What Happened to Primary Care?

In the 16th century, Tibetan physicians stated that a group of diseases called "Nyen" would spring up toward the end of the 20th century. Nyen diseases were defined as "diseases with no known cause

In the 16th century, Tibetan physicians stated that a group of diseases called "Nyen" would spring up toward the end of the 20th century. Nyen diseases were defined as "diseases with no known cause and no known cure."

It's just one glimpse into ancient prophecies pertaining to our modern lifestyle. We've heard many.

In the early 1970s, while we were meeting with one of the chief African witchdoctors, he prophesied that "huge changes would occur in the Western medical system by the turn of the century." No big deal. Lots of people were predicting changes and simultaneously trying to prevent them.

In the early 1990s, primary care was heralded by many — ourselves included — as the solution to rising medical costs and multiple specialists. Encouraged by the Clinton foray into health care reform, hospitals began buying primary care practices in droves, trying to control costs by controlling the "gatekeepers" themselves.

What Happened?
In terms of predictions, it turns out that the Tibetans and the witchdoctor were correct. Yet primary care as a solution to all health care woes wasn't the answer.

Over the past few years, we've witnessed a rocky marriage between the previously divergent paths of primary care physicians and hospital groups. Financially, these partnerships have been disastrous, losing money from the beginning. One could argue in general that almost everyone in health care is losing money these days, so it's easy to create scapegoats — especially those that reduce staffing or nursing needs.

But all of this has been done to reduce the bottom line. After all, medicine is a business, and in business all that counts is the bottom line. Right?

Somewhere in between demanding total health care for a $10 office co-pay and decreasing medical reimbursement due to rising costs, the very soul of medicine seems to have been lost.

Recently, Western medicine has been caught in another crosscurrent of two other colliding paths — those of primary care physicians and alternative medicine providers. A study done by David Eisenberg at Harvard University in 1990 showed that more people were seeing alternative medicine providers than primary care physicians. A follow-up study conducted in 1997 revealed that the trend is continuing.

A Prediction for Cincinnati
In terms of reimbursement, Cincinnati has a reputation as being one of the worst places for physicians to practice in the United States — the result of pressure from big insurer groups and a fairly closed marketplace. Doctors here are facing unforeseen rapid and tumultuous changes. We've personally witnessed and experienced the closing of offices and the loss of physician, nursing and other personnel jobs, each with its ensuing pain. Yet the demand for higher standards and lower costs persists.

Big cracks are about to appear in the system. The end-point in this process will be the consumer, the very patient who needs it the most.

We know that Greece, which spends one-tenth per capita on health care costs as compared to the United States, outperforms the U.S. on most major health care indicators. Why is this? Is there an answer?

We don't have a solution to our country's current health care issues, nor do we pretend to have one. It appears that changes will be directed predominantly by external market forces until a huge crisis looms.

We do, however, advocate an answer — and that's to be aware of your own health.

Pay more attention to how you live, how you eat and how you breathe. Health care is more than end-of-life or crisis intervention. Improved economic indicators aren't always accompanied by improved health care statistics, especially when we look at our society's lack of clean air and water, increased commuting time, anger and high frustration levels. An article published in the March 2000 issue of Journal of the American Medical Association offers insight into this issue: Coronary artery calcification has been directly correlated with hostility levels.

So where do we go when pursuing this elusive sense of good health and well-being? We believe that the answer is to create your own health care team, with you at its center, surrounded by various health care providers. When you see a physician, be aware of his or her time constraints. Perhaps write down your symptoms prior to your visit so you can remember key points and help your physician work with you for a quick and effective solution. Your physician will appreciate it as well.

Learn to access reputable sources of knowledge so you can learn more about your diagnosis and possible treatment options. Be aware that the Internet is both a wonderful and problematic source of medical information.

Learn to slow your life down. Eat a fresh and varied diet, exercise moderately and stretch. We also believe that utilizing complementary and alternative therapies might have great results in terms of health care benefits. Massage, gentle manipulation, acupuncture, energy healing and relaxation techniques all have been shown to produce good health care benefits, as well as an improved sense of well-being.

Ultimately, your own consciousness is the driving force in health care. Learn to work with your own emotions and sense of spirituality. Develop a physical and emotional environment that's nurturing.

And, by the way, good luck!

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