Primary Medical Care
Primary Care physicians can “investigate disease before the occurrence of any structural change in any organ of the body… in order to obtain knowledge of the circumstances that favor the onset of disease”
–Sir James Mackenzie (1853-1925), A father of primary care and cardiology
Apart from obvious emergencies, it is symptoms, problems, complaints and questions, not labeled “diseases,” that characterize the initial encounters between patients and physicians. “Symptoms are the language of disease”. You don’t have “it” until a doctor labels “it”! Primary medical care doctors are personal physicians who respond, treat, and manage the great bulk of these initial encounters. They provide comprehensive services to individuals and families over long periods of time—often lifetimes. Primary care physicians accept all comers no matter how frequent or trivial the complaint.
Family physicians, general internists and general pediatricians, and increasingly, nurse practitioners provide the great bulk of primary care in the United States. In other countries these arbitrary academic and professional divisions do not exist. Family physicians or general practitioners (a term rarely used now) constitute half or more of their nation’s clinical personnel. They recognize that primary medical care clinicians provide the essential underpinning of any rational, balanced, and cost-effective health care system. Virtually all other developed countries recognize this well-documented fact, but unfortunately the United States has created a seriously distorted imbalance with specialists and super-specialists predominating over primary care physicians. This costly, hospital-based, and error-prone system is in urgent need of substantial modification.
Life for primary care doctors in the United States has not always been easy and the financial rewards have been modest. All that may change as new practice patterns allow primary care physicians more satisfactory personal and family lives and fee schedules that are more realistic. A physician who is curious about the genesis and natural history of disease and illness, and who enjoys people and tolerates ambiguity would find primary care to be a fascinating and rewarding career.