Friday, March 27, 2009
On the Daily Beast's website, Dr. Abraham Verghese writes about the problem of a shortage of primary care physicians.
President Obama’s proposal to solve the nation’s health-care woes includes a plan to commit billions of dollars to “digitizing” medical records. Incredibly, there is much more money flagged for that goal than for easing the critical shortage of primary-care physicians. That suggests to me thatthere’s a voice not being heard in this debate. It’s not the voice of Medicare or insurance companies or organized medicine--it’s the patient’s voice.If health-care reform puts billions of dollars into programs that add more computer screens and create more iPatients, but does nothing for the true care of the patient, things will only get worse.
The patient’s voice, alas, is difficult to hear even in our hospitals, because the patient in the bed is overshadowed by machines and activity; the anxious soul under the covers has become a mere icon for the “real” patient in the computer. Indeed, the “iPatient” (my term for this virtual patient entity) has never been better cared for: buffed up and polished, with pop-up flags telling physicians when to feed and bleed and send postcards to bring them back to the office. And if health-care reform puts billions of dollars into programs that add more computer screens and create more iPatients, but does nothing for the true care of the patient, things will only get worse.
Real patients will tell you they want real, live physicians. Most diagnoses can be found in the patient’s history, in the story the patient has to tell. But you can’t hear it if you aren’t listening, and you can’t listen if you’re staring at the computer screen. You have to be with the patient to hear their story; the telling is important. Real patients want someone whose examining skills, when combined with common sense and sound judgment, can spare us the costly, blind, shotgun, ‘tick-all-the-boxes” kind of testing and imaging that has come to be the American brand of medicine. We want a doctor who orders tests judiciously, who calls in specialists sparingly, and who rides herd on them and weighs and translates what they say. What we want, in other words, is a primary-care physician.
A bank collapse, an auto-industry collapse, hurts the pocketbook and is easily measured. But the dwindling numbers of primary-care physicians is just as devastating and will cost us even more in the health of our nation. That‘s the crisis we are facing. Instead of pouring money into “digitizing the medical records,” we need to rescue primary care. . . .