"It is my conviction that, on balance, the family practice movement has more in common with this counterculture than it does with the dominant scientific medical establishment. Maybe we never intended that it should be this way, and I doubt that many of us have an image of ourselves as revolutionaries. Most of us deal, on a day-to-day basis, with a much smaller quantum of reality; and, in truth, are much more motivated by purely personal goals than the heady stuff of national purpose. I suspect that that is the way all revolutions look from the inside."
- Dr. G. Gayle Stephens, "Family Medicine as Counterculture," 1979
It was late at night and I was researching, of all things, the origins and meaning of #FMRevolution, the role of social media as a galvanizing force for family medicine, and what it really means to be a family physician in our current health care system. I have often heard about family medicine's origin as a counter cultural movement, but as a trainee half a century removed from the social upheaval of the 1960s, it wasn't clear to me what that really meant.
Dr. Stephens' seminal work, "Family Medicine as Counterculture," originally presented in 1979, was the revolutionary spark that humbly defined many of our values as a specialty, identifying family physicians, "… with issues that have deep roots in American history: the preservation of rural life, humane values, consumerism, and the rights of women." The concept of family medicine revolution, the ideals and virtues that drive our passion, began decades before the Internet.
As a soon-to-be intern, I realize I am finally joining the ranks of family physicians to train and fulfill what I believe to be my life's purpose: to be a resource for the health of my community, to be an advocate, a social activist, and a healer.
These are heavy words, ones I have rarely shared during medical school, unsure of how to respond to the cynicism I would inevitably encounter. We have been too deeply immersed in the basic sciences, in innovative research and new therapies, disease mechanisms and their sequelae, that such words held little value. Above all, we face a healthcare system in turmoil, and every day I read news articles about why going into medicine was a mistake; about how we are burned out, underpaid, and in debt. As a colleague astutely pointed out, idealism alone will not bend the cost curve of health care in this country, nor will it address the practical issues that plague our system such as the need for sustainable growth rate (SGR) repeal. I am certain, however, that unbridled cynicism will not solve our problems.
Only among family physicians have I heard conversations about health care reform, social justice, care for the underserved and undocumented, and the need for revolution. Only among family physicians have I been encouraged to participate, to be a part of our current era of #FMRevolution and help define what it means to our generation. As Dr. Marco Angulo, a family physician at the University of California, Irvine, once said to me in times of great questioning, "If not you, then who?”
I would argue that every ounce of cynicism I have seen has been met by the passion and fury of family physicians on Capitol Hill. Those physicians proudly hold banners and advocate, in front of microphones and on social media, not only for our profession, but also for bills that directly affect the health of our communities and our patients. I am convinced that a strategic, practical idealism and a great sense of purpose will be the keys to making progress.
As family physicians, we have inherited the formidable task of helping reform our health care system, one that is even larger and more complex than our predecessors faced. Dr. Stephens, who passed away earlier this year, left us with a legacy rooted firmly in counterculture. We have become the arbiters of revolution. Our time is now.
Dr. Stephens, "Family Medicine as Counterculture" can be found on the AAFP website.