Out of Practice

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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.

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.)

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

Product Details

ISBN-13: 9780801449765
Publisher: Cornell University Press
Publication date: 4/14/2011
Pages: 264
Sales rank: 187,666
Series: The Culture and Politics of Health Care Work
Product dimensions: 6.20 (w) x 9.10 (h) x 1.00 (d)

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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Out of Practice

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Overview

Customers Who Bought This Also Bought

More About This Book

Overview

Editorial Reviews

Publishers Weekly

Library Journal

Product Details

Table of Contents

Customer Reviews

Rating Distribution

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1 Star

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