We chose primary care because we understood its importance. We understood its need. In a healthcare system that divides patients into their biological parts and isolates them from their life’s rich context, primary care promises to reconstitute patients into whole people and return them to the complex ecosystem that makes them who they are.
As members of primary care teams, we understand that this reductionism results in fragmented and ineffective care. So, we specialize in complexity, in interconnectedness, and in interactionality. By maintaining meaningful and ongoing relationships with our patients and the important people in their lives, we become effective partners on the road to health.
Fundamentally, primary care teams specialize in relationships. Here are some of the ideal features of that relationship.
Along the way, we find our ability to develop these effective partnerships becomes hindered by system pressures, such as payment models, documentation requirements, quality metrics, and time constraints. These conditions often result in disjointed, lower quality care; a rise in healthcare costs; and care teams who fall out of love with the practice of medicine.
The pressures of a disjointed, overworked system often pile up to impede the growth, trust, and effectiveness of a primary care team-patient relationship.
As health educators, we are doubly concerned by the current trajectory of primary care. We see medical students avoiding primary care careers, residents refraining from full time clinical practice, and graduates working in environments that prevent them practicing the best of what they’ve learned.
The UCSF Double Helix Curriculum teaches how to alleviate some of these system pressures while empowering the next generation of primary care providers with the awareness, motivation, and skills to transform primary care. If we teach our residents the best of medicine, the depth of the primary care relationship, and the way to think about system structures and system change, they will someday teach us how to approach primary care better than we do today.
Beal et al, Closing the Divide: How Medical Homes Promote Health Equity in Health Care
Peccoralo et al, Resident Satisfaction with Continuity Clinic and Career Choice in General Internal Medicine