The New York Academy of Medicine Department of Historical Collections announces the first in a series of book talks in the history of medicine:

"Big Doctoring in America: Primary Care -- The Way of the Future or an Endangered Species?"
Fitzhugh Mullan, M.D.
Tuesday, January 21, 2003, 6:00PM
Reception and book signing following lecture

Dr. Mullan, Clinical Professor of Pediatrics and Public Health at the George Washington University, is the author of Big Doctoring in America: Profiles in Primary Care, published in 2002 by the University of California Press. For more about this book, see http://www.ucpress.edu/books/pages/9081.html.

Abstract:
Once upon a time, the general practitioner was America's doctor. The GP delivered babies, treated colic, extracted gall bladders, and sat by the bedside of the sick elderly. As the 20th century progressed, though, and as scientific medicine advanced and differentiated, specialty medicine was born and the pattern of medical care in the United States changed dramatically. By 1960, the GP was almost extinct.

The last 40 years, however, have seen the concept of general practice rebound with a new name—“primary care”—and with new practitioners. The general practitioner has been reborn as the family physician and joined by the general internist, and the general pediatrician in providing big doctoring—comprehensive care over time. Additionally, new clinicians — nurse practitioners and physician assistants—play important roles in the "general practice" of the 21st century.

Primary care has rebounded because it is both humanistic (ensuring continuity and personal care) and efficient (minimizing unnecessary referrals and interventions). Yet its role at the center of health care delivery is uncertain. Generalist practitioners are paid less than specialists. Medical students are told they are “too smart” to go into primary care. Managed care has made the gatekeeper role of primary care controversial.

What is the future of primary care in America? To answer that question, Fitzhugh Mullan, a pediatrician, writer, and historian went to the source. He traveled the United States interviewing dozens of practitioners of primary care, querying them about their lives and their work. A book entitled Big Doctoring in America: Profiles in Primary Care (University Of Californian Press, August, 2002) is the product of that research. It is composed of fifteen oral histories of clinicians he visited as well as his own provocative essays about the past and future of generalism in health care.

John Moses, an academic pediatrician and a documentary photographer, paid visits to the fifteen practitioners profiled in Big Doctoring and photographed each of them extensively. Fifteen of those photographs—one for each practitioner— accompany the text in the book.

Big Doctoring makes the case that primary care is a fascinating, important, and endangered calling.

This event is free and open to the public. For more information about NYAM programs in the history of medicine, write history@nyam.org or call Christian Warren.

The New York Academy of Medicine - Historical Collections Department Founded in 1847, the New York Academy of Medicine is a non-profit organization dedicated to enhancing the health of the public through research, education and advocacy, with a particular focus on disadvantaged urban populations. Please visit our website.