The U.S. Health Care System Isn’t Built for Primary Care⁠↗

Primary care is unique in health care. It cannot be managed the same way as other parts of health care where the emphasis has rightly been on streamlining and cutting waste from a bloated system. At the heart of primary care’s success remains a unique relationship between physicians and patients built on trust.

Primary care interactions, more so than in any other discipline of medicine, cover a vast territory. Both physician and patient bring an agenda, and conversations often become tangential and circle back. Attempts to make this interaction more “efficient” through technology and processes superimpose artificiality and rob the physician of the very responsibilities they are trained for — to build a bond of trust and ultimately influence healthier, life-giving behavior.

Checklists and templates may bring value for specific services, such as ordering a mammogram or administering vaccines. But the emphasis on discrete services and processes should not come at the expense of timely access to comprehensive longitudinal care with a physician you know and trust; we must not lose sight of the long-term outcomes in the quality and cost of care that should be the priority. In fact, I often joke that consciousness is a good place to draw the line: By all means use a checklist during surgery or in the ICU, but if your patients are awake and talking, listen to them.