Division of General Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Division of Hospital Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
J Gen Intern Med. 2021 Feb;36(2):515-517. doi: 10.1007/s11606-020-06077-6. Epub 2020 Jul 29.
Primary care is widely viewed as being in crisis despite its purported central role in addressing population issues related to healthcare cost, quality, access, and equity. Despite this pivotal role, the nature of the clinical practice today has largely emerged by default. We review the evolution of clinical practice in primary care from its genesis in small practices with paper charts and telephonic patient communication to managed care, pay-for-performance, and today's era of the electronic medical record, value-based payment, and consumerism. We suggest a necessary "reset" of expectations that focuses on today's practice structure and the historic face-to-face patient care expectations. Only by doing so can we successfully meet the demands of patients, society, and practicing internists.
尽管初级保健被广泛认为处于危机之中，但它在解决与医疗成本、质量、可及性和公平性相关的人口问题方面被认为起着核心作用。尽管具有这一关键作用，但今天临床实践的性质在很大程度上是默认形成的。我们回顾了初级保健临床实践的演变，从最初的小型实践，使用纸质图表和电话进行患者沟通，到管理式医疗、按效付费，再到今天的电子病历、基于价值的支付和消费者主义时代。我们建议对期望进行必要的“重置”，重点关注今天的实践结构和历史上的面对面患者护理期望。只有这样，我们才能成功满足患者、社会和执业内科医生的需求。
