Philosophy Discussion Forums | A Humans-Only Club for Open-Minded Discussion & Debate

[Sushan]

To me, cradle-to-grave caregiver means that she can provide care to anyone at any stage of life. I like that idea and I feel it shows her compassion to her fellow man.

Actually a doctor with a MBBS (or an equivalent) can treat many general conditions of patients in any age group. But when someone choose family practice, as the name implies, it is a care for a family (families). So the physician will look after all the family members starting from the infant to the old ones. In many occasions these doctors are based on one location and throughout their service they remain there. So they see many life stages of the family members that they treat.

Sure they're trained to treat all ages, but it is common for many to choose not to. In order to do uncomplicated deliveries of newborns, for example, requires being available 24/7 (instead of just office hours for someone with an office based practice). The vast majority of FPs choose not to work on Labor and Delivery and who can blame them. It is a highly litigious practice that, to be honest, is not suited to most personalities.

Similarly a lot of FPs hate doing pediatrics, even though they have some training in it, because dealing with other people's children drives many people (of every profession) crazy and they hate it.

It's a compelling point you bring up. The versatility of Family Physicians (FPs) is indeed vast, and while their training equips them to handle a wide spectrum of age groups and conditions, the practicalities of day-to-day practice, as you mentioned, can sometimes influence their choices. Specializing in certain areas or even avoiding certain treatments due to the inherent risks or personal preferences is valid.

However, the essence of the term "Cradle to Grave Caregiver" might be less about the literal application across all life stages and more about the ethos of family medicine. FPs often take a more holistic approach, considering not just the immediate ailment, but the broader context of family, environment, and long-term well-being. They are positioned to see the bigger picture, which includes understanding a patient's journey from infancy to old age, even if they don't actively treat every stage.

It's a philosophy that emphasizes continuity and comprehensive care. While not every FP might cater to every age group, the idea is that they are equipped and trained to do so. Would you agree that it's this comprehensive approach, more than the specific age groups they treat, that sets them apart?

[Sushan]

Maybe she was referring to the fact that she treats all life stages, however, she could have used other terms such as general practitioner or doctor for all phases of life. I understood cradle to grave to mean that she cares for individuals since birth to the day they die. Or that she helps them being born and being buried. Therefore, I personally would have used another term. On the positive side however, describing a general practitioner in this way does make it seem more dramatic and gets the point across that she has no preference for any age or life stage.

There is a need for those who know a little bit about many subjects and for those who know a lot about fewer subjects. One is not superior to the other.

Indeed, you've touched upon an age-old dichotomy that exists not just in medicine but across many disciplines: the generalist vs. the specialist. Both roles are crucial in their own right. A family physician, or a "Cradle to Grave Caregiver" as the author terms it, epitomizes the role of a generalist. They're often the first point of contact, providing holistic care, understanding a patient's overall context, and guiding them through various life stages. Their breadth of knowledge is commendable.

On the other hand, specialists delve deep into specific areas, offering expert advice and care for particular conditions. Their depth of knowledge is equally valuable. The healthcare system ideally works best when these two approaches harmoniously complement each other, with generalists providing broad care and specialists stepping in for more specific needs.

Do you think there's merit in seeing "Cradle to Grave Caregiver" not just as a literal descriptor but also as a philosophical stance on holistic healthcare?

[Sushan]

I like the term and think it conveys her message clearly. I have never heard it referred to like this - I think it’s a great way to let potential patients know she sees all ages. I have encountered many Family Practice offices that will not see children under 12 or anyone under 18. That’s not a family practice, that’s a general practice. I wish I could have found a true family practice when my child was younger.

You raise a valid point. The term "Cradle to Grave Caregiver" does offer a broader, more encompassing sense of care. It's indeed disheartening when certain "Family Practice" offices limit their care to specific age groups, potentially creating gaps in continuous family healthcare. A true family practice should ideally cater to all family members, irrespective of age. This provides an opportunity for the physician to understand the family dynamics, genetics, and environmental factors, enabling a more holistic approach to healthcare. It's essential that terminologies resonate with the ethos they are meant to portray, and in this case, I believe the author's choice aptly captures the essence of an all-encompassing care provider. Would you say that having such a comprehensive healthcare provider has advantages beyond mere medical care, perhaps in understanding and addressing the intertwined dynamics of familial health?

