Primary Care

Dr. Benjamin Brewer, in his Wall Street Journal column (subscription, or read a summary in the Wall Street Journal health blog) wonders: who will take care of the 47 million uninsured in a system that already undervalues family medicine and primary care?

We would suggest that the uninsured are getting care – not enough care, too- late care, expensive emergency room care instead of more appropriate and cost-effective primary care. But Dr. Brewer’s central point is correct. Our system gives short shrift to primary care and is chockfull of incentives for fragmented specialization. In the health care system we envision for the future, primary care doctors (internists, family doctors, pediatricians, geriatricians, perhaps for some women OB/GYNs) would play an elevated role in coordinating patient care. And they would be paid for doing it well.

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.