Sunday, February 23, 2014

The Primary Care Provider, an Indispensable Role

A recent article highlighted the experience of a Harvard Medical School physician who got a "crash course" in the way American medical care is delivered.

"After falling down a flight of stairs, breaking his neck and nearly dying, a Massachusetts physician is now speaking out about the stark deficiencies he saw in his own treatment -- and how those shortcomings relate to more general problems he sees plaguing medical care in America."

Dr. Relman takes no issue with the care he received. He called his life-saving care "excellent." He noted that the physicians "simply refused to let (him) die." 

What he was surprised by was the ever present technology. He noted that his physicians were focused more on "the masses of data generated" by testing, than on him. He read the physicians' notes about his care, and "found only a few brief descriptions of how I felt or looked." His conversations with the physicians were "infrequent, brief and hardly ever reported." 

Dr. Relman did not feel like there was a single doctor overseeing the spectrum of his case. He says that "someone who knows the patient oversees their care," essentially coordinating the efforts of the various specialists. This should be the primary care physician. He contends that the absence of primary care from the experience "allows for fragmentation, duplication and lack of coordination of medical services." He laments the "growing national shortage of primary care physicians. 

While his experience is poignant due to his unique perspective as a physician, is it any different for anyone who suffers a traumatic injury and seeks care? Is the current state of workers' compensation medical care subject to the same concerns of "fragmentation, duplication and lack of coordination of medical services." Is there any one more critical element than the primary care physician, the occupational medicine physician, in  achieving the lofty goal of "quick and efficient delivery of disability and medical benefits to an injured worker and to facilitate the workers' return to gainful employment . . . .." Fla. Stat. 440.015?

It appears that the primary care physician is critical. That is a "take away" from his article. I would suggest that another "take away" should be that people need to be listened to, heard, and communicated with. I understand the role of diagnostic testing. I understand the role of data. But in the end, we all want someone to talk to about our maladies and illness and complaints. I suspect that this is important from a physical and psychological standpoint. 

Do we really need a doctor to explain this to us?

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