Optimism: A Good Theme for Family Medicine

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“What seems to us as bitter trials are often blessings in disguise.”—Oscar Wilde (Irish poet, novelist, dramatist, and critic, 1854–1900)

Dr. Pugno's commentary1 provides a good case for continuing to believe in the specialty of family medicine—optimism can spread optimism. Katerndahl et al's2 article about perceived complexity of care, autonomy, and career satisfaction is consistent with Dr. Pugno's thesis. First, most primary care physicians in the study were satisfied with their primary care careers. Most felt they could make autonomous medical decisions, and this was important to their satisfaction. However, the practice environment was more important than physician perception of complexity or autonomy. The availability of health care support services such as physical therapy, home health, and mental health services were associated with higher satisfaction, probably because being able to get patients the care they need makes physicians feel better, too. Group practice physicians were more satisfied than solo physicians. Physicians who felt the complexity was higher than desirable were less satisfied across the 3 specialties of family medicine, internal medicine, and pediatrics. Note that this was a perception of complexity, not measured complexity. We know that physicians can be trained to deal with multiple concurrent problems, thereby potentially enhancing their ability to deal with complexity and the sense of whether or not it felt like “too much.” Still, only approximately 12% of the variance in satisfaction was explained through all the variables. Perhaps thinking more positively could help the 20% of physicians who were dissatisfied.