Physicians and their fathers
For the last several months I have been observing the care being provided to my father-in-law, a man whose body is under attack by an unusually aggressive prostate cancer. His last 2 hospitalizations for acute episodes have been under the care of a hospitalist, with no involvement by his primary care physician. Today we learned that he has spent the last 2 days in the hospital without the benefit of any of the medications he had been taking to control his symptoms while at home. When called to the attention of the hospital staff a flurry of finger pointing, blame, and denial ensued. Basically, he has been victimized by a system of discontinuity, narrowly focused technical specialists, disregard for the patient’s (and his family’s) emotional needs, and a lack of coordination of care. What this man needs is an engaged and accountable personal physician.
I just reread the article by Chen and colleagues1 on family physicians’ experiences of their fathers’ health care, and it is happening here just like in that article. This causes me to wonder. Is the best care in our nation currently delivered by the family physician who takes personal responsibility for the care of his or her patients when they are hospitalized? I believe the answer may be: “Yes, it certainly is!” I know consumer surveys show that the general public seems content with episodic specialty-focused “convenient” care (as long as free parking is included). That may be the case, until they get really sick and really scared. Then the compassionate physician who knows you and your family and who will advocate for you in this complex and challenging health care environment is exactly who you want at your bedside. We owe it to this nation to continue to train the kind of physician the American people need and want—even if they do not know it yet.
Name withheld at the author’s request
- Chen FM, Rhodes LA, Green LA. Family physicians’ personal experiences of their fathers’ health care. J Fam Pract 2001; 9:762.
I would like to offer my profound thanks to JFP and Chen and colleagues for the paper on the care of our fathers. I am certain that I am not alone in expressing a feeling of deep resonance with these family physicians and their plight, despite being junior faculty, rather than a chair, and in my 30s rather than 40s or 50s. It is not easy being a member of a “sandwich” generation, caring for a generation above and below. Our faceless medical system does not make it any easier. Although the authors state that their sample was well distributed geographically, I am curious about the demographics, particularly about the type of medical system involved. Were these men admitted to large academic medical centers or (as I suspect) is this happening right under our noses, in our own beloved community settings?
Peter C. Smith, MD
University of Colorado
Health Sciences Center
Denver
Drs Chen, Rhodes, and Green responded as follows:
Although we were careful not to generalize our results beyond our physician sample, Dr Smith’s sentiments echo those of many of our colleagues. Our own experiences with the health care system and the experiences of our patients validate the challenges faced by the physicians in our study.
In response to Dr Smith’s question, the fathers in our study were hospitalized in a range of settings, from large academic centers to local community hospitals. We share his concern that the problems highlighted by the study physicians are widespread in our health care system and right under our noses.
Frederick Chen, MD, MPH
Lorna A. Rhodes, PhD
Larry A. Green, MD