There’s a crisis in primary health care. In some cities, almost 90 percent of primary care physicians are not accepting new patients because their practices are full. And it’s only going to get worse, warns noted physician and emeritus professor of medicine Dr. Paul Griner , author of “The Power of Patient Stories: Learning Moments in Medicine.”
“In 2014, 32 million people currently without health insurance will become insured and there will be nowhere near enough primary-care physicians to meet their needs,” Griner says. “Less than 20 percent of new physicians are entering primary care, which includes the specialties of family medicine, general internal medicine and general pediatrics.”
Griner, an internist and longtime advocate of physician-patient relationship as the first and most vital diagnostic tool, says it’s important to find a doctor who will take the time to listen to you. But first, you need to decide what kind of primary care physician will best meet your needs. For instance, a family physician can care for both you and your children. A general internist is trained for the care of adults. A geriatrician has additional training in the care of older patients. A gynecologist may also have an interest in primary care.
Once you’ve made that decision, he offers these suggestions for qualities to look for:
• Someone who is interested in knowing the whole patient — not just the illness. As the great Sir William Osler, Regis Professor of Medicine at Oxford, once said, “The good physician knows the disease the patient has. The great physician knows the patient who has the disease.”
• A patient-centered atmosphere in the office
• Someone who is a good listener. Most diagnoses can be made or suspected by letting the patient tell his or her story
• Someone who is willing to say, “I don’t know,” but does know where to go to get the answer, such as referring you to another doctor or using medical knowledge bases such as “Up To Date.”
• Readiness to use the latest technology for communicating with patients, such as the I-phone, e-mail or Skype.
• Someone who values team care and values the role of advanced practice nurses or physician’s assistants.
“Ask around,” Griner says. “Get recommendations from friends and colleagues; the experience of other patients is always helpful. Askyour county medical society for names of physicians who are accepting new patients, or ask the premier hospital in your area, then check their credentials and look for feedback about timeliness, friendliness, etc., on-line.”
If you want to do something about the primary care physician shortage, there are ways the public can help, Griner adds.
• Advocate for more support for primary care through your state and U.S. representatives. “Support” can include more money for primary care training grants; better compensation for primary care physicians; and expansion of sites that qualify as physician shortage areas
• Support the development of local “accountable care organizations” or networks by your local hospital, health system or group practice. The goal of these new organizations is to guarantee comprehensive, continuous care with the primary care physician as the manager of a team of health professionals.
• Support community initiatives to recruit primary care physicians through incentives such as loan relief.
Hematologist/internist Paul Griner has had a 59-year career in medicine. He is a professor of medicine emeritus at the University of Rochester School of Medicine and Dentistry and was a consultant at the Massachusetts General Hospital, senior lecturer at Harvard Medical School, and consultant to the Institute for Healthcare Improvement (IHI) in Cambridge, Mass. He has written or co-written 130 journal articles, book chapters, and books on clinical medicine, medical education, and health policy. He is a member of the Institute of Medicine of the National Academy of Sciences and was president of a number of national medical organizations, including the American College of Physicians.