We need more early intervention and prevention, not more late-stage expensive patches. Smoking cessation counseling isn't sexy the way humming machines and newly approved biologics are, but it's effective, inexpensive and what our country really needs. Unfortunately, the way the house of medicine is carved now, it's not the specialists who are providing it.
The balance between primary care and specialty services is a delicate one, and some would argue that health care is already too specialized ― why does one patient need an entire Rolodex of "-ologists" — a cardiologist, a nephrologist, an endocrinologist, a pulmonologist and a dermatologist?
Patients are not sliced into the "organ systems" we divide specialty lines across. And there is no better example of this than the patients we see in the emergency room, confused by their multiple canisters of co-interacting meds, sent to see us by one of their specialists who, after expensive tests on the organ of expertise, couldn't figure out what was going on and sent the patient to the ER. Ophthalmologists refer patients to the ER for high blood pressure found in the clinic. Orthopedists send patients to the ER when they find incidental elevated blood sugar prior to an operation.
Yes, some referrals are appropriate, but some are plainly wasteful. The ER, designed to be full of "resuscitation-ists" — providers trained to take care of life-threatening events like heart attacks, strokes and gunshot wounds — has quickly become a catch-all of "available-ists" — providers who happen to be available 24/7/365. In between the heart attacks and car accidents, I also counsel patients on smoking and drug cessation, advise them on the importance of seat belts, teach them to use their glucometers and adjust their daily meds.
Why? Because not only are these patients unable to get in to see all of their specialists in a timely manner, but many don't even have a primary care doctor.
We can't force medical students to become primary care physicians, nor should we. But education reform isn't necessarily going to fix our health care system, either.