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An Ode to the Primary Care Physician

A recent editorial in The Journal of Graduate Medical Education reminded me of a classic Mark Twain quote. When confronted by reporters about rumors of his untimely demise, Twain, both irritated and amused, famously remarked, “The report of my death has been greatly exaggerated.” In “A Eulogy for the Primary Care Physician,” Forrest Bohler and David Blumenthal offer a tongue-in-cheek requiem for primary care medicine. In this satirical piece, the authors enumerate the systemic forces that have led to our specialty’s purported demise. While their “eulogy” contains elements of truth, it is greatly exaggerated, and more importantly, we’re not dead yet! Bohler and Blumenthal begin by lauding the noble idea that everyone deserves a trusted primary care physician to navigate the complexities of our healthcare system. They then explain the various threats to primary care, including physician shortages in rural and underserved areas, as well as the fee-for-service system's preference fo...
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Move Fast and Break Things

My father was a brickmason. As a teenager, I spent many summer days working as his assistant. I despised almost every moment—the heat, the drudgery, and my father’s company. My attitude was much like Mark Twain's, who wrote, “When I was a boy of fourteen, my father was so ignorant I could hardly stand to have the old man around. But when I got to be twenty-one, I was astonished at how much he had learned in seven years.” Looking back, I am ashamed of my adolescent disrespect for his hard work, skill, and meticulous attention to detail. One incident stands out vividly. He and his crew had just completed the hearth and chimney for an imposing multi-story home. A critical error in the blueprints caused the hearth to be misaligned by several inches, a minor flaw that compromised the living room’s aesthetic balance. The homeowners were adamant that this mistake be corrected. Unfortunately, moving the entire house would have been far easier than relocating the chimney. The only solutio...

A Candle in the Dark

The struggle between reason and superstition has raged for centuries. Since the Age of Enlightenment, the proponents of science have mainly carried the day. The byproduct of these victories is a world replete with material abundance, technological wonders, and healthy children. Unfortunately, the rise of political regimes promoting misinformation and quackery presents a unique threat to the public good. As experts in healthcare and guardians of patient well-being, physicians have a crucial role in combating this dangerous trend. Nearly three decades ago, astronomer Carl Sagan published The Demon-Haunted World , a book dedicated to educating the public about the scientific method and the importance of critical thinking. In general, Sagan was hopeful that science would prevail by serving as a “candle in the dark.” Despite his optimism, a sense of dread permeated his writing. He took note of the explosive growth of the Internet in the 1990s and observed that pre-millennial America was rip...

Backstage People

Remarks on being named South Carolina Family Physician of the Year. I am humbled and incredibly grateful for this honor. Let me start by thanking the Board of Directors of the South Carolina Academy of Family Physicians and our Executive Vice President, Paquita Turner, for allowing me to serve in this organization for the past three decades. I also want to recognize my wife, Betty, for her support, encouragement, and patience for nearly 42 years. This honor means the world to me — but, honestly, I can’t get over a nagging feeling. If you have impostor syndrome, you know what I’m talking about. It’s the feeling that maybe you don’t deserve it. Imposter syndrome is very common in our profession. A recent study said forty percent of physicians have this affliction. Betty, however, has a different name for this phenomenon. She calls us Backstage People. For many years, Betty and I volunteered with our local professional ballet company (no, we didn’t dance!). For a while, she was president...