Primary care and the physical exam; why it stops at the navel and is part of the reason our healthcare system is so inefficient.
How many doctors does it take to screw in a lightbulb? Strange question right, but our healthcare system has way too many people involved in your health problems, leading to poor treatments, diagnosis and of course high prices. This fragmentation of care management is simply bad for our health and our wallets as well.
One primary care doctor recently raised the same concern I have raised for years, which is that at the primary care level, doctors are not comprehensive enough, which this doctor believes starts with a complete evaluation of everything.
She found out that as her practice got busier, and her reimbursement became more limited, she had less time to spend with a patient, and the costs of doing certain things such as gynecological exams which required a second observer became too great, and reimbursements made it unaffordable to continue this comprehensive approach to care.
This insurance based solutions of the last 30 years to the cost of care which evolved from the HMO’s and their capitation methods, as well as the AMA’s attempt to develop many more medical specialties since the 1960’s had promised to save us in costs and improve quality, yet it has exploded the cost of care and made primary care much less effective. The body is made of systems and most symptoms are rarely investigated properly at the primary care level, and instead, a drug is given to control the symptom to our detriment often months but sometimes years later. Many musculoskeletal symptoms blur the line with organ involvement, leading to unnecessary and sometimes invasive tests which are expensive, and often come back negative, because of the failure of primary care to be able to take the time, and have the knowledge to properly evaluate and treat or refer the patient properly. Often, symptoms are misread by everyone, including the patient who may have many comorbidities that may in fact all be intertwined, yet most doctors simply try to treat each symptom without understanding why the symptoms exist and which system is truly at fault.
This doctor believes, as I do that the more fragmented the care is, the more expensive and the less effective it is. The Opioid epidemic is just a symptom of our failure to properly manage and refer at the primary care level.
This brings me to our current system, which is about fragmentation, is expensive beyond belief, while not being necessarily better. Perhaps, if we moved backward and began to embrace old style primary care from 40 years ago, we can get some sanity back into the system.
While I do also believe that we need some better training of primary doctors in understanding the musculoskeletal system and its connection to pain, something groups such as chiropractors excel in, she raises some great points after having years of experience.
Check out her opinion here. This is a great point of view. Policy wonks, are you listening?
Why Does the Physical Exam Stop at the Navel?
By Danielle Ofri, M.D. May 19, 2016
Recently a young woman came to my office. She hadn”™t seen a doctor in several years and requested a checkup. The bulk of the annual physical isn”™t the physical at all “” it”™s the talking, and we discussed diet, exercise, sleep, mood, alcohol, drugs, smoking, sunscreen, vaccinations, contraception, safe sex. In the last few minutes, however, I did turn to the physical exam.
I proceeded the way I do all my physical exams: I start with the eyes, ears and mouth and methodically work my way south “” checking the lymph nodes and thyroid of the neck, listening to the heart and the lungs, percussing the abdomen, all the way down to feeling the pulses near the big toe.