The demise of primary care: a diatribe from the trenches.

Abstract:

:Medical school graduates are avoiding primary care. The very aspects that once attracted students have been subverted. The breadth of practice that was once appealing has become the breadth of heavy-handed scrutiny, as politicians and business leaders have demanded quality--simplistically defined as dogmatic adherence to a standard. Individualized clinical judgment has been devalued; thinking has been replaced by algorithms. Practice guidelines have been usurped by pay-for-performance police, on patrol for deviations--not understanding that knowing and allowing for exceptions is the heart and soul of primary care. The coercive surveillance of "Quality Improvement" has become oppressive, making single organ-system specialties increasingly attractive (or at least more tolerable). Generalists are spending so much time proving they are good doctors, they don't have time to be good doctors. A remedy is suggested: a pilot project of volunteer salaried internists (more trusted, less audited) commissioned to our expandable national health care program, Medicare.

journal_name

Ann Intern Med

authors

Norenberg DD

doi

10.7326/0003-4819-150-10-200905190-00011

subject

Has Abstract

pub_date

2009-05-19 00:00:00

pages

725-6

issue

10

eissn

0003-4819

issn

1539-3704

pii

150/10/725

journal_volume

150

pub_type

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