Too little training in acute care

I read Dr. Hickner’s editorial, “Have family physicians abandoned acute care?” (J Fam Pract. 62;7:333) shortly after graduating from residency and starting my job as a full-spectrum family physician at a federally qualified health center, and it really resonated with me.

In the residency program, we managed many patients with chronic conditions. But they tended to use the emergency department or urgent care for acute conditions, at least in part because we could never figure out a way to offer extended hours.

Now I see many acute care patients, especially among the uninsured.  I’ve come to see that my residency training was a bit weak in this area, but I’m learning on the job. I’ve discovered that chronic conditions tend not to improve without first addressing the things the patient acutely cares about.

Dan Krebs, MD
Tacoma, Wash