the journal artice leading this post measures quality care as the percentage of health screening tests that were ordered or doumented.

The above poster sees quality care realted to good listening skills, empathy, and humility.

ahard to provide both types of quality in rushed office visits

bottom line: Quality care as defined by anyone is more likeley to be practiced if the practioner is given enough time

http://www.ajph.org/cgi/content/abstract/93/4/635

He was young and an osteopath and works in clinic with about ten other IM drs. He talked with me for almost thirty minutes, explained that he really didn’t know what was wrong with me, agreed that it is really, really odd, then asked me ” As a scientist you’ve done a lot of research on this, what do you think is going on?” I almost fell off the table.

He listened to me talk and didn’t treat me like an idiot or a hypochondriac. He looked at the labs but then listened to my clinical symptoms as well which in several cases contridict the lab results. Then we discussed a possible underlying genetic disorder in my family, normally asymptomatic in women, but exposed in a case of extreme hypothyroidism.

Mostly he just listened and respected what knowledge I could provide. wow! is this what drs are supposed to be like? Bravo!

so the question is then how does one convince or force physicians to choose primary care…and then how do you incent them to stay in primary care. ?

“Healthcare is highly fragmented. Let’s say a person with asthma or high blood pressure or diabetes sees several doctors,” says Berwick, whose organization is working to reduce the numbers of preventable deaths among hospitalized patients. “They don’t share common records, they don’t share information, and the ball gets dropped.”

Dr. Centor, this post illustrates some of the things I’ve been saying for a long time – from hospitalists right on through specialists.

Going back to the original generalist model and cutting out specialists unless there’s a very urgent need would help balance things.

As a patient with a chronic illness, I was shunted off to 7 different specialists in about a year and a half. I was finally able to discern what the underlying medical problem was, but I’m fairly certain that none of my physicians tied it all together, because none of them saw the entire picture. That’s a pretty scary realization, from a patient’s perspective.

A friend who is a physician sent me a link to a chart earlier this week – http://www.aafp.org/match/graph05.html – and told me that in a few years, primary care will be managed by mid level providers. If my PCP can’t tie things together, then I’m supposed to trust a PA to do so?

Health care is crumbling. It’s hard to pinpoint one particular cause – there are too many. But it’s not too late to restore some balance, and really, it needs to be done soon.