The general practitioner was once America's doctor. The GP delivered babies, removed gallbladders, and sat by the bedsides of the dying. But as the twentieth century progressed, the pattern of medical care in the United States changed dramatically. By the 1960s, the GP was almost extinct. The later part of the twentieth century, however, saw a rebirth of the idea of the GP in the form of primary care practitioners. In this engrossing collection of oral histories and provocative essays about the past and future of generalism in health care, Fitzhugh Mullan—a pediatrician, writer, and historian—argues that primary care is a fascinating, important, and still endangered calling. In conveying the personal voices of primary care practitioners, Mullan sheds light on the political and economic contradictions that confront American medicine.
Mullan interviewed dozens of primary care practitioners—family physicians, internists, pediatricians, nurse practitioners, and physician assistants—asking them about their lives and their work. He explains how, during the last forty years, the primary care movement has emerged built on the principles of "big doctoring"--coordinated, comprehensive care over time. This book is essential reading for understanding core issues of the current health care dilemma. As our country struggles with managed care, market reforms, and cost containment strategies in medicine, Big Doctoring in America provides an engrossing and illuminating look at those in the trenches of the profession.
Fitzhugh Mullan, M.D. is Professor of Pediatrics and Public Health at George Washington University and a contributing editor of the journal Health Affairs. He is the author of Plagues and Politics: The Story of the United States Public Health Service (1989), Vital Signs: A Young Physician's Struggle with Cancer (1983), and White Coat, Clenched Fist: The Political Education of an American Physician (1976).
"Mullan gets it right! His 'big doctors' are the unsung heroes of American medicine. Their stories —and they are great stories—tell us where we have to go to build a medical system that will work for everybody. And I mean everybody - the CEO, the family on welfare, you, and me."—Studs Terkel, author of Working, The Good War, and Coming of Age
"Big Doctoring is a unique undertaking. We hear people in the frontlines of medicine tell us their story, and tell it in their own voices. In these pages, which are a joy to read, we find proof that medicine is, and always will be, both art and science."—Abraham Verghese, M.D., author of The Tennis Partner
"Big Doctoring is an extraordinarily compelling effort by a dedicated and idealistic physician -- who offers us, through the voices of his informants, a clearly written narrative that tells of a profession's contemporary challenges and difficulties. Here is documentary work of the most instructive and telling kind -- a nation's healers become witnesses and teachers for us readers."—Robert Coles, M.D.
"At a time when both doctors and patients in record numbers abhor the shadowy mass of gloomy economics and gruesome bureaucracy that has overtaken American medicine, Mullan shows us a path out of the darkness. And his is a desperately needed map, as physicins and nurses are now quitting in droves, tens of millions of Americans are losing their health insurance, and millions more, though insured, are forbidden treatments and primary care that could save their lives. Bravo!"—Laurie Garrett, author of The Coming Plague and Betrayal of Trust
275 pp.6 x 9Illus: 15 b/w photographs
9780520243316$31.95|£27.00Paper
Sep 2004