By HANS DUVEFELT
I suspect that the notion of calling for more limited specialties is quite different from mine. Surgeons operate, neurologists treat diseases of the nervous system, even as the methods they use change over time.
Primary care has fundamentally changed since I started. Others, in fact, have modified the definition of what primary care is, and there is a growing mismatch between what we imagine and what we train ourselves for and what we are now being asked to do. Our specialty is often the first to see a patient and also the last stop when no other specialty wants to deal with him.
We have also been asked to do more public health, more office work, more protocol-based pseudo-care and pseudo-documentation, such as current forms of depression screening and follow-up documentation. And don’t help me get started with the Medicare Annual Wellness Visit. How can we follow rigid protocol and be culturally and ethnically sensitive at the same time?
We are less and less valued for our ability, by virtue of our education and experience, to take general principles and apply them to individuals or individual cases that are not like the research populations behind the data and guidelines. The cultural climate in healthcare today is that conformity equals quality and thinking outside the box is not welcome. The heavy-handed mandates imposed on our ongoing screening and evaluation run the risk of eroding our patients’ trust in us as their confidants and advocates. The delicacy and sensitivity of the wise old-fashioned family doctor is gradually disappearing.
The call to primary care medicine, if it is not going to pave the way directly to professional burnout, today should be a bit like the call to be a missionary doctor somewhere far away:
Entering a sometimes hostile environment, without adequate resources, where people do not speak your language, where you never feel like you can do everything you hoped to do for your patient, and where some of the things you want to do may even run into cultural taboos or politicians.
In other words, doing what we can in the moment for each patient, regardless of the system and circumstances.
That is a very noble call, but not for the faint-hearted.
Hans Duvefelt is a rural family physician of Swedish origin in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.