Guest Editorial

Primary Care: Happily Keeping America Healthy

October 06, 2015 03:46 pm T.R. Reid

When the Health is Primary(healthisprimary.org) campaign held seminars with primary care doctors around the country, we heard from city docs and country docs, from freshly minted physicians just out of school and long-timers who started out when Medicare was still a controversial new idea. Our speakers included physicians who treat children still shy of their first birthday and hospice doctors whose patients are 90 years further along the path of life.

Author and documentary filmmaker T.R. Reid speaks about the importance of a strong primary care system for the Health is Primary campaign.

But for all this diversity of geography, experience and practice, we heard a common theme repeated around the country. Over and over, primary care doctors told us: "I love my job."

As the moderator for these panel discussions, I was surprised to hear it. It is conventional wisdom in health policy circles that primary care gets far too little respect in the American health care system. Although the friendly, familiar family doctor or pediatrician is the linchpin of American medicine, the high-powered specialists always seem to garner the most prestige (and the highest incomes). Frankly, we heard some comments along those lines in our sessions. Overall, though, I came away with a strong sense that America's primary care doctors are proud of their central role in maintaining the nation's health -- and happy in their work.

A key reason, these physicians told us, is that the primary care doctor develops a long-term personal partnership with the patient that most specialists can only dream of. In primary care, the physician is not treating just a fractured bone or a diseased organ. Rather, she treats the whole person; she has overall responsibility for the physical and emotional well-being of a human being, often a friend whom the doctor has known for years. The primary care doctor's office served as a "medical home" long before that concept caught on with the policymakers.

That characteristic primary care relationship leads to health care based on collaboration between doctor and patient. In our panels, doctors kept saying that they worked with the patient -- not on the patient -- to maintain health and to treat illness. As one physician put it, "Patient engagement is a wonder drug."

Thomas White, M.D., a family physician in Cherryville, N.C., told us that he had learned a key lesson in health care from his patients in the local fire department. The firefighters told their doctor about a standard rule of their trade: "Two In, Two Out." That is, a firefighter should never enter a burning building alone. Rather, there should always be at least two working together, so that one can help if the other is hurt. "And I came to realize," Dr. White explained, "that Two In, Two Out is the correct recipe for health care, as well. The doctor and the patient need to work together."

This unique partnership helps explain why primary care is an essential element of a cost-effective health care system. By keeping tabs on his patient, by spotting potential problems early, by intervening before a patient requires costly diagnostic testing or hospitalization, the primary care physician enhances overall health and saves significant sums for the payer, whether it is a patient, an employer or an insurer.

All over the world, health care economists and health officials recognize this value proposition. When I was studying the health care systems in the world's other rich democracies, national health ministers repeatedly told me that they preferred to have about two primary care doctors for every one specialist. Most of the other developed countries have maintained roughly this ratio. The United States, of course, has it backward; only about one-third of American physicians are specializing in primary care. That's a major reason why our country pays far more for health care than other developed countries, but gets far less in return.

But there are grounds for hope. More and more, health policy experts, patients and those who pay the bills are coming to realize that an emphasis on primary care is an essential requirement for better health outcomes at lower cost. Our seminars around the country(healthisprimary.org) (which will continue for the next two years) are helping to emphasize a key point: Primary care doctors love their work; it's time for America to love them back.

Journalist and documentary filmmaker T.R. Reid has been part of the Health is Primary campaign since its launch at the 2014 AAFP Assembly. This guest editorial is the foreword to Making Health Primary: How Family Medicine and Primary Care are Delivering on the Triple Aim,(healthisprimary.org) published this month by the Health is Primary campaign.

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