A Country Doctor Writes:

American Primary Care is a dinosaur, threatened by extinction. It is too large and too slow moving for today’s fast paced society. The Fed made us that way.

When this country needed to vaccinate more than a hundred million people, nobody imagined Primary Care offices could be of any help. Instead, pharmacies became the outlet, along with temporary sites in sports arenas and community centers.

Why were clinics like mine excluded?

It all happened because of all the requirements of comprehensiveness we slave under. Even if a patient only comes in once a year for something simple, we have to screen them for everything from food insecurity to depression to domestic abuse. We also have to address any elevated random blood pressure or gaps in preventative care, like annual flu shots or smoking cessation counseling.

This cumbersome requirement stems from the misguided notion that people who choose not to partake in preventative medicine should be ambushed (see my 2018 post Upselling in Medicine: Would You Like a Pap Smear With That ankle Brace, Ma’am?) if they happen to seek us out for a medical concern they themselves see as a priority.

We do offer those screenings when people come in for a physical or a Medicare Annual Wellness Visit, but why are we held responsible for doing them with people who elect not to come in for health maintenance visits?

In today’s reality, a quick visit for a wart or a urinary tract infection creates a lack-of-comprehensiveness quality liability. What if the patient doesn’t return for another year and we missed our opportunity to address everything our payers require of us?

The irony here is that the buzzword for Primary Care these days is Patient Centered. But it is anything but that when our required agenda pushes our patients’ own concerns aside.

The quick and easy patient driven services we could so easily perform are instead being delivered at freestanding urgent care centers, in pharmacies and big box stores, even through telemedicine companies. This fragments care and removes from our workday the less complicated, lighter visits that could give us a welcome variety in our otherwise chronic care focused workday.

Family doctors were trained to offer a broad variety of health care services according to our patients’ needs. We are instead now more and more working as geriatricians and public health policy enforcers.

Comprehensiveness is Killing Primary Care