Focused practice: broadening the scope of family medicine

Craig Appleyard

There are clearly reservations about focused practice.1 The concern seems to be a perceived threat to comprehensive family medicine. Yet, far from being a threat, focused practices offer a vital dimension by backfilling areas of medical practice that have manpower shortages (eg, FPs that handle dialysis, oncology, and palliative care) and areas in which medical education has been deficient (eg, structural assessment within orthopedics, environmental medicine, and—that great black hole of medical training—nutrition). In addition, there are areas of emerging knowledge dealing with disease entities traditionally not thought to be valid but that are proving to be very real over time (chronic fatigue syndrome, chronic Lyme disease, etc). I can think of several GPs and FPs who have been swimming for years against the current of mainstream medical opinion to work with these often very unfortunate and sick people. The extraordinary patient loyalty they often engender is something we should all note.

We should also take into account the array of complementary approaches, which have been of benefit to a substantial number of people. Some of these modalities have bodies of evidence that might surprise many doctors (eg, acupuncture, homeopathy), while others are more esoteric and remain unfamiliar to most practitioners (eg, traditional Chinese medicine, Ayurveda, anthroposophic medicine) yet have subgroups of patients who benefit from their practices.

Think of focused practices as broadening the scope of family medicine rather than as a threat. We are all FPs or GPs and many of us have Certification from the College of Family Physicians of Canada. We think like family doctors—indeed, many of us have had long careers in family medicine—and working with family doctors is second nature, notwithstanding the divisiveness of the changes within primary care.