Everyone in the class replied, “Yes.” He said, “Really?” He reached under the table and pulled out a bucket of gravel. He dumped some gravel in the Mason jar, and shook the jar causing pieces of gravel to work themselves down into the space between the big rocks. Then he asked the group once more, “Is this jar full?”
By this time, the class was on to him. “Probably not,” one of them answered. “Good!” he replied. He reached under the table and brought out a bucket of sand. He started dumping the sand in the jar and it went into all of the spaces left between the rocks and the gravel. Once more he asked the question. “So, is the jar full?”
“No!” the class shouted.
Once again he said, “Good.” Then he grabbed a pitcher of water and began to pour it until the jar was filled to the brim. Then he looked at the class and asked, “What is the point of this illustration?” One eager student raised his hand and said, “The point is, no matter how full your schedule is, if you try really hard you can always fit some more things in it!” He must have been a pre-med student.
“No,” the speaker replied, “That’s not the point. The truth this illustration teaches is this: if you don’t put the big rocks in first, you’ll never get them in at all.”
What are the “big rocks” for family medicine? What are our touchstones — those words or phrases that evoke our discipline, as certain words such as “To be or not to be” evoke an entire play; or in Texas, “Remember the Alamo” defines a time and event in history?
As most of you are already aware, the AAFP with its foundation and five other academic family medicine organizations recently published the Future of Family Medicine report in a supplement to the Annals of Family Medicine last April. It is a look at where we have been, where we are now and a blueprint for what we need to become. Our touchstones in family medicine, to define a family physician, have traditionally been the four Cs: continuity of care, comprehensiveness, first contact, and community. These touchstones are evolving. We are not discarding our prior foundations, we are moving forward, toward the future and from the past.
Our touchstones, key attributes of family physicians, have been redefined as the following through the FFM project. Please consider these carefully, as they ring very true to me:
“A family physician has a deep understanding of the dynamics of the whole person and a generative impact on patients’ lives. They have a talent for humanizing the health care experience, a natural command of complexity and a commitment to multidimensional accessibility, working with a team approach.”
In the 1991 movie “City Slickers,” a disillusioned, discontented businessman, (how much different is he from some of us in medicine today?) goes to a dude ranch out west to revitalize himself in the company of friends. There, he meets Curly, the seasoned trail boss. Curly talks about how it comes down to this one thing — but he never defines what that one thing is. What is that one thing which we, as family physicians, are going to rally around and revitalize ourselves with?
I would propose as a guiding principle for family medicine a concept that I first heard articulated at the October 2001 AAFP Annual Session expressed by Dr. Charles Kilo, a fellow at the Institute for Healthcare Improvement, to which I have added a friendly amendment. It incorporates all of our touchstones and is fundamentally patient-centered. When I heard this thought, it succinctly coalesced my thoughts about what the goal of medicine is and should be:
“Medicine must provide that all and only the right care at the right time is delivered as guided by the desires of the individual patient, offered consistently, every time to every patient.”
In essence, this defines quality medical care, encompasses preventative care, addresses not only fraud but abuse and waste of resources and funds, and addresses futile end of life care. It embodies medical ethics and business ethics. This guiding principle can be the engine for the space shuttle, which will carry us toward the future, from our past.
What do I ask of you? What do I ask of the Academy? That we get our message out. That we carry the banner of our guiding principle and our touchstones. We market our basket of services. We, as a specialty, (just like myself as an individual and I’m sure many of you as well) hope our pure motives, hard work, and accomplishments will be noticed and rewarded on their own merits. As a specialty, we are still waiting for that recognition.
As our FFM consultants said, our heritage is sound. As a specialty, we became who we set out to become in 1947, but we are the best kept secret in America! This should not be so. At this year’s Annual Leadership Forum, there was a breakout session for the chapter leadership and chapter executives on public relations. The top priority identified by the largest number of people was promoting family medicine to the public. However, in general the perception is that neither the state nor the national organization really promotes family medicine to the public. But shouldn’t they? The individual member certainly doesn’t have the resources for this activity.
Let us get our light out from under a basket and instead shine it from the hillside. Family physicians can generate a demand for what we know America needs: an appropriately valued, primary-care-driven, family-physician-based health care system emphasizing evidence-based, high-tech, high-quality care. The Texas chapter can again lead the national organization in demonstrating the marketing of our specialty to the people. We need to advocate to the public. We need to prioritize public relations, just as we consciously prioritized legislative advocacy 15 years ago — and look how effective we are today in the legislative arena.
Public relations can be done with little or no money spent on advertising per se. I would envision instead coordinated statewide events especially in the urban areas where the concept of a family physician — who we are and what we do — has been blurred. These events would be around campaigns that could help solidify in patients’ minds the positive associations we would like them to make, especially to concepts such as: family physicians care for infants and children. TAFP could do this in conjunction with established programs. TMA has the “Be Wise, Immunize” campaign slated for October and the TMA Foundation sponsors “Hard Hats for Little Heads,” where for about $5, (1/2 the cost of a bike helmet), helmets are provided for children.
Imagine the power of a statewide coordinated effort concentrated over the span of one to two weeks and how this would raise awareness of family physicians and create a media-worthy event. This is where you come in. You would be asked to volunteer your time, your talent and your staff to host these events at your clinic sites. We need to put ourselves, family medicine and family physicians in the public eye. From this, the public will become familiar with our touchstones and our guiding principle.
This journey from the past, toward the future may not be without some bumps along the way. Therefore, I leave you with these thoughts. In the 2001 sleeper of a movie, “The Dish,” a team of four engineers and scientists need to learn to trust each other and overcome several adverse events. Ultimately, it comes down to a decision that must be made in a critical time frame regarding whether to jeopardize the largest radio telescope in the world in hopes of being able to transmit the historic TV broadcast of man’s first step on the moon, one of science’s finest moments. NASA certainly would have understood if the physical conditions — wind — prevented the satellite dish from being moved into position.
However, as the project director declares, “Failure is never quite as frightening as regret.”
Babe Ruth said, “Never let the fear of striking out get in your way.” Writer Kathleen Norris has said, “Disconnecting from change does not recapture the past. It loses the future.”
We cannot fear striking out, nor can we afford regrets for failing to act. We must embrace the changes recommended by the Future of Family Medicine project. We must begin our public relations initiative. Help me help family medicine move toward the future, from the past.
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