Defining family medicine as a scientific discipline

Recently Dr Cal Gutkin pointed out the importance of having family medicine recognized as a specialty within the academic community.¹ Whether or not it is called a specialty, we need a clear definition of our role as a unique medical discipline.

If a field of knowledge is to be accepted as a scientific discipline, it must have a clear, concise definition that delineates its content, distinguishes it from other disciplines, and indicates its methodology (ie, identifies its scientific nature). I have prepared a definition of family medicine as a scientific discipline that should explain our uniqueness to the academic community. I welcome input from other family physicians.

Content

Family medicine has been described as continuing, comprehensive medical care of the patient in the context of the family and community. Continuing whole-patient care incorporates prevention, diagnosis, and treatment of undifferentiated illness; acute and chronic care; recognition of family and social needs; long-term support; and epidemiologic and environmental awareness. It includes the following:

• primary prevention—opportunities for preventive medicine and patient education;

• secondary prevention—treating undifferentiated or minor illnesses to prevent more serious disease and hospitalizations (this important function of family physicians is the most economically feasible aspect of medical practice);

• acute illness—most illnesses are treated at home and by family physicians;

• chronic and palliative care; and

• obstetric care.

Although family physicians might limit their practices, the principles of whole-patient care apply within those limits.

Caring for individuals through various illnesses and stages in the life cycle, understanding family roles in illness, and using community resources makes family medicine unique.

Team medicine

Family physicians work as part of a health care team that includes medical specialists, nurses, social workers, and behavioural science professionals. They ensure appropriate referrals and coordinate patient care.

Socialization into family medicine differs from socialization into a specialty. The integrative role of family medicine is best taught by family physicians with experience in community medicine.

Methodology

Family medicine utilizes the methodology of specialty medicine in treatment of disease and the methodology of social science in its understanding of the individual, but it adds to these its own unique methodology—the integration of various specialized methods to provide a holistic perspective and appropriate care of patients within families and communities.

This integration is a scientific method that involves interviewing; accurate observation and physical examination; delineation of patterns of behaviour and of community epidemiology and ecology; explanations and hypotheses based on the observations; and testing by laboratory investigation, collation of facts, comparative analysis, and further observation. The integrative role of family medicine has sometimes been called the “art of family medicine.”

Research and practice management

Family physicians do community-oriented research. Training in research methods is included in their education.

Family physicians need to be good managers. They make economical use of medical resources. Their comprehensive knowledge of patients reduces the number of laboratory investigations, and prevention and early recognition of disease reduces suffering and medical costs.

Family medicine is a scientific discipline, separate from, but holding a legitimate position among, other medical disciplines. Its focus on the whole patient, its holistic perspective, its continuity of care, its family and community orientation, and its integrative methodology makes the field unique.