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The Place of the General Practitioner in Child Health Care
The Place of the General Practitioner in Child Health Care CARROLL L. WITTEN, M.D.
Three basic questions must be answered to determine the place of the general practitioner in the delivery of health services to pediatric patients. They might be posed as: 1. How does the general practitioner (or family physician) take part in the provision of child health care? 2. Will medical schools adjust their programs in order to produce more family physicians? 3. In recognition of the fact that in-depth training for specialties such as pediatrics requires additional years, is it possible that the family physician can provide such quality health services?
In regard to the first question, one should recognize that all physicians, regardless of their field of practice, who are engaged in pediatric care must be deeply involved in the provision of continuity in and comprehensiveness of service. Without exception, any realistic definition of family medicine must conclude that the family physician assumes continuing responsibility for the health care of the individual and the family. Health care responsibilities flow uninterruptedly, in times of illness and in times of health, and in this respect, the family physician often differs from those who have chosen to limit their practice to an age group, to a portion of the human anatomy, or to a disease-oriented specialty. This does not mean that other physicians might not be involved in continuity of care, for indeed most pediatricians are up to a point, but for physicians other than pediatricians and family physicians, those who are so involved are the exception rather than the rule. Comprehensive health care implies continuity and a personal interest in the patient and his environment, plus the cognitive and perceptive ability to distinguish physical from emotional problems. It is difficult to answer the second question that has been posed. Experience teaches that it is extremely doubtful that those who are involved in full-time medical educational activities can adequately understand the needs of the patients served by those of us in the fulltime practice of medicine. Because of this and not because of unwillingness, medical educators are reluctant to make the necessary changes in their programs. The scope and nature of the physician's practice are, Pediatric Clinics of North America- Vol. 16, No.4, November, 1969
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for the most part, established by influences which are brought to bear during his medical school days. In today's medical school environment, the student seldom has an appreciable opportunity to understand the comprehensive and behavioral aspects of medicine. Such medical school exposure, therefore, leads to disease orientation rather than to an understanding of the comprehensive concept of total patient care. Unfortunately, without major changes in the make-up and attitude of the average medical educator, it does not appear likely that medical schools can produce sufficient numbers of physicians to serve as the family physicians of our nation. The third question is one that seems to bother many people. How can physicians with less in-depth training provide services comparable in quality to those of a physician with longer training? Longer training is actually concentrated experience; therefore, it is reasonable to assume that sufficient experience can in fact lead to the same high quality standards. It is not so much the nature of the training, nor the nature of the experience, that determines the ultimate quality of health service, but rather the attitude of the physician decides what position he may take in the broad scope of health services. Regardless of this, however, the future training of the family physician will be lengthened and will be comparable to that of other specialists. It is easy to foresee the day when all of us involved in direct services to patients will more fully understand the role of others so engaged. When this does occur, one can foresee that working side by side will be people primarily engaged as family physicians, as pediatricians, as internists, as psychiatrists, and as behavioral specialists. Consultative and manipulative specialists in other fields will be readily available. Until such an arrangement is accepted by the profession and understood by the medical educators, there can be no successful system for the delivery of comprehensive and continuous health care. 2237 Taylorsville Road Louisville, Kentucky 40205
Three basic questions must be answered to determine the place of the general practitioner in the delivery of health services to pediatric patients. They might be posed as: 1. How does the general practitioner (or family physician) take part in the provision of child health care? 2. Will medical schools adjust their programs in order to produce more family physicians? 3. In recognition of the fact that in-depth training for specialties such as pediatrics requires additional years, is it possible that the family physician can provide such quality health services?
In regard to the first question, one should recognize that all physicians, regardless of their field of practice, who are engaged in pediatric care must be deeply involved in the provision of continuity in and comprehensiveness of service. Without exception, any realistic definition of family medicine must conclude that the family physician assumes continuing responsibility for the health care of the individual and the family. Health care responsibilities flow uninterruptedly, in times of illness and in times of health, and in this respect, the family physician often differs from those who have chosen to limit their practice to an age group, to a portion of the human anatomy, or to a disease-oriented specialty. This does not mean that other physicians might not be involved in continuity of care, for indeed most pediatricians are up to a point, but for physicians other than pediatricians and family physicians, those who are so involved are the exception rather than the rule. Comprehensive health care implies continuity and a personal interest in the patient and his environment, plus the cognitive and perceptive ability to distinguish physical from emotional problems. It is difficult to answer the second question that has been posed. Experience teaches that it is extremely doubtful that those who are involved in full-time medical educational activities can adequately understand the needs of the patients served by those of us in the fulltime practice of medicine. Because of this and not because of unwillingness, medical educators are reluctant to make the necessary changes in their programs. The scope and nature of the physician's practice are, Pediatric Clinics of North America- Vol. 16, No.4, November, 1969
945
r
946
CARROLL
L.
WITTEN
for the most part, established by influences which are brought to bear during his medical school days. In today's medical school environment, the student seldom has an appreciable opportunity to understand the comprehensive and behavioral aspects of medicine. Such medical school exposure, therefore, leads to disease orientation rather than to an understanding of the comprehensive concept of total patient care. Unfortunately, without major changes in the make-up and attitude of the average medical educator, it does not appear likely that medical schools can produce sufficient numbers of physicians to serve as the family physicians of our nation. The third question is one that seems to bother many people. How can physicians with less in-depth training provide services comparable in quality to those of a physician with longer training? Longer training is actually concentrated experience; therefore, it is reasonable to assume that sufficient experience can in fact lead to the same high quality standards. It is not so much the nature of the training, nor the nature of the experience, that determines the ultimate quality of health service, but rather the attitude of the physician decides what position he may take in the broad scope of health services. Regardless of this, however, the future training of the family physician will be lengthened and will be comparable to that of other specialists. It is easy to foresee the day when all of us involved in direct services to patients will more fully understand the role of others so engaged. When this does occur, one can foresee that working side by side will be people primarily engaged as family physicians, as pediatricians, as internists, as psychiatrists, and as behavioral specialists. Consultative and manipulative specialists in other fields will be readily available. Until such an arrangement is accepted by the profession and understood by the medical educators, there can be no successful system for the delivery of comprehensive and continuous health care. 2237 Taylorsville Road Louisville, Kentucky 40205