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Primary Medical Care For The New Age: What About The Rest Of Us?

It was a brochure in the mail sent to someone much younger than me who used to live at our address:

“Exceptional primary care for real life: Get care wherever you need it—safely in person or in your PJs.”

OK, I thought: sounds like a deal! I can get care for my chronic medical problems in my pj’s whenever I want it? Wow…that is innovative!

But alas, I don’t think that brochure was aimed at me but rather for a much younger audience: one that is more technologically attuned (although I am fairly competent in that category), one that is not particularly afflicted with serious or complex medical problems, and one that is seeking a care source that is a step more coordinated than an urgent care clinic.

In other words, people who may want primary care of some sort just not the ones who have the really serious medical needs.

And there is more:

“Great care wherever you are (where) you can safely book appointments at any of our 125+ beautiful offices around the country (if your insurance will cover it, according to the brochure) and

“Easier access to specialists” at the (major hospital) network with a “dedicated scheduling team. That means you can get in sooner and get the care you need without the hassle if you choose care through the (major hospital) network.”

That last one got my attention, because as a patient at the major hospital network getting an appointment with a specialist for me or the folks I know can be quite an exasperating experience. This company is offering to cut all that nasty red tape out of the process.

And this teaser:

“Especially in uncertain times, having a place to turn for your physical and mental health can be reassuring. That’s where we come in. Our partnership with the (major hospital) network makes it fast and easy, and enjoyable (emphasis mine) to get care whenever you need it…”

Wow, sounds like a deal to me!

After all, these days getting a parking space at the (major hospital) network is in fact a feat to find a space, let alone get inside to see a doctor. And appointments for some medical specialists are months away. This outfit is claiming to cut through all the nasty stuff that most of us must go through these days to get quality primary care or specialty care, if we can even get it at all.

I regret that I am so cynical about what in fact may be an outstanding service. After all, I firmly believe and advocate for a strong primary care system. To me, primary care is the lynch pin of high-quality care. Whatever we can do to recreate an effective primary care system is vital to our health.

Longitudinal, responsive, and patient centric are key factors for effective primary care. Sadly, I see them slipping away day by day as we move primary health care from relationship-focused to a more corporate approach where everything is based on efficiency and silos rather than actually having the clinician know the patient and the patient know the clinician over time and have the clinician actually having a knowledgeable relationship with the specialists providing the more advanced care.

Maybe this new approach as advertised in the brochure has the answers. My hunch is that they are trying to focus on a younger audience that doesn’t have quite the medical needs or demands that filter up through most primary care practices. They are starting fresh with new faces and new technologies that may in fact make the “system” more responsive for the consumers they are trying to reach.

However, for the rest of us who must deal with an incredibly burdensome system that penalizes consumers, clinicians, and growing legions of support staff with overwhelming requirements that frequently aren’t visible to patients and caregivers there is little hope that many of us will be part of a system that makes care “fast, easy, and enjoyable” (note to self: no mention of affordable) let alone accessible.

Here is the mess in a nutshell:

How many times have I been asked, “Do you know any good primary care doctors that are still taking new patients?”  and how rarely have I been able to answer, “Yes, I do”?

I hope that I am not a Luddite. After all, a good part of my professional activity these days involves promoting technologies that should improve the patient journey.

And I no longer expect that the model of primary care I grew up on—where doctors knew their patients, where doctors would see their own patients in the hospital and help those patients make critical life-altering decisions based on the patients’ wishes and desires, or where the doctor would answer the phone after hours or see the patients in the emergency department at 2AM on a Sunday morning (yes, I did that fairly often)—will ever come back. And there are reasonable arguments as to why it should not come back.

My question right now is what will replace it: brochure-medicine that promises fast, easy and enjoyable health care (which I suspect over time will prove to be an oxymoron as practices become more mature and subject to the same procedures and rules that afflict everyone else), or some other model which will be equipped to offer quality care that is accessible to more folks and actually work to improve health by making certain everyone has the care they need to stay healthy and achieve their best opportunity for health based on their needs?

I suspect we are headed to a dual system that is even more divided than it is today. There will be the concierge practices like the one in the brochure, and then everyone else. As some of my physician colleagues have told me, “That is the American Way.”

Well, maybe it is. However, I can’t stop thinking about all the other Americans—including me– who will never have their health care delivered “that way” because I am too old with too many medical conditions to be on the mailing list for the brochure which says, “Nice to treat you, Atlanta.”

Nope, I have no expectation (or desire, for that matter) that I will be getting my medical care in my PJ’s—until I am unable to get out of my PJ’s.