In this week’s article by Dr. Smith, he begins to lay out his concerns for the direct modern primary care is heading.
This has been a crazy, but mostly enjoyable week. We moved our medical office about a half mile closer to the mountains on Rt. 321. It’s exciting to see a band of workers busily laboring to turn a beautiful but empty shell of a building into a humming place ready to provide medical care. When everything is first pulled out of a few dozen cabinets, drawers and cupboards, brought to the new place and strewn around, it looks like a bomb went off. It seems impossible that that much stuff was stowed away in the old medical office. It’s a bit overwhelming. But slowly, with everyone doing their part, some semblance of order and organization is restored. Monday morning, we were (mostly) ready to roll.
It makes me think of how medicine as a whole is constantly moving, and the pace just seems to be constantly accelerating. Some of the movement is exciting and helpful, while some of it is distracting, burdensome and counter-productive. The part that’s exciting is the explosion of medical knowledge: new treatments, better surgical approaches, more accurate understanding of the causes and prevention of disease. Every time I start to get a migraine and reach for the medicine that stops it in its tracks and lets me keep working without the rather horrific pain I used to experience, I’m thankful for the advances of modern medicine, and that I didn’t live with migraines fifty or a hundred years ago.
At the same time, not every new discovery is better than what came before it. New treatments sometimes come with new complications and almost always come at significant cost. And realistically, trying to keep up with the steady doubling of medical knowledge is no easy task for any physician. Happily, there are lots of online resources that can get you the information you need in a heartbeat. Gone are the days of my bookshelves of medical texts that are already becoming outdated when they come to print, or the files of articles on recent studies that I used to keep. Now a few clicks can get me where I need to go to find the latest studies and information on a given disease or treatment.
But as I make what I expect will be my final physical office move, I must confess to some major concerns about where medicine is moving. Although much of this movement would apply to all branches of medicine, I’m mostly referring to primary care medicine – the front line, “blue collar” medicine done by family physicians, pediatricians, and general internists. These are the first line of medical contact, often aided by physician assistants and nurse practitioners, who sort through someone’s symptoms and seek to arrive at a diagnosis and treatment plan. It is estimated that 80% of the time a primary care doctor will completely handle whatever problem comes to them, and the other 20% or so, they will access an appropriate specialist.
So, what are the major threats to good, satisfying primary medical care? Many answers could be given, but I see four major threats that end up producing the depersonalization of medical care. By depersonalization in medical care, I mean that the idea of one human being trying to engage and help another achieve relief of symptoms and maximal health in the midst of a personal one-on-one human encounter, is being lost. In its place is often a fast-paced, distracted, non-empathetic, and all-too-short visit.
While some efficiency is a good thing, medical care is best delivered when a personal human connection is made. The iconic family doctor of Norman Rockwell paintings and stories of family physicians who personally knew their patients over decades seem quaint and unattainable in today’s medical and social climate. That may be true, but if we recognize what is driving us toward an impersonal medical care we may be able to slow, or even reverse, the drift in that direction. Next article I want to lay out the four factors that seem to be driving us toward an impersonal, unsatisfying medical care. Maybe we can get medicine moving in a more positive direction, at least on a local level here in the Maryville area.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. He is contracted with some commercial insurance carriers and sees Direct Primary Care patients who do not have insurance, who belong to a cost sharing ministry, or who are on Medicare. He is accepting new patients. You may contact him at 982-0835