David D. Norenberg, MD
Medical school graduates are avoiding primary care. The very aspects that once attracted students have been subverted. The breadth of practice that was once appealing has become the breadth of heavy-handed scrutiny, as politicians and business leaders have demanded qualityâ€”simplistically defined as dogmatic adherence to a standard. Individualized clinical judgment has been devalued; thinking has been replaced by algorithms. Practice guidelines have been usurped by pay-for-performance police, on patrol for deviationsâ€”not understanding that knowing and allowing for exceptions is the heart and soul of primary care. The coercive surveillance of â€œQuality Improvementâ€ has become oppressive, making single organâ€“system specialties increasingly attractive (or at least more tolerable). Generalists are spending so much time proving they are good doctors, they don't have time to be good doctors. A remedy is suggested: a pilot project of volunteer salaried internists (more trusted, less audited) commissioned to our expandable national health care program, Medicare.
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Norenberg DD. The Demise of Primary Care: A Diatribe From the Trenches. Ann Intern Med. 2009;150:725-726. doi: 10.7326/0003-4819-150-10-200905190-00011
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Published: Ann Intern Med. 2009;150(10):725-726.
Healthcare Delivery and Policy, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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