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This compelling plea for primary care medicine reveals a disturbing situation:

“Primary care medicine is collapsing, a victim of economists’ tenets of maximized efficiency, profit, and productivity.” The system will be further strained by the large numbers of aging baby boomers. Barken uses his own experience as a physician who retired early at age 51 due to dissatisfaction with the current situation to illustrate the state of his profession. He finds it overwhelmed, underfinanced, and ill-equipped to deal with older patients suffering from complex medical issues. Barken warns that doctors, patients, and politicians will have to accept that the primary physician’s role must change, that a bigger health care industry isn’t necessarily a better one, that malpractice liability, along with its high costs and demoralization of doctors, must be reined in. Primary-care doctors must resist the pressure to prescribe too many drugs and must manage a plethora of specialists who want to administer overly aggressive treatments that have little impact in prolonging life or making patients more comfortable. Physicians treating aging patients must also see them not as solitary units but as part of a well-prepared, involved family. In the end, he says, American health will be saved by its most important virtue: a strong physician-patient relationship.

Publisher’s Weekly

“Primary care physicians should be at the center of our medical care system, but they are fast disappearing. Dr. Barken’s engrossing account of his former professional life as a primary care doctor in upstate New York tells us why. This is the best description of general medical practice by a physician that I have ever read.”

– Arnold S. Relman, M.D.

Professor Emeritus of Medicine and of Social Medicine, Harvard Medical School
Former Editor-in-Chief, New England Journal of Medicine

“It was a great pleasure to read Out of Practice. It is brilliantly written: lucid, vivid, even picturesque. It ought to be the first required reading for entering medical students and for new faculty as well.”

– Dr. Barbara Starfield,

Johns Hopkins Bloomberg School of Public Health, author of Primary Care

“This book comes during a critical time of health reform when over 30 million newly insured persons will have greater access to care, but may be unable to find a primary care provider. Dr. Frederick M. Barken’s narrative critically illustrates the importance of provider-patient relationships in primary care and sets forth the challenges we will all face if we fail to consider this part of the therapeutic milieu in new and emerging models of care and payment. To continue to lose primary care providers such as Barken, multiplied, will be our loss and will be bad for our health.”

Julie Fairman, University of Pennsylvania School of Nursing

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