DIY primary care

During all the hubbub about President Obama’s signing the insurance reform bill yesterday I saw CNN’s Dr. Sanjay Gupta say that a recent report on new medical school graduates in the US shows that only 2%! intend to be primary care docs. Uh-oh! That’s a problem because, according to the traditional model, that’s not nearly enough to serve as entry points for all the specialties in the system.

So I’ll return to the proposal I made in my post about establishing a new 21st  century health paradigm:

Develop an actionable plan for the goal of enabling each individual to become his or her own primary care authority for 90%-95% of health incidents.

If the docs don’t want to do it then let’s build a system to support every person becoming their own primary care person. Doctors coming out of medical school evidently don’t want to do primary care because the pay isn’t good.  Maybe it’s because the skill and knowledge is of lower value than, say, brain surgery. We lay people already handle about 80% of the physical problems we have. Just go to any drugstore and walk through the OTC products for flu, aches and pains, cuts and sprains, sleep aids, hemorrhoids, eye and ear care, constipation and on and on. Add to that the ~$100 billion “nutraceutical” (foods that have a health benefit like vitamins, herbs, fish oil, etc.) business and you see we citizens are already doing a lot. But we still have the paternalistic doctor culture that makes expanded DIY unthinkable to most people, and we have only poorly developed systems of support. We’ve got organizations advocating “participation” in medicine, but I’m advocating going further over the next decades.

Actually I think the paradigm shift is already underway. We’ve got health 2.0, mobile health, e-health, the quantified self, whole-family genomes under discussion, personal health records, and self-organizing support in social media. But these things are pieces of a bigger puzzle. What we need is a total system putting these components into a synergistic whole that is of much greater utility and impact for the average person. We need to develop information and educational resources using the power of the digital, connected environment to empower folks. This will take time — perhaps a couple of generations — and the investment of goal-directed resources.

I think the internet is about to do for health care what it has done for communication and other professions formerly centered on experts: allow ordinary people to have access to information and powerful tools for the first time. But to put it together we need to hold a new vision and to work toward its achievement in a concerted way.


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