Soundings Soundings

Perils of primary care

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7131.635 (Published 14 February 1998) Cite this as: BMJ 1998;316:635
  1. George Dunea, attending physician
  1. Cook County Hospital, Chicago, USA

    By all accounts Dr Fox should be happy in his profession. He graduated from a prestigious university and was courted by several academic departments, but thought that he would like treating people better. He accordingly opted for primary care, a line of work currently much favoured by managed care organisations, government bureaucrats, and healthcare philosophers.

    But Dr Fox is not happy. Too much has changed and too many people are telling him what to do. Government agencies now address him as “Dear provider” and even tell him how to write his notes: for a problem focused history his “documentation” must show the “patient's positive and pertinent negatives” for the system affected; for a detailed history he will be …

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