Is there is a difference between medical care and health care? There is.
Medical care is what physicians and other clinicians do every day with you in offices, labs, surgery centers, and hospitals. Titrating blood pressure meds. Checking blood sugar. Adding this medication on and stopping that medication. Heart bypass surgery. X-rays. MRI’s. All that constitutes medical care. In America, we do a lot of it and we are the best. Hands down. However, medical care probably constitutes only 10% – 20% of health outcomes.
Health care is a much broader idea of which medical care is only a subset and constitutes the remaining 80-90% of health outcomes. It incorporates other elements such as Social Determinants (the circumstances under which you are born, live, play, socialize, work and die), genetics, behaviors such as eating, smoking, exercise and drinking, and a myriad of other factors. All these issues may seem out of place in the context of a Primary Care practice but they matter more for health outcomes. And in this overall picture when considering infant mortality, the rates of chronic disease, mortality for certain demographic sections, and access to health insurance, the US does not do as well compared to other countries. True, the USA is much larger and much more diverse than other countries to which we are often compared, such as the Nordic countries or Canada but this just illustrates the challenge before us as a nation.
So how is Primary Care to engage with the rest of this Health Care paradigm?
First, we need to continue to do well what we have been doing well. We will continue to focus on making sure that the tests and procedures we recommend for you and the medications we prescribe to you are necessary and valuable for your overall medical care. We will continue to coordinate care among specialists and other players in your medical care. We will continue to try and improve access to high-quality medical care. All this we have to keep doing well and even continue to improve.
Second, we need to engage on a broader front. We need to help to connect you with resources or organizations that can help you with financial constraints. We need to continue efforts to improve counseling about smoking, alcohol use, physical activity, and nutrition. We need to develop and implement strategies to better help you if you have issues with substance abuse and mental health. The need is great.
Primary Care has a front line role in health care, not just medical care, and we will always be seeking ways to help you improve your health.