What went wrong? How come doctors get paid a lot for doing surgical procedures, but not much for sitting with patients, trying to diagnose what is wrong with them and coming up with the right treatment for them? If universal healthcare is far beyond our reach at this point…and we have to work within this corrupted system, then we need to find a way to repair primary care as best as possible because this is an area that could make a big difference in the quality of care we receive. Primary care is like the backbone of the nation’s health care system…and will collapse unless some changes are made. There are a few primary care models that I’ve been researching. One of them is the “medical home” with the basic idea being that everyone should have a relationship with a doctor who both treats the patient and, in conjunction with a team, helps the patient navigate the health-care system (which is definitely valuable in this complex mess of a health care system we have right now). Right now, primary care practitioners don’t get paid to help patients navigate the system (coordinating visits to specialists, for example). Maybe these kinds of payments could make primary care sexier for med school students. Another model is where patients see more of “non-physician clinicians and staff” (basically advanced practice nurses, physicians assistants, etc). The physicians manage the team and provide direct care for patients who have more complex medical problems, and oversee the nurses who treat the healthier patients. I’m skeptical about this because I am not sure that nurses and Pas can diagnose patients as well as doctors can. The last model is my least favorite, but provides the best care…the type of care everyone should be receiving already with the amount of money we are spending. In the last model people who can afford it will pay anywhere between a few hundred and a few thousand dollars a year to the doctor on top of their insurance, and get the kind of attentive care and easy access we all want. One online source says that with this concierge model, “you will get an hour long physical, preventative and nutrition counseling, thorough evaluation of problems, a cell phone number for out of hours access, an advocate who can meet you in the ER in case of a dire emergency and champion your case during necessary specialty care. A house call can also be accommodated if you are unable to leave home. Prescriptions will be called in or electronically sent in directly to you pharmacy minimizing the chance of error. You will never have less than 30 minutes with you doctor and he/she will refer you only when a joint decision is made that it is absolutely necessary.”—now that’s the kind of health care I want!!…why can’t we get that without going broke?
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