Patient Care at the Crossroads: An Optimist's View

Christine A. Sinsky, MD FACP

Patient care is at a crossroads in a rapidly changing healthcare landscape. Going forward, will the majority of patients receive most of their care from a highly trained, well-supported primary care physician and team they know and trust? Or, in contrast, will patients receive care through a series of loosely connected episodes, from a wide array of narrowly focused providers? Who will adjudicate care for the whole person across competing conditions and multiple settings--the primary care team, the individual patient or even a new type of entrepreneurial navigator?

From the professionals' perspective, will primary care be a specialty that allows professionals to develop relationship and continuity with their patients, manage complexity and do meaningful work; or will it become the specialty where the core work consists of triage, information management and documentation?

My view on these central questions is a mixture of optimism and caution. I am optimistic that patients can receive personalized, coordinated, consolidated care that matches their needs and preferences. For the professionals, primary care can be one of the best of specialties, contributing greatly to individual patients' and communities' health, while also being rewarding as a life's vocation.

Imagine the possibilities when family physicians, general internists and other primary care professionals (PCPs) are able to spend the majority of their workdays adding high value to patient care. Imagine a wider ecosystem set up to support PCPs doing this work. Where, for example, policy explicitly limits the current crushing weight of clerical work distracting physicians from their mission. Where, by another example, subspecialists' core work includes supporting the PCP in managing patients further into each subspecialty, allowing patients to get most of their care "at home" rather than shuttling between multiple providers.

Imagine the possibilities when healthcare resources support primary care in meeting patients' social and behavioral needs, where the primary care team includes health coaches, pharmacists and social workers on location, ready to work collaboratively and on-the-spot with patients and PCPs.

Primary care can be the lynch pin in a high quality, cost-conscious, patient-centered healthcare system, and the Health Is Primary initiative can contribute to bringing this vision to life.

(Commentary first published at Annals of Family Medicine as letter to editor