The Real Value of Primary Care
Dr. Rob makes an excellent point in his post regarding preventive medicine and its costs:
…if you go to the neurosurgeon with sciatic nerve pain that has gone on for 2 weeks and is excruciatingly painful, what do you think the chance that the doctor will order an MRI scan? Fairly high. Why? Because they are used to seeing a population of people with much more severe disease. This is because these people usually come to the PCP first. When I see someone with these symptoms, I give them a prednisone pack, pain medications, and a handout on sciatica. 90% of these people get better. The remaining 10% I send to physical therapy and, if the symptoms are not responding or are getting worse, order an MRI scan. Only those people who have failed conservative therapy end up seeing the neurosurgeon.
The fact is, most of the time we DO get better. Our bodies are amazing at healing themselves. So, when a problem comes along that we think we should get checked out, a primary care doctor is absolutely the best first-stop. They see all different kinds of illnesses and they are specifically trained to determine what’s serious and what’s not. For most stuff, they can develop basic treatment plans that will almost always take care of the problem. For the more complicated things, they can monitor them with a close eye and then pass them along to specialists when necessary.
The dark secret of specialists is that they are trained to see the bizarre. In order to adequately train a specialist in diseases and illnesses that rarely occur, they must train at large, academic medical centers. In such places, where doctors throughout the region send their difficult cases, they do end up seeing quite a few bizarre cases. To deal with the bizarre, they do lots of tests and perform lots of procedures. Because they are trained this way, they carry these habits out into the real world. Thus, when they see rather simple cases they are more likely to overtreat them or try to make the bizarre out of the ordinary.
A primary care doctor’s skill at triaging a wide range of cases is their most important asset. Unfortunately, our current medical care system doesn’t reward them for this difficult skill. Health care reform has to begin with changing this fact and providing incentives for medical students to go into primary care while keeping PCPs in their current practices.