I hope y’all aren’t too tired of my continuing posts explaining how family physicians deliver better care at a lower cost than any other model. As I continue to talk about the findings in our recently published study I am now shifting away from describing how family physicians are different people than other physicians — their values, attitudes, and characteristics — and moving toward how these personality differences translate into different medical decision making patterns.
One difference is that compared to ologists, family physicians reported that they are more likely to use time to sort out symptoms that were either vague — they didn’t fit any clear pattern — or of a low probability of representing a life- or limb-threatening illness.
To the physicians: did any professor in your medical school pimp you about how to diagnose a patient where the right answer he or she was looking for was for you to order no test or empiric treatment? Probably not, except on a family medicine rotation.
Family physicians take this approach all the time. “I don’t know why your hair feels cold and tingly to you Mrs. Jones, but it and your scalp look fine to me. Let me know if this feeling gets worse, your hair starts falling out, or you get a rash on your scalp.”
Or to the anxious 18-year-old girl, “Your chest pain is not caused by a heart attack or any other life-threatening serious disease. If the pain gets worse, come back and we can re-think this. In the meantime, I bet you pulled a muscle or something like that. Unfortunately there’s no test to prove this. If the pain gets real bad, try A, B, and C and let’s see if that helps your pain before we do anything else.”
These answers were never the right answer in my medical school internal medicine rounds. But they are the right answer for the U.S. to start to make a dent in its exorbitant healthcare costs.