As a primary care physician's career unfolds, he or she interprets and responds to the world in ways unique to his or her own character. An understanding of evolutionary dynamics provides a road map in determining and guiding educational objectives allowing for successful integration into the practicing environment. Stern and Papadakis
6 wrote:
Without well-defined expectations, students will not have a clear model to strive for. Educators must design clinical experiences that allow students to see how seasoned practitioners negotiate the dilemmas of medical practice.
Constant, uncontrollable outside forces substantially impact the development of a medical practice. Such forces include personal, business, governmental, and legal issues (eg, pressures from rising malpractice risks
7) along with consistent commercial and financial decisions. Internal forces facing the physician center on the successful integration and adaptation into multifaceted environments critical for a successful career. Certain regressive preoccupations may overcome the physician's urge to complete development as he or she struggles between progressive and regressive forces. An example of this struggle is the physician who, after 30 years of practice, tells his cigarette-smoking patients, “either stop smoking or find another physician.”
8,9
Noteworthy transitions from a physician's early professional life to retirement age might be characterized by adjusting preferred modes of dealing with internal and external demands. Although such reorganizations may sometimes be regressive in nature, most result in heightened rather than diminished adaptability.
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