To the Editor: Dr. Whitcomb's1 article on the redesign of residency training in family medicine was read with great interest. It was refreshing to have someone of his insight and expertise give a view of our specialty from the outside. His comments will help facilitate needed educational change to better serve patient need.
I would like to take his recommendations and repackage them into a definition that retains the heart of our specialty and allows us to be successful in recruiting future colleagues. Dr. Whitcomb recommends that we focus family medicine training to create chronic disease experts to serve the rising prevalence of these conditions in our culture. This supports a disease-oriented focus and does not honor the relationship-centered care that allows insight into understanding how to prevent or reverse the disease process. Being a “chronic disease specialist” feels heavy, burdensome, and reductionistic. Not once have I had a medical student come up to me and say, “I want to be a chronic disease specialist!” But I am seeing my younger colleagues have a passion to understand how the body self-heals. Their pupils dilate when they talk about being physician healers. This defines the package of what it means to be a family doc. Family medicine was founded on the bio-psycho-social model and the specialty is in the best position to use this insight to create experts in health and healing. This is what students want to be “experts” in. They want to be navigators of health, not a slave to the markers of chronic disease management. They want to develop meaningful relationships that allow them to reach in and grab onto the essence of what is needed for positive behavior change. They want to be experts in salutogenesis (the creation of health) as well as pathogenesis (the creation of disease and suffering).
Creating expertise in chronic disease supports a passive health care model in which our patients become more dependent on expensive external influences for health (pharmaceuticals, surgical therapy). Antidepressants and proton pump inhibitors are prescribed at a cost of billions of dollars each year. We simply treat the symptoms instead of asking the deeper question: Why is everyone in America depressed with an upset stomach? Family medicine has the opportunity to create leaders in understanding the process of healing so we can reverse the trend toward disease and empower healthy lifestyle behaviors. Success in defining this package will bring more joy to our work and reduce disease burden and the need for chronic disease experts.