Letter from Our Chairman
New industry and technology that brought advances in communication, transportation mechanized agriculture and manufacturing heralded the late 19th and early 20th centuries. A result of these rapid changes was the perception that human capacity to master the forces of nature to create expanding wealth and comfort was boundless. At the same time, the science of medicine identified bacteria and viruses as the cause of many diseases, thereby, replacing the attribution models of "miasmas" and supernatural forces held by prior generations. The promise of science and technology to delay death and cure disease now seemed achievable. The picture of the general practitioner compassionately holding the patient's hand at bedside was altered by a post WWII scientific and technological explosion, and replaced with specialists cloaked in white coats in sterile environments. An era marked by extraordinary medical advances through scientific reductionism had begun at the expense of fragmenting and depersonalizing patient care. Physicians in-training were not content to remain generalists, and were drawn to the glamour and higher salaries of the multiple, new specialties. They became adept in narrower areas that they studied in depth; fewer generalists existed to provide necessary care in breadth. It was disease that medicine, in this post-war society, attacked as the enemy, and the stance was taken that physicians must intervene. Little thought was given to prevention, and no thought at all to enhancing the body's own mechanisms of healing. This was an era of the mechanistic, warrior approach of biomedicine in which the body was viewed little more than a machine, disease as the breakdown of the machine, and the physician's sole job being to fix the machine once broken. Psychosocial variables and their effects on health; the importance of looking at an illness within the context of the person and their life stresses and habits were considered outside the domain of medicine. These, as variables, did not lend themselves easily to study and testing through scientific reductionism. Within the medical community, it became apparent to some, that this lack of appreciation for the context of the illness, the medicalization of life problems without addressing the patient's life and the fragmentation of medical care did not meet patients' needs.
Public dissatisfaction with fragmentation of their health care in the decade of the sixties led to the establishment of the Citizens Commission on Graduate Medical Education. Their report was largely responsible for the birth of a new specialty, Family Medicine, based on an older more contextual paradigm, yet one versed and comfortable with the newer technology and information. It was a specialty of breadth and not depth, quite difficult for mainstream medicine to accept because it crossed the artificial boundaries set by the reductionistic model.
Our Department of Family Medicine was established a quarter of a century ago simultaneously with the Stony Brook University Medical Center. It was among the first in the country to have a mandatory 3rd year clerkship and has earned a reputation for having an innovative & highly competitive residency training program We hold the following values of the department as highest priority:
The Department will be in an academic & clinical setting in which primary care family physicians have time and resources to engage in practice that facilitates and empowers patients to take responsibility for their health. This is a setting in which physicians respect the importance of technology and specialization (knowing enough biomedicine to utilize them with wisdom); yet give credence to the importance of psychosocial issues in the etiology and management of illness. Paralleling this is a belief in context, i.e. disease does not exist by itself. This implies an understanding espousing that what happens in one part of the system affects the whole, and that there exists a balance between the biological, emotional and spiritual aspects of people that is recursive. Intrinsic to this endeavor is the belief in the body’s inherent potential to heal; that symptoms are not just to be eliminated, but to be listened to as wake-up calls and utilized to guide physician and patient direction. Finally, this is a Department of Family Medicine that believes time spent with the patient uncovering their “story” is paramount, for it is the story that gives meaning and context to illness.
My goal is for the Department of Family Medicine at SUNY @ Stony Brook to be a model for the delivery and teaching of community oriented primary care. The objectives to meet this goal are to:
- Demonstrate that a model that respects the body's inherent ability to heal and views disease as an indication of dysfunction in a connected, self-regulating, homeostatic, self-healing life system can be successful where a more mechanistic approach may fail,
- Demonstrate better outcome in terms of cost and quality of care when family physicians are utilized appropriately for their knowledge and skills as opposed to being gatekeepers of medical care,
- Demonstrate that it can be feasible to decrease clinician/academician perceptions of feeling overloaded, as well as free creativity, and improve performance clinically, academically, and economically,
- Demonstrate the ability for a program founded on these goals to be economically self-sufficient.
Jeffrey S Trilling, MD