[Sushan]

I like the term and think it conveys her message clearly. I have never heard it referred to like this - I think it’s a great way to let potential patients know she sees all ages. I have encountered many Family Practice offices that will not see children under 12 or anyone under 18. That’s not a family practice, that’s a general practice. I wish I could have found a true family practice when my child was younger.

Nope, as mentioned FPs choosing not to do Pediatrics is common. If that's not what you're interested in, great, choose an FP who does. Simple, really.

Of course, I understand your perspective. However, the term "Family Practice" inherently suggests a comprehensive care approach for all family members, regardless of age. When families seek a "family physician," they often expect care for all members, from the youngest to the oldest. While many FPs might choose not to focus on Pediatrics or other specific areas, it's essential for patients to have clarity on these specifics to make informed decisions about their healthcare. It's about meeting the expectations set by the terminology and ensuring patients receive the holistic care they anticipate.

[LuckyR]

I like the term and think it conveys her message clearly. I have never heard it referred to like this - I think it’s a great way to let potential patients know she sees all ages. I have encountered many Family Practice offices that will not see children under 12 or anyone under 18. That’s not a family practice, that’s a general practice. I wish I could have found a true family practice when my child was younger.

Nope, as mentioned FPs choosing not to do Pediatrics is common. If that's not what you're interested in, great, choose an FP who does. Simple, really.

Of course, I understand your perspective. However, the term "Family Practice" inherently suggests a comprehensive care approach for all family members, regardless of age. When families seek a "family physician," they often expect care for all members, from the youngest to the oldest. While many FPs might choose not to focus on Pediatrics or other specific areas, it's essential for patients to have clarity on these specifics to make informed decisions about their healthcare. It's about meeting the expectations set by the terminology and ensuring patients receive the holistic care they anticipate.

Not an unreasonable thought experiment, but like a "family car" from the 1980s, the term is merely quasi-descriptive, rather it is a label (much like a girl named Charity isn't necessarily charitable). The field of Family Practice is just a name, like General Surgery. It doesn't mean that some General Surgeons don't specialize in just, say breast surgery.

[Stoppelmann]

This topic is related to the philosophical book for the month of June Surviving the Business of Healthcare: Knowledge is Power by Barbara Galutia Regis PA-C

https://forums.onlinebookclub.org/shelv ... ?id=419391

Following quote which is found in Location 157 shows the author's view on the job of a Family Physician.

Family Practice—cradle to grave—is my specialty.

Do you agree with this statement, naming a family physician as a Cradle to Grave Caregiver? Why?

They can be. The real questions are: do they want to be? And as Dirty Harry put it: "A man's gotta know his limitations". That is, you need to know what you don't know and refer the patient to someone who is more knowledgeable than you are.

Exactly. As the family physicians are doctors with a basic degree ( though some are specialists in the field of family medicine, still they are not specialists in various fields in medicine) their knowledge and skills can be limited. And it is not something to be shamed of because no one can know everything. But it is of utmost importance to know one's limitations and whenever a patient's condition seems out of scope of a family physician, he should refer the patient without any hesitations because what is at risk is nothing else but a human life.

Unfortunately, we are so obsessed with specialisation that we fail to value the role of the generalist, which is what family practice is all about. This is something that Iain McGilchrist found as a psychiatrist: “generalists appreciate the need for specialists, while the specialist is less able to see the need for the generalist.” And later “In theory, our very best philosophers, civil servants, political leaders, and writers are expert generalists – their defining skill is inclusive synthesis and their defining qualities are epistemic acumen and agility: knowhow with knowledge, having enough expertise in one domain to value different forms of understanding, and knowing how to integrate them while retaining curiosity towards whatever remains unfamiliar.”
McGilchrist, Iain. The Matter With Things: Our Brains, Our Delusions and the Unmaking of the World (p. 2995). Perspectiva Press.

This is no less important in medicine, and it is the generalist that ideally combines the somatic diagnosis with psychological, but also with social aspects, and comes up with a holistic view of the ailment that is causing problems. Barbara Galutia follows in the footsteps of three generations of family practice physicians, and says, “this was a natural and genetic calling that I am deeply proud of.” This indicates that she has attempted to be an “expert generalist” like McGilchrist used the term, and her book shows the importance of seeing the other side.

