HEALTH A FAMILY AFFAIR:FAMILY MEDICINE SPECIALISTS TAKE CARE OF WHOLE PATIENT, AND MULTIPLE GENERATIONS

Remember Marcus Welby? He was the compassionate TV doctor of our dreams, who always had his patients' backs. No matter what their ailment, he was on top of the case.

At a time when the U.S. health care system is seen as increasingly impersonal, the image of the kindly family doc stands out like a nostalgic memory. And yet, there still are physicians who, despite tough market forces, take pride in practicing a Dr. Welby style of medicine.

They're family medicine physicians, the contemporary heirs to the old general practitioner, but with far more training. They will treat your sore throat, set a broken bone, deliver babies, listen to your problems and prescribe medications. They treat people from birth to death and an alphabet of ailments from arthritis to yeast infections.

While family physicians appear to be generalists, family practice medicine itself is a recognized specialty, requiring three years of residency training that touches on the whole body. They even do minor surgical procedures in the office and assist in hospital surgeries if a patient wishes.

Dr. Richard Powers, who has been practicing family medicine in Sebastopol for 35 years, said he has treated five generations in a single family.

"I've taken care of parents and their children and their children's children and their children's children's children," said Powers, 65, who was named Family Physician of the Year by the Sonoma County Academy of Family Practice and was a finalist for the same title from the state Family Practice Association.

A college English major, he said he was driven by a desire to help people and was torn between teaching and medicine. Ultimately, he decided he could be of greater service in medicine. He has one of the few remaining small, independent practices with his associate of 30 years, Dr. Nancy Davidson.

He still makes the occasional house call to a shut-in, toting an old-fashioned doctor's kit, although his leather bag has been replaced by a metal toolbox big enough for all the new gear a modern doc needs.

"The mantra of family medicine is that we look at the whole family," he said. "We know when an illness is wearing out a caregiver, or when an illness is making someone else in the family sick because either it's contagious or making another person work harder."

Family dynamics can create stress-related illnesses or symptoms from anxiety to insomnia. Knowing the whole family can help Powers get to the root of a problem faster. His policy is to spend a minimum of 20 minutes with each patient to deal with their multiple health issues.

And because they deal with the whole body rather than just one part, Powers said, a family-medicine doctor will have "the whole picture" of a patient.

"Many times," he stressed, "the treatment for one disease can harm another disease."

The field of family medicine was formally recognized in 1969 in response to the boom in specialized medicine in the 1960s.

"The American Medical Association recognized that people were getting lost because they didn't have a physician who would relate to them over time as a whole person," said Dr. Bo Greaves, a former president of the California Academy of Family Physicians and one of 12 doctors in a Santa Rosa family practice that is part of the Sutter Medical Group of the Redwoods.

Like many local colleagues, he went through the Santa Rosa Family Medicine Residency Program and has served on its faculty. Affiliated with the University of California, San Francisco, it is one of 38 such programs in the state, covering everything from preventative care to managing chronic illnesses such as asthma. The program, he said, guides new doctors to understand a patient's relationship among "mind, spirit and body," as well as a patient's place within their whole social setting.

"There's a lot of emphasis on the psycho-social aspects of health, as well as hands-on learning," he said.

Sonoma County Public Health Officer Dr. Mary Maddux-Gonzales said family medicine is the cornerstone of primary care, "and primary care is absolutely the key to having an effective health care delivery system."

"Multiple studies have shown that with access to primary care, the quality of medical care improves significantly, while costs actually decrease," she said.

Dr. Cynthia Morris, who shares a small Santa Rosa practice with one partner, believes an important part of working with patients is coaxing them to talk about their feelings, since sometimes symptoms can be traced not to disease, but lifestyle and stress.

"I'm good at thinking to say to people, 'How are you feeling about that?' Then they cry," Morris said. "I make my patients cry all the time, and then we deal with whatever that brings up."

Yvonne Lancina has been seeing Morris for years, ever since her 80-year-old mother referred her. Since then her husband, her 11-year-old son and an adult daughter also joined.

"I had a death in my family and Dr. Morris knew the whole history," Lancina said. "She knew how to treat every member of my family. She knows the whole background, so you don't have to tell the story over and over."

Greaves said he finds the old-school personal care of of family practice rewarding.

"I love being part of the important transitions of a patient's life, whether it is delivering babies or helping people approach the end of life. Whether it's helping a patient with a teenager who is driving them crazy or helping direct them through the stresses of living up to the expectations of everyone in their lives. It's interesting every day. And all of that is exhilarating."

You can reach Staff Writer Meg McConahey at 521-5204 or meg.mcconahey@pressdemocrat.com.