What Is Family Practice?
Family practice is the medical specialty, which provides continuing and comprehensive health care for the individual and the family. It is the specialty in breadth, which integrates the biological, clinical, and behavioral sciences. The scope of family practice encompasses all ages, both sexes, each organ system and every disease entity. Quality healthcare in family practice is the achievement of optimal physical and mental health through accessible, cost-effective care that is based on best evidence, responsive to the needs and preferences of patients and populations, and respectful of patients' families, personal values, and beliefs.
Scope, Philosophical Statement
Family practice is the continuing and current expression of the historical medical practitioner. The first physicians were generalists. For thousands of years, these generalists provided all of the medical care available. They diagnosed and treated illnesses, performed surgery, and delivered babies. As medical knowledge expanded and technology advanced, many physicians chose to limit their practices to specific, defined areas of medicine. With World War II, the age of specialization began to flourish. In the two decades following the war, the number of specialists and sub-specialists increased at a phenomenal rate, while the number of general practitioners declined dramatically. The public became increasingly vocal about the fragmentation of their care and the shortage of personal physicians who could provide initial, continuing and comprehensive care. Thus began the reorientation of medicine back to personal, primary care. The concept of the generalist was reborn with the establishment of family practice as medicine's twentieth specialty.
Family practice is a three-dimensional specialty, incorporating the dimensions of (1) knowledge, (2) skill, and (3) process. While knowledge and skill may be shared with other specialties, the family practice process is unique. At the center of this process is the patient-physician relationship with the patient viewed in the context of the family. It is the extent to which this relationship is valued, developed, nurtured and maintained that distinguishes family practice from all other specialties.
In the dimension of process, the family physician functions as the patient's means of entry into the health care system. The family physician is the physician of first contact in most situations and, as the initial provider, is in a unique position to form a bond with the patient. The family physician evaluates the patient's total health needs, and provides personal care within one or more fields of medicine. The family physician's care is comprehensive and not limited by age, sex, organ system or type of problem, be it biological, behavioral, or social. The family physician's care utilizes knowledge of the patient in the context of the family and the community. This care emphasizes disease prevention and health promotion. The family physician refers the patient when indicated to other sources of care while preserving continuity of care. The family physician's role as a cost-effective coordinator of the patient's health services is integral to the care provided. If the patient is hospitalized, this role prevents fragmentation and a lack of coordination of care. This role also allows the family physician to serve as the patient's advocate in dealing with third-party payers, employers, and others.
Thus, in the family practice process the patient-physician relationship is initiated, established, developed, and maintained for both sexes, for all ages, across time, and independent of problem type. Although all family physicians share a core of information, the dimensions of knowledge and skill vary with the individual family physician based on patient needs and the physician's continuing education. As patient needs differ in various geographic areas, the content of a family physician's practice varies accordingly. For example, the knowledge and skills used by a family physician practicing in an inner city may vary from those utilized by a family physician practicing in a rural setting. Furthermore, the scope of practice changes over time. The family physician's practice continually evolves as competency in current skills is maintained and new knowledge and skill are obtained through continuing medical education. This growth in medical information also confers on the family physician a responsibility for the assessment of new medical technology and for participation in resolving ethical dilemmas brought about by these technological advances.
In summary, the family physician of today is rooted in the historical generalist tradition. The specialty is three dimensional, combining knowledge and skill with a unique process. The patient-physician relationship in the context of the family is central to this process and distinguishes family practice from other specialties. Knowledge and skills vary among family physicians according to their patients' needs and the ability to incorporate new information into their practices. Above all, the scope of family practice is dynamic, expanding, and evolutionary.
The American Academy of Family Physicians defines a "specialist" in family practice as a physician who meets at least one of the following three criteria: