What the Pandemic Taught Us About Public Health

When this country needed to immunize a few hundred million citizens, primary care clinics were generally the last institutions that got invited to participate.

Instead, hospital systems held clinics in huge venues like stadiums and conference centers and retail pharmacies expanded their vaccination offerings to include in-store and drive through Covid immunizations.

Why were primary care clinics the last resort for the vaccine rollout?

The sad reality is that we are too inefficient to be part of a fast moving mass immunization. We are not designed to be fast. We are designed, or shall we say redesigned -away from the way things used to be- to be comprehensive and geared up for at least the possibility that whoever walks through our doors will be a long term user of our services. This is why new patients get inundated with questionnaires that have nothing to do with their presenting concern (which we used to call complaint) and which nobody in their right mind would expect completely truthful answers to at the first encounter, like “do you need a drink first thing in the morning to feeel okay?”

My pet peeve is that primary care offices are ill suited for being the primary source of public health. We are very good at working one-on-one when patients are ready for it or seek us out. But there are just too many public health messages out there to cram them into what patients expect to be problem solving visits when they have chest pain, shortness of breath or unexplained weight loss, and even if they want a “complete physical”. How could you possibly be “complete” in 30 minutes, which is all the time you have for it if you’re lucky?

Let the pandemic teach us that public health is a mass market kind of thing. We’re happy to reinforce its messages, but please abandon the illusion that we can or should shoulder the responsibility for it.

And use existing resources to their fullest, like immunizations at pharmacies. Then, if those get recorded so primary care clinics can follow up (provided we get paid for such work) when our patients didn’t get their shot, we would have more comprehensiveness. And we would be working more one-on one, the way we were designed.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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