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

"What freshman doesn’t think that she can do anything and everything?"

To be honest, I have a hard time remembering the specifics of the whirlwind that was freshman year: I have vague recollections of excitement, happiness, insecurity, and confusion. But the one thing I do remember is that by October, the once-majestic Sanders Theater was merely a Life Sci lecture hall seating a sea of freshmen and problem sets were already the bane of my existence. I remember my frustration with feeling that I had an obligation to prioritize my science classes over all else even though I found that reading for my Hebrew Bible class was the only schoolwork I really enjoyed doing. So despite my parents’ fears that I was abandoning my plans to become a doctor to instead become a priest or to join a cult, I reassured them that I could concentrate in the comparative study of religion while being pre-med. After all, what freshman doesn’t think that she can do anything and everything?

While trying to survive on a few hours of sleep and over-committing myself to various extracurricular activities proved to be unsustainable, it turned out that if anything, being a non-science pre-med was possible. Of course, I was fortunate enough to decide this rather early on in my Harvard career, as planning a four-year schedule that fulfilled all requirements for my concentration, secondary (in chemistry), med school, and cores was crucial in making it all happen. It would have been nice to have more room for electives, but I was already taking so many classes that I absolutely loved that I did not mind. Being a religion concentrator was rewarding in so many ways—the contrasting workload for my religion classes and science classes kept me from getting too bored of either, I loved the attention I received from the faculty, and the small department provided a close community as I developed relationships with the seven other religion concentrators of my year.

Most importantly, it constantly challenged my plans and desire to pursue medicine. Being passionate about another field of study made me question if medicine was really for me. Though doubt and uncertainty are not the most comfortable of feelings, I’m glad I experienced them. It pushed me to give myself some flexibility to consider other career paths and the possibility of study abroad. After some exploration in the food industry and an amazing semester abroad in Israel, when I came back to the pre-med track, I did so with conviction. It was only when I allowed myself to fully pursue my other academic interests but found myself a pre-med once again that I felt like I had made an active decision.

I want to encourage all students considering the pre-med track to feel empowered to and give themselves the opportunity to explore other interests without guilt. If anyone has the privilege of taking risks and stretching limits of comfort zones, it should be Harvard students.

—Paula Bu, '12

Introducing Paula

Hi, I’m currently a senior in Quincy House, concentrating in the comparative study of religion with a secondary in chemistry and I plan to apply to medical school next year after graduation. Throughout my time at Harvard, I’ve had the opportunity to explore my interests in science and health in a variety of ways: I’ve co-directed the Health Advocacy Program, an organization that aims to teach Boston middle school children about healthy eating habits, I’ve worked in the HEB Nutrition lab my sophomore summer, I’ve shadowed at MGH, and I’ve worked with Unite For Sight in Chennai, India. While these experiences were undeniably enriching for a person who was seriously considering the field of medicine, there is still a certain level of disconnect I feel with the label of being a “pre-med.”

I’ve also spent much of my Harvard career traveling, being involved in interfaith initiatives, and exploring my passion in food. Spending my junior spring semester abroad in Jerusalem, Israel, was singlehandedly the best decision I had ever made at Harvard and was an experience that critically informed my thesis for the study of religion, all the while solidifying my desire to become a doctor. I would love to talk about my experience as a non-science pre-med and as a student who has gone abroad. I am also currently working on my thesis (which is on Jews and sustainable eating), so if you are interested in any aspect of my experiences or have any questions, please don’t hesitate to contact me!

Introducing Meg

Hi! I’m Meg and I’m a junior in Dunster House concentrating in psychology with a secondary concentration in Spanish as well as pre-med. On-campus I am a Research Assistant in the Lab for Developmental Studies where I help run studies on child development, co-direct the PBHA program Harvard Emerging Literacy Project that sends volunteers to read in local Head Start pre-schools, and work as a student adviser at the Office of International Education. I am also a member of the Women’s Club Soccer team. I spent the spring semester of my sophomore year studying abroad in Alicante, Spain taking Spanish language and culture classes. I spent this past summer participating in the DRCLAS Summer Internship Program in Lima, Peru, where I interned at a child therapy center shadowing physical, speech and occupational therapists. I plan on taking a year off before applying to medical school, but am unsure how that year will be spent. I would love to talk to you about studying abroad as a pre-med, being a non-science concentrator, or pre-med in general at Harvard!