When it came to being your family doc, I tried darn hard to do it all. I delivered your babies, took care of you in the hospital, palpated your parts, and much more. If space aliens had flown out of your navel I would have tried to fix that problem for you, too.
Unfortunately, it turns out that what I thought was pretty good care for you has not been good enough. I could not do enough comprehensive care of my patients with diabetes, high blood pressure, heart troubles, or other chronic diseases to help them avoid some preventable complications. Too many of my patients with congestive heart failure ended up in the hospital too often. I thought I was doing a great job, but I was wrong. Smart and dedicated, but wrong.
So were many thousands of my colleagues in primary care — the family docs, internists, family nurse practitioners and physician assistants who have been working like demons providing preventive and chronic illness care for millions of Americans. We practiced good care to the limits of our training and our resources, and it was not enough. Study after study started showing we were not doing nearly as good a job as we hoped.
When we figured that out, we did what good doctors always do; berated ourselves and worked harder. Pirates would have been impressed as we flogged ourselves until morale and performance improved. It barely helped. So we did it some more, which barely helped some more, but not enough.
Now, slowly and surely, we are coming to understand what it really takes to take great care of you in your primary care physician’s office — a whole darn team. That’s a team of nurses, medical assistants, office staff, computer geeks, and all the other people around town in emergency rooms, hospitals, specialist offices, labs, etc. that also help take care of you. And it takes you, too, more than ever. Your primary care is a team sport.
Nothing but a real team can keep all of your information straight, keep in touch with you often enough to keep your health front and center, and keep everyone else taking care of you coordinated so they know which of your ends is up. It takes a team to check in frequently with patients living on the health care edge, to know when they are getting in some trouble, and then rapidly arrange an office visit so we can get things turned around before such patients are in big trouble and in the emergency room in the middle of the night. It takes a team to troll through the 2,000 patients of a typical family doc to find all of the ones with blood sugars or blood pressures under poor control, and get them engaged with more focused and intense care, and with the kind of success that might save their feet, kidneys, eyes and hearts from the ravages of poorly controlled diabetes.
So there are going to be more people directly involved in your primary care than ever before. The staff at the front desk of your PCP’s office might ask if you are up to date on your mammogram, and schedule it right then and there if the answer is, “No.” The team nurse will be calling you to see if you are accumulating fluid in your legs or lungs, and telling you to take some extra fluid pills and see your PCP tomorrow if the answer is, “Yes.”
Your PCP will direct that team with you, but your care cannot be as good as it needs to be without you, your PCP, and that team working in real, continuous concert. You and your PCP will have to work to keep your relationship intact and meaningful despite more involvement of others in your care.
You will have to be more interested than ever in your health, more driven than ever to get to your health care goals, and more connected than ever to the PCP team. You, me, a new team — together we can do a much better job taking care of you than I ever did alone. Thanks for the help, at last — I was getting very tired.
Erik Steele, a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.