Primary care is so much more than treating disease. Treating disease is part of what we do but does not define what we do.
I’m fascinated by the studies that delve into what helps people do better with managing their conditions - be it diabetes or heart disease, exercise, or consistency in taking pills.
What fascinates me is what you find when you read studies that demonstrate an improvement in populations of patients with - for instance - diabetes. Often we find that the intervention was some person or persons charged with doing extra stuff.
Some studies use diabetes educators to help teach diabetics more about their disease. Good results lead the logical conclusion that we must all have diabetes educators if we hope to do a good job for people with diabetes.
Some studies show that telephone calls from health coaches lead to improvement in management of chronic pain. Hey - let’s get health coaches!
Others demonstrate the value of cool technology: “Look! We put a registry in place to track patients with diabetes so we could remind them to get the care they need and we got good results!”
At the core of all of these is the basic premise that if we do a little more for people - remind them that we care and want to help, work with them to improve their understanding, provide consistent follow up and follow-through.
Good primary care is based on doing well for all of our patients not just those with diabetes, heart disease or a few other conditions. Sequestering our resources in one or a few conditions makes us quasi-specialists. Specialists have their place but it is not that of primary care.
If we want to effect the greatest change for the greatest possible population we serve we would do well to invest in improvement that accrues to our entire population and not just the lucky few.
Good primary care benefits society with improved population health outcomes at lower cost. This is in part due to the role of primary care in understanding the importance of taking care of the whole person, not just an organ system.
This leads me to question why have we accepted a quality measurement paradigm that is specialty based and has almost no reflection of the systemic work we do in primary care?
