Primary Care Shrugged

I remember reading Ayn Rand's Fountainhead as a senior in high school.  I voraciously lapped up every word, every movement of her protagonist, Howard Roark.  My adolescent yearning for identity and integrity meshed well with the book's message.  The black and white morality fit well for one who was unable recognize shades of gray.

My freshman year of college, I read Atlas Shrugged.  And again, I found that Rand's words reverberated deeply in my soul.  I so wanted to believe that the able few drove the motor of the world.  For the rest of the poor slobs, it was either put up or get out of the way.  I was young and very impressionable.

As I grew older and experienced more, I began to change.  The simplistic morality play in Rand's novels started to feel crude.  Sometimes the poor and uneducated suffer their lot in life despite their best intentions.  Sometimes will and ability are just not good enough.  And luck often prevails over skill.  I became an adult and my sensibilities changed.

Strangely, as we talk about the state of health care in America, I find myself coming full circle.  There is whispering about a Primary Care revolution.  The pundits are already starting to critique the next steps of the movement.  Primary Care will arise again and become the lynch pin of a new era.  Affordable, practical, evidence based medicine will follow shortly over the horizon.  We are saved!

But if you ask me.  I think a little differently.

I think Primary Care shrugged long ago.  We just now are beginning to see the effects.

How else do we explain the drop in training in outpatient medicine and family practice?  What other forces explain the overuse of diagnostic testing and high utilization of referrals instead of deep thinking?

Many may have stayed in practice because of economic necessity,

but the heart of the speciality is gone.