It’s a fact - better primary care improves the quality and cost of our health. Study after study confirms the countries that make investments in primary care consistently rank above us. According to the World Health Organization, 36 countries deliver better care that’s more cost effective. When comparing them and us, one inherent difference stands out. Outside of entitlement programs like Medicaid and Medicare, our system is purely for- profit. It’s obvious that the insurance and drug industries are huge forces separating the doctors from their patients. But as a primary care physician for almost a decade, I see how the market itself has become the wedge that distance our patients from the quality of care they need.
One example is the exponential rise of urgent care centers around the large, urban area in which I practice. In this stagnant economy, many patients can’t afford to take time off of work, wait for hours in the doctor’s office, and then wait more hours at the pharmacy. Each step is one a sick, or even well, person would rather not take. In my market place, it’s common to see five urgent care centers within a ten mile radius. Even huge corporations like CVS have taken notice and set up their own minute clinics, staffed by nurse practitioners. In recent years, pharmacies have begun to offer vaccinations and even cholesterol testing, and consistently remind patients of these services first before proceeding to the other options on their voicemail.
Although the added value of their service can sometimes be appreciated when a patient is saved from a worse fate that comes with delayed treatment, we’ve traded the quality of the patient-doctor relationship for convenience. One of my patients was diagnosed with advanced lung cancer after he’d been to the urgent care clinics several times over the course of two years. At each visit, he was diagnosed with acute bronchitis and sent home with a script for antibiotics. No one inquired about his smoking status, strong family history of cancers or the frequencies of his bronchitis infections. Another example is a toddler who began treatment for her hip dysplasia past the most effective therapeutic time interval because her parents had been getting her vaccinations at the local pharmacy. These clinics and pharmacies fulfill their promise of quick, convenient service but can’t be substitutes for the real care that comes from a sustained and familiar relationship between patients and their doctors.