Why (not) Family Medicine? – Patrick Courneya, MD

Why (not) Family Medicine? is a series of posts from health care thought leaders, both inside and outside of Family Medicine. These will be posted every Friday. The participants were asked to focus on whatever they wanted in response to this question. We are glad that so many of these impressive leaders were willing to participate, and we hope that you enjoy their responses!

The Future of Family Medicine

I practiced medicine as a family doctor for 25 years, in the same clinic, in the same suburb of St. Paul, Minnesota. I saw my last patient 4 years ago and by that time, I had been at it long enough to be delivering the babies of babies I delivered. I enjoyed that style of full spectrum family practice that put me in the maternity unit, the emergency room, the halls of the medical and surgical wards and in the familiar trio of exam rooms I used to sit with my patients and listen to them talk about their lives, their worries, their illnesses. I had been there for them when they truly needed my help.  I finished my clinical practice knowing that the style of primary care I had enjoyed was fading away.


During the course of those years, I also learned how to really understand quality, to face the truth that measurement and transparency showed me about how well I was doing, and I got better.  We got better.  My colleagues, the teams that supported us, and the systems, information, and tools we used all improved.  We saved limbs and kidneys and hearts and vision and birthdays, anniversaries, seasons, and moments that otherwise would have failed to happen. Without measurement and improvement we never would have known the additional good we could do.  And we learned as well, what we couldn’t do.  We learned, or came to accept, that so much of health and well-being was beyond our skills, in the hands of our patients, in the choices they made, in the families where they were raised, in the communities where they lived, in the classrooms where they learned, and in the societies that they built. We learned that so much of health is beyond the expensive, invasive, amazing innovations we have seen in these last few decades.  And we learned that for all the objective measurement we can do to judge our effectiveness, health finds its real meaning in the subjective. Joy, passion, love, connection, and purpose all are beyond the specificity, sensitivity, confidence intervals and double blind, placebo controlled certainty we value in medicine.


And that, I believe, is where the future of family medicine and of primary care in general sits.  We will, in fact we must, continue to improve in the hard, evidence-based, high reliability care that we know will give people longer, healthier, more active lives. Family medicine, in unique ways, gives us the chance to apply our skills, lead our teams, and execute on the kind of high quality, evidence-based care we know is our obligation, while being present in our patients’ lives sharing their joy, fear, triumph and passing. The future of family medicine rests on our ability to find joyful, satisfying and sustainable professional and personal lives while we practice our profession.


A little over two years ago, my wife and I pulled up stakes and moved to California. My job now, as a physician leader for quality at Kaiser Permanente, has taken me a long way from the exam room but I still feel connected to the lives our caregivers touch. I still find joy as a physician because of what I can do to assure improved health for our members, our patients, and the communities we serve.  Joy is the key to the future of family medicine.


Patrick Courneya, MD is the Executive Vice President and Chief Medical Officer with Kaiser Foundation Health Plan and Hospitals

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