Out of Practice

Overview

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 ...

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Out of Practice: Fighting for Primary Care Medicine in America

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Overview

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.

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Editorial Reviews

Publishers Weekly
This compelling plea for primary care medicine reveals a disturbing situation: "Primary care medicine is collapsing, a victim of economists' tenets of maximized efficiency, profit, and productivity." The system will be further strained by the large numbers of aging baby boomers. Barken uses his own experience as a physician who retired early at age 51 due to dissatisfaction with the current situation to illustrate the state of his profession. He finds it overwhelmed, underfinanced, and ill-equipped to deal with older patients suffering from complex medical issues. Barken warns that doctors, patients, and politicians will have to accept that the primary physician's role must change, that a bigger health care industry isn't necessarily a better one, that malpractice liability, along with its high costs and demoralization of doctors, must be reined in. Primary-care doctors must resist the pressure to prescribe too many drugs and must manage a plethora of specialists who want to administer overly aggressive treatments that have little impact in prolonging life or making patients more comfortable. Physicians treating aging patients must also see them not as solitary units but as part of a well-prepared, involved family. In the end, he says, American health will be saved by its most important virtue: a strong physician-patient relationship. (Apr.)
From the Publisher

"Barken puts a highly personal spin on issues in health policy and health care, such as dealing with aging patients, dishonest insurance companies, and the patterns of physicians' own personal lives. Those seeking a readable, understandable, and personal primer on debates about primary care and American health care will be both educated and moved by this outstanding book."—Library Journal, 1 May 2011

"This compelling plea for primary care medicine reveals a disturbing situation: primary care medicine is collapsing, a victim of economists' tenets of maximized efficiency, profit, and productivity. The system will be further strained by the large numbers of aging baby boomers. Barken uses his own experience as a physician who retired early at age 51 due to dissatisfaction with the current situation to illustrate the state of his profession. . . . In the end, he says, American health will be saved by its most important virtue: a strong physician-patient relationship."—Publishers Weekly

"Barken does an outstanding job of chronicling the challenges widespread in practicing primary care medicine in the early 21st century. . . . He offers an astute analysis of how the current cultures of medicine, financial reimbursement, and medical malpractice . . . have effectively diminished the capacity of primary care physicians to do what they do best. . . . Barken is at once on target and engaging. His writing is logical and concise, and he intersperses detailed critiques of the system as a whole with interesting (and entertaining) case studies from his practice. For each problem he perceives, he suggests plausible and thoughtful solutions. . . . Reading Out of Practice is an excellent way to begin envisioning how the system can be changed to provide primary care."—William Ventres, MD, MA, Journal of the American Medical Association (26 December 2012)

"It was a great pleasure to read Out of Practice. It is brilliantly written: lucid, vivid, even picturesque. It ought to be the first required reading for entering medical students and for new faculty as well."—Barbara Starfield, MD, Johns Hopkins Bloomberg School of Public Health, author of Primary Care

"Primary care physicians should be at the center of our medical care system, but they are fast disappearing. Frederick M. Barken's engrossing account of his former professional life as a primary care doctor in upstate New York tells us why. This is the best description of general medical practice by a physician that I have ever read."—Arnold S. Relman, MD, Professor Emeritus of Medicine and of Social Medicine, Harvard Medical School and former Editor-in-Chief, New England Journal of Medicine

"This book comes during a critical time of health reform when over 30 million newly insured persons will have greater access to care, but may be unable to find a primary care provider. Dr. Frederick M. Barken's narrative critically illustrates the importance of provider-patient relationships in primary care and sets forth the challenges we will all face if we fail to consider this part of the therapeutic milieu in new and emerging models of care and payment. To continue to lose primary care providers such as Barken, multiplied, will be our loss and will be bad for our health."—Julie Fairman, FAAN, RN, University of Pennsylvania School of Nursing

Library Journal
Barken (health policy, Ithaca Coll.), a retired primary-care physician and health-policy researcher, gives us an insightful, personal, and thoughtful look into the past, present, and future of American health care. Unlike many authors who simply examine policies or demographics in abstract terms, Barken puts a highly personal spin on issues in health policy and health care, such as dealing with aging patients, dishonest insurance companies, and the patterns of physicians' own personal lives. He presents a combination of firsthand perspective on medical practice and clear graphs, tables, and explanations of the policy, demographic, and technological changes that have and will continue to affect the practice of primary-care medicine in America. VERDICT Those seeking a readable, understandable, and personal primer on debates about primary care and American health care will be both educated and moved by this outstanding book.—Aaron Klink, Duke Univ., Durham, NC
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Product Details

Meet the Author

Dr. Frederick Barken has retired from his solo practice as a primary care physician. He is an adjunct instructor in health policy at Ithaca College. Visit his website at frederickbarkenmd.com.

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Table of Contents

Acknowledgments ix

Introduction: The Doctor Is Out 1

1 A First Visit with the Doctor 7

2 "Tell Him Not to Drive" 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

7 The Supply Side 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

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