03/07/17  Portland, Ore.

By Jennifer DeVoe, M.D., D.Phil., OHSU Family Medicine Chair

In 1979, just eight years after our department was founded, Dr. Gayle Stephens published his famous article describing family medicine as counterculture.(1) Dr. Stephens asserted that family medicine successfully harnessed the social movements of the 1960s to affirm the need for a personal doctor grounded in strong relationships with patients, families, and communities. He argued that family medicine aligned with reforms that defined the counterculture of the day: ". . . agrarianism, utopianism, humanism, consumerism, and feminism. These are all themes of reform that can be traced in American history, and their emergence in the 1960s and 1970s created the climate of public opinion that made it possible for family practice to succeed in such an unprecedented way. We benefited from them even though we may not have been conscious that we were drawing on their strength" (p. 104;1).

Fast forward nearly 40 years from Dr. Stephen's article, and we find ourselves with a dominant healthcare paradigm of specialization and fragmentation that is bankrupting our nation and ineffective at achieving its ultimate goal of improving health. Despite the trillions of dollars spent on healthcare in this country each year, our population is leading shorter lives, in poorer health.(2) Practicing medicine in the current healthcare system that is fraught with inefficiencies, inequities, impersonal interactions, and unfulfilled promises is challenging and sometimes paralyzing. Yet, it is amidst this prevailing paradigm that family medicine's counterculture spirit, our healing touch, our commitment to relationships, and our unique connection to humanity is needed more than ever.

After the recent G. Gayle Stephens Keystone IV conference, I was energized to renew my commitment to establishing longitudinal, meaningful, personal relationships with patients and families. I was reminded of the need to leverage our research expertise to identify when relationships matter most in healthcare and to understand how we can better harness paradigm shifts in information technology, team-based care, and population health to strengthen rather than undermine personal doctoring.(3) I was also reminded of how family medicine's core value of personal relationships remains very much counterculture to the more dominant paradigm of today, much like Dr. Stephens observed decades ago.

Working alongside all of you in this amazing department is a powerful motivation to keep our counterculture flame burning brightly in today's tumultuous healthcare environment. Your compassion and dedication to our mission and values is an inspiration to me each and every day. I am proud to play a small part in our counterculture movement and remain committed to ensuring that family medicine thrives at OHSU and that our light shines brightly in the healthcare system.

Note: There was an entire supplement of the Journal of the American Board of Family Medicine, July-August 2016 dedicated to reflections from the G. Gayle Stephens Keystone IV conference. Several short videos were also created using content from the conference. These articles and videos can be used to facilitate conversations regarding some of the important core values of family medicine. The short videos and other materials from this conference series can be found on the Gayle Stephens website.

Thanks to the American Board of Family Medicine foundation for supporting this conference series!