I remember the moment I chose family medicine as my specialty. My medical school class had just experienced a tragedy: the sudden and accidental death of a beloved classmate. In the context of that grief, I was on my internal medicine rotation at the Veterans Affairs hospital and was disillusioned with how transactional the care seemed to be. Our patients entered acutely ill, our team would tune them up, send them out, and they would return a month later, unable to maintain themselves outside the structure of the hospital. I questioned whether anything about medicine could feel fulfilling as a career. During that rotation, I spent a day at a local hospice, learning about end-of-life care with another classmate. That day, we faced our class’s collective grief and I had a glimmer of insight into understanding health in the context of mortality. The hospice director was a family physician who had a deep understanding of the beauty of a life well lived, from birth to death. By the day’s end, I felt like the philosophy of family medicine was the only way to practice as holistically as I wanted.
Dr. Timothy Hoff does a remarkable job of aggregating similar stories in his book Searching for the Family Doctor, and contextualizes them within the historical development of Family Medicine as a specialty, while piecing out the cognitive dissonance of practicing family medicine in a broken health care system. He spends many chapters profiling med students and physicians at different periods of their careers, painting a picture of the tension between mission-driven altruism and the pragmatism of financial stability. He ties that tension to why today’s family physicians struggle to embody the grand vision of well-trained physicians who render diagnostic and therapeutic measures to all ages, serve as the primary decision maker for illness inside and outside the hospital, and take the role of community advocate and specialty liaison.
