The problem with primary care

This morning has been spent poring over data for work – interview transcripts that talk, broadly, about the primary care system in the US. It’s understaffed, broken and full of tension. To me, a lot of the tension, at least from what I can tell in my brief time studying this, comes from juggling the priorities of meeting metrics and standards that fund the practice and actually wanting to help patients. Of course, there is substantial overlap between providing quality care in terms of following care guidelines and treating patients as individuals, but it seems as the former gains traction through the power of insurance companies and funding mechanisms, the latter suffers. We all know that doctor visits are painfully short  – just a few minutes of time is all we can get with our primary care/family doctor to get out all our questions and concerns, and hope to get at least a few answers back. And the answers the doctor’s give us are more likely going to be in the form of a prescription – because that’s something that can be accomplished in the little time allotted.

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While the subject matter may not be pretty, at least the view is. OHSU campus.

Where is the time to have a doctor and patient understand each other? To develop a relationship so that trust builds over time, so that when something big happens, a doctor is a comfortable person to turn to? It’s not available in our current healthcare system, thanks to fee-for-service models, which pay better when doctors see more patients, not spend quality time with fewer. And the time doctors do have with patients are often spent focusing on one or two billable things (though thanks to the new ICD-10 codes, the options are endless! Or read this for a more serious look into the importance of coding in financing primary care practices), not checking in to see if your dog is doing well, or if your child still loves playing the clarinet.

People are complicated. They aren’t machines where one part is broken and then easily fixed. They have lives and those lives impact their health, and one condition impacts another. Being overweight causes back or knee pain and heart problems. Having diabetes can impact one’s sexual health. Needing surgery can stir up anxiety. Then there are all the ways that medication side effects cause more health problems. And these are just the ways “one medical condition” impacts an individual; it says nothing about how family and friends also are affected.

I am fortunate enough to have read a series of interviews from a practice in a rural community in New England that’s trying very hard not to forget the patient. They set up programs for patients and work odd schedules all in the name of true patient care. Yet, because they are an officially-designated Federally Qualified Health Center, there is a lot of documentation and care protocol that follows. While the added financial security has its benefits, and allows the clinic to stay open while supporting a large portion of publicly-funded patients, one doctor admitted that this change in status “certainly changed the way we enjoy taking care of patients.” Enjoy. I wonder how many doctors can say that? And I wonder how much longer this one will.

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One thought on “The problem with primary care

  1. Pingback: The problem with primary care | oshriradhekrishnabole

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