Intended for healthcare professionals

Observations Letter from New England

No mission without the marginalized: the scope of family medicine

BMJ 2014; 348 doi: (Published 26 February 2014) Cite this as: BMJ 2014;348:g1707
  1. David Loxterkamp, medical director
  1. 1Seaport Community Health Center, Belfast, Maine 04915, USA
  1. david.loxterkamp{at}

Giving up on opioid users is not an option: the stakes are too high, as failure pulls down a circle of people

In the 44 years since it became the 19th American medical specialty, family medicine has never faced such challenges and uncertainty as it does today. The hours have lightened, our pay improved, and the future has never seemed brighter. But our sense of identity and purpose have splintered like light through a prism: who we are depends on where we stand.

Increasingly, family doctors stand outside the obstetrical wards, inpatient units, and emergency departments where we once belonged. We insist on seeing patients in our medical home but not in theirs—nor in nursing and boarding homes where the less fortunate are placed. We have pared our practice from the care of all patients to the care of adults, to insured adults, to insured adults without psychosis or chemical dependency. But is this what we trained for? Can this kind of work—so safe and controlled—really sustain us intellectually and morally? Should we not ask what our communities need of us and what of this work we are willing to …

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