What is family medicine?

Family medicine is the medical specialty that provides continuing, comprehensive health care for the individual and the family. It is a specialty in breadth that integrates the biological, clinical, and behavioral sciences. The scope of family medicine encompasses all ages, all genders, each organ system, and every disease entity.

Family medicine is the natural evolution of historical medical practice. The first physicians were generalists. For thousands of years, 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 subspecialists increased at a phenomenal rate, while the number of generalists 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 medicine as medicine’s twentieth specialty.

Family medicine is a three-dimensional specialty, incorporating knowledge, skill, and process. Although knowledge and skill may be shared with other specialties, the family medicine 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 medicine from all other specialties.

As the physician of first contact in most situations, the family physician is in a unique position to form a bond with the patient. The family physician’s care is both personal and comprehensive, based on knowledge of the patient in the context of the family and the community, and emphasizing disease prevention and health promotion. When referral is indicated, the family physician refers the patient to other specialists or caregivers but remains the coordinator of the patient’s health care. This prevents fragmentation of that care in both the outpatient and inpatient settings. The family physician serves as the patient’s advocate in interacting with other medical professionals, third party payers, employers, and others and as such is a cost-effective coordinator of the patient’s health services.

Although all family physicians share a core of information, the dimensions of knowledge and skill vary with the individual family physician. Patient needs differ in various geographic areas, and family physicians’ practices vary accordingly. For example, the knowledge and skills useful to a family physician practicing in an inner city may vary from those needed by a family physician with a rural practice. Furthermore, the scope of an individual family physician’s practice changes over time, evolving 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.

Today’s family physician 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 medicine from other specialties. Above all, the scope of family medicine is dynamic, expanding, and evolutionary.