Saturday, August 29, 2009

Can You Recognize Primary Care When You See It?

Wired has an article discussing the market advantage of cheap, simple solutions over more expensive, feature rich products. The thesis of this argument is that we consumers prefer the quick, easier option most of the time and only rarely desire the more detailed, fancy choice. Their first example describes how photography enthusiasts may demand the more powerful DSLR cameras, but the average person prefers the simple point and shoot cameras for their ease of use and lower price point.

Another example they describe is the new Kaiser Permanente "microclinics". Kaiser Permanente is described as
the largest not-for-profit medical organization in the country, Kaiser has long relied on a simple strategy of building complete, self-sustaining hospitals—employing 50 doctors or more—in each region it serves.
These microclinics are run by two doctors and set up in strip malls. They share electronic medical records with larger regional Kaiser Permanente hospitals, but do not contain a radiology department, pharmacy, or any additional features you would expect from a hospital. The wired article reports that
What they found is that the system performed very well. Two doctors working out of a microclinic could meet 80 percent of a typical patient's needs. With a hi-def video conferencing add-on, members could even link to a nearby hospital for a quick consult with a specialist. Patients would still need to travel to a full-size facility for major trauma, surgery, or access to expensive diagnostic equipment, but those are situations that arise infrequently.
This microclinic is being heralded as an amazing step to reducing costs and simplifying health care for patients. However, I don't understand how this is different from primary care? Aren't these "microclinics" simply doing the job of a family physician? Family physicians are easeier to access than specialists in the hospital (or at least they should be!). They provide preventative care and establish a long term relationship with their patients. They treat the average patient's needs and consult with specialists in the scenarios that are beyond their professional scope. This is the role of a general practitioner. They are vital to our health care system, but I don't think the general public sees their importance. Patients sometimes even view their family physicians as obstacles to reaching specialists who are the "real doctors". This could not be further from the truth.

I strongly believe that strengthening primary care will reduce overall costs of health care, but I think primary care needs to do a better job of marketing themselves so the public understand their value. Otherwise, you get articles like this, that praise Kaiser Permanente for re-inventing the wheel.

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