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Primary care is not always the best way to care for patients with chronic illness. There is too much information for doctors to keep up on all the current recommendations for certain problems. At Kaiser Permanente, nephrologists provide all care for people with chronic kidney disease, heart failure patients are followed by cardiologists and nurse practitioners and pts with diabetics are followed by diabetic nurse specialists.
Trying to get Primary care doctors to know all areas well can detract from care. We often see people with heart failure, for example, being treated with inhalers by PCPs who are not used to chronic heart failure care and patients.
It's hard to find a consensus about anything in this ongoing healthcare debate. But if I've heard anything approaching a seemingly uncontroversial consensus, it's that primary care should play a larger role in American healthcare — both to make us healthier and to keep costs down — not a smaller one. (Among many other places, you could hear that idea emerging prominently on our recent health promotion show.)
So I called Porter1828 to find out why specialists, not primary care docs, deserve more attention.
It turns out that Porter1828 is Susan Porter, a nurse practitioner specializing in arrhythmias and defibrillators at Kaiser Permanente. She reiterated what she'd written in the post, and then told me:
The primary care person is normally seen as a gatekeeper. You do everything you can before you send the patient on to the specialist. I think that’s the wrong model. Medicine is getting so complex, and changing so quickly, that no primary care physician can be expected to keep up with everything.
I heard [on the show] the idea that if we want to keep costs down, we should stay away from specialists. I don’t think that’s right. I think it’s the incentives that need to change. Specialists shouldn’t get more money for ordering more tests.
...which opens up a whole other conversation. As it turns out, if you're interested in this question of incentives, you might want to check out the hour we did on and doctors' salaries and compensation.
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