On the value of primary care

The New Yorker published another piece of Dr. Atul Gawande. In the piece, Dr. Gawande covers a number of related topics, and of particular interest to me was the importance of relationships in health care. Dr. Gawande lists some evidence showing that populations that have better access to primary care tend to have better health, and he then raises the question of why: what benefit does a primary care physician offer over direct consultations with specialists? By observing a primary clinic in action and talking with its staff, Dr. Gawande comes to the conclusion that the core advantage comes down to long-term relationships. While specialists theoretically should be able to more accurately diagnose and treat patients who have ailments in their own areas of expertise, primary care physicians have recurring contact with patients over long periods of time. Among other benefits, this exposure allows primary care physicians to make small adjustments tailored to the patient's progress and to follow up and investigate puzzling questions. After laying out this context, Dr. Gawande forecasts how health care can be different in the country, including why primary care physicians should be compensated more for their time.

An interesting implication of this analysis is that rapport with one's primary care doctor might be unexpectedly important. The physician might have all of the necessary credentials and then some, but if the patient does not feel comfortable disclosing relevant information and engaging in the process, the patient might be forgoing the main benefit of having a primary care doctor.