“A superior doctor prevents sickness; A mediocre doctor attends to impending sickness; An inferior doctor treats sickness.” -Chinese Proverb
Sir William Osler said, “The good physician treats the disease; the great physician treats the patient who has the disease.”
Having the time to sit down, discuss your concerns with your doctor and then to follow up on those concerns over time is not just a luxury, it may end up saving your family’s life. Research has suggested that those with continuous care with the same doctor have lower risk of death1. Children are also more likely to get more of the preventive care that they require when they see the same doctor from birth2.
Access to quality medical care is more than just having a 24 hour urgent care center in your neighborhood. It is about forming a trusted bond with a member of your own community. If primary care doctors take good care of patients there would be no need for an urgent care industry. The fact that this industry even exists is an indictment on the entire medical system.
Think about it for yourself. Are you more likely to trust someone you have known and worked with for years or some flashy stranger? The roots of primary care medicine came from the belief that having repeated contact with the health system at a point before many chronic illnesses begin could realize fantastic benefits for years to come.
Unfortunately today in the US that vision is being eroded daily. Only 55% of recommended preventive care for patients are actually performed3. Just 55% !?!? that’s a failing grade in my opinion especially with something as important as things that could cause death and disability for life!
Preventing disease is not prioritized in the current health payment system. Procedure based medicine done by specialists include activities such as surgeries, skin biopsies, blood tests and medical imaging are funding the beautiful and fancy medical facilities we love to stare at. Independent doctors that focus on disease prevention cannot keep their practices open in this environment and as a result have had to sell themselves as an employee to a hospital network. Hospital owned physician practices have tripled from 25% to 75% between 2002 and 20114. The financial incentive in the hospital owned health care system is to use primary care to funnel people into these money making procedures and tests whether people need them or not. I am not saying that all medical systems only care about money, it’s just the environment in which they operate.
Given these incentives, in order to funnel the most people into speciality based care, there needs to be a large flow of people into primary care offices. This large flow cannot be reasonably managed by a single doctor because they may have to see dozens of patients in a single day in addition to growing administrative burdens. What patients end up seeing is a long wait for appointments (national average 1 month per Merritt Hawkins), packed waiting rooms and an inability to contact their own doctor with a question when not in the office. In other words, there is poor actual access to doctors.
That erosion of trust leads to a vacuum and people still want medical guidance so they turn to urgent care centers who may not have a long term relationship with them but at least they are available when you have a need. In a recent physician survey, 75% of all primary doctor, ER, and urgent care visits are unnecessary and could have been handled via virtual visits or phone calls4.
The addition of nurse practitioners and physician assistants do help reduce some of the patient load in primary care offices. The problem with adding more people into the patient-doctor relationship is that there is no trust being built over time. If every time you go to see Dr. Smith you are actually are seeing his nurse practitioner or another doctor in his group then what basis do you have to trust Dr. Smith at all? When you have a question, he cannot answer because he is taking care of his 30-50 patients for that day. He didn’t directly take care of you when you were well and now when you have a complex medical question you are expected to put your full faith into his recommendations?!?…Trust does NOT work this way. I would not trust the opinion of a doctor who I barely know.
I was drawn to an alternative and direct structure of healthcare for my own practice because for me it addresses the question of access and trust. Everything starts with one person matched with one doctor. The patient-doctor dyad then navigates all the additional needed care. When healthy they see their doctor. When sick, they see their doctor. When they have a question they ask their doctor directly. I love removing barriers to the people I care for. Over 250,000 people have taken advantage of this style of medicine and I see that number growing more into the future.
- Pereira Gray, Denis J et al. “Continuity of care with doctors-a matter of life and death? A systematic review of continuity of care and mortality.” BMJ open vol. 8,6 e021161. 28 Jun. 2018, doi:10.1136/bmjopen-2017-
- Flores, Ana I., Warren B. Bilker, and Evaline A. Alessandrini. “Effects of continuity of care in infancy on receipt of lead, anemia, and tuberculosis screening.” Pediatrics 121.3 (2008): e399-e406.
- McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348 (26):2635–2645
- Jackson Healthcare. “2016 physician trends”. J Accessed on 03/03/2021. https://www.
jacksonphysiciansearch.com/wp- content/uploads/2017/02/ Jackson-Healthcare-2016- Physician-Trends.pdf