The HOWs and WHYs of Primary Care

We often think of primary care doctors as our hometown physicians - the pediatricians, internists and family practitioners that serve as the front line of patient care and treatment. For me, my first point of contact with the medical world entailed a visit with Dr. Kielar, the white-coated, bushy-bearded family medicine physician who served my small, 10,000 person town. Dr. Kielar ran his private practice on his own and was a recognizable figure about town; everyone at some point or another brought their colds, allergies, and school physical forms to Dr. Kielar.

This hometown doctor model of primary care is familiar to most, quaint and unexciting to others. Tuesday's discussion with several HMS affiliates dedicated to primary care, however, suggested that we should broaden our understanding of primary care beyond the one-physician operations that dole out our albuterol and vaccines. Instead, the speakers at Monday's event touched upon about new, medical team-based models, primary care physicians as important agents of driving down healthcare costs, and the increasing interest and value of incorporating lessons from public health and business into medical degrees. As the physician and two HMS students elaborated on, primary care provides an arena for important research on social determinants of health and the use of information technology in health, as well as a stage for social justice efforts. Most striking were the parallels Dr. Andrew Ellner drew between primary care and a field of increasing popularity amongst undergrads: "Global health is primary care." For medical students and doctors traveling abroad, taking on global health endeavors meant becoming that first line of medical response for those who otherwise would not have access to health care - and without the ample personnel, equipment, and resources typically available in American hospitals and clinics.

Whereas the Dr. Kielar model of primary care certainly still exists, the general theme that the speakers ultimately highlighted is that primary care is an advancing, changing field that will be crucial to tackling domestic and international health care concerns in the future. At Harvard, this change is taking place through the work of dedicated faculty and medical students - not just the white-bearded, small town doctors - and championed by groups like Primary Care Progress and the Center for Primary Care. Thanks to an anonymous $30 million donation granted to Harvard in the name of advancing primary care, these initiatives will become fixtures within Harvard culture as they attempt to make in an impact in a broader medical context.

Interested undergraduates can seek out learning experiences from groups such as those listed above as well as OCS.

-Emmett Kistler '11, Comparative Study of Religion, Eliot House

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What exactly is primary care and what should future physicians know about this ever-changing and dynamic field? This, among many other questions, was the focus last Tuesday when affiliates from the HMS Center for Primary Care came in to talk about their experiences thus far in primary care and to give advice to other aspiring physicians.

The event began with a brief primer on the state of primary care from Dr. Andrew Ellner, interim co-director of the Center for Primary Care. As a primary care physician (PCP) himself who has worked both domestically and abroad, he pointed out some of the flaws of the current U.S. health care system. The U.S. spends almost twice as much as any other country in the OECD, yet our outcomes are subpar for a multitude of indicators. The most frequently cited indicator: life expectancy. But what was more important were his views about why we actually see these trends for the United States. And the answer, as the data points out, is the behavioral aspect of how individuals interact with our medical system. It is fraught with ultra-specialization, where incentives revolve around emerging (and expensive) biomedical technologies and procedures rather than enhancing holistic medical care (e.g. the likes of family medicine, internal medicine, and pediatrics) that is more cost-efficient.

With these big-picture ideas in mind, students were able to ask more focused questions about the intricacies of primary care. This was an interesting discussion because in addition to Dr. Ellner’s thoughts, there were two HMS students, Deep Shah and Janine Knudsen, who were in the process of their own medical training. A lot of the students’ questions ran the gamut, from the stigma of going into primary care to the connections of global health and primary care to the benefits of taking a year (or more!) off.

One of thing that all panelists hoped to get across to students was that the necessary policy changes are being put in place to level the playing field among specialties, especially in the financial realm. As Deep put it, “There can be a lack of understanding of the health care system and how PCPs fit into it. Nevertheless, this perception of primary care is changing. But when it comes down to it, when you think about what being a doctor actually means to most individuals, primary care really fits this vision quite well.” Janine echoed these sentiments, talking about her experiences working with the Crimson Care Collaborative as well as her experiences helping a PCP improve the efficiency of his practice.

Throughout all of these questions and conversations, the panelists did a wonderful job of embodying what primary care is and how it is going to redefine the face of American health care in the coming years. At the end of the event, there was a concrete message for students: as broad-based policy reforms and funding initiatives take effect, the field of primary care will have opportunities for all of us to make the medical system a more interactive and user-friendly environment for patients.

-Vishal Arora '14, Economics, Pforzheimer House