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Good incremental primary care delivers better health, longer life

Written by Diane Archer

If you’ve ever questioned why having a good primary care doctor is so critical, Atul Gawande explains in no uncertain terms in the January 23, 2017 New Yorker. In a nutshell, well-trained primary care doctors understand the whole range of issues affecting a patient’s health; and, they take an incremental approach to treatment that often delivers better health and longer life.

Gawande tells us about spending time with a primary care doctor and patient with a serious chronic condition at the Graham Headache Center in Massachusetts. Rather than prescribing a battery of tests to help treat the patient’s migraine condition, the doctor has the patient explain his 40-year history of suffering from debilitating headaches and listens. The patient describes trying a battery of treatments to no avail, with his migraines only becoming more severe and more frequent.

Gawande then shares with us that, after four years of slow and steady progress, the patient’s migraines have largely subsided. What was the treatment? The patient kept a diary of each migraine attack and met with his doctor every three months to adjust treatment based on the diary entries. That simple. But, the patient’s improvement was barely perceptible to the patient during the first three years. It took four years for the migraines to stop recurring at a frequent pace and devastating intensity.

Gawande also describes a patient whose face is entirely swollen seeking treatment at a clinic in Jamaica Plain, Massachusetts. Again, rather than delivering the battery of tests to rule out conditions that are unlikely, the doctor takes advantage of her understanding of the patient’s full condition and the trust she has built with her patient. She takes “the long view.”

“They focus on the course of a person’s health over time—even through a life. All understanding is provisional and subject to continual adjustment. For Rose, taking the long view meant thinking not just about her patient’s bouts of facial swelling, or her headaches, or her depression, but about all of it—along with her living situation, her family history, her nutrition, her stress levels, and how they interrelated—and what that picture meant a doctor could do to improve her patient’s long-term health and well-being throughout her life.”

This approach led the patient’s medical team to determine she was allergic to naproxen, which she took to relieve migraine pain, and that it was causing the swelling.

The big problem, according to Gawande, is that we do not value incremental care. Primary care doctors tend not to have the resources at their fingertips to diagnose and treat patients that are available to specialists. And, their annual income is on average half of that of specialists. So, it can be hard to find a good primary care doctor. But, especially if you suffer from one or more chronic conditions, a good primary care doctor can improve your health and extend your life immeasurably.

Gawande notes that many Medicare Advantage plans charge high copays for primary care visits, deterring people from getting primary care. With traditional Medicare and supplemental coverage, you have no out-of-pocket costs. And, no matter which Medicare option you choose, Medicare covers the full cost of many preventive care services.

Here’s more from Just Care:


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