Out of Practice: Fighting for Primary Care Medicine in America

This compelling plea for primary care medicine reveals a disturbing situation: "Primary care medicine is collapsing, a victim of economists' tenets of maximized efficiency, profit, and productivity." The system will be further strained by the large numbers of aging baby boomers. Barken uses his own experience as a physician who retired early at age 51 due to dissatisfaction with the current situation to illustrate the state of his profession. He finds it overwhelmed, underfinanced, and ill-equipped to deal with older patients suffering from complex medical issues. Barken warns that doctors, patients, and politicians will have to accept that the primary physician's role must change, that a bigger health care industry isn't necessarily a better one, that malpractice liability, along with its high costs and demoralization of doctors, must be reined in. Primary-care doctors must resist the pressure to prescribe too many drugs and must manage a plethora of specialists who want to administer overly aggressive treatments that have little impact in prolonging life or making patients more comfortable. Physicians treating aging patients must also see them not as solitary units but as part of a well-prepared, involved family. In the end, he says, American health will be saved by its most important virtue: a strong physician-patient relationship. (Apr.)