By Troy Fiesinger, M.D.
TAFP Vice President
I was playing golf recently in a charity tournament with a couple of orthopedic surgeons whose office is down the road from mine. As we made the usual small talk about where we went to medical school and residency, I mentioned that I delivered babies. The response I received was tinged with incredulousness: “You deliver babies? I didn’t know family doctors still did that.”
For me, obstetrics is part of what defines me as a family physician. Few things can compare to meeting a patient as a teenager, caring for her through high school and early adulthood, delivering her first child, and then helping her cope with the stresses of motherhood while her husband is deployed in Iraq. Her parents and little brother were also my patients. That is the essence of family medicine. Why wouldn’t I want to care for the entire family throughout the life cycle? When I am asked what I specialize in, I answer “everything.” I enjoy being a jack of all trades.
While many of us assume that this breadth of skill is obvious to our colleagues and patients, I have to explain myself far too many times to believe that they appreciate the full scope of what we do. How many times have you offered to take off a patient’s mole and been asked, “You can do that? Don’t I need to see a dermatologist?” A patient that I have been working up for galactorrhea saw one of our residents recently. She wanted a referral to an endocrinologist and a gynecologist. The resident showed her the lab results and multiple phone calls and letters detailing her normal test results and asked if she was wearing any tight fitting clothing. “No,” she replied. “What about a sports bra when you work out?” “Well, yeah.” “Didn’t Dr. Fiesinger tell you to not do that? The sports bra is causing your problem.”
The lack of knowledge about what family physicians actually do is truly staggering. In my first year in practice, a 14-year-old girl came in with her mother for a one-centimeter laceration on her chin. I told her that she needed a few stitches but it should turn out fine. Her mother asked if I could refer her to a plastic surgeon to make sure that her appearance was not affected. After unsuccessfully trying to persuade her that I could easily handle this, I called the plastic surgeon on call.
“You can sew up that laceration, right?”
“Of course I can. She wants you to do it to make sure that the scar does not affect her appearance.”
“You tell her there’s nothing I can do that you can’t.”
I repaired the cut with three stitches and saved an unnecessary trip to a busy surgeon 30 miles away.
At our urban teaching hospital, we care for mostly uninsured patients with few resources and numerous complex problems. Our admissions on a typical call night range from a pneumothorax and rib fractures from bull riding to renal failure from diabetic nephropathy. We can usually handle these ourselves with assistance from our specialty colleagues when needed.
When we recently discharged a middle-aged gentleman with newly diagnosed chronic kidney disease from diabetic nephropathy, we told the family that he did not need dialysis now but needed to manage his diabetes well to preserve renal function after he followed up with his doctor.
“Oh, he’s just a primary care doctor.”
“That is exactly who he needs to see,” I responded. Without insurance, he doesn’t need a bunch of expensive tests. He needs common sense of the kind demonstrated by the resident mentioned above.
These are just a few examples and you can probably tell similar stories from your office. As frustrating as such encounters can be, they only reinforce the need to educate our patients and colleagues about the breadth of skills that family physicians possess. They also illustrate why we must cultivate relationships with individual specialist consultants and professional organizations that understand the breadth of family physicians’ skills.
The next time you complain that you are not compensated for your hard work and broad training and wonder why no one else recognizes this, remember the last time you had to explain to a patient, colleague or neighbor what you do. We know we have the skills and the training to care for most of the problems that come through our doors and refer them appropriately when a consultant’s services are needed. Our knowledge of our patients enables us to make the right decisions and cannot be replaced by thousands of dollars of tests. We need to shout this from the rooftops.