[Sushan]

This topic is related to the philosophical book for the month of June Surviving the Business of Healthcare: Knowledge is Power by Barbara Galutia Regis PA-C

https://forums.onlinebookclub.org/shelv ... ?id=419391

Following quote which is found in Location 157 shows the author's view on the job of a Family Physician.



Do you agree with this statement, naming a family physician as a Cradle to Grave Caregiver? Why?

They can be. The real questions are: do they want to be? And as Dirty Harry put it: "A man's gotta know his limitations". That is, you need to know what you don't know and refer the patient to someone who is more knowledgeable than you are.

Exactly. As the family physicians are doctors with a basic degree ( though some are specialists in the field of family medicine, still they are not specialists in various fields in medicine) their knowledge and skills can be limited. And it is not something to be shamed of because no one can know everything. But it is of utmost importance to know one's limitations and whenever a patient's condition seems out of scope of a family physician, he should refer the patient without any hesitations because what is at risk is nothing else but a human life.

Unfortunately, we are so obsessed with specialisation that we fail to value the role of the generalist, which is what family practice is all about. This is something that Iain McGilchrist found as a psychiatrist: “generalists appreciate the need for specialists, while the specialist is less able to see the need for the generalist.” And later “In theory, our very best philosophers, civil servants, political leaders, and writers are expert generalists – their defining skill is inclusive synthesis and their defining qualities are epistemic acumen and agility: knowhow with knowledge, having enough expertise in one domain to value different forms of understanding, and knowing how to integrate them while retaining curiosity towards whatever remains unfamiliar.”
McGilchrist, Iain. The Matter With Things: Our Brains, Our Delusions and the Unmaking of the World (p. 2995). Perspectiva Press.

This is no less important in medicine, and it is the generalist that ideally combines the somatic diagnosis with psychological, but also with social aspects, and comes up with a holistic view of the ailment that is causing problems. Barbara Galutia follows in the footsteps of three generations of family practice physicians, and says, “this was a natural and genetic calling that I am deeply proud of.” This indicates that she has attempted to be an “expert generalist” like McGilchrist used the term, and her book shows the importance of seeing the other side.

That's a very insightful point. The role of the generalist, or the "expert generalist" as Iain McGilchrist puts it, is indeed critical, and perhaps underappreciated in our increasingly specialized world. Generalists, like family physicians, are tasked with synthesizing a broad array of information in a way that specialists, focused deeply on one area, might not need to do on a daily basis.

Family physicians, serving as 'cradle to grave' caregivers, are often in a unique position to understand the broader context of a patient's life and health, both physically and emotionally. They see patients in various stages of life and are often familiar with their family history, lifestyle, and other factors that can impact health. This comprehensive perspective enables them to approach patient care in a more holistic manner, which is invaluable.

This isn't to diminish the essential role of specialists, who have deep expertise in a particular area of medicine and are absolutely necessary for managing specific conditions. But family physicians serve as a sort of 'quarterback' for their patient’s health, coordinating care and making sure all of the pieces fit together in a coherent way.

The words of Barbara Galutia Regis PA-C, indicating a deep pride in her calling as a family practice physician, seem to resonate with this 'expert generalist' role—a doctor who doesn't just treat an array of disparate conditions, but sees and treats the whole patient throughout their life.

Given this, do you think that the healthcare system, particularly in its education and training programs, does enough to emphasize and foster the role of family physicians as 'expert generalists'? Or are there ways that this aspect of medical education could be improved to further highlight the importance of this role?

[Sushan]

I like the term and think it conveys her message clearly. I have never heard it referred to like this - I think it’s a great way to let potential patients know she sees all ages. I have encountered many Family Practice offices that will not see children under 12 or anyone under 18. That’s not a family practice, that’s a general practice. I wish I could have found a true family practice when my child was younger.

Nope, as mentioned FPs choosing not to do Pediatrics is common. If that's not what you're interested in, great, choose an FP who does. Simple, really.

Of course, I understand your perspective. However, the term "Family Practice" inherently suggests a comprehensive care approach for all family members, regardless of age. When families seek a "family physician," they often expect care for all members, from the youngest to the oldest. While many FPs might choose not to focus on Pediatrics or other specific areas, it's essential for patients to have clarity on these specifics to make informed decisions about their healthcare. It's about meeting the expectations set by the terminology and ensuring patients receive the holistic care they anticipate.

