By Evan Falchuk

In my post yesterday about lessons we can learn from Israel’s health care system I wrote:

So, yes, the focus on health insurance reform will lead to many changes, and more complexity.  And some day, years from now, someone will be explaining the American system to an audience, and people will wonder, how did anyone ever create a system such as this?

In response, a friend of mine challenged me:  if the system is too complicated, how should we simplify it?

I wish more policy-makers were asking this question.

For me, the answer is clear: Primary care.  Time was, your primary care doctor was able to serve as the hub of your medical activity.  He or she could spend all the time needed to figure out what was wrong and to coordinate with your specialists.  It’s not true anymore.  Patients are left on their own trying to navigate the system.  In many ways they end up acting  almost as their own primary care doctors.  Patients try to pick their specialists, find out what to do about their condition, decide on good treatment choices.

It’s a problem that is well reflected in data collected by Best Doctors from people calling for help with that process.  Here’s our latest data on why people call:

Primary Reason for Call

Need help deciding among treatments          46%

Symptoms not improving                                   27%

Don’t understand diagnosis                              20%

Skeptical of doctor                                                 8%

It tells quite a striking story.  Patients, on their own, end up struggling with some very fundamental questions.  You could say that their primary care doctors should resolve these questions.  But with typical primary care doctors carrying as many as 5,000 patients and spending 15 minutes or less in each visit, it shouldn’t be surprising that they can’t.

What’s worse is what happens in this environment.  Studies – and Best Doctors data – show that 15% or more of patients end up with the wrong diagnosis, and more than half end up making the wrong treatment decisions.  The biggest reason?  The cognitive errors that happen when you try to make complicated decisions with fragmented information and insufficient time.   We estimate that, on average, each time you fix one of these problems you save about $20,000.  But sometimes it’s much, much more than that – and I’m talking about more than just money.

You don’t have to believe me, though.  An increasingly significant body of research shows that focusing resources on primary care is the best way to address the fundamental cost and quality problems we face in health care.  Reformers still aren’t getting it.  Pay more money for primary care?  The conventional wisdom says that doctors who say this are just trying to make more money for less work.  Really?  If a primary care doctor spends more time with his patients, he can do a better job figuring out the patient’s diagnosis, guiding them to the right treatment choices, and helping them, as a human being, cope with the difficulties of being sick.

So, if I had to pick just one thing to fix in our health care system, it would be this.  Focus on making primary care the fundamental basis for the system.  I think it is clear that it would save substantial amounts of money and lead to higher quality medical care.  But it would do more than this.  As Dr. Robert Centor said recently:

Patients need physicians who spend time with them. Patients need physicians who sit down, look them in the eye and talk. Patients need honesty and empathy.

He’s right.  Any health care system, or health care reform, that doesn’t create a stronger doctor-patient relationship, is failing.