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Recently, I had my annual physical, and I kid you not, my doctor of almost ten years spent a mere 8 minutes with me. He asked how I was doing, listened to my heart and lungs,
Palpated my abdomen, and then congratulated me on my weight loss journey, which I had embarked on at the beginning of the year. He left to send my prescriptions to the pharmacy and briefly returned to say goodbye. As he was walking out the door, I mentioned my blood pressure, which had been elevated despite taking two medications. His response? "Are you checking it at home? If this is your best, we have a problem; if it's your worst, keep an eye on it." And with that, he left.
Three months prior, I expressed concern about my blood pressure being consistently elevated despite taking medication for it. He responded, "It will get better now that you're working on losing weight." As a family nurse practitioner who used to work in primary care, I can't remember spending just 5-8 minutes with a patient, especially not for an annual wellness visit. I understand that while my maximum patient load during an 8-hour shift was eighth teen patients, physicians in primary care clinics are often expected to see anywhere between twenty and thirty plus patients daily.
Our healthcare system is not just struggling; it is in critical condition. Primary care should be the backbone of our healthcare system. Instead, we do not have a healthcare but a sick care model. Managing real problems like acute strokes pays more than preventing them. Surely, controlling hypertension can help prevent strokes, but the current system rewards the treatment of acute conditions over preventive care. The pressure to see an overwhelming number of patients daily leaves little time for thorough, patient-centered care. Consequently, many primary care providers spend extra time charting after hours because the time is insufficient to provide decent care. This often means sacrificing personal and family time.
As nurses, we are driven by a deep sense of care and responsibility, but the current system makes it nearly impossible to provide the care our patients deserve. I left primary care because the system is fundamentally broken. Seeing patients as numbers rather than individuals with unique needs is demoralizing. The focus on quantity over quality in patient interactions undermines the very essence of healthcare: caring for and supporting patients in achieving optimal health. Our current model incentivizes reactive rather than proactive care, emphasizing treatment over prevention.
The book "Patients in Peril: The Demise of Primary Care in America" by Philip A. Masters examines the significant challenges confronting primary care in the United States. Masters emphasizes the mounting pressures on primary care physicians, such as administrative burdens, decreasing reimbursements, and the increasing complexity of patient care. These factors lead to physician burnout and a shortage of primary care providers, ultimately undermining the quality of patient care.
That being said, I see both sides of the coin here. As a provider and patient, I realized that I felt bad for my primary care doctor for the past nine years. To make things easier for him, I allowed him to do a suboptimal job of taking care of my health. It wasn't until I left primary care and returned for my annual visit that, for the first time, I saw myself as a patient. I realized that all these years, I had been making myself aware of all my yearly screenings without my doctor ever mentioning them. He never acknowledged that he might not have mentioned these screenings perhaps because he assumed I knew what to do since I was a provider.
Reforming our healthcare system is imperative. We need a model that values and rewards preventive care, ensuring that primary care providers have the time and resources to care for their patients. We must address these systemic issues before we continue to have a sick care system that fails to support patients and providers adequately.
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