Andy Rooney: We Need More Family Doctors

This commentary was first published on April 25, 2010.

There's a lot in the newspapers these days about health care reform but I think they ought to be more specific and talk about something we all need: one all-purpose doctor.

There's just no doubt we have an acute shortage of what we used to call "family physicians."

We need more medical schools that graduate doctors who specialize in everything and nothing - the whole body, not just one part of it.

The practice of medicine has become too specialized, I think. Several years ago I had surgery on my right wrist. The doctor was very good. Two years later my left hand started to hurt so I went back to the doctor but I found out he only worked on right wrists. I mean, you talk about specializing.

We all need a doctor who'd give us a complete physical check-up for everything - kidney stones, cancer, lung problems, eyesight, even our hearing. They're all part of our one body.

A good friend of mine whose wife had a hip replacement was having trouble with a knee he hurt years ago, and he decided he might need a knee replacement.

I asked if he was going to his wife's orthopedic surgeon.

"No" my friend said in a way that suggested I was dumb for asking.

"He doesn't do knees!!!"

Well, pardon me.


Written by Andy Rooney

[rgmdc]

Mr. Rooney,

Your comments are on needing more Family Practitioners in this country is 100% correct. The most shocking thing is that these same specialist are the ones that do Impairment Ratings on injured employees in the state of Texas. If you have a low back injury, then what the heck is a specialist that specializes in another part of the body doing an impairment rating on the low back. I was attending an Impairment Rating Seminar to become an impairment rating doctor. I was appalled at the number of MD specialist that had no clue as to what was going on that was outside of their specialty.
As someone else stated earlier in their comment "If whatever you have is not getting better, or if the diagnosis is in doubt, at all, then you had better go to a specialist, ASAP." My response to that is "If this patient is not getting any better and the Doctor that they are currently seeing does not know what is going on, then how in the world would you expect the untrained patient know what specialist to see for their condition. That's why they went to the Doctor in the first place."
I have better results by asking a Chiropractor, Nurse or Veterinarian then asking a MD specialist.

[bankersvox]

If whatever you have is not getting better, or if the diagnosis is in doubt, at all, then you had better go to a specialist, ASAP.

something rare and exotic for the FP world , may be "routine" for the sp in that field. AND......Rapid therapy may mean the difference between a life in a wheel chair or walking !

Go to the best, right away is always the best idea if you can. Again if it is not getting better, see the EXPERT who can help you.

FP are wonderful, and hard working, and do a 100 % great job, as do NP.

[UCSFnewgrad]

Andy,
There is a pervasive misconception about the role and the amount of training and intelligence required to become a nurse practitioner. I am a student nurse pursuing my RN at UCSF, one of the top nursing and medical schools in the nation. I have already completed over 8 years of university and post-graduate work, and have worked over 7 years in a hospital in a related field. I still need to complete 2 years of classes and clinical hours before I will have enough training to become a nurse practitioner. Sure, we will see our own patients, but we will always have the opportunity to collaborate with our colleagues, medical doctors, and to refer our patients to them as needed (just as primary care physicians refer patients to specialists). We are not in competition with the medical doctors, but part of the same health care team. Some of us will specialize, others will become family nurse practitioners ( the ones you would prefer to visit). There are countless ways for us to meet the needs of the general public. Nursing is the combination of intelligence and empathy that America is looking for in their providers.

[thepacificmist]

I was not finished with my earlier comment when I accidentally hit "submit". When "managed (mangled)care" came on the scene in the late 70s one the first things cut out of patient care was the time to listen to a clear statement of present illness; accurate and insightful history taking; differential diagnosis; well analyzed working diagnosis; and necessary followup. Over time, doctors, nurses, patients, etc were restrained by insurers from practicing what they knew and, in many, these valuable akills assets withered, and patients have suffered many complications as a result. Most "specialists" practice a very constrained bit of medicine. And, sorry to say, though nurses are not thoroughly enough trained to be "family doctors" they will probably fill in as best they can. I do believe that real doctors can be trained and their numbers strenghthened with time and that is what needs to happen. Thanks for the chance to sound off.

