Practice under Pressure: Primary Care Physicians and Their Medicine in the Twenty-First Century

Practice under Pressure: Primary Care Physicians and Their Medicine in the Twenty-First Century

Practice under Pressure: Primary Care Physicians and Their Medicine in the Twenty-First Century

Practice under Pressure: Primary Care Physicians and Their Medicine in the Twenty-First Century

Synopsis

Through ninety-five in-depth interviews with primary care physicians (PCPs) working in different settings, as well as medical students and residents, Practice Under Pressure provides rich insight into the everyday lives of generalist physicians in the early twenty-first century- their work, stresses, hopes, expectations, and values. Timothy Hoff supports this dialogue with secondary data, statistics, and in-depth comparisons that capture the changing face of primary care medicine- larger numbers of younger, female, and foreign-born physicians.

Excerpt

Why a book on primary care? Because there is no other part of the health care system that is in greater trouble right now, and no other part that plays such an important role in people’s lives. Primary care always receives less attention than sexier specialty counterparts such as surgery and emergency medicine. a surgeon I once interviewed said his job consisted of “assaulting people.” He said the hardest decision he had to make was in knowing when to assault patients for their own good and when to leave them alone. Now that sounds like an exciting, rewarding, difficult, and life-altering job for the person brave enough to do it.

I once observed a group of emergency room physicians do their work at a local academic medical center. in between the routine emergencies came patients with dramatic penetrating wounds from knives and gunshots, blunt traumas from car accidents and attempted suicides, and emergent abdominal pains just hours away from a burst appendix or acute pancreatitis. This work, while boring and frustrating at times, also sounds pretty stimulating given its unpredictability and time-sensitive nature. and because of this appeal, these types of medical specialties get a lot of attention in the press, on television, and by writers and academic researchers.

But primary care medicine is still the unsung hero of our health care system, and primary care physicians (PCPs) are its main caretaker. It is a field of medicine aimed at preventing us from getting sick and taking care of us in the early stages of illness to reduce the need for expensive and intrusive health care services. Too bad the notion of prevention is out of vogue in much of American society at present—a society that gets unhealthier by the year. Primary care physicians may not deal much with acute life-and-death situations, but they are more important than any other physician in giving us a chance to avoid serious procedures such as cardiac bypass surgery or the amputation of a limb due to diabetes complications.

The current medical scene is not a pretty picture for primary care physicians or the medicine they practice. It will not get significantly better in the near future. We talk about national health reform in this country, and about the theoretical importance of primary care in stemming runaway health inflation and enhancing people’s lives. We talk about coming to the rescue with new money and gimmicky programs that are not based on any real evidence.

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