as a family physician. These "spaces" represent cultural, personal, and relational environments in which he has practiced over the course of >30 years since beginning medical school. They concern, respectively, the dominant culture of medicine, one core philosophy of family medicine (the biopsychosocialexistential model), and the development of strong therapeutic bonds with patients. The author presents this textual and graphic exploration of "space" in hopes that others might reflect on their work, examine how they approach it, and bring richness and renewed meaning to their work as family physicians. This is a special period in the history of family medicine in the United States. Almost 50 years after its founding as an academic discipline, our professional organizations have introduced "Family Medicine for America's Health" as a well-timed examination of our collective identity and purpose.1 As a result, many family physicians are reevaluating their places in the health care arena. Some wonder what will become of our specialty and whether it will weather varied ongoing challenges, among them the politics surrounding the Patient Protection and Affordable Care Act, the changes triggered by electronic medical records, and the continued misrepresentation of family medicine's presence within academic institutions. [2][3][4] Others are more encouraging about family medicine's future, buoyed by data that support expanding family medicine's role on the stage of medical care and learned insights as to the wisdom of a family medicine model for delivering rational health care services. 5,6As a family physician with over 25 years' experience in community-based practice, I have not been immune to harboring doubts about the future of family medicine-the cultural and political-economic power of the current biomedically focused, subspecialty-oriented, market-based care model is indeed a daunting force to contend with. Yet I remain optimistic about our future, especially when I appreciate the metaphoric "spaces" that have helped me map the nature of my work. These spaces have helped me provide, as I have been able, the kind of quality care that results from being my patients' personal physician.In this essay I explore 3 distinct "spaces" that, over time, have come to frame my practice of family medicine. First, cultural space describes where I stand relative to the dominant values of medicine. Second, philosophical space expresses how I make sense of the clinical process as a generalist physician. Third, relational space spotlights the connection in between my patients and me; this "space" both illuminates important illness-related issues and is therapeutic in and of itself.My purpose is not only to illustrate how such spaces have been vitally important for my professional growth but also to invite other family physicians to consider what "spaces" have helped them cultivate the healing presence that forms the ...

Chronic pain care

“…A biopsychosocial-existential model might offer a more comprehensive approach to care. 25 In fact, a recent Nordic study 26 shows that this existential dimension is indeed present in medical practice and care.…”

Personalizing the BioPsychoSocial Approach: “Add-Ons” and “Add-Ins” in Generalist Practice

“…The point of introducing these considerations is to suggest that generalist practitioners consider the BPS approach not as a model set in stone, but as (1) an inspiration for further integrating BPS concepts into practice, (2) a stimulus to promote patient- and relationship- centered approaches to patient care, and (3) a means to of repositioning themselves in the space between patients' lived experience and the culture of medicine ( 87 ). The BPS approach offers generalists not only a broad understanding of the many factors that contribute to the evaluation, diagnosis, and management of presenting problems, but also a path to reconceptualize professional growth in service of therapeutic agency (one's ability to affect positive change) and well-being on both sides of the stethoscope.…”

Inviting Introspection:Intentions for Ethical Engagement in Practice

“…Fourth is empathy: assurance that I recognize patients' concerns in context of their lives and reassurance that I will be available prospectively to help them, cooperatively with other professional colleagues. "May I help alleviate suffering" helps me recall how inquiry, intimacy, and information all play critical parts in this process [14][15][16]…”