But I think primary care can make a difference

But I think primary care can make a difference

Posted by Katherine Ellington on May 10, 2012 5:51 pm

“But I think primary care can make a difference...”    —John Lantos, MD

Whether you choose to listen or read “A Tale of Dollars, Pediatrics And Late Night Calls About Infant Constipation” by pediatrician and bioethicist John Lantos in the May 2012 issue of Health Affairs, you'll find that his storytelling offers a view into primary care in the margins between academic medical centers and federally qualified health centers (FQHCs). Dr. Lantos characterizes his rich experiences with patients, hospital administrators and the health care delivery system. 

I’m glad for the layout of the FQHCs mission, community governance and comprehensive approach to primary care. There are more than 1,000 FQHCs seeing 20 million patients; these centers are also a rich training ground for medical student and residents. Lantos' candid discussion of reimbursement models and safety net policy reveals the myriad challenges embedded within the health system. Cost-effective, high quality patient care seems to implode budgets creating political battle grounds. For example, night call by telephone with nurses allows doctors to sleep for the most part while acheiving the goal of comprehensive care without unnecessary visits to the Emergency Department as in the case of pediatric constipation.  In these cases, Dr. Lantos suggests that the dilemma of revenue lost in the ED devalues cost-effective care in the health center.  He suggests incentives and rewards for systems improvement and quality patient care for solvency.

One long hot summer, I did research where I reviewed over 100 pediatric medical records in the lower level of an urban academic medical center.  I observed the value of well-child visits, follow-up phone calls and comprehensive treatment strategies that reduced ED visits most significantly in asthma cases. It was also interesting that rapid weight gain in some cases, perhaps due to medication, went unaddressed.  I still agree comprehensive coordinated primary care can make a difference!

What’s your take?

Re: But I think primary care can make a difference

Posted by Beth Nelsen on May 15, 2012 12:35 pm

I absolutely agree comprehensive primary care can make a difference. There are two major factors that hinder the rest of the world from agreeing: the patients and the trainees. I spend an enormous amount of time engaged in what I like to call "herding cats". I chase down one problem only to be confronted with another. This is the never-ending lament of the primary care doc. Once we can convince our patients that living healthier lifestyles is better for them and that taking an active role in their health is important, then they will buy in to primary care. Instead, we deal on a daily basis with poorly controlled asthma and four-year olds that weigh more than I do. We also need to convince our medical students and residents that working in primary care is rewarding despite its challenges. I work in an outpatient general pediatric office associated with a medical center and children's hospital. I spend more than 80% of my time working with students and residents. In that time, I try my best to show them how much fun I have at work, talking to patients, helping them work through issues, and watching them grow and develop. It's not glamorous. But it's a great job to have.

Re: But I think primary care can make a difference

Posted by Sohail Azeem on Jun 6, 2012 9:17 pm

Katherine and Beth,

I completely agree with your depictions wholeheartedly.  During my family and peds medical rotations, I experienced these descrepencies.  Although neither were in academic hospitals, both community based hospitals showed completely different scenes.  One was more organized and under control with less important issues being still important.  The other was less organized and less important patients' issues went unnoticed as you were mentioning.  The key thing here is definitely minimizing these desparities while not becoming such a sad situation for the care providers.  The doctors as you said must be having fun and enjoying what they do to improve these peoples' health.  I believe this is definitely the key as we will see an increase in primary care focus in the upcoming years.  I will continue to do my best to help promote this feeling as we are truly the front line soldiers in this battle.


-Sohail
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