There is a provocative Perspective article in the November 13, 2008 issue of the New England Journal of Medicine. The basic question argued about is whether or not it is physically possible to provide primary care to the extent required to prevent illness and treat chronic disease effectively. There are so many things a primary care provider must do that she or he would need to work 18 hours every day. Whereas a specialist can focus on just one part of the body or one illness, a primary care provider must focus on everything from acute illness to preventive care to managing chronic illness -- and all in a 15-20 min patient visit. What do you think? No time to read the article? Check out the video.
As an example from my own practice, a 72 year old man has just been discharged from the hospital after being admitted for shortness of breath. He has chronic illness which include the following: diabetes, hypertension, coronary artery disease, sleep apnea, renal failure, severe arthritis, glaucoma and high cholesterol. He needs his list of medications from the hospital reconciled which what he was taking before he was admitted. In addition, he is due for his flu shot and other preventive interventions. Go. You have 20 minutes start to finish.
And, don't forget the follow up phone calls to pharmacy and specialists after the visit is over. Of course, now we have email too.
Is this an extreme example? Not really. Many adult patients suffering from chronic illness have more than one; way more than one.
As of 2008, health care providers get reimbursed based on the individual patient encounter. One visit equals one payment. Complexity of illness only plays a minor role in the amount of reimbursement, and all work done outside the exam room doesn't count. This is just as true for those providing health care without regard to the ability to pay, like community health centers, as it is for practices caring for a largely insured population. At health centers such as ours -- Erie Family Health Center -- we look for innovative ways to soak up the cost and we rely on winning competitive federal, state and local grants.
But our doctors, nurse practitioners, certified nurse midwives, physicians assistants, and dentists all have the same stress and challenge of trying to do everything, every day. We clearly need to invent something new.
END OF POST. THANK YOU FOR READING.
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