Over time, the nature of medicine has changed. There is ever less time with patients. There is ever more reliance on technology and drugs. These can offer powerful benefits, but at times there are kinder, gentler modalities to get the same job done.
Access to care is an important element in the quality of both health care, and the overall public health. All too often small problems neglected for a while turn into larger problems. Barriers to care propagate just such costly misfortune.
Veronica's story illustrates how clinicians can effectively address the social determinants of health by using tools that assess a patient's community and environmental circumstances, as well as by including non-medical providers as part of a health care team.
I make it a point to include a statement of uncertainty when offering my assessment and plan to patients in situations where a constellation of symptoms don't immediately add up by the end of an office visit. Am I right to do this? Well, I don't know.
With an estimated 1.6 million New Yorkers remaining uninsured even after health reform is implemented fully, some health centers (and hospitals, too) will continue to see large shares of uninsured patients.
Rather than relying on the traditional approach of almost begging young medical students to consider primary care, we should change regulations and energize the market so that care managers can deliver more aspects of primary care.
If you haven't already, you will someday see a primary care doctor (PCP). It's practically unavoidable. The reason for this self-declared truth is that PCPs are the shape shifters of medicine, assuming various roles at different stages of an adult's life and wellbeing.
The FDA is going to have catch up with technology, doctors are going to have to practice letting go, the tort system is going to have to be reformed, and patients are going to step up if we're going to solve this health care crisis.
As more people gain health insurance coverage, and as the health care system looks to save money and emphasize keeping people healthy (not just treating them once they're sick), primary care is becoming more important than ever.
Although further investigations may be useful in further legitimizing this innovative method in controlling blood pressure, this study demonstrates that there may be more effective ways in managing hypertension than the current standard of care.
This year, America has a once-in-a-generation chance to fix our broken health care system. As policy-makers discuss implementation of the Accountable Care Act, they should learn from China's experience and decide whether they see medical care as a commodity or social provision.
Why not eliminate this anachronistic charade of the general practitioner and use nurse practitioners and physician assistants to fill the gap? This is already happening in rural areas, which sometimes lack even a single primary care physician.
Private practices will not disappear, but increasingly they will become a niche to provide good old fashioned service to the generation in the habit of "going to see my doctor," while the more mobile young have already discovered the instant gratification of clinics and particularly the ERs.
When you visit your physician -- or general practitioner -- what usually happens? They usually give you a referral. Even if you don't have the type of insurance that requires referrals, if you have anything that requires a skill set beyond giving a flu shot, you will be referred elsewhere.
Policymakers should be aware that even well-informed patients with good access to primary care need the ER. Legislation should aim to increase availability of primary care, but not penalize for use of emergency services.
The insufferable pace of primary care combined with the erosion of the doctor-patient relationship deters young physicians from entering the field. In my graduating class of 30 or so internal medicine trainees, only two of us chose to go into primary care.
Although it may be a little tricky to schedule an appointment, it is well worth the wait. To get an initial meet-and-greet exam with the nurse, one must have all standard vaccines previously administered.
For those of you who get annual physicals, check out with your physician whether this is a necessary checkup. You may be pleasantly surprised that you can forego this routine ritual and see that your kids do it, instead.