Domhnall MacAuley: Comprehensivists vs partialists at NAPCRG

Domhnall MacauleyInnovative primary care pilot programmes are big news in the US. Money talks, and from a business perspective, primary care is good value. So good, that Paul Grundy’s (US) company IBM provides free primary care to its employees and incentivises referral strategies. Rebranded as the advanced medical home in the US, his model of personal and integrated care seems little different from the traditional UK model of general practice, UK listeners were also fascinated to hear that Andrew Lansley (Secretary of State for Health)  had telephoned him to hear how the system worked prior to the recent change of government. We might ask why he didn’t first ask primary care health service researchers in the UK.  But, let’s look positively. If the US embarks on a programme of (rediscovered) primary health care, perhaps the UK government will value what it already has. 

Paul introduced a new lexicon. Rather than specialists and generalists, he spoke of  partialists and  comprehensivists. He described the family doctor as the quarterback- the key player in American football. And, his basketball analogy for specialist based health care, was the 2004 US Dream Team  which brought together the very best individual NBA players (specialists) but was soundly and unexpectedly beaten  in the Olympics.

How will women deliver babies in the future?  Michael Klein (Canada), who has a lifelong interest in obstetrics presented the results of a nationwide survey of obstetricians and identified major differences in attitudes towards vaginal delivery. Those under 40 years of age were much more worried about the complications of delivery. Although 81% of the younger obstetricians were female, he felt this was a generational rather than a gender effect. The difference in attitudes was remarkable. Why? From this observational study, one cannot tell. Perhaps, its because modern obstetricians have little experience of normal deliveries. On the other hand, maybe they are right about the risks.

“Sanjikan machi, sanpun shinsatsu”- How good is your Japanese? It means: A three hour wait for three minutes with the doctor. This intriguing Japanese saying was the  title of a paper by Adam Woodridge (US), a medical student, who  described his study of the duration and content of consultations in a rural Japanese practice. And, is it true? Partly. The mean consultation was just over 6 minutes but 11% were under 3 minutes. A very different type of practice.

And, finally, while doctors and researchers might think smart card technology that allows patients to carry their own comprehensive medical records is a good thing, patients may not agree. Jane Gunn, told us of a newspaper headline she spotted before she left. It asked “Do you want your dentist to know you have haemorrhoids?”

Domhnall Macauley is primary care editor, BMJ