Primary Care Doesn't Always Mean Preventive Care
December 2, 2003
As medical knowledge proliferates, so do treatment options, which means that while the standard of care is rising, the ability of physicians to meet the standard is falling due to constraints on their time.
Primary care, particularly preventive medicine, is becoming untenable in the era of 15-minute office visits, say physicians. A study in the American Journal of Public Health estimated that it would take over four hours a day for a general internist to provide the preventive care that is recommended for an average-size panel of adult patients.
Furthermore, doctors aren't prescribing all of the tests required by practice guidelines:
- A study of 6,700 patients in 12 metropolitan areas found that the medical care for 30 different disorders, including diabetes, alcoholism and pneumonia, met national guidelines only slightly more than half the time.
- A recent study of family practice patients in Michigan found that only 3 percent of the women and 5 percent of the men over 50 had completed age-appropriate cancer screening tests.
- Nationwide, less than a third of older adults have had their stool tested within the past two years for occult blood, one of the first signs of colon cancer.
- Only 33 percent have ever had a sigmoidoscopy, even though recent research suggests that performing this test more frequently could detect more intestinal cancers.
Many primary care physicians have hired nurse practitioners or physician assistants to help them manage their patients. Some have started using e-mail to communicate with patients; others are experimenting with group visits.
But, with decreasing reimbursement and increasing medical liability costs, some doctors are asking, who needs the hassle?
Source: Sandeep J. Jauhar (M.D.), "That Ounce of Prevention Grew Too Big," New York Times, December 2, 2003.
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