Friday, April 8, 2011

Medicine is a team game…and every team needs a good family physician

I recently matched into family medicine in the 2011 NRMP residency match, and I have to say the process reminded me a bit of “draft days” where the NFL, NBA, and other professional sports organizations carefully consider their current strengths and weaknesses and choose prospects accordingly. In light of the recent match and the exciting conclusion of the NCAA basketball tournament (yes, this post might clue you in to my interest in sports medicine), I thought I’d take the opportunity to discuss just what it is that makes teams work well and how family physicians and other specialists can learn from sports philosophy.

I’ve played a multitude of sports throughout my life, and I’ve been on teams that won championships and teams that were absolutely awful, bottom-dwellers of their league. And I’ve seen incredibly gifted players on both kinds of teams. It still never ceases to amaze me how some teams incorporate this talent into their overall strategy while others self-destruct in spite of it. Either way, one player does not make a team, no matter how good that player is. If you’ve followed NCAA basketball this year, you might have watched BYU’s Jimmer Fredette almost single-handedly dismantle New Mexico, going on a 52-point scoring rampage. But a team like this year’s BYU squad will never win an NCAA championship; despite advancing to the sweet 16, they were ousted by Florida in a game where no BYU player other than Fredette scored in double figures.

I admit that I wasn’t the star forward on the soccer team in high school, but I will venture to guess that without solid defenders and skilled passers (I’ll give myself a little credit for being one of these), a teammate of mine who would go on to play in Major League Soccer would never have scored 26 goals in his freshman year.

The practice of medicine is no different. Games against formidable opponents like myocardial infarction and diabetes are being played on a daily basis in hospitals and outpatient offices around the country. And as in sports, the glory or derision often is directed at the 52-point scorer, whether that be Jimmer Fredette, MD, who performs the triple bypass to defeat symptoms of unstable angina, or Jimmer Fredette the saddle pulmonary embolism which no thrombolytic therapy can beat. (Sorry Jimmer, don’t mean to equate you with sudden death; this is all metaphorical.)

Stars take the limelight, and sometimes little recognition goes to the supporting cast – the other players who come to every practice, put in hard work day after day, and set the star up for success.

Family physicians are the most crucial of these supporting players in medicine. They are the modest team leaders, assisting other specialists in executing their temporary functions while also making sure that team coherence and morale stays consistently high over the course of a patient’s life. They perform the menial work in the trenches, modifying medications to optimize Hemoglobin A1cs and forming long-standing relationships to encourage smoking cessation. Family physicians are also those teammates most poised to involve other skill players in team play: these include the patient and his family, nurses and nurse practitioners, physician assistants, social workers, behavioral health professionals, and pharmacists, among others. In short, family physicians are player-coaches, managers, and cheerleaders rolled into one.

Team success goes south when teammates don’t see eye to eye. Disagreement about each player’s level of responsibility or about team strategy can quickly lead to failure. Jim Thome, when he was a slugger for the Phillies, described his philosophy for guarding against team dysfunction: “I just stay in my lane,” he said, maturely recognizing that his contribution to the Phillies success was in his bat, his first base glove, and his quiet work ethic.

The NRMP match separates us, as physicians, into different specialties, just as athletes are specialists at their respective positions. But when we start to make a distinction between the value of each specialty, that is when team health care loses its effectiveness. In a prior post on this blog, one of the student authors described the “hazing of family medicine,” in reference to stereotypical condescension by other physician specialists towards the specialty of family medicine. Certainly this condescension exists, although I’ve encountered it more rarely than frequently, I'm happy to say. Some family physicians, however, are as guilty as some of their specialist brethren of perpetuating this supposed professional divide. Certain of us in family medicine are quick to decry the missions of large academic medical centers and proclaim that they don’t place enough emphasis on the specialty of family medicine. By doing so, these family physicians are lending validity to the stereotype and alienating our specialty from all the rest.

Any academic distinction we make between primary care physicians and specialists is a bunch of hooey. We can only blame any “us and them” rhetoric on ourselves as a whole body of physicians. In terms of patient care (reimbursement aside), there is no difference between primary care physicians and specialists. We all have a responsibility to provide the best care possible to our patients, and we need to respect the unique special training we each receive. We wear the same white uniforms. We are a team.

The best way to influence medical students to choose family medicine (and thus fulfill the ambitious goals of vastly increasing the number of primary care physicians in this country over the next several decades) is not necessarily by fighting our colleagues for reimbursement equality or by distancing ourselves from them by elucidating the differences between FM and other specialties, but instead by making sure we as current and future family physicians are well integrated into large academic centers and smaller community hospitals alike. By working hard day in and day out to provide quality patient care along side of our colleagues, who all have their own special unique training. By coaching our patients who, if they love who we are and what we do, will clamor for more of us and force insurance companies and policymakers to recognize our value, both in monetary and intangible terms.

To bring the NCAA basketball metaphor full circle, we who are current and future family physicians need to rebrand ourselves as the hard-working team player that all the other members of our health system teams can rely on every game, not the player who whines about not getting the ball enough. We need to be outspoken in our leadership of the team, but we also need to be patient and non-antagonistic in our criticism of the current health care strategy. We need to be as accessible as possible to our patients and to our peers. The way to win the hearts of medical students, health administrators and insurance company CEOs alike over to an FM-based team strategy is through hard work, dedication, and serving as role models for students and the rest of our colleagues. As for our patients, many already know our value, and they just want to win more games than not. No 52-point outings necessary.

1 comment:

  1. Great Analogy! As a sports fan, I can definitely see striking parallels between successful athletic teams and successful medical teams.

    Not everyone can be Michael Jordan, just like everyone can't be a neurosurgeon. But that doesn't mean Jordan didn't need his Pippen, Phil Jackson, and Horace Grant. No one does it alone.

    So are you trying to say that Family Docs are great "assist" leaders in the NHL (National Healthcare League)?