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The advantage of primary care doctors
Robert Martensen, doctor and author of "A Life Worth Living"
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TEXT OF COMMENTARY
Kai Ryssdal:
There's more troubling news on health care today.
A new study out from the Robert Wood Johnson Foundation says family doctors aren't getting the funding or the respect that they ought to from the National Institutes of Health. That's too bad, says commentator and physician Robert Martensen, for all of us.
Robert Martensen:
Drive through an affluent suburb or retirement haven, and you'll find the usual up-market clothing boutiques. You'll also find an ample selection of medical boutiques staffed by medical specialists who offer an array of treatments for those who can afford them. Shoppers in these boutiques may dress smarter and see multiple doctors more often. But people who rely on their own collection of specialists don't tend to live longer than those who go to primary care physicians for most of their care.
Take Boca Raton, Florida. Along with its great winter climate, the city has one of the highest concentrations of medical specialists, procedures and hospitalizations in the U.S. But the average older person lives longer in Pierre, South Dakota, where winters are frigid and specialists comparatively sparse. In medical terms, the big difference is that in Boca Raton, people tend to go directly to specialists for their care, whereas in Pierre, people tend to see primary care physicians for most problems.
In short, more is not better. Why? In large part, it's because in medicine genius lies in managing the details, and that only happens when one's medical care is coordinated.
Most specialists -- cardiologists, neurologists, nephrologists and the like -- are expert in their one area. Because their focus is narrow but deep, few of them, however well meaning, are likely to have the big picture about you. If you just doctor shop among the specialists, your care will not be coordinated. But coordinated and detailed attention to your overall health turns out to make the difference. It's that attention, and the truly informed consent that goes with it, that makes for what's known as "effective" care. At the moment, only about 55 percent of patients with Medicare receive effective care.
Regular attention toward you as a person from a careful primary care physician is a good thing. Vigilance toward all your problems likely will accomplish more than just seeing specialists. You are likely to save a lot of money, and studies indicate you'll live a healthier life.
Ryssdal: Robert Martensen's new book is called "A Life Worth Living, a Doctor's Reflections on Illness in a High-Tech Era."
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IIRC, the "fight" to change the pronunciation of that little tiny place started only about 30 years ago. Or maybe that city's preferred pronunciation only escaped the ice then...
It's a French name, despite the wishes of fewer than 20K people. Do you also say New-cue-lar?
Change the spelling to Pier, problem solved.
The value of coordinated care is what makes the specialty physician system work. We appreciate the specialists that come to our town and help us provide that quality. Unfortunately primary care medicine is a dying breed. Private medicine is going the way of the dodo as hospital systems gather the diamonds in the rough to fill the gaps. In order to save primary care and improve patient outcomes we need the "Medical Centered Home" concept to develop that the AMA, ACP and AAFP promote. Without the Medical centered home, and increased payments to primary care physicians to fund it, quality will diminish as we have physicans continue to retire early and become frustrated with the ever paper burdened daily grind. Patient's won't have access to physicians and physician extenders with much less training will be the only ones providing care.
I would like to know where Dr. Martensen got the statistic that; "At the moment, only about 55 percent of patients with Medicare receive effective care."
For the folks in Pierre, SD, there are many of us around the country that live in places that you can't spell or pronounce like me in Timonium, MD.
Dr. Martensen is surely correct in emphasing the importance of coordinating a patient's care. But the game in the medical industry (docs, hospitals, insurance companies, employers) is not about providing high quality care to patients but about shifting costs to patients and each other. For a comprehensive analysis those keen to understand this mess could do worse than read "Redefining Health Care; creating value-based competition on results" by Michael Porter and Elizabeth Teisberg.
Thank you, Dr. Martensen, for bringing to light the value of primary care. My wife and I are both family physicians. We witness time and again the "tunnel vision" that our patients' specialist physicians demonstrate and those physicians' typical unwillingness to manage any problem or disease not associated with their specialty. It is unfortunate that there are not more studies that give credence to your remarks about the cost effectiveness and value of primary care. What is needed at this time in our health care system is truly a "system" that is focused on the overall health of patients as opposed to how many procedures a single patient can undergo. Perhaps by enhancing the awareness of our patients and their insurance companies, we may someday be given the respect we deserve from the National Institues of Health.
I am a practicing vascular surgeon and one of those specialist that Dr. Martensen was referring to on your show today. I agree with him since many of my patients are quite ill and I heavily depend on their primary physicians to coordinate their care and treatment plans. We have simply lost the focus on what's important in health care in this nation. We are now a sicker nation as a result. There must be more emphasis on preventive care and better reimbursement (pay) to doctors who don't do cosmetic procedures. My specialty focuses on supplying blood to compromised limbs at risk. My surgeries are often many hours long, but Medicare will only reimburse us $1500-$2000 per case no matter how long it takes. I am not greedy, but the average malpractice premium annually for vascular surgeons is $99,000 and many of us are still paying back loans. Now, does that sound fair? Sadly, Joe the plummer makes more per hour than many doctors. This must change!
Hey Doc;
The South Dakotans beat me to the punch on pronunciation, sooo....
Have you controlled for other factors besides the GP/specialist ratio comparing South Dakota and Florida? Have you compared areas with comparable climate and demographics to measure the efficacy of GP and specialist approaches in organizing medicine?
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