Several weeks ago, Primary Care Progress asked me to serve as one of their guest bloggers for this year’s National Primary Care Week, writing on the theme: “Why is primary care the future of healthcare?” I didn’t end up contributing a post, for a few reasons:
1) not enough time.
2) concern that the question was too physician-centric (rather than patient-centered).
3) the feeling that I had nothing new to say on the topic that I hadn’t already written before.
Today, however, while teaching a group of first-year medical students about the Patient-Centered Medical Home and its potential to put primary care back in the center of the health system (in my opinion, exactly where it belongs), I had second thoughts.
As the “Healthcare Headaches” blogger for U.S. News and World Report for 2010-11, I often wrote about the future of healthcare from my perspective as a family physician. Below I’ve assembled some links to — and excerpts from — posts that I think do a good job of describing why primary care is the future of healthcare.
1. Your Primary Care Team Will See You Now: The future of healthcare includes working in integrated teams, which will allow primary care physicians to meet current and future increased demand for medical services.
In the primary care team model, the receptionist or a medical assistant could ask each patient to fill out a form with the necessary information. The medical assistant could then input this information into the tool and create a customized list of preventive recommendations. A medical assistant or nurse could then counsel patients about exercise habits, dietary practices, and smoking cessation before they even saw the doctor. They could also provide basic information about screening tests and immunizations, leaving the doctor to answer any remaining questions. If a referral was needed to obtain, say, a mammogram or a colonoscopy, the assistant could start the necessary paperwork while the doctor performed the examination.
2. New Electronic Medical Records Software Could Improve Your Health: Used properly, electronic health records will allow primary care practices to create registries to proactively manage the health of populations of patients.
The latest research suggests that electronic health records don’t necessarily improve care unless they include interactive features: They should make it easier for doctors to implement proven guidelines for good care, providing the necessary shots and screenings, follow-up exams and treatments to help patients live longer with chronic diseases or to prevent these diseases altogether. Ideally, these records should include a software tool that periodically culls patients’ records looking for gaps in care, such as who is overdue for a cholesterol screening or flu vaccine. The system would then send out reminders to patients to come in for a test or appointment.
3. Healthy Habits Are Hard to Maintain — Even If You Know What Lies Ahead: Genomic medicine is overrated, and will never be able to replace common-sense advice from a trusted family physician.
The take-home message is that providing personalized health information to my patients based on the “old-fashioned” collection of family history data is likely to be at least as good as – if not better than – sequencing their genomes. A potential reason for why participants in the New England Journal study weren’t able to change their health habits is that high-tech genetic profiles can’t substitute for personal contact. Much of the training primary care physicians receive is geared toward learning how to help people make good decisions about their health. So if you fear that your New Year’s resolution may be falling by the wayside, I encourage you to make an appointment to see your family doctor to discuss small, realistic steps that you can take to get back on track. Obviously, your doctor can only do so much by outlining your personal health risks and suggesting ways you can reduce them. The rest is up to you.
4. How to See A Doctor — Stat: New scheduling models such as open-access and technology such as secure patient portals will make it more convenient to consult a primary care physician than ever before.
Primary care offices have historically handled patients with urgent problems by assigning one doctor “acute care” responsibilities for the day or squeezing extra patients into already crammed schedules. The down side: Patients can end up seeing doctors who are unfamiliar with their medical histories, harried due to time pressures, or both, which raises the risk of misdiagnosis or improper treatment. That’s why some practices (including the federally funded Veterans Health Administration clinics) have switched to “advanced” or “open-access” scheduling. Rather than scheduling a visit weeks or months in advance, patients can call for an urgent or routine appointment the day before or the same day they want to be seen. A recent review of 28 studies found that advanced-access scheduling increases the chance that a patient will be able to see his or her doctor and reduces no-show rates.
5. Diabetes Prevention Starts With Your Doctor: Substitute “any chronic condition” for diabetes, and the primary care physician is the first doctor that people are most likely to see when they are healthy. Good primary care, prevention, and health promotion go hand-in-hand.
Recent research confirms the huge impact that convincing people to change their lifestyles can have on lowering their future diabetes risk. A study of more than 200,000 adults found that the odds of developing diabetes over an 11-year timeframe were 30 to 40 percent lower for older adults with one or more good habits: healthy eating, moderate alcohol consumption, and being smoke-free and physically active. For you to benefit personally from this research, though, you need to make sure that your doctor isn’t just going through the motions of lifestyle counseling, electronic medical record or not. Given the myriad agenda items doctors must squeeze into a 15-minute office visit, skipping counseling can be an easy way to cut corners and stay on schedule. Don’t let it be. There can be no better use of your visit than to discuss how to stay healthy and lower your risk of health problems down the road.
So there you have it. Primary care is the future of health care because we will function in teams; use electronic registries to practice proactive rather than reactive care; make it more convenient for patients to see, speak to, or message us; provide personalized health counseling; and assist patients in making lifestyle changes to avoid preventable chronic conditions. And as regular readers of my blog know, these reasons represent only the tip of the iceberg.
Dr. Lin is a board-certified Family Physician practicing in the Washington, DC area. He is also Associate Deputy Editor of the journal American Family Physician and teaches family and preventive medicine at the Georgetown University School of Medicine, Uniformed Services University of the Health Sciences, and the Johns Hopkins University Bloomberg School of Public Health. Read more blogs by Dr. Lin at Common Sense Family Doctor.