Not an unreasonable thought experiment, but like a "family car" from the 1980s, the term is merely quasi-descriptive, rather it is a label (much like a girl named Charity isn't necessarily charitable). The field of Family Practice is just a name, like General Surgery. It doesn't mean that some General Surgeons don't specialize in just, say breast surgery.

You raise a valid point about the potential for a difference between the name of a field and the actual scope of practice it may encompass. It is indeed true that titles, including professional ones, can sometimes be more of a traditional or historical label rather than a precise descriptor of what one can expect. Your comparison to the specialization within General Surgery highlights this perfectly; a name does not always encapsulate all the nuances of a profession.

However, the name of a medical specialty, in an ideal world, should serve as a guide to patients. If the term "Family Practice" is widely understood to imply a certain breadth of care, from young children to elderly individuals, then a practice under this name that significantly limits the age range of its patients might create confusion or even mistrust.

Given the potential for such misunderstandings, do you think there might be a benefit in reconsidering how we name and define various medical practices? Could this be one step towards clearer and more effective communication between healthcare providers and patients, ultimately leading to more satisfactory healthcare experiences?

[Stoppelmann]

The role of the generalist, or the "expert generalist" as Iain McGilchrist puts it, is indeed critical, and perhaps underappreciated in our increasingly specialized world. Generalists, like family physicians, are tasked with synthesizing a broad array of information in a way that specialists, focused deeply on one area, might not need to do on a daily basis.

Family physicians, serving as 'cradle to grave' caregivers, are often in a unique position to understand the broader context of a patient's life and health, both physically and emotionally. They see patients in various stages of life and are often familiar with their family history, lifestyle, and other factors that can impact health. This comprehensive perspective enables them to approach patient care in a more holistic manner, which is invaluable.

This isn't to diminish the essential role of specialists, who have deep expertise in a particular area of medicine and are absolutely necessary for managing specific conditions. But family physicians serve as a sort of 'quarterback' for their patient’s health, coordinating care and making sure all of the pieces fit together in a coherent way.

The words of Barbara Galutia Regis PA-C, indicating a deep pride in her calling as a family practice physician, seem to resonate with this 'expert generalist' role—a doctor who doesn't just treat an array of disparate conditions, but sees and treats the whole patient throughout their life.

Given this, do you think that the healthcare system, particularly in its education and training programs, does enough to emphasize and foster the role of family physicians as 'expert generalists'? Or are there ways that this aspect of medical education could be improved to further highlight the importance of this role?

No, I think that all healthcare systems are transitioning into profit-orientated, specialised, and minimalistic services, although our lifestyles are increasingly the cause of illnesses. The connection between habits and lifestyles and illnesses are underemphasised, hence the increasing amount of money spent despite an increase in illnesses and overload of health services. It is that bad that people are suspecting that it is a form of population reduction, although if it were, it is a bad one. Our population reduces through the smaller size or disappearance of traditional families.

There are branches of Western medicine that incorporate some elements of holistic assessment and personalized treatment, but this approach is becoming restricted to alternative medicine like Ayurveda, TCM. A branch called Integrative Medicine combines conventional medical treatments with complementary therapies such as acupuncture, yoga, nutrition, and mindfulness. Practitioners aim to treat the whole person—mind, body, and spirit—by integrating evidence-based complementary therapies alongside traditional medical interventions.

Functional Medicine seeks to identify and address the root causes of disease by looking at the interactions between genetics, environment, and lifestyle. Its practitioners consider a patient's unique biochemical makeup and develop personalized treatment plans to restore balance and optimize health. Some functional medicine practitioners are becoming recognized by insurance companies, and certain aspects of functional medicine, such as laboratory tests and consultations, may be covered by health insurance plans.

However, coverage of these branches can vary widely depending on the insurance company and are subject to criticism by people who haven’t experienced their effectiveness.

[taherehbakhshi]

This is an interesting term that I have never seen in connection with the work of doctors because their work is examination, while this term has a deeper meaning in my opinion. Of course, on the other hand, a family doctor will be in a working and therapeutic relationship with a family for a long time, which can indicate this term. And in this sense, I congratulate this author.

