The popular narrative of medicine models that of a comic book hero or heroine—angst, turmoil, followed by a close save as the champion swoops in at the last minute to save the day. It is this story line that drives many of us into a career in medicine, feeling the pull to be the knight in shining armor. We as health care providers want to affect a tangible change in each of our patients lives. However, in the progress we have made in pharmaceutical and technological advances in the last 75 years the opportunities for these bold interventions have become less and less frequent.
The roles we play as healthcare providers are quickly evolving as more long-term health concerns make their way to the forefront: 36.7 million people worldwide are living with HIV/AIDS, 422 million patients have diabetes, and it is estimated that 17.3 million people die each year due to heart disease. These pandemics just scratch the surface of the innumerable chronic diseases the must be managed to improve health care delivery, and not a single one of them has an answer that can be delivered with a finite, distinct procedure or medication. Medicine can no longer be practiced on the basis of short appointments with a high-tech fix, or even a yearly check-up.
Now that American patients are (for now) able to seek care without the fear of being dropped from their insurance carrier, health care providers are able to address much more than the issues that give quantity of life, but can now start chipping away at the barriers restricting quality of life. In Dr. Atul Gawande’s article “The Heroism of Incremental Care” he explores just what mystical powers providers in generalist and primary care specialties harness in order to reduce long-term morbidity and mortality while simultaneously improving a patient’s day-to-day living.
Each of the providers Dr. Gawande spends time with knows the value and skill set they possess is vital to their patients’ well-being. Yet, in a compensation survey conducted in 2016, these physicians are rewarded at half the rate of their proceduralist or interventionalist counterparts. Not only are these “incrementalist” physicians making substantially less money, but their access to the funds for appropriate medical staff and equipment is woefully lacking. Just how is a doctor supposed to provide adequate care for her patients’ diverse needs, many of which reflect the patients’ status as part of a very high-risk population, when the office is unable to afford a nurse to coordinate referrals, or to purchase lab equipment allowing them more real-time knowledge of their patient’s progress? America is in desperate need of a health care and insurance system that allows primary care providers access to the same resources that their interventionalist counterparts have. Medicine is facing a new frontier of chronic disease management and we must evolve our approaches if our patients are going to survive it.
Postscript, by Justin Moore: I *ahem* roll in a pretty important crowd sometimes: