The question of what the role of a primary-care physician should be, and how it should be valued, has perhaps never been more urgent. That figure, typically a general practitioner, family doctor or internist, is a patient’s first and often most personal connection to the rest of the health care system. But well-known corporations are betting that Americans would prefer to have health care “delivered” by a trusted brand rather than a trusted physician. At least 10 of the nation’s largest tech companies, including Apple, Microsoft and Alphabet, Google’s parent company, have designed tools and software for medical use and increased their involvement in health care start-up deals in recent years; the size of those deals went to nearly $3 billion in 2017 from under $300 million in 2012. Amazon, in partnership with Berkshire Hathaway and JPMorgan Chase, has announced its intent to disrupt the industry — among other ways, by reinventing primary-care delivery. Walmart now offers primary-care services in some of its stores
Surprisingly little is known, though, about what the relationship between a patient and his or her primary-care doctor is actually worth, in terms of that patient’s overall well-being or medical costs, regardless of who bears them. In fact, David Meltzer, an economist and a primary-care physician at the University of Chicago, may be the first and only researcher in the country trying to quantify that relationship’s value in a randomized clinical trial, the most rigorous scientific method.
as more working Americans signed up for employer-sponsored health insurance, many of them — 41 percent, in one survey — “severed established relationships with their physicians in order to seek new providers,” according to a 1996 study in The American Journal of Public Health. The same study estimated that more than a third of Americans on Medicare who were 65 and older and who had a regular physician had been seeing him or her for a decade or more — and those with the longest ties had lower medical costs and were less likely to be hospitalized than those with the shortest
One afternoon I watched one doctor, Ram Krishnamoorthi, examine L.A. Kizer, who had just turned 70. He was wearing a new-looking ball cap with a trout on it and pulling an oxygen tank. “Did you go fishing?” Krishnamoorthi asked. He had been Kizer’s doctor for more than two years, but he could never tell when such an innocuous question might turn out to be significant: If Kizer said yes, Krishnamoorthi could try using the activity to motivate healthful behavior, or he might find out that someone who could be tapped as a source of support had accompanied Kizer on the outing.
“Used to,” Kizer said. He suffered from congestive heart failure and was still breathing heavily from the trip down the hall.
“Let me see you walk over,” Krishnamoorthi said. “This is a lot worse than before. What happened?”
‘THE AWESOME PART OF IT IS, I DON’T HAVE TO LOOK STUFF UP ABOUT MY PATIENTS. I DON’T HAVE A PERFECT MEMORY; IT’S JUST THAT I’VE SEEN THEM A BUNCH OF TIMES.’
“I saw you two weeks ago,” Kizer said, “and it feels like I woke up and I can’t move.” He added that he had gained four pounds. Krishnamoorthi rolled up his pants legs and probed his ankles. He pressed a stethoscope to his back. A doctor who had not seen Kizer so recently would have no reason to investigate his sudden decline (and Kizer, who said he didn’t like doctors, might not have told an unfamiliar doctor that anything had changed). “How’d you get here?” Krishnamoorthi asked.
“Bus.”
“How many?”
“One.”
“It’s fluid,” Krishnamoorthi said, referring to Kizer’s added weight and difficulty walking and breathing. He asked if Kizer wanted to be admitted to the hospital, where he could get additional medications; Kizer declined. Krishnamoorthi eventually agreed to let him go home if he turned off his tank, waited for 10 minutes and had his blood-oxygen level checked. This would take up more of Krishnamoorthi’s time — without generating additional reimbursement — but it would mean vast savings for the health care system if it helped him prevent Kizer from having an emergency on the bus later. Heeding Kizer’s preference probably made him more likely to keep future appointments.
“Why am I doing so bad?” Kizer asked as Krishnamoorthi clipped an oxygen meter to his finger. “Is it all the meds?”
“I don’t know. Maybe.” Krishnamoorthi read the meter display: “98 percent. I think you’re safe. Don’t croak on the bus.”
“If I do, you won’t find out.”
“I’ll find out. They call the doctor first. What’d you do for your birthday?” A physician in a hurry might not have noticed the date — or accepted his first answer.
“What I’m doing now. Nothing.”
“Did you have guests over?”
“Yes.”
“What did you do?”
“Played cards.”
“Did you eat chips while you were playing cards?”
“A couple. You know I do.”
“Do you think that might be part of the reason for the weight?” Extra sodium can cause fluid buildup.
