Apologies for the irony of blogging about a two-year old journal article titled "MIssed and Delayed Diagnoses" but Paul Levy on his "Running a Hospital" blog recently brought it to our attention. The study adds to the mounting evidence that the way our $2 trillion system tilts toward highly paid specialists versus primary care doctors may be hazardous to our health.

Levy points out the 2006 Annals of Internal Medicine study ("Missed and Delayed Diagnoses in the Ambulatory Setting: A Study of Closed Malpractice Claims" by Dr. Tejal K. Gandhi, et al.) about diagnostic errors that harmed patients—or contributed to their deaths. Common errors included not ordering the right tests or not interpreting tests correctly, not providing follow-up, or not doing a thorough enough physical exam. Sounds shocking until you remember that primary care physicians have 20 minutes or so with a patient.

Levy writes, "The first line of defense in proper patient care is the primary care system, yet this portion of health care delivery is systematically undercompensated and undervalued in the medical payment spectrum. We have relegated primary care doctors to a triage function, requiring them to see a large number of patients in a short period of time. It should come as no surprise that the kinds of errors mentioned in this article happen when a PCP (primary care physician) is expected to spend about 20 minutes with each patient."

Politicians on both the left and right have begun to talk about changing the way we pay doctors. Let's hope whatever new system they come up with takes into account the essential role of PCPs—those people who in a simpler era of health care we simply called our "family doctor."