A new Model of Medicine Death by Disruption !

"a model of medicine in which the functions of a physician are teased out, stratifi ed, and supplied in bulk by technically optimized deliverers of narrow and specific services. (For example, a hernia is repaired in a hernia center.) Care is commoditized. The wholesale liquidation of traditional holistic primary care, however, recapitulates the creative packaging and repackaging of mortgage “products,” credit default swaps, and the clever “stripping” of securities into tranches (peeled-off profitable portions), which contributed ultimately to the massive financial market meltdown of 2007. As a physician, that is a path I choose not to take"

"Primary care, as I knew and enjoyed it, is principal care, relational in
its very nature. It is delivered in a continuum, sometimes over decades,
often across generations of family members. It is not merely a series of
short, staccato transactions, technically correct but emotionally empty and
dispensed like fast food. The practice of primary care fundamentally does
not lend itself to fractionation or focused factories. Primary care is different;
it is a unique health resource and a national asset, but its survival is in
serious doubt. I am neither the first nor the last to close up shop. By leaving
practice, I lost many delicate, slowly cultivated, and sustained relationships
with my patients; such relationships are remarkable phenomena
that lie beyond the purview of any conventional business model. Yet, it is
I who am now out of business, not the economists at the Harvard Business
School. The postmortem on primary care in the United States may well
read: “Death by Disruption.”
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Out of practice : fighting for primary care medicine in America Barken, Frederick M. (Frederick Mitchell), 1955- Ithaca [N.Y.] : ILR Press, 2011. (Culture and politics of health care work.)