When my parents were growing up, it was common for the family doctor to know your parents, kids, cousins, and neighbors; to make house calls; and to take your full situation (social, economic, cultural, familial) into consideration in treatment. Of course, payment might be made in dollars, insurance, or chicken eggs.
That time in medicine, of course, is gone. While some elements of this system are having a rebirth (like the dawn of the concierge family doctor), the structures that supported it have crumbled.
Until recently, though, primary care doctors have been a core part of the healthcare system, and the foundation of most people's experience as patients. Primary care doctors, of course:
- Give continuity of care, remembering your last visit and your overall life situation, embedding their perspective in these elements
- Coordinate care, playing the role as the key intersection point among specialists and family and patient.
- Tend to have long-term incentives, meaning their motivation is usually providing the right care over the long term, not necessarily providing a quick fix.
Recently, as the New York Times investigates, urgent care and "minute clinics" have begun to supersede primary care doctors as the first place people go when they need medical care. There are 12,000 across the country and as visits increase, visits to primary care doctors have dropped. There are multiple factors that contribute to this, including the key advantages of urgent care or retail clinics:
- Expanded office hours, which often coincide with hours that busy working people are available.
- Affordable, clear fees.
- Perception of faster results and more streamlined treatment.
There certainly is no replacement for a caring doctor who can truly care for you and understand the context of what you’re going through. Many in the healthcare field worry that outcomes will be worse from urgent care approaches, that antibiotics may be prescribed unnecessarily, and that key conditions or issues may be missed. Plus, fast isn’t always better — or cheaper. “None of the research has shown any of these approaches to delivering care has meaningfully addressed cost,” Dr. Werner said in the New York Times.
That said, even the best primary care doctor doesn’t eliminate the need for excellent care coordination and healthcare collaboration. For many years, the primary care doctor seemed like the panacea for coordinated, thoughtful care. But in reality, so much has fallen through the cracks for so long. And overloaded providers struggle to do healthcare collaboration and care coordination in the right ways.
So much is lost when we transition from primary care doctors to urgent care clinics. But something might be gained as well. Perhaps, as the traditional structures of healthcare change, doctors and patients may begin to be more open to new solutions. Demands for speed and efficiency are exposing the weaknesses of the old system, certainly -- it's up to us whether we rise to the occasion and create better things to replace what's no longer possible to depend on.
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