[Sushan]

The role of the generalist, or the "expert generalist" as Iain McGilchrist puts it, is indeed critical, and perhaps underappreciated in our increasingly specialized world. Generalists, like family physicians, are tasked with synthesizing a broad array of information in a way that specialists, focused deeply on one area, might not need to do on a daily basis.

Family physicians, serving as 'cradle to grave' caregivers, are often in a unique position to understand the broader context of a patient's life and health, both physically and emotionally. They see patients in various stages of life and are often familiar with their family history, lifestyle, and other factors that can impact health. This comprehensive perspective enables them to approach patient care in a more holistic manner, which is invaluable.

This isn't to diminish the essential role of specialists, who have deep expertise in a particular area of medicine and are absolutely necessary for managing specific conditions. But family physicians serve as a sort of 'quarterback' for their patient’s health, coordinating care and making sure all of the pieces fit together in a coherent way.

The words of Barbara Galutia Regis PA-C, indicating a deep pride in her calling as a family practice physician, seem to resonate with this 'expert generalist' role—a doctor who doesn't just treat an array of disparate conditions, but sees and treats the whole patient throughout their life.

Given this, do you think that the healthcare system, particularly in its education and training programs, does enough to emphasize and foster the role of family physicians as 'expert generalists'? Or are there ways that this aspect of medical education could be improved to further highlight the importance of this role?

No, I think that all healthcare systems are transitioning into profit-orientated, specialised, and minimalistic services, although our lifestyles are increasingly the cause of illnesses. The connection between habits and lifestyles and illnesses are underemphasised, hence the increasing amount of money spent despite an increase in illnesses and overload of health services. It is that bad that people are suspecting that it is a form of population reduction, although if it were, it is a bad one. Our population reduces through the smaller size or disappearance of traditional families.

There are branches of Western medicine that incorporate some elements of holistic assessment and personalized treatment, but this approach is becoming restricted to alternative medicine like Ayurveda, TCM. A branch called Integrative Medicine combines conventional medical treatments with complementary therapies such as acupuncture, yoga, nutrition, and mindfulness. Practitioners aim to treat the whole person—mind, body, and spirit—by integrating evidence-based complementary therapies alongside traditional medical interventions.

Functional Medicine seeks to identify and address the root causes of disease by looking at the interactions between genetics, environment, and lifestyle. Its practitioners consider a patient's unique biochemical makeup and develop personalized treatment plans to restore balance and optimize health. Some functional medicine practitioners are becoming recognized by insurance companies, and certain aspects of functional medicine, such as laboratory tests and consultations, may be covered by health insurance plans.

However, coverage of these branches can vary widely depending on the insurance company and are subject to criticism by people who haven’t experienced their effectiveness.

Thank you for sharing that detailed perspective. It’s clear that you have thought deeply about this issue. I share your concern about the increasing trend towards profit-oriented and specialized healthcare systems. Such a system, as you aptly point out, can overlook the significant connection between lifestyle factors and health, missing opportunities for prevention and holistic care.

I find your mention of integrative and functional medicine particularly interesting. These approaches, which aim to treat the patient as a whole and seek to address root causes of disease, do indeed represent a sort of return to a more 'generalist' approach. They require a physician to synthesize a broad array of information and consider the patient’s lifestyle, emotional well-being, and other factors, not unlike the role of the family physician as an 'expert generalist'. They represent a step toward more personalized, comprehensive healthcare, acknowledging the complex interplay between our genetics, environment, lifestyle, and health.

Your point about the partial coverage of these branches of medicine by insurance companies is well taken. It seems to underscore a broader issue in our healthcare system—namely, that insurance and healthcare policies do not always align with what might be best for patient care. When effective treatments are not covered by insurance, it limits access and perpetuates a system where only certain segments of the population can afford the best care.

Given the promising nature of these holistic approaches, I wonder what you think might be effective strategies to incorporate more of these principles into mainstream medical education and practice. Do you envision this as a practical step towards re-emphasizing the role of the generalist and addressing the limitations of our increasingly specialized healthcare systems? Would this also possibly address the disconnect between healthcare as a service for well-being and healthcare as a profit-oriented industry?

