Primary Care and Longevity
| Life expectancy at birth in these United States is significantly lower than most countries within Europe and even in neighboring Canada life expectancy is two years longer. We are almost 30th in the world in infant mortality. The fact that life expectancy varies significantly among different segments of our population makes comparisons more difficult; however, overall we lag behind.. A recent Scientific American article [How Primary Care Heals Health Disparities, by Christine Gorman, - October 2010 issue] analyzed this and in looking for an answer concluded: "An easier fix may be under our noses: primary care. The idea is to have a clinician who knows your health history, will continue caring for you over the long term, and can recommend specialists and coordinate your treatment if you need to see them. Primary care can handle the health problems that most people have most of the time. Research confirms the value of such care for the general population. The greatest benefits come to the poor and socially disadvantaged groups, but they also extend to the well-to-do. Indeed, the need to strengthen primary care in the U.S.-making it move available-is one of the major tenets of the health reform laws that were enacted this past spring. A decline in availability in recent decades is a big reason why U.S. health has lagged behind that of other wealthy nations." With the advent of needed specialization has come the decline in primary care with only one-third of doctors now considered primary care and even some of these doctors have sub-specialty interests. They go on in the article to say: "Primary care increases life span and decreases disease burden in part because it helps to prevent small problems, such as strep throat, from becoming big ones, such as in a life-threatening infection of the heart. Having a regular clinician makes you a better patient because you trust the advice you receive and so are more likely to follow it. It also gives you access to someone who attends to the whole person, not just one part. In addition, having someone to coordinate your care can be critical if you have multiple providers, as for example when you leave the hospital." And further they state: "The many benefits of primary care show up in a range of research. Studies in the 1990s showed that those parts of the U.S. that had more primary care physicians for a given population had lower mortality rates for cancer, heart disease or stroke-three major causes of premature death-even after controlling for certain lifestyle factors (seat belt use, smoking rates) and demographic attributes (proportion of elderly people). By the 2000s researchers had linked access to such clinicians to lower rates of specific conditions, such as ruptured appendix (which requires emergency surgery) and low birth weight (which causes health problems in many infants). A study of more than 9,500 people with either high blood pressure or high cholesterol, which was published in the American Heart Journal this past July, sheds a little more light on why this relationship works so well. It found that having a usual source of care-a primary care provider or clinic-significantly decreased a person's risk of going untreated for high blood pressure or high cholesterol whether or not the individual had insurance. This finding suggests that health reform has to do more than provide affordable health coverage for all who need it." The article proceeds to point out the problems associated with excessive specialty care: "Among wealthier people, a big, perhaps surprising benefit of primary care is that it keeps patients from going too often to a specialist, where they can be over-treated or misdiagnosed. "Most people do not realize the dangers of too much specialty care;' says Barbara Starfield, a health systems researcher at the Johns Hopkins Bloomberg School of Public Health. She points to research showing that primary care physicians are better all-around diagnosticians than specialists and achieve better overall health outcomes for their patients. Unnecessary treatment turns out to be a bigger problem than most people in the medical field-including specialists-care to admit. Every test, every diagnostic procedure, every surgery has its own complication rates. For example, undergoing cardiac catheterization to see if the arteries in your heart are blocked slightly increases the risk of fatal internal bleeding-which is why you have to lie so still after the procedure." In October of 2010 Harvard University announced a new Center for Primary Care geared toward transforming primary care education, research, and delivery systems. This was made possible by a large anonymous donation and this grant will allow for training and innovation in primary care medicine. Harvard's leadership in this area should be helpful; however, the best way to allow primary care to become the centerpiece of health care with improved life expectancy and decreased infant mortality is to financially reward the primary care physician. This will allow primary care Internal Medicine programs to grow and with good training to flourish again. Also, insurance incentives should be created which utilize the primary care doctor not as a gatekeeper but as the caring physician who can do what is best for the patient for in the end that will also control cost and save lives. Hospitals need to recognize the importance of the primary care physician and reverse the trend of relying on hospitalists to care for the patient rather than the primary physician who knows the patient best. Hospitals need to end the practice of encouraging excessive specialty consultations, which often exists for each patient in the hospital. For the two-thirds of doctors in specialties many will push for a primary care from physician assistants and nurse practitioners within their own practices. One should realize that such an approach is counterproductive to the need for an independent well-trained primary care physician. | ||||||||||||||||||||
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