Primary care medicine, as we know and remember it, is in crisis.
While policymakers, government administrators, and the health
insurance industry pay lip service to the personal relationship
between physician and patient, dissatisfaction and disaffection run
rampant among primary care doctors, and medical students steer
clear in order to pursue more lucrative specialties. Patients feel
helpless, well aware that they are losing a valued close connection
as health care steadily becomes more transactional than relational.
The thin-margin efficiency, rapid pace, and high volume demanded by
the new health care economics do not work for primary care, an
inherently slower, more personal, and uniquely tailored
In Out of Practice, Dr. Frederick Barken juxtaposes his
personal experience with the latest research on the transformations
in the medical field. He offers a cool critique of the "market
model of medicine" while vividly illustrating how the seemingly
inexorable trend toward specialization in the last few decades has
shifted emphasis away from what was once the foundation of medical
practice. Dr. Barken addresses the complexities of modern
practice-overuse of diagnostic studies, fragmentation of care,
increasing reliance on an array of prescription drugs, and the
practice of defensive medicine. He shows how changes in medicine,
the family, and society have left physicians to deal with a wide
range of geriatric issues, from limited mobility to dementia, that
are not addressed by health care policy and are not entirely
amenable to a physician's prescription. Indeed, Dr. Barken
contends, the very survival of primary care is in jeopardy at a
time when its practitioners are needed more than ever.
Illustrated with case studies gleaned from more than twenty
years in private practice and data from a wide range of sources,
Out of Practice is more than a jeremiad about a broken
system. Throughout, Dr. Barken offers cogent suggestions for
policymakers and practitioners alike, making clear that as valuable
as the latest drug or medical device may be, a successful health
care system depends just as much on the doctor-patient relationship
embodied by primary care medicine.
Subjects: Health Sciences
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