Primary care physicians and specialists as personal physicians: can there be harmony? - Editorial

Journal of Family Practice, August, 1998 by Joseph E. Scherger

I still believe most people are better off having a primary care physician as their personal physician. But for those patients with special problems, such as lupus, severe obstructive lung disease, or severe psoriasis, it is reasonable to refer to a rheumatologist, a pulmonologist, or a dermatologist as a personal physician to provide comprehensive services, or to form a primary care team with them. For example, my mother-in-law has pancreatic cancer, and the job of personal physician has been passed from her family physician to her oncologist. This specialist is giving my mother-in-law more life, both in quality and quantity, with a new therapy I never heard of until after the referral, and the oncologist is giving this treatment with all the care and compassion of the best physicians in family practice.

If a peace accord can be agreed on in Ireland, then there can certainly can be peace among American personal physicians. If we agree that we can all be good doctors, and perhaps even help each other toward that end, we will create a much better landscape of care. Of course there will need to be some order as to which physician does what, with compromises on both sides, but I have seen such harmony in more than one medical group, so I know that it is possible. As the new American health care delivery systems mature, I suspect that someday we will look back and regret today's battle between primary care physicians and specialists.

REFERENCES

[1.] Franks P, Fiscella K. Primary care physicians and specialists as personal physicians: health care expenditures and mortality experience. J Faro Pract 1998; 47:105-9.

[2.] Rosenblatt RA, Hart LG, Baldwin LM, et al. The generalist role of specialty physicians. JAMA 1998; 279:1364-70.

All correspondence should be addressed to Joseph E. Scherger, MD, MPH, Department of Family Medicine, UCI Medical Center, Bldg 200, Rm 512, R. 81, 101 The City Drive South, Orange, CA 92868-3298. E-mail: scherger@uci.edu