Friday, May 22, 2009

The Demise of Primary Care


Sounds like a depressing title, doesn't it? That was the title of a recent article in the Annals of Internal Medicine.

"The demise of primary care: a diatribe from the trenches."

The trenches? Is it really that bad? Most medical students are not inclined to pursue a career in primary care, and now this comes out to encourage them even more? Something doesn't make sense here.

Here's a segment from the abstract: "Individualized clinical judgment has been devalued; thinking has been replaced by algorithms. Practice guidelines have been usurped by pay-for-performance police, on patrol for deviations--not understanding that knowing and allowing for exceptions is the heart and soul of primary care. The coercive surveillance of "Quality Improvement" has become oppressive, making single organ-system specialties increasingly attractive (or at least more tolerable). Generalists are spending so much time proving they are good doctors, they don't have time to be good doctors."

Then, the author (David D. Norenberg, MD) proposes a very interesting idea: a pilot project of volunteer salaried internists (more trusted, less audited) commissioned to our expandable national health care program, Medicare.

So, what do you think? Is primary care dying? Dead? Does it have a chance of getting revived? Will Obama create new policies that will bring new life to the world of primary care? Or, will primary care physicians slowly get replaced by non-physician healthcare providers like nurse practitioners, physician assistants, and others?

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