Guest Rant: The Crux of the Problem

Discussing the value (or lack thereof) placed by patients on primary care and preventive medicine, my friend and fellow dinosaur Dr. G puts it so well:

It all seems to boil down to "How do we make sure that people get the things they need but don't value enough to pay for themselves?"

No wonder primary care is in the mess it is (and specialists thrive.) Here comes the the light bulb: the real reason for the demise of Family Medicine is that people don't want us. They do if someone else pays for it, but not if they have to pay out of their own pockets.

Specialists get paid for the things people value: "Bail my butt out of the jam I got myself into" care. People want the angioplasty and they'll raise the funds for a specialist to do a procedure, even if it only adds a week to their life. Yet they won't pay a $20 copay to discuss preventive care with us.

Patients often make these same kinds of decisions in the face of dismal prognoses: full court press with the chemo, ICU, etc. The oncologist, thoracic surgeons, intensivists, pulmonologists, cardiologists and others all get rich billing desperate people who were too busy to think about preventive care, or didn't care enough to pay for it before they got sick. The statistics on how much of our healthcare dollar we spend in the last few months of our lives escape me, but they point to why our system is in the state it is.

Couldn't have said it better myself, and believe me: I've tried.