Is the Primary Care Doctor Obsolete?

During the Great Depression, we had a family doctor who was a general practitioner. He took care of adults, delivered babies, took care of them as well as their brothers and sisters, set bones, and did surgery. Today, family doctors are usually board-certified family or internal medicine specialists who do not deliver babies nor do surgery. They are regarded as “primary care doctors.”

Primary care doctors are the first ones the patient should consult regarding their medical concerns. That doctor is the first to assess their problems and manage their medical care.  For primary care doctors, the patient is at the center of care. This may seem obvious, but many doctors no longer do this. They focus on the disease and its treatment, often ignoring the personal needs of the patient.

Today, many regard medical care as the applied science of statistically derived, evidence-based medicine based upon practices shown to be effective for the majority of a group. They treat the individual as a statistical integer in a group or herd, and not as a person.

Medical care should be more than individual care. It should be personal care. Individual care defines a person in terms of measureable characteristics such as age, weight, height, blood pressure, blood tests for sugar, cholesterol, hemoglobin and many others tests such as genetic makeup, to name a few.

Personal care, on the other hand, includes not only measureable characteristics, but other factors that lend themselves less readily to measurement, such as cultural background, education, training, likes, dislikes, view of health and disease, and other biases. These factors have been proven to have a significant impact upon the effectiveness of disease management. They’re mostly ignored in herd care.

I want to emphasize that personal medical care should not be confused with personal-ized medical care, a term hijacked by geneticists and deceptively used starting 10 years ago. This genome-based care focuses on genetic markers to target diseases and care methods, such as susceptibility to certain drug treatments. This alone may help provide more precise individual care, but it is no more personal than a fingerprint.

Primary care physicians are the ones who traditionally focus on personal care.   Health systems that incorporate the primary care physician as a central part of treatment have better outcomes at lower cost than those systems without them.  

Despite the obvious advantages of using primary care doctors, they are in danger of becoming obsolete. They are the victims of a medical system that now largely focuses on costly technology in the treatment of disease.

The challenge today is to return the primary care doctor to the center of patient care.

Norman Makous, M.D.

[ Excerpted from the article, “Is the Primary Care Doctor Obsolete?” by Norman Makous, M.D. Follow this link to view the complete article. ]

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