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Value-based purchasing. Accountable care. The 10 members of the Generation III youngest generation group at the conference have been closely involved with many of these changes through practice, policy, research, and medical education; in many ways these changes represent a microcosm of the diversity among family physicians today.

TRACK Comments:

Those of us in Generation III, some late baby boomers and some early Gen Xers those born — , undoubtedly had expectations of work-life balance, the scope of our practices, and how we might structure our practices and careers that were different from those held by Generations I and II. Over the intervening years, it has become evident that one might best describe the ideal family physician as a pluripotent stem cell; our generalist inclination, diverse training, and range of meta-skills listening, systems thinking, team-building, advocacy, etc allow family physicians to pursue a wide range of careers both in and out of medicine, and even change careers within family medicine.

Nationally, family physicians lead government programs, serve as medical directors for corporations and insurance companies, invent new technologies, develop and franchise new models of practice, and enter additional professions, such as politics, information technology IT , law, and business. Even among the 10 of us, we have 3 department chairs, an associate dean, a mayor, a state senator, a medical director of Planned Parenthood, a state Medicaid director, a research director for a nonprofit IT collaborative, and a chief executive officer of a direct primary care organization.

Each of us has chosen to interpret our mission as a family physician differently and believes that each is serving as a family physician every day, regardless of whether we see a patient that day in a traditional family medicine clinic.

Top 20 Medical Technology Advances: Medicine in the Future

The historical article presented in this issue, written by our group immediately after the Keystone III conference, reflects well the overall tenor of the conversation around family medicine at the beginning of the century. We were, in many ways, playing defense, frustrated by the increasing industrialization of medicine, with terms such as relative value units and productivity permeating our daily practice.

This industrialization only accelerated in the decade after Keystone III, becoming almost an arms race between the various segments of the health care system; clinicians were trying to maximize revenue by any means possible, and payers were instituting complex mechanisms to control costs.


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The economic boom that allowed medical costs to balloon without consequence, pushing high-tech rather than high-touch as the best form of health care, even as health outcomes worsened, further exacerbated industrialization. Family physicians were dragged further and further away from our core: whole-person, whole-family, and whole—community-centered care. We responded and continue to respond through various strategies to preserve that core. In response to the unsustainable trajectory of health care costs seen by politicians, employers, insurers, and providers of health care of all types, the family of family medicine ultimately has chosen a more proactive course.

We have engaged increasingly in advocacy, and many family physicians have taken on new roles in leadership, both in medicine and beyond. We have reframed the conversation and educated the public and decision makers about the value of prevention rather than cure, as well as the necessity of empowering and partnering with patients to improve their health care experience and health outcomes. In many ways, family physicians have had a substantial influence on the Affordable Care Act, which will have lasting implications on the future of health care in the United States.

Furthermore, family medicine has been a leader in developing the evidence for and implementation of practice redesign and payment reform. Family medicine appears to be adapting more rapidly than most specialties to practice-based research and the technologic changes in care delivery. Many family physicians understand that direct, one-on-one, face-to-face contact may not always represent the best, most patient-centered care.

For example, many use asynchronous communication by means of the electronic health record to help patients with diabetes adjust their insulin dosing, rather than rely on frequent office visits. Paradoxically, many in our generation have found that the ability to be always on call using modern technology has decreased our anxiety about work-life balance eg, we can go home directly after office hours are done, have dinner with our families, and finish charting later from home and allowed us to focus on one of the aspects of family medicine—true engagement with our patients—that drew us to the specialty in the first place.

Editorial team. Stanley Joel Reiser. Cambridge University Press Advances in medicine have brought us the stethoscope, artificial kidneys, and computerized health records.

They have also changed the doctor-patient relationship. This book explores how the technologies of medicine are created and how we respond to the problems and successes of their use. Stanley Joel Reiser, MD, walks us through the ways medical innovations exert their influence by discussing a number of selected technologies, including the X-ray, ultrasound, and respirator. Reiser creates a new understanding of thinking about how health care is practiced in the United States and thereby suggests new methods to effectively meet the challenges of living with technological medicine.

As healthcare reform continues to be an intensely debated topic in America, Technological Medicine shows us the pros and cons of applying technological solutions health and illness. Ethics in Value Theory, Miscellaneous.


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