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OUT OF PRACTICE:

Fighting For Primary Care Medicine In America


What became of the Physician-Patient Relationship, that special bond that is the heart of good primary care medicine and the core of US health care?  Patients,  as well as their doctors, all would like to know.  The Patient Protection and Affordable Care Act of 2010, “Obamacare,” legislates health insurance, but fails to tackle an insidious health care crisis: the steady erosion of high-quality, relational primary care delivered by physicians who derive great personal and professional satisfaction from the bonds they form with their patients over many years.

Medical care today is commoditized care, transactional rather than relational, and it satisfies neither patient nor doctor.    The elements of efficient modern business—high volume, ultra-thin margins, and rapid routinized protocols— have transformed a visit with your personal physician into a Walmart-style commercial transaction, an experience akin to a hurried fast-food meal.  “Big-Box” uniformity of care—“one size fits all”—while measurable, reimbursable, and defensible in court, has a serious side effect: it de-professionalizes the primary care provider and it breaks the bond between physician and patient that is unique to primary care medicine.  Stripped of the professional pride and personal commitment derived from the practice of medicine, primary care becomes not a calling, but a job, and a government job at that.

The new primary care—less art, more math—may be good enough for government work, but it falls flat at delivering compassionate, personalized, principal care for our nation, precisely as 78-million soon-to-be-senescent Baby Boomers are searching the Yellow Pages, each looking for a primary care physician for the Golden Years.  Yet, physicians’ feelings of alienation, suppressed anger, and de-professionalization are poisoning our supply of good primary care practitioners, as market-style medicine supplants the once socially-rich environment of the doctor’s office.  Young doctors still in their residency training programs, the hatcheries of tomorrow’s health care, are avoiding primary care like the plague, opting for more lucrative, better respected, and more hassle-free specialty care.  This bodes badly for our nation’s health.  Primary care is, by nature, and if done properly, an inefficient product.  Nevertheless, in sickness and in health, the relationship between doctor and patient must endure.  Every American deserves access to a sustained relationship with a physician who offers comprehensive, competent, and compassionate primary care.  Preserving that relationship is a healthy choice, a national imperative, and the right thing to do.

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