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On many occasions I’ve told people that Family Physicians possess a much broader wealth of medical knowledge than any other group of physicians. I’m not bragging; it’s true! They’re not necessarily smarter, but family docs are interested, inquisitive, and want to be informed. As such, a broader knowledge means the family doctor feels comfortable in diagnosing and treating a wider variety of problems than any other physician specialty. My proof of that previously could be found in the 3000+ pages of “The Physician’s Desk Reference (PDR)”, the comprehensive compendium (collection) of every pharmaceutical product physicians are able to prescribe. If you open the PDR randomly to any page, there is a very good chance the family doctor will be familiar with the drug on that page and may actually have prescribed it. I’ve tried it, and it’s true.

Of course, a claim like that is boastful, but what it really points out is the comprehensive scope of Family Medicine. “Anything is fair game” and the family doctor “sees it all.” Family physicians have the potential to prescribe nearly every drug included in that huge book. If he doesn’t actually prescribe it, you can bet he has a good idea what it is, what it’s used for, and may even know the dose. This type of proof is only anecdotal (a supposition on my part), and doesn’t hold any credence. But because of an AAFP study we now know for sure.

Recently, convincing proof of the comprehensive nature of Family Medicine has been documented. The December, 2021 issue of American Family Physician contains a brief article that supports my point through the use of diagnosis codes. As you know from previous blogs, physicians use numeric codes for diagnoses when submitting claims for payment. All diagnosis codes are listed categorically in the International Classification of Diseases, 10th Revision (ICD-10), a huge reference manual. The Robert Graham Center of the American Academy of Family Physicians and the American Board of Family Medicine together, using ICD-10 and claims data, tabulated the number of different diagnoses used by family doctors. 

The results prove my point, decisively. There’s no argument! Primary care physicians use more diagnosis codes than any other specialty with family medicine reporting by far the most ICD-10 codes. To cite exact numbers, Family Physicians used over 800 diagnoses. The next closest were Internal Medicine and Pediatrics, both at just over 400; half as many as family docs. This is no surprise to any family doc. During his workday he will see the elderly, teenagers, and newborns, and may do PAP smears, joint injections, or mole biopsies. Anything is possible.

So when someone says they offer “comprehensive care,” if they’re not a family physician, they mean comprehensive only in the sense of the narrow specialty area they treat. Comprehensive care to a family doc means he treats anything from A to Z whereas comprehensive obstetric care is related only to the prenatal, delivery, and post-partum periods. There is a difference and the numbers prove it.

What I found over the years, though, was the scope of my practice narrowed gradually. When you’re fresh out of residency, you’re eager to tackle just about anything, and you do. As time passes, though, you stop delivering babies, stop taking care of ICU patients, stop making hospital rounds, and even stop seeing children. Keeping up with the multiple changes that occur in medicine literally every day and being well-versed in the variety of problems encountered is a difficult task. It takes a lot of time and as we age, our enthusiasm and energy for educational efforts wane. You prefer to be less busy rather than more, so you set limits for your practice and yourself. 

The most difficult decision for me was to stop making hospital rounds. It was very time-consuming, but it kept me informed of what was going on with my hospitalized patients and allowed me to interact with and get to know specialists and other family doctors on the staff. If there’s any doubt where my allegiance lies, however, it should be evident by this blog. Family medicine is the most challenging, most comprehensive, and most important medical specialty of all, and don’t you forget it!

Reference: Graham Policy Center One-Pager. Ajinkya M, Petterson S, Westfall J, Jabbarpour Y. Family Physicians Continue to Offer the Most Comprehensive Care. Am Fam Phys 2021 Dec;104(6):560.

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