Sunday, July 23, 2017

Comfort comes from continuity.

Comfort comes from continuity.
Continuity, staying in one place, doing the same thing, slowly and steadily, year after year, is an anachronism in today’s high-speed world of modern American business. “Just in time” inventory control, cost cut-ting by service outsourcing, and the economics of creative destruction are anathema to a profession built on sustained human relationships. Primary care, fundamentally, is not big business.

The physician-patient relationship is an odd amalgam, demanding of the doctor a unique blend of empathy and authority, a comforting demeanor and an even tem-per, a familiarity just bordering on personal friendship (but not quite), and advocacy.

Ninety percent of good primary care is just showing an interest in the patient, as remarkable as that may seem.
Data management, however, cannot supplant good relational primary care. More than managerial, the strong and sustained physician-patient relationship is of prime importance, now more than ever, because it offers solace and solidarity for a patient and family coping with chronic, complicated illnesses. How quaint this seems in an age of whole-body CT scans, comprehensive multidiagnostic blood analyses, and the entire
U.S. pharmacopeia on a chip. Today we are awash in medical data, yet a good primary care doctor is hard to find. For better or worse, the cowboys are gone.

the victim of death by a thousand cuts, the primary care doctor has lost motivation.

Although good primary care is the right of every American, we are, to be sure, a senescing society. Demography is destiny. Demand for service will rise precipitously at precisely the same time as primary care physician morale craters. We are now at a crossroads in care, changing the very meaning of what it is to be a primary physician. This is an experiment in progress, a bit of social tinkering, and we don’t yet know the outcome. As we reconfigure primary care for future generations, however, we should be very careful what we wish for; we may get it at our next office visit.

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