On Primary Care

I think the appeal of primary care which i didn't appreciate until i saw patients have really bad or no primary care is that it appeals to the editor in people. The power of the word is not the word itself, but like sculpture, all the words removed. Like the good news story with impeccably gathered facts, the complicated patient has a million and one rabbit holes to be lost in, and sometimes they are worth pursuing with full investigative and management gear on. But sometimes not, and if you let all the jumble sit there as it is, you lose the point all together. And so it becomes the fine art of editing--reducing medications, streamlining self care plans, construing an elegant model of health that engages the patient, yourself and all the other people invested in this person's well being. Medicine has always prided itself in the elegance and cleverness of its diagnostics, but it seems to me (at least in American medicine) this idea of the elegant therapeutics is still relatively new (perhaps the Cubans have long been far ahead?), what with the forced hand by economic factors and the revelation that you can't put 80 year old people on 27 different medications and think thats going to be totally innocuous.