Tuesday, June 14, 2011

The underrepresentation of primary care

Like many in the FM world, I was saddened to learn yesterday of Dr. Barbara Starfield's death.  Also, like many in the FM world, I was disheartened to see the scant amount of coverage in the medical news sphere about her passing.

Dr. Mike Sevilla had a great post on this same subject yesterday.  He included links to Dr. Starfield's research and an embedded video of her receiving the FMEC Lifetime Achievement Award:
http://www.familymedicinerocks.com/family-medicine-rocks-blog/2011/6/13/passing-of-family-medicine-friend-our-silence.html?lastPage=true&postSubmitted=true

I left a small comment at the bottom of Dr. Sevilla's post that I'd like to expand upon.  It's baffled me for years that Dr. Starfield's findings have not enjoyed greater publicity in the lay press.  With all of the national chatter about heath care costs, why hasn't the media broadcasted the message of primary care's cost-saving and health-prolonging benefits?

Her findings are pretty darn news-worthy:
US counties with more primary care docs per capita have lower mortality rates; counties with more specialists per capita, well, don't.  (1) 
Inappropriate medical interventions (unnecessary medications and procedures) - which are more likely to be done by specialists - are actually the 3rd leading cause of death in the US.  (2) 
After controlling for other factors, Canada's better health equality (compared to the US) is likely due to its robust primary care infrastructure.  (3)
Instead of sharing these critically important findings, however, the lay press focuses on health scares (cell phones!  tanning!  meningitis!) and picking apart the the Affordable Care Act (you'll have to pay for insurance!).  Sure, occasionally a primary care story makes the national media rounds (remember Dr. Gawande's NY Times article about Dr. Jeff Brenner? [4]).  Apparently, though, robust primary care doesn't sell ad space as well as bedlam and furor.

Perhaps we're not selling primary care correctly; after all, primary care is downright fascinating.  Yesterday I treated a child's asthma exacerbation, buddy taped a middle-aged broken toe, and juggled an older patient's insulin doses.  Today I could see a septic newborn, someone with a psychotic break, even someone having a heart attack.

And infinitely more interesting than the diseases are the people.  The professor whose trigger finger is keeping her from her enormous garden.  The college athlete whose football talent made him the first in his family to get past high school.  The 40-year-old who became a mother (again) and a grandmother in the same week.

These sometimes brave, sometimes witty, and always genuine human beings pepper our careers with depth and meaning.  Their stories happen countless times every day in primary care offices across the country.  I applaud the primary care bloggers out there (some of whom are featured in that column to the right of these words) who are fearlessly sharing our stories and perspective with a wider audience.

What might happen to our national sentiments about health care if the lay press started picking up on those stories?

http://content.healthaffairs.org/content/early/2005/03/15/hlthaff.w5.97/suppl/DC1
http://bostonreview.net/BR30.6/starfield.php
http://content.healthaffairs.org/content/29/5/1030.abstract
http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande

3 comments:

  1. I think that the biggest problem is a corollary to the media mentality of "if it leads it bleeds." Happy stories about family doctors treating interesting patients don't sell newspapers or get people to come back after commercial breaks. You're going to have to come up with a better hook, like the ones about cost savings.

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  2. Well phoo, I realize upon re-reading that you just said that up above. So much for being insightful. Score one for subliminal messages!

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