Letter re: Primary Care Internal Medicine Is Dead—Long Live Primary Care Internal Medicine

Excerpt

I could not agree more with Dr. Salib’s call for “rebranding” the primary care general internist as the “cerebralist,” the “complexist,” the “Sherlock Holmes of medicine.” To my mind, that requires removing from the primary care internist’s daily workload those tasks which can be done effectively, if not more effectively, by other members of a well-structured, multidisciplinary medical home team. These include chronic care management, minor urgent care, routine screening and health maintenance, medication refills, prior approvals, EHR patient queries, and ordering of routine tests and referrals. Freed of such currently overwhelming mundane responsibilities, the work of the highly trained primary care general internist can be repurposed to serve as the apex clinician to the team or to a community of primary care practitioners. This creates time and access to address complex diagnostic or management issues faced by team members or community practitioners as well as to provide personal primary care to a small panel of patients with complex medical issues. The latter is especially important because long-term relationships contribute much to the joy of primary care practice, especially when supported by a well-functioning multidisciplinary team. As noted, fundamental payment reform is essential to fielding a robust multidisciplinary team. Without it, the practice of primary care becomes impossible to sustain. …