How primary care needs to change

Theresa Chan left primary care for greener hospitalist pastures. Can’t say I blame her, with the current deck stacked against generalist physicians.

The question is, what will it take for her to re-enter the field, and can enough change to make primary care enticing to prospective doctors?

One area she touches upon are the bugs with electronic medical records version 1.0. It’s been mentioned before, but the problems with the current crop of programs are a real obstacle. Here’s one example:

Providers using EMR as a crutch, not a tool. One example would be over-reliance upon progress note templates within an EMR. If an individual doctor of mid-level chooses to rely upon pull-down menu choices, the resulting progress notes will read as “CC: f/up meds, S: No c/o, O: AVSS, NAD, CTAB, RRR, Abd SNTND w/NABS, A: HTN, incompletely controlled, P: Increase ACEI.”

With the economic burden electronic records place on doctors, the financial benefits are emphasized. This normally means using EHRs solely for better coding and reimbursement, which is not to the patient’s benefit.

Next, the realities of the payment system are incongruent with patient expectations. Physician practices are dependent on quantity and volume. This lends itself to “conveyor belt”-style primary care that is predominant. The limitations of the 15-minute office visit, which is the basis of most schedules, need to be understood.

At the very least, patients need to accept the dynamic between waiting for the doctor and face to face physician time. It’s impossible to have both, so expect long waits if you want the doctor to spend time with you. The opposite is also true, as punctual doctors spend less time with patients.

There are doctors at both ends of the spectrum, so choose one that fits your expectations.

Hard to say what the future bodes, but it’s safe to say that unless these issues are addressed forcefully and becomes a top priority, more doctors are going to continue leave primary care in droves with few medical students willing to take their place.

topics: primary care, electronic records

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