I read primary care and health related discussions on blogs and discussion forums (fora?) around the web daily.  I figure that when I have the time and energy, I should make you privy a nice digest of those digital meanderings too, since they’re frequently so riveting:

Over at KevinMD – a health blog generally focusing on primary care in the U.S. – a good discussion is brewing about making medical school free to anyone choosing to go into primary care.

Kevin says even this likely won’t save primary care in the U.S.  An annonymous poster counters that Dr. Nurses (try not to get hung up on that oxymoron) take over primary care.  I sent in the comment that I can’t imagine being unhappy with primary care if I were completely out of debt.  How can anyone be unhappy with $100,000 a year if they have no debt?!

At iMedExchange (have to be a doc to join, sorry), I’m watching a discussion among family doctors as they ponder quitting the profession if U.S. healthcare goes “socialist” under our new Dem leaders.  Most of the respondents says they’d stick around, but they wouldn’t be happy about it.

I won’t reveal much here because the whole point of a ‘doctors only’ message board is to allow docs to vent and rant among themselves, but the discussion is thoughtful and insightful….and tense.

My thinking is that a socialist system would work fine if it paid well.  The whole problem with socialized medicine is that the workers get ripped off and have no autonomy.

If I told the average family medicine doc that they would make $250,000 a year working 60 hours a week, they’d sign up in droves.  Given all the worthless costs in our medical system, I’m sure we could eliminate just a few things and put up this kind of salary for our primary care providers.

There.  Problem solved.  Everybody’s happy (except insurance billionaires and lawyers, which is fine with me).

The Wall Street Journal Health Blog has an extensive discussion here, over frequent comments made by California Democratic U.S. Rep Pete Stark (he’s the author of ‘Stark Laws’ governing hospital interactions with community doctors…I’m not a fan) about how insurance companies are “the General Motors of the American Health Care industry”.  I’m pretty sure he didn’t mean that as a compliment.

One responder, Michael Proffit, claims that Stark is a socialist with no concept of the idea of “profit” (no pun intended, I assume).  A writer named Republican states that insurance companies cost the health care system too much money. macman2 says that Stark is “finally” a politician willing to state the truth that insurance and pharmacy industries have a stranglehold on U.S. Health Care.  So, it’s a nice, occasionally testy exchange going on over there.

My take is that insurance shouldn’t be a for-profit business.  Not with health care.  Everything else, maybe.  But not health care.  Not when the government – and many people – believe health care is a basic human right.  If health care is a right, not a commodity, then nobody should be getting rich by insuring it.

Also at WSJ is an article suggesting that yearly physical exams are useless and expensive.  They mention an article in the NYTimes from 2003 suggesting that the utility of yearly exams aren’t proven.  2003?!

Anyway, they also interview Ned Calonge, a family doctor and chair of the U.S. Preventive Services Task Force.  I use this group’s recommendations all the time to determine what sorts of screening tests a patient should get, and when.

Ned says that yearly PE’s aren’t proven to extend life or limit morbidity (bad happenings), and a patient should develop an individual schedule with their doctor regarding when they should be seen.

The write-in’s seem to generally support the idea that yearly physical exams, like much of American medicine, are added expense with little to show for it.

A commenter named Evidence suggests that “other countries” don’t give annual PE’s but their populations live just as long as ours.  That’s a little vague for me, but I do agree that we do lots of fairly dumb stuff in our medical system, often for no other reason than to be able to say we did it when the lawyers come calling.  And data does show numerous countries with similar or better health markers like life-expectancy, infant mortality, etc while our’s costs nearly three times more.

I’ve been a reader and contributor to Student Doctor Network since I was a med student weenie.  Their family med and general residency forums are throwing sparks, as usual.

Of the many topics I’ve scanned, a couple of primary care threads caught my eye.  One references an article written by an apparently bitter ER doc decrying primary care as a field of medicine.  The letter, an Op-Ed in Emergency Medicine News, is written by an ER doc at Case Western U – read here if you like ignorant propaganda.

The responses from the primary care docs and students on the SDN thread are rather level-headed and polite.  In particular, I appreciate the response by Ted Epperly, the current president of the AAFP.  You can read his letter in the discussion thread at SDN – to read it at AAFP you need to log in as a member (why would they do that?).  I’ve met the guy and he really is as cool as his response letter suggests.

Another concerning discussion thread is open at SDN citing an LATimes article that describes a failing FP doc in California.  The discussion is here, the Times article is here.

My opinon on this one is that the lady in the article just isn’t much of a businesswoman, and in today’s medical marketplace you need to be just that to survive.  If you want to provide medicine as a product or commodity, you better be able to work a balance sheet and pro forma.

The Times describes her pulling out her wallet and giving a patient cash for food, for example.  While kindhearted, that kind of gesture is colossally stupid from a business perspective.  You can’t survive in business with this kind of mentality, and in fact, this doc’s practice didn’t.  However, I don’t think the story really gives a good perspective on the state of primary care in America.