The Mad Doctor

Tin Foil HatAssistant professor of medicine at Case Western Reserve University Dr. Jonathan Glauser seems to have quite a bit of hostility toward primary care physicians.  And surgeons.  And his kids’ own pediatrician.  And orthopedists.

Fund physicians to promote primary care? Why throw good money after bad? If ever there was a group that has failed in providing care, it is our primary care system.

Really?  Funny how over 100 peer-reviewed studies say otherwise.  Dr. Glauser goes on to site a few anecdotes to support his (such as it is) “case”.  But one will search his op-ed piece in vain for an independent study or article.  The astute reader is however rewarded with insights like the following:

How could we as physicians ever allow a doctor to call himself primary care when he can’t manage simple chronic illness, cannot definitively treat acute illness or injury, often has no skills to save lives and no access to equipment if he had the skills, and does not even see patients at their own (the customers’) convenience? Did I mention seeing people who simply need care, regardless of ability to pay?

Primary care docs have lots of skills to save lives, including their own cognitive abilities and the dispensing of generic prescription drugs both of which make it less likely that the patient will need the kinds of equipment Dr. Glauser is probably referring to such as mechanical ventilators and defibrillators.  As for not mentioning seeing people who simply need care regardless of ability to pay, the good doctor’s failure to mention that heretofore is probably because academic physicians attached to fine intuitions like Case Western Reserve University and the Cleveland Clinic Foundation are doubtless shielded from those pesky market forces and practice management headaches.

There isn’t much laying on of hands anymore. If I were really a suspicious person, which surely I am not, I would find the clinical skills of many primary care providers to differentiate splenomegaly from lymphoma or a direct from an indirect hernia suspect.

Yes, if you want old school medicine bereft of lab tests and imaging studies of dubious necessity, you can do no better than to head to your local emergency department.  In tone and content the article meanders from the humorous:

…they [meaning primary care physicians] and their office staff can knock off at 4:30 p.m.

To the disingenuous:

If I were really cynical, which of course I am not…

ACP blogger Bob Doherty reports that the American College of Physicians plans to send a response to Emergency Medical News, despite the fact that this odd little tirade seems to justify little response beyond passing copies of it around the office or physician’s lounge for a laugh.


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