Out of Practice

M. Barken Frederick

Description

Primary care medicine, as we know and remember it, is in crisis. While policymakers, government administrators, and the health insurance industry pay lip service to the personal relationship between physician and patient, dissatisfaction and disaffection run rampant among primary care doctors, and medical students steer clear in order to pursue more lucrative specialties. Patients feel helpless, well aware that they are losing a valued close connection as health care steadily becomes more transactional than relational. The thin-margin efficiency, rapid pace, and high volume demanded by the new health care economics do not work for primary care, an inherently slower, more personal, and uniquely tailored service.

In Out of Practice, Dr. Frederick Barken juxtaposes his personal experience with the latest research on the transformations in the medical field. He offers a cool critique of the "market model of medicine" while vividly illustrating how the seemingly inexorable trend toward specialization in the last few decades has shifted emphasis away from what was once the foundation of medical practice. Dr. Barken addresses the complexities of modern practice—overuse of diagnostic studies, fragmentation of care, increasing reliance on an array of prescription drugs, and the practice of defensive medicine. He shows how changes in medicine, the family, and society have left physicians to deal with a wide range of geriatric issues, from limited mobility to dementia, that are not addressed by health care policy and are not entirely amenable to a physician’s prescription. Indeed, Dr. Barken contends, the very survival of primary care is in jeopardy at a time when its practitioners are needed more than ever.

Illustrated with case studies gleaned from more than twenty years in private practice and data from a wide range of sources, Out of Practice is more than a jeremiad about a broken system. Throughout, Dr. Barken offers cogent suggestions for policymakers and practitioners alike, making clear that as valuable as the latest drug or medical device may be, a successful health care system depends just as much on the doctor-patient relationship embodied by primary care medicine.

Sujets

• Employabilité, métiers et formations
• USA
• Industrial relations
• General practitioner
• États-Unis

Informations

• Publié par: Cornell University Press
• Date de parution: 15 avril 2011
• Nombre de lectures: 0
• EAN13: 9780801460609
• Langue: English

Extrait

OUT OF PRACTICE

A VOLUME IN THE SERIES

The Culture and Politics of Health Care Work edited by Suzanne Gordon and Sioban Nelson

A list of titles in this series is available at

www.cornellpress.cornell.edu.

OUT OF PRACTICE

FIGHTING FOR PRIMARY CARE MEDICINE IN AMERICA

Frederick M. Barken, MD

ILR PRESS AN IMPRINT OF CORNELL UNIVERSITY PRESS ITHACA AND LONDON

Copyright © 2011 by Cornell University

All rights reserved. Except for brief quotations in a review, this book, or parts thereof, must not be reproduced in any form without permission in writing from the publisher. For information, address Cornell University Press, Sage House, 512 East State Street, Ithaca, New York 14850.

First published 2011 by Cornell University Press

Printed in the United States of America

Library of Congress CataloginginPublication Data Barken, Frederick M. (Frederick Mitchell), 1955–  Out of practice : fighting for primary care medicine in America / Frederick M. Barken.  p. cm. — (The culture and politics of health care work)  Includes bibliographical references.  ISBN 9780801449765 (cloth : alk. paper)  1. Primary care (Medicine)—Practice—United States. 2. Physicians (General practice)—United States. 3. Physician and patient—United States. I. Title. II. Series: Culture and politics of health care work.  R729.5.G4B36 2011  610.68—dc22 2010041490

Cornell University Press strives to use environmentally responsible suppliers and materials to the fullest extent possible in the publishing of its books. Such materials include vegetablebased, lowVOC inks and acidfree papers that are recycled, totally chlorinefree, or partly composed of nonwood fibers. For further information, visit our website at www.cornellpress.cornell.edu.

Cloth printing

10 9 8 7 6 5 4 3 2

In memory of my mother and father, Norma and Herbert Barken

CONTENTS

 Acknowledgments ix

 Introduction: The Doctor Is Out 1  1 A First Visit with the Doctor 7  2Him Not to Drive” “Tell 29  3 Polypharmacy: The Problem with Pills 49  4 Poly-Doctoring: A Doctor for Every Disease 72  5 A Bubble Off 92  6 On the Road Again 111  7Supply Side The 131  8 All in the Family 151  9 Practice/Malpractice 170 10 You Get What You Pay For 190  Epilogue 213

 Notes 219  References 227  Index 241

ACKNOWLEDGMENTS

For most of my adult life, busily spent practicing primary care medicine, I wrote nothing longer than a prescription. The prospect of a sustained project involving uninterrupted research, writing, and reflection seemed an appealing personal indulgence, but also a daunting challenge of orga nization and discipline, resisting the chaos and attention deficit of daily life. Luckily, I had help. I am most grateful for the sage advice and unwavering encouragement I received from my friend Richard Polenberg, professor of history at Cornell University, to whom I first proposed the premise for this book three years ago. His kind words, support, and thoughtful commentary correctly an ticipated the unavoidable wrong turns and dead ends inherent in writing. They were medicinal. I wish to give special thanks to David Williams, professor of theater at the Ohio State University at Newark, who volunteered to review and critique my writing, gently tweaking my grammar with his powerful pedagogical red pen. I have the greatest respect for Dave’s high regard of literature, theater, and the elegance of the wellturned phrase. Narrowly trained in the sciences, I admire his love for, and life in, the arts. The writer’s life, I feared, was one of solitude; I could not have been more wrong. I am fortunate to have a group of friends and colleagues, all from diverse fields and life experiences, each with a personal perspective on the matter of health care. It seems as long as I continue to write about the plight of the physicianpatient relationship, I will never be lonely. Dave Ahlers, Lorraine Anastasio, David Bick, Tim Cardina, Mitchell Green berg, Bruce Korf, David R. Lee, and Chris Ober provided challenging cri tiques and engaging commentary as they graciously devoted their time