Primary care and medical education.

There is considerable argument for the value of educating medical students in the basics of primary care, comprehensive care and concern for psychological needs of patients. However, medical schools do not place much emphasis on primary care. Most clinical experiences take place in tertiary care centers, and most teaching is provided by specialists. Relatively little attention is paid to psychological issues of care and development of interpersonal skills among would-be physicians. The impact of the tertiary care orientation is widespread. Medical students are expected to adopt the role of the physician-specialist or technologist. Those who want to be primary care physicians have to face value conflicts with the establishment, and some develop emotional problems. The effects carry over into practice. Physicians who do not develop adequate personal skills are less likely to be viewed as competent by their patients. They are also more likely to develop mental health problems themselves. This article argues for a modification of the medical school curriculum to reflect the orientation of the primary care model.