What happened to primary care?

We tell our patients that our chiropractic practice is primary care for the musculoskeletal system.   The idea is that medicine is a disconnected mess when it comes to evaluating and treating what hurts us and what makes us feel ill.   I approach to care as a whole body problem so we are not likely to miss the reason you hurt and find sensible cost-effective solutions to your problems.

If your problem is medical, we would refer you to your primary care medical provider who years ago was the person who evaluated your blood, and your other organ systems and handled many of your basic needs medically.   While they rarely had the skills or experience to handle musculoskeletal problems, for many they were the first place patients were evaluated for those painful conditions as well. Some doctors continue to practice independently and work with these ideals while others now work as employees for larger systems.

Over the years, medical primary care went from keeping you out of the system to being the gatekeeper who in our American system, was the person who referred you around to specialists.  This costly medical merry-go-round has resulted in many expensive tests and concerns that often were diagnostic and costly, but rarely curative. The days of the primary care doctor spending an hour trying to look over everything in your file and help you figure out your problem have gone away, giving way to the machine we now are frustrated by.   Hospitals have purchased many medical practices and groups as well as wall street using this model to earn profits before patients.

A recent blog post I found asked the question of what is the point of primary care.  The blog looks at the British system vs the for-profit system here which amplifies costs for profits and tests too much without anything to show for it.  It is a thoughtful read.

What’s the Point of a Primary Care Doctor?

They seem to exist entirely to funnel patients to more expensive specialists—but it may be the consumer, not the healthcare industry, who’s really to blame for this, and we’re suffering as a result.

MEL Magazine; Chris Bourn

“I still don’t really understand what’s going on with the health system, and I’ve been here nearly five years,” says Alistair, a sports journalist who lives and works in New York City. An American citizen by parentage, but brought up in England, he says he’s only now coming to grips with the risky business of insurance. “In Britain you don’t need to understand it — you just go to a doctor and they treat you and then you go home. But here there’s co-pays, deductibles and all these words. It’s just not nice to have that extra stress when you’re ill.”

For someone who had never once had to pay for treatment, nor so much as glance at a medical bill or insurance form until he was in his 30s, Alistair’s experiences in American doctors’ offices have so far made him wary of physicians’ motives. “You’re always suspicious about over-treatment here,” he sighs. When he saw a dermatologist about a worrying mole, for example, it was recommended he undergo a procedure to have it surgically removed. But it wasn’t until afterwards that his friend, a qualified doctor from Australia (which currently holds the dubious title of the worldwide home of melanoma), told him: “That’s bullshit, in Australia they’d have scraped it off. They’ve completely over-treated you there so they could charge you.”

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