Goroll_Primary Care Medicine, 8e

FOREWORD TO THE FIRST EDITION

P hysicians have traditionally provided direct, initial, comprehensive care for patients as well as continuity of care. In the past two decades, the growing proportion of specialist physicians has endangered this traditional role of the physician. The development of highly technologic, tertiary, inpatient medical care has preoccupied the attention of our teaching institutions. Coping with the increased armamentarium of diagnostic and therapeutic interventions has distracted some physicians from traditional roles in patient care. The primary care movement has been a national response to this situation aimed at providing more physicians skilled in dealing wisely and humanely with illness in their patients and providing the overall supervision and continuity of medical care that we expect of good generalists. It encourages these physicians to know their patients as human and social beings as well as bearers of organ pathology. Promotion of prevention as well as the practice of curing is an important part of primary care. The concerns that have led to renewed attention of the medical profession to primary care medicine have had a very salutary effect on our teaching institutions. There has been a resurgence of training in the ambulatory setting. Medical students and residents have learned that many illnesses formerly thought to require hospitalization can be effectively managed in the ambulatory setting. As usual, this is not an original discovery; rather, it is a return to the emphasis that was very much a part of training programs in the earlier decades of this century. Primary Care Medicine has grown out of the experiences of a group of young physicians who have pioneered in the rebirth of primary care medicine within the Harvard medical community. They have organized primary care practices that have served as training sites for other physicians and health workers. They have examined their own practices, as well as the published experience of others, in order to provide within this text a synthesis of the best available information for ambulatory manage ment of adult medical patients. Their discussions are brief and practical rather than exhaustive, but the interested reader is provided with a key annotated bibliography that directs him to further sources of information. This book is not meant to compete with the traditional exhaustive textbook of Medicine. Rather, its brief, clear discussions and analyses of current knowledge are prepared for the busy practitio ner who daily encounters many problems for which he needs to quickly know the best available answers. To whom is the book addressed? To the primary care physician, of course. It will be his bible—a valuable source of guidance and of solace in innumerable management situations. But it is becoming increasingly evident that the medical subspecialist devotes a considerable portion of his practice time to the provision of first contact and continuous care of the medical needs of his patients. This book will, therefore, find a welcome place on the desk of both the medical subspecialist and the medical generalist and is addressed to everyone engaged in the clinical practice of adult Medicine. Alexander Leaf, MD Jackson Professor of Medicine

Harvard Medical School Chief, Medical Services Massachusetts General Hospital Boston, Massachusetts April 1981

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