Essay: The Sad State of Affairs for American Medicine Primary Care

December 26, 2018- by Steven E. Greer, MD

I am so saddened by the state of our profession. I have been in different industries and unaware of the seismic shifts in clinical medicine. In my experiences over the last 12-months, the “primary care” concept doctor is dead.

In 2013, when it became known that President Obama and his stooges flat out lied when they promised, “If you like your doctor, you can keep your doctor”, in order to get the ACA passed, why was there no outrage by Americans? That should have been a wakeup call to the doctor groups.

There was no large-scale outrage because most people did not miss their doctors. They disliked their doctors. Doctor visits were burdensome and provided no sense of caring. Then, they got hit with large out-of-pockets bills created by the fake insurance of Obamacare.

I am seeing firsthand the extent of the deterioration of American medicine. No longer are primary care doctors the persons who quarterback the overall care of patients. Rarely are they even visiting patients in hospitals these days.

They are doing nothing but annual physical exams and other ineffective care, such as monitoring diabetes or hypertensions. The therapies they administer make almost no difference in outcomes, for the most part. Patients with diabetes and hypertension are not given effective weight loss programs, for examples. Instead, they are given branded drugs at outrageous prices, which hurt the patients tremendously due to financial stress. Meanwhile, low-cost drugs that could help them are not being prescribed.

My parents’ cases are typical. They have a newly-graduated pipsqueak “primary care” doctor who simply sees office visits and makes no effort to oversee the patient when they need their myriad of specialists.

He does not even read the latest journals to stay aware of major trials. Over the last 12-months or so, major papers were published in JAMA showing that it is safe after all to use estrogen and progesterone in post-menopausal women, and NEJM papers based on several large trials showed that daily aspirin was deadly rather then beneficial. However, the vast majority of primary care doctors have neither read these papers nor changed their practice.

My father now needs knee-replacement surgery. He had to diagnose that himself and then choose the orthopedic team himself. The primary care doctor should have been doing that.

My father was in the ICU last week from a GI bleed due to aspirin he was taking for the knee pain (unbeknownst to me). The so-called primary care doctor was aware and yet never stepped foot into the hospital or even called my father. A Russian-born and trained “hospitalist” mismanaged the case until I stepped in.

I tried to call a “geriatrician” in the hospital network who might be better at overseeing the complex problems of elder care. However, they are all “specialists” and just see the patients for assessments of home needs, fall risks, etc.

Once in a nursing home, the doctors in the long-term care facilities are often deadly. They treat everyone as if they are in hospice.

It was not this way as shortly as 20-years ago.

Meanwhile, filling the void is the rise of nurse practitioners. They call themselves doctors, confusing patients, and demand to be considered as equal “providers”

Overseeing all of this are legions of woefully unqualified MD’s acting has hospital administrators fiddling as Rome burns. They rose to the top ranks of their hospitals by cronyism, usually.

Funding this extremely ineffective model of American healthcare is the federal government’s CMS and private payers that both reward doctors with a fee-for-service model. But none of this is sustainable. Winter is coming for American medicine.

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