Although progress is being made toward defining the family physician and the specialty of family practice, there remains a need to describe more clearly a conceptual base for family medicine as an academic discipline. This paper explores common misconceptions and fallacies which have confused or prevented greater understanding of the intellectual basis for family practice. A thesis is presented and defended which holds that patient management is the quintessential skill of clinical practice and the unique field of knowledge of family physicians. The sine qua non of family practice is the knowledge and skill which allow the family physician to confront relatively large numbers of unselected patients with unselected conditions and to carry on therapeutic relationships with patients over time.