The day before, she’d had a whole body PET scan. Before that, it was a chest and pelvis CT. With her history of breast cancer, they were looking for metastases after she’d lost half her body weight in three years. She now weighed 97 pounds and looked like a skeleton with sun-bleached skin wrapped around it. When I asked her how things were at home she said: “It’s hard having a husband and a son with severe depression.” “Have you talked to someone about that?” – I asked. “Some,” she said. – “And has it helped?” – “A little”, she answered. “Well, has it helped more or less than the PET scan?” – I said. “Oh, much, much more.”
We have MRI and CT scanners; we have EKG machines and the ability to thread a catheter through a coronary artery at a moment’s notice – in time to save the life of a person who, fifty years ago, would likely have died in his or her loved-one’s arms – but these improvements exist only in the short term. We do well when it comes to ordering tests to uncover problems once they already exist. We have drugs for nearly every disease and more drugs being developed all the time. In terms of short-term care of an individual, the United States is second to none in the entire world; however, that measure relates only to surrogate markers that are not related to the ultimate clinical outcome: mortality. Thus, the US is second to none at addressing and aiming at false surrogate markers that improve neither the quality nor the quantity of life even though increasing the length of time a person lives, is certainly the goal of American medicine.
It’s time for a paradigm shift and the Affordable Care Act is a phenomenal tool to make that paradigm shift feasible. By supporting medical homes and accountable care organizations that focus on prevention and the quality of care provided rather than focusing on increasing revenue, the Affordable Care Act has the ability to push American medicine towards quality of care over quantity of patient visits and procedures, which have never proven to improve health outcomes.
Primary care doctors are the physicians who will make this paradigm shift possible because it will be their work, streamlining care and supporting people day after day in maintaining their health. These will allow the quality of care and thus the quality of life of Americans to improve.
Is it a hard job? Yes. Is it a scary job? Yes. Is it a rewarding job? The most! The reason is that you have to actually know what you learned in medical school. You have to understand why you’re doing a neurologic exam. You have to know what you’re looking for in a wellness check for a 16 month old versus a 3 week old. You have to be able to take care of men and women, gay and straight, funny and serious, those with families and big support networks and those who are completely alone in the world. And in so doing you will be doing the greatest work in medicine. When someone asks one of your patients who their doctor is, they’ll say your name. And when someone asks one of your patients what helped them the most in terms of their health, they’ll say: she listened or he was always willing to hear me out.
All you have to do is make sure you’re listening closely so you order the right test.
Autor: Dr. Owen Kendall