What I couldn’t quite believe was that these lengthy conversations were economically sustainable. Nationwide, primary-care physicians often can’t afford to spend more than 15 minutes with each patient, because of the way the health care system values their time. I had seen Krishnamoorthi and colleagues take that long to sort through patients’ medications, often more than a dozen, which they asked patients to gather up and bring to appointments. During one visit, Grace Berry, another doctor, Google-mapped a patient’s new address to locate a nearby pharmacy, transferring her prescriptions there and helping her secure reliable transportation to and from the clinic.
Interesting thing I noticed 2 of the primary care physicins whose stories are given in the article both are Indians .
Surprisingly little is known, though, about what the relationship between a patient and his or her primary-care doctor is actually worth, in terms of that patient’s overall well-being or medical costs, regardless of who bears them. In fact, David Meltzer, an economist and a primary-care physician at the University of Chicago, may be the first and only researcher in the country trying to quantify that relationship’s value in a randomized clinical trial, the most rigorous scientific method.
as more working Americans signed up for employer-sponsored health insurance, many of them — 41 percent, in one survey — “severed established relationships with their physicians in order to seek new providers,” according to a 1996 study in The American Journal of Public Health. The same study estimated that more than a third of Americans on Medicare who were 65 and older and who had a regular physician had been seeing him or her for a decade or more — and those with the longest ties had lower medical costs and were less likely to be hospitalized than those with the shortest
One afternoon I watched one doctor, Ram Krishnamoorthi, examine L.A. Kizer, who had just turned 70. He was wearing a new-looking ball cap with a trout on it and pulling an oxygen tank. “Did you go fishing?” Krishnamoorthi asked. He had been Kizer’s doctor for more than two years, but he could never tell when such an innocuous question might turn out to be significant: If Kizer said yes, Krishnamoorthi could try using the activity to motivate healthful behavior, or he might find out that someone who could be tapped as a source of support had accompanied Kizer on the outing.
“Used to,” Kizer said. He suffered from congestive heart failure and was still breathing heavily from the trip down the hall.
“Let me see you walk over,” Krishnamoorthi said. “This is a lot worse than before. What happened?”
‘THE AWESOME PART OF IT IS, I DON’T HAVE TO LOOK STUFF UP ABOUT MY PATIENTS. I DON’T HAVE A PERFECT MEMORY; IT’S JUST THAT I’VE SEEN THEM A BUNCH OF TIMES.’
“I saw you two weeks ago,” Kizer said, “and it feels like I woke up and I can’t move.” He added that he had gained four pounds. Krishnamoorthi rolled up his pants legs and probed his ankles. He pressed a stethoscope to his back. A doctor who had not seen Kizer so recently would have no reason to investigate his sudden decline (and Kizer, who said he didn’t like doctors, might not have told an unfamiliar doctor that anything had changed). “How’d you get here?” Krishnamoorthi asked.
“Bus.”
“How many?”
“One.”
“It’s fluid,” Krishnamoorthi said, referring to Kizer’s added weight and difficulty walking and breathing. He asked if Kizer wanted to be admitted to the hospital, where he could get additional medications; Kizer declined. Krishnamoorthi eventually agreed to let him go home if he turned off his tank, waited for 10 minutes and had his blood-oxygen level checked. This would take up more of Krishnamoorthi’s time — without generating additional reimbursement — but it would mean vast savings for the health care system if it helped him prevent Kizer from having an emergency on the bus later. Heeding Kizer’s preference probably made him more likely to keep future appointments.
“Why am I doing so bad?” Kizer asked as Krishnamoorthi clipped an oxygen meter to his finger. “Is it all the meds?”
“I don’t know. Maybe.” Krishnamoorthi read the meter display: “98 percent. I think you’re safe. Don’t croak on the bus.”
“If I do, you won’t find out.”
“I’ll find out. They call the doctor first. What’d you do for your birthday?” A physician in a hurry might not have noticed the date — or accepted his first answer.
“What I’m doing now. Nothing.”
“Did you have guests over?”
“Yes.”
“What did you do?”
“Played cards.”
“Did you eat chips while you were playing cards?”
“A couple. You know I do.”
“Do you think that might be part of the reason for the weight?” Extra sodium can cause fluid buildup.
What I couldn’t quite believe was that these lengthy conversations were economically sustainable. Nationwide, primary-care physicians often can’t afford to spend more than 15 minutes with each patient, because of the way the health care system values their time. I had seen Krishnamoorthi and colleagues take that long to sort through patients’ medications, often more than a dozen, which they asked patients to gather up and bring to appointments. During one visit, Grace Berry, another doctor, Google-mapped a patient’s new address to locate a nearby pharmacy, transferring her prescriptions there and helping her secure reliable transportation to and from the clinic.
Interesting thing I noticed 2 of the primary care physicins whose stories are given in the article both are Indians .
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