[thepacificmist]

Andy, When I studied medicine at The State University of Iowa in the 1950s all medical students, including those who were to later go on to specialize in some area of medicine, were expected to know all there was to know at the time re "the whole person". We were taught how to clearly define the "present illness"; take a thorough personal, family, and social history; complete a thorough "review of systems; perform a thorough physical, mental, and neurological examination; perform any laboratory, x-ray, or other studies to support, rule out, or otherwise clarify positive or negative findings on examination as required; narrow down list of conditions - "differential diagnosis" to be considered in arriving at a working diagnosis; set up a treatment and followup plan. The well trained family doctor of those days could quickly do a mountain of work by taking the time to listen carefully to the patient, family, and relevant others.

[TomColt]

I was just at the VA Outpatient Clinic where I had to spend some time with the "Nurse Practioner" before I could see a doctor. The nurse's roll was limited to taking my vitals and inputting via the computer to my record, even though she diagnosed my ailment and told me what the doctor would prescribe for me. Yes, I agree, she could have handled the whole visit by herself.

As for more GP docs - great idea, but it's not something that happens automatically. You need some ideas and organization to make that happen.

Just a thought - why not make fully paid med school a GI Bill option for our returning vets - on the proviso that they serve at least 5 years in rural communities, or 3 years back with the troops?

[thepacificmist]

I was trained as a corpsman in 1951 at the Medical Field Service School Brooke Army Hospital and after 4 years in service and 4 years undergraduate was admitted to medical school. I had enough GI bill to cover just the first year. Because of my earlier training I was able to work my way through the following 3 years. It was hard, particularly on my family. It would have been much better if I had had GI Bill support through those years. I like your ideas and think that there would be many already partially trained and skilled vets who would opt to take advantage of such a program.

[tsigili]

We need more informed citizens, who can determine for themselves, many of their own minor problems, and take corrective action without seeing a doctor at all.

Today, the average family visits a doctor 4 times as often as they did just 50 yrs. ago. That's what "insurance" did for us.

We are ANIMALS, and we have to fend for ourselves in many ways, until there is a serious need for medical attention.

Now we take tons of drugs to make up for what we don't get in our diets, to try and maintain our health. What sense does that make?

We need humans to take more responsibility for themselves, and their own well being, and to treat themselves when possible.

[dunnbv]

Andy Rooney ...This is so serendipitious. We were out with friends today and I said the exact same thing!!!
I am tired of having 7 doctors, a different one for every little thing....we only had 1 when I was a kid and he did everything....even operating on my mom (now I don't want that!!).And having 7 doctors means you have7 appointments at least once a year but usually twice a year (that makes 14 appointments) and each time you have to remind each doctor of all the meds you are on....and all the tests that were done....and do they talk to each other??? No ! Do they read the reports the other doctor's office sends?? NO!!! It's a wonder we don't all die from specialty overload!!!
Bernie Dunn [e-mail]

[iwebz]

Rooney Rooney Rooney. Once again a story that is all complete bias without looking up a single fact. I definitely agree with the above comment. Physician extenders such as nurse practioners help offset the loss of primary care physicians and they do a great job. True they are not physicians but they can probably diagnose and treat 85 % of what comes in. If it is complicated they can refer on. So Rooney don't run around like chicken little shouting the sky is falling when really it is not.

Now on your second point about the hand and wrist or the knee and hip. Orthopaedics is sub specialized. But 99% of those who specialize in joints do both hip and knee replacements. As well as those who specialize in hand do both hand and wrist. Your examples are so off from the norm. In fact with you living in new York I can only think of one place that would be so ridicously sub sub specialized, a hospital on the upper east side. But if you want an orthopedic surgeon who does everything from hand to joints you can find those as well. They are called general orthopedic surgeons. And they do a great job. So Rooney if you and your friends want to go to one orthopedic surgeon for all of your musculoskeletal needs they exist. However I sense that wouldn't be en vogue for your hoity toity needs.

[delean1]

You are absolutely right, we need more primary care physicians. But what we have available now, are primary care nurse practitioners who are already stepping in to provide the care that so many people in this country need - basic, comprehensive, prevention-focused health care. Recent legislation in Maryland allows nurse practitioner to open access of health care to more individuals by eliminating a cumbersome collaborative agreement. If this were done all over the country for nurse practitioners, with focus on cost effective prevention, more care could be provided at a lesser cost.
susan Delean-Botkin, CRNP, MSN, BSN, BS, leg chair, Nurse Practitioner Association of MAryland