Family practice and the advancement of medical understanding. The first 50 years

In the last half of the twentieth century, family practice has emerged as a strong influence in both community practice and academic medical centers. Since the formation in 1947 of the American Academy of General Practice, family practice has changed from a group of physicians applying the knowledge of other disciplines into a recognized specialty with its own body of learning. Family medicine has advanced medical understanding in: (1) relationship-based health care as the foundation of a specialty; (2) the process of comprehensive clinical reasoning; (3) the recognition of problems of living as a health care concern; (4) the meanings of words such as pain, disease, and disability; (5) the systems approach to primary health care; and (6) the clinical encounter as the definable unit of family practice. These 6 concepts have helped expand the specialty's body of knowledge and clarify its values. They will also serve as a template for the future evolution of family practice as the specialty faces new challenges, including managed care, the aging population, the rapid growth of medical knowledge, and the increased use of computers and technology in health care.