CURRENT BOOKS: The Heart and Soul of Family Medicine

Lori Selleck, MD

The Santa Rosa Reader: A Personal Anthology from the Family Medicine Residency, by Rick Flinders, MD, 95 pages, Sonoma County Medical Association, $9.95.

When asked to read and review The Santa Rosa Reader, I agreed, happy to see that at only 95 pages it would be an “easy read.” I was not expecting to enjoy it as much as I did. The book presents selections from the writings of family physician Dr. Rick Flinders over the past four decades, generally tracing his experience as faculty at the Santa Rosa Family Medicine Residency Program.

While training as an internist, I never really understood family physicians. I was amazed at the breadth of their knowledge, as they cared for patients essentially from cradle to grave. Family medicine made some sense to me during the days when we also worked in the hospital dealing with critically ill patients; but now that adult medicine has, for the most part, been divided into outpatient and inpatient specialties, I have been curious as to how our different training has prepared us for outpatient primary care medicine.

Family practice (now known as family medicine) became its own three-year specialty with board status in 1969. At that time Community Hospital, which had been a general practice residency located in the foothills above Santa Rosa, became one of the nation’s first family practice residencies. Flinders writes about this “Quiet Revolution,” attributing the birth of family practice to the ideals of the sixties:

"The generation of the sixties regarded the medical profession (indeed, most professions) with the same suspicion it projected onto the rest of the establishment. … At the same time, what better profession than medicine to fulfill the call to human service articulated by so many of the disenchanted? And what better specialty than family practice to bring to medicine a restoration of the values perceived missing from the profession? A personal physician, a caring physician, one who listens to you, who knows the rest of your family, who will “be there for you” when it counts and will take care of most of your problems without referring you off to some specialist? It was to become this kind of personal physician, who wouldn’t hide behind technical jargon or a white coat, that many who had dropped out of school in the sixties found themselves re-enrolling in the seventies.”

One of the most touching chapters in the book is “Chimes of Freedom,” a transcript of Flinders’ commencement speech to the 1999 Santa Rosa residency graduates. His speech is patterned after the lyrics of the Bob Dylan song of the same name, which captured the cultural and socioeconomic struggles of the sixties. In the same year Dylan wrote the song (1964), Congress passed legislation extending Social Security benefits for the elderly (Medicare), passed civil rights legislation and declared a national War on Poverty. “These were times when government was still trusted,” writes Flinders, “when medicine was still personal … it was a time of social conscience.”

By 1999, however, times had changed. During the 1990s, HMOs “became the most visible symbol of the for-profit corporate tidal wave that has swept up over American medicine,” observes Flinders, adding that “we can do better” and concluding with these stirring words:

"Because where there is care there is light. And the light at the end of the tunnel is you. You’re our best hope, because you came to medical school at a time when a chorus of lesser voices told you not to do it. You were told you would go into debt, struggle with red tape, hold lower status and less autonomy. But you rose to the challenge and kept your promise, and you have already inspired us all. … I want you to remember the person you were when you first chose to become physicians, because the voice of that person is worth listening to for the rest of your careers. In that person’s choice was something more enduring than naive impressionability or youthful idealism. I believe it’s at the core of what makes you doctors: It is that you care."

In “Residency at the Crossroads” (2006), Flinders describes the residency’s effect on the healthcare economics of Sonoma County. Of the 264 graduates of the program over the previous 25 years, 147 were still practicing in the county, including 82 in private practice, 29 at local community clinics and Public Health, 25 at Kaiser facilities, and 11 at Sutter. Many more practiced in neighboring counties. This “river of residents” has been and continues to be an important producer of family physicians in the North Bay region.

We now find ourselves on the cusp of meaningful healthcare reform, with an increasing number of people being able to get health insurance, and with more focus on wellness and prevention. A cornerstone of this process will be to have an adequate supply of primary care doctors, which at this point we do not have. With fewer general internists going into primary care for adults, the role of the family physician will be of paramount importance. As Flinders states in “Family Medicine as Counter-Culture”: “If you look at the salaries of other specialties, the choice to enter family medicine today is essentially one of social conscience, and in these times an act of political courage. … If revolution in healthcare is what is needed to change medicine for the better, then let it begin here, in family medicine.”

The Santa Rosa Reader paints a wonderful picture of the heart and soul of family medicine, giving insight into what it means to practice as a family physician. If we are smart, our country will do what it takes to encourage other motivated, smart people to go into this field, to help move us in the right direction toward good health for all.

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Dr. Selleck, an internist at Kaiser Novato, serves on the MMS board of directors.

Email: lori.selleck@kp.org

Note: All proceeds from sales of The Santa Rosa Reader benefit the Santa Rosa Family Medicine Residency Program. To order by phone with a credit card, call the Sonoma County Medical Association at 707-525-4375. To order online, visit www.scma.org. An eBook edition is available at Amazon and other online retailers.