Editorials

Primary care in the United States

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7063.955 (Published 19 October 1996) Cite this as: BMJ 1996;313:955
  1. Trish Groves, General practice editor,
  2. John Roberts, Physician
  1. BMJ, London WC1H 9JR
  2. York Health System Medical Group, York, Pennsylvania 17403, USA

    Getting more academic but needs greater cooperation between family physicians and primary care internists

    Primary care is on the up in the United States. Despite the failure of the Clinton health plan, many American politicians now believe what governments know worldwide—that primary care delivered by generalist doctors is the most cost effective way to deliver health care. Of course, primary care means many things in the United States: general internal medicine, paediatrics, and obstetrics, as well as family practice. But its core is the same as anywhere else.

    The American Board of Family Practice defines primary care as a highly personalised type of first contact care that is comprehensive, ensures continuity of care and continuing responsibility for individual patients, and coordinates all a patient's health care needs. This sounds like general practice to the European ear. But Americans steer clear of the term because the general internists don't want to be muddled up with the family physicians and the family physicians don't want their broad biopsychosocial approach to be underestimated.

    However, semantic scuffles and more serious …

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