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On Being a Doctor |

Of Leaves, Trees, Forests, and Primary CareOf Leaves, Trees, Forests, and Primary Care

Adam Seth Cifu, MD
[+] Article and Author Information

From University of Chicago, Chicago, Illinois.

Requests for Single Reprints: Adam Seth Cifu, MD, Professor of Medicine, University of Chicago, 5841 South Maryland Avenue, MC3051, Chicago, IL 60637; e-mail, adamcifu@uchicago.edu.


Ann Intern Med. 2014;160(11):806. doi:10.7326/M13-2984
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We all recognize that we are not the same doctor from day to day. Although we like to think that the quality of care we deliver stays constant, the focus with which I attend to my patients varies enormously.

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Geriatrics: Focus on the Forest
Posted on June 20, 2014
Katherine Thompson, MD
University of Chicago
Conflict of Interest: None Declared
Cifu’s thoughtful reflection (1) on primary care resonated with me as a geriatrician practicing primarily in the outpatient setting. In general, geriatricians tend to have higher job satisfaction than physicians in other specialties (2). While we all have good and bad days, I find that my good days in patient care far outnumber my bad, and Cifu’s article helped to articulate why. As a geriatrician, I manage patients with complex medical issues every day, but my primary focus remains on outcomes important to patients. Helping patients achieve their goals—such as maintaining physical functioning and independence, freedom from pain, and relief of caregiver burden--is rewarding because of the focus on the “forest”. As Cifu rightly notes, this requires sufficient time. Developing better tools to help providers communicate with patients about their goals and preferences would also enable us all to focus less on the leaves and more on the forest, thus engendering improved satisfaction for both patients and providers and leading to improvement in the outcomes that matter most, those that are important to patients.

1. Cifu AS. Of Leaves, Trees, Forests, and Primary Care. Ann Intern Med. 2014;160:806.
2. Leigh JP, Kravitz RL, Schembri M, Samuels SJ, Mobley S. Physician Career Satisfaction Across Specialties. Arch Intern Med. 2002;162: 1577-84.
Aging Differently - environment, not genes.
Posted on July 14, 2014
Bert M. Bieler, MD
Cooper University Hospital
Conflict of Interest: None Declared











































A very insightful piece but I do take issue with one statement - "We should never forget that, for reasons mostly out of our control, we all age very differently." Perhaps in the sense that our modern society can make it difficult for people to make healthy food choices and exercise daily, yes, but in reality, this is not the case. The majority of older people who are ill need not look to the stars for the cause but rather to themselves. It is hard to reverse a lifetime of smoking, drinking, overeating and a lack of daily exercise, which all lead to a host of health problems. I certainly agree that we should never lose our empathy, but to blame it on the genes and not look to environment and bad habits is disingenuous and may lead to a lack of effort on the part of physicians in trying to promote changes in lifestyle, something I have seen many times when shadowing other physicians.



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