There Are Three Kinds Of Primary Care

Check this out. What you will see is a fascinating little piece by our old friend “The Country Doctor,” pictured here. In it, he explains the three functions that a PCP serves. Sick Care, Chronic Disease Management and Disease Prevention and Screening are all inherently parts of being a Family Physician.” Goes without saying. BUT. The real point of this piece is that the emphasis that is placed on each of these areas of practice requires some careful thought and is really situation specific.  

For example. “Sick Care” is what immediately comes to mind when most people think about primary care. The rapid proliferation of Doc-In-A-Box facilities and telemedicine, both of which are focused on immediate care for the sick, are supportive of this perception. Sick Care is sort of all they do.

On the other hand, at Hilton Head Island’s Volunteers In Medicine, where I am proud to be on the Board of Directors, we emphasize the other two functions. Given that the majority of our 10,000 patients are underserved minorities, we feel that we can do the most good by helping them to manage conditions like hypertension and diabetes, and by making sure that they get screening procedures like mammography done according to guidelines. Sure, we treat the sniffles too, but that is a secondary function.  

In most private Primary Care practices, as the good doctor points out, there is a real issue of the availability of time to perform all of these functions, so prioritization becomes extremely important. For example, Disease Prevention, if left to its own devices, can be very time consuming. Because of its “routine” nature, this post suggests that an MD degree is not required to perform this function. Support personnel and media like emails and letters can meet this need very adequately.

Bottom Line. SO. Again, the optimal emphasis of primary care really comes down to “setting.” As usual, reading Dr. Duvefelt’s piece got me to thinking. What is the primary value of being a member of a “concierge” practice, such as the one of which I am fortunate to be a member? Is it more the ability to get a same day appointment if you are sick, or to have a doctor with time available to service you in all of these three areas? I am thinking the latter. 

The title of this post is correct. We should in no way confuse the three functions of primary care. Rather, we should consider each of them and decide, for a particular practice setting, which should be emphasized.  

“Horses for courses!”

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