[Sushan]

This is an interesting term that I have never seen in connection with the work of doctors because their work is examination, while this term has a deeper meaning in my opinion. Of course, on the other hand, a family doctor will be in a working and therapeutic relationship with a family for a long time, which can indicate this term. And in this sense, I congratulate this author.

Thank you for sharing your perspective on the term "Cradle to Grave Caregiver" in relation to a family physician's role. I appreciate your observation that the term seems to carry a deeper meaning than what might typically be associated with a clinical medical practice. It appears to encompass a long-term, continuous, and deeply involved relationship with patients.

I agree that the term extends beyond mere medical examination and treatment. It suggests that a family physician is not only a healthcare provider but also a consistent figure in an individual's life, from infancy through old age—a source of guidance, reassurance, and stability. In this sense, the family physician’s role becomes significantly relational and possibly even educational, as they are often in a unique position to observe and understand the long-term health trajectory of a patient and can provide continuous and tailored advice and care.

I believe this relational aspect of family medicine is of immense value. It adds a layer of humanity and personal touch that can be lacking in more transactional medical interactions. It acknowledges that health is not just about treating diseases as they appear but involves a deeper understanding of a person's life, habits, and circumstances.

Do you think this “cradle to grave” approach is something that should be emphasized more in the training of doctors, considering the potential for a more humane and comprehensive form of care? Or do you see potential drawbacks to this kind of close, long-term relationship between doctor and patient?

[taherehbakhshi]

By using this term, it seems that the family doctor is closer to any family than other doctors, and using it means knowing more about a family, and in some cases, even more intimacy can be pointed out, and because this term is the first I heard it many times and it was interesting to me.

[Stoppelmann]

Given the promising nature of these holistic approaches, I wonder what you think might be effective strategies to incorporate more of these principles into mainstream medical education and practice. Do you envision this as a practical step towards re-emphasizing the role of the generalist and addressing the limitations of our increasingly specialized healthcare systems? Would this also possibly address the disconnect between healthcare as a service for well-being and healthcare as a profit-oriented industry?

It would, but it won't, but this is because we are quite delusional in the conception of our societies, and power structures will only serve the 1% of the population that rewards them. Rather than developing a wider society in which a healthy and sustainable life is pursued for as many people as possible, we have an egocentric materialist perspective that suffers from an underlying moral deprivation, and all attempts to make a holistic approach towards the health of the population is marginalised.

We see that physicians are under pressure to see more patients in less time, how their financial burden makes the survival of their practise questionable, and everything is geared towards profit. If a practise underperforms with regard to profit, its viability is questioned. It has nothing to do with effectiveness with regard to patients health, which isn't even measured. An Ayurveda doctor told me that his practise is financed according to the health of his patients, and if they are ill, they don't pay. This is of course a completely strange perspective for us, but I found it does pose the right questions. The same is with regard to foodstuffs, which should achieve a certain quality, and if they don't, they could be taxed.

It is all a question of perspective and whether those in power have the right perspective.

[Sushan]

By using this term, it seems that the family doctor is closer to any family than other doctors, and using it means knowing more about a family, and in some cases, even more intimacy can be pointed out, and because this term is the first I heard it many times and it was interesting to me.

Indeed, it's quite striking how a single term can encapsulate such a comprehensive and intimate understanding of a relationship. The term "Cradle to Grave Caregiver" does seem to suggest that a family physician might have a depth of knowledge and intimacy with a family that is unparalleled by other medical professionals. This knowledge is not just medical but also involves understanding the dynamics, habits, and even the emotional landscape of a family.

This deeper connection can undoubtedly offer advantages in terms of personalized care and better health outcomes. A family physician, having such a close relationship with the family, can provide advice that takes into account the unique dynamics and challenges of that particular family. Furthermore, there might be a heightened level of trust, enabling the patients to be more open about their health concerns and adhere more closely to medical advice.

However, it's also worth pondering upon the potential challenges this might pose. Could such a close relationship sometimes blur the professional boundaries? Might it be difficult for a physician to deliver bad news or make tough decisions when they are so closely intertwined with the family's life?

It's a delicate balance, and perhaps the key lies in maintaining that professional integrity while offering the warmth, understanding, and personalized care that this "cradle to grave" approach signifies. Would you think that such a balance is achievable, or could the closeness compromise the efficacy of medical care in some cases?