New industry and technology that brought advances in communication, transportation mechanized agriculture and manufacturing
heralded the late 19th and early 20th centuries. A result of these rapid changes was the perception that human capacity to
master the forces of nature to create expanding wealth and comfort was boundless. At the same time, the science of medicine
identified bacteria and viruses as the cause of many diseases, thereby, replacing the attribution models of "miasmas" and
supernatural forces held by prior generations. The promise of science and technology to delay death and cure disease now
seemed achievable. The picture of the general practitioner compassionately holding the patient's hand at bedside was altered
by a post WWII scientific and technological explosion, and replaced with specialists cloaked in white coats in sterile
environments. An era marked by extraordinary medical advances through scientific reductionism had begun at the expense
of fragmenting and depersonalizing patient care. Physicians in-training were not content to remain generalists, and were
drawn to the glamour and higher salaries of the multiple, new specialties. They became adept in narrower areas that they
studied in depth; fewer generalists existed to provide necessary care in breadth. It was disease that medicine, in this
post-war society, attacked as the enemy, and the stance was taken that physicians must intervene. Little thought was given
to prevention, and no thought at all to enhancing the body's own mechanisms of healing. This was an era of the mechanistic,
warrior approach of biomedicine in which the body was viewed little more than a machine, disease as the breakdown of the
machine, and the physician's sole job being to fix the machine once broken. Psychosocial variables and their effects on
health; the importance of looking at an illness within the context of the person and their life stresses and habits were
considered outside the domain of medicine. These, as variables, did not lend themselves easily to study and testing through
scientific reductionism. Within the medical community, it became apparent to some, that this lack of appreciation for the
context of the illness, the medicalization of life problems without addressing the patient's life and the fragmentation of
medical care did not meet patients' needs.
Public dissatisfaction with fragmentation of their health care in the decade of the sixties led to the establishment
of the Citizens Commission on Graduate Medical Education. Their report was largely responsible for the birth of a new specialty,
Family Medicine, based on an older more contextual paradigm, yet one versed and comfortable with the newer technology and
information. It was a specialty of breadth and not depth, quite difficult for mainstream medicine to accept because it crossed
the artificial boundaries set by the reductionistic model.
Our Department of Family Medicine was established a quarter of a century ago simultaneously with the Stony Brook University
Medical Center. It was among the first in the country to have a mandatory 3rd year clerkship and has earned a reputation for having
an innovative & highly competitive residency training program We hold the following values of the department as highest priority:
Values:
The Department will be in an academic & clinical setting in which primary care family physicians have time and resources to
engage in practice that facilitates and empowers patients to take responsibility for their health. This is a setting in which
physicians respect the importance of technology and specialization (knowing enough biomedicine to utilize them with wisdom); yet
give credence to the importance of psychosocial issues in the etiology and management of illness. Paralleling this is a belief in
context, i.e. disease does not exist by itself. This implies an understanding espousing that what happens in one part of the
system affects the whole, and that there exists a balance between the biological, emotional and spiritual aspects of people
that is recursive. Intrinsic to this endeavor is the belief in the body’s inherent potential to heal; that symptoms are not
just to be eliminated, but to be listened to as wake-up calls and utilized to guide physician and patient direction. Finally,
this is a Department of Family Medicine that believes time spent with the patient uncovering their “story” is paramount, for
it is the story that gives meaning and context to illness.
Vision:
My goal is for the Department of Family Medicine at SUNY @ Stony Brook to be a model for the delivery and teaching of community
oriented primary care. The objectives to meet this goal are to:
- Demonstrate that a model that respects the body's inherent ability to heal and views disease as an indication of
dysfunction in a connected, self-regulating, homeostatic, self-healing life system can be successful where a more
mechanistic approach may fail,
- Demonstrate better outcome in terms of cost and quality of care when family physicians are utilized appropriately
for their knowledge and skills as opposed to being gatekeepers of medical care,
- Demonstrate that it can be feasible to decrease clinician/academician perceptions of feeling overloaded, as well
as free creativity, and improve performance clinically, academically, and economically,
- Demonstrate the ability for a program founded on these goals to be economically self-sufficient.
Respectfully Submitted,
Jeffrey S Trilling, MD
Chair
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