How a model of multidisciplinary team based care may save primary care

I didn’t expect to bump into “Max” on the streets.

“I was kicked out of the house by my wife,” he sighed. Max shifted around on his feet, eyes puffy and cheeks pink.

“Did you start using again?” I asked.

Max looked down and didn’t say anything. In the three years I had known Max, an alcoholic and former drug user, he had been clean. But recently he had started struggling. He lost his job, began drinking again, experienced episodes of depression, couldn’t afford medication for his diabetes, and became overweight. Now it appeared that he was using heroin and was homeless.

In my work with drug users in Boston through the Prevention and Access to Care and Treatment (PACT) program, I encountered many individuals like Max. I remember thinking to myself, how could I even begin to help them? When I entered medical school and thought about which field could address the spectrum of problems that people faced, I turned to primary care.

As a first-year medical student, I have not had any clinical experience, but I have observed that primary care physicians (PCPs) are able to see patients beyond their individual medical problems. Because PCPs develop a strong understanding of their patients over time, they are able to take a holistic approach to illness and manage the intersection of various disease and problems. In Max’s case, a PCP could connect his story together – that he lost his job which caused him to become depressed and take up drugs again – and find ways to tackle not just his problems with substance abuse and diabetes but also his socioeconomic problems of unemployment and homelessness.

Perhaps PCPs are no longer the all-knowing healers that they were a generation ago because today, there is simply too much to know. However, a new model of multidisciplinary team-based care is evolving to accommodate the important role of PCPs and allow them to tackle issues that fit within their interest and expertise.

Ultimately, what attracts me to primary care is the chance to work on the frontlines of medicine and to develop a solid relationship with the local community I’m working with, allowing me to not only better understand my patients but also to connect them with vital resources. Although fewer medical students are pursuing primary care, doctors I’ve talked to predict a revival of the field. I am encouraged by the efforts of medical schools, including Harvard and the University of California, San Francisco, to devote resources, energy, and time to primary care innovation and research, and by the World Health Organization’s 2008 report calling for more PCPs around the world to address issues in health care delivery. I see the current problems in primary care not as a disincentive but rather as an opportunity to go into this field, improve our health care system, and provide better care for the people we serve.

Unfortunately, I haven’t seen Max since that chance encounter on the streets, but I know that a strong primary care system would greatly help provide the resources and services that he and all of my future patients need.

Eric Lu is a medical student who blogs at Elusions.

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