Ears / Harvard / Boston

Dave responded to my post below.

I didn't have my facts right.  Dave called his primary care physician first.

I posted a response to the Boston Common weblog   post  (and his response) … here's what I said:

Dave is sharing some tidbits of his personal life with us, and I shouldn't chastise him for doing so .. I should applaud him. This sort of transparency is educational. Dave is teaching … and I suppose my goal was/is to teach as well.

Dave – I didn't mean to infer that you were casual about your care. My inference (albeit incorrect!) was that you — like many — have been taught — by a system and culture that values specialty care above primary care — to seek specialty care before the problem was evaualted by a family physician or general internist.   As point out, I was wrong about how this panned out.  Given your "celebrity" status, and your willingness to share these details of your personal life with us, I used this event as an example of a component of our healthcare system that I believe is dysfunctional.

It turns out that the example was a rotten one, but my sentiment about the dysfunctional system/culture remains the same.

Most patients who reach out to me are seen promptly and are referred to specialists only when necessary. Yes – we see patients on Saturday and Sunday and even at night.  Had you called me, I would have offered to see you in the office.  This is the core of what we do – we are the primary care physicians and we specialize in primary CARE — not primary referral. We take care of very sick people and very well people. Young, old, pregnant, depressed, sexually active and impotent.

As one who teaches family medicine to medical students, I struggle with the biases against primary care every day. Specialists tell our students that family physicians are "stupid" or that the only role we should have is to "pop the pimples on farmers' butts and refer the rest of the patients to appropriate specialists." No kidding .. this came right out of one of my specialists colleagues' mouths.

My comment speaks to a culture of medicine — and the role of primary care in how we treat our patients.

Yes .. I have a bit of a chip on my shoulder. (see above re: farmers butts). Primary care physicians are the Rodney Dangerfields of medicine.

We earn respect in an 8 x 10 room with our patients one-by-one-by-one. My post starts with a comment about Dave's encoiunter, but if one reads the whole post, you can see that I discuss much more than that.

Some places – and Harvard is one of them – have developed a culture that remains specialty -focused. I grew up in Boston – where I didn't know what a family physician was until I was 18.   Boston was one of the last of the major cities to host a residency in Family Medicine (There are several in the Boston Metro area now), and there remains NO family medicine education at Harvard. See this note in Harvard Medical School's weekly paper about the dearth of family medicine education at Harvard, and how unhappy the students are about this.  


Finally – since we're all in this to educate … here's a link explaining why you shouldn't use q-tips in your ears .. and a reminder (I've posted on this one before) that colace (Docusate Sodium) is very good at softening earwax.  I sometimes suggest that people use this once a week to avoid impaction problems alltogether.