Primary Care

Times are tough enough for Californians; they're even tougher for Californians' teeth. "One-quarter of all adults and 28% of children in California have untreated dental caries [cavities]," says Len Finocchio, a senior program officer at the California Healthcare Foundation, a health advocacy group. "Our research tells us that many people in California have been avoiding routine care that might have cost about $100 for a checkup and cleaning, and then find themselves in the emergency room, where they get only an antibiotic, a bill that can average over $600 and instructions to see a dentist."

Is the routine PSA test to screen for prostate cancer going to fade away now that the U.S. Preventive Services Task Force has recommended against it for men of all ages? The signs are maybe not, according to a survey of primary care physicians done by Dr. Craig E. Pollack and colleagues at Johns Hopkins University School of Medicine. The survey was done in November, after the task force's draft recommendations had been released but before the final ones were published earlier this week in the Annals of Internal Medicine . In the survey, 125 primary care physicians and nurse practitioners affiliated with Johns Hopkins responded to a questionnaire about their approach to PSA screening.

The future for medical students with large educational debts is not as bleak as "Med Students Seek Cure for Debt" [Nov. 27] portrayed, especially for those future doctors interested in working with the underserved. It is true that the practice of medicine is becoming much more difficult with many bureaucratic hurdles that interfere with patient care and reimbursement. Further, many young specialist physicians will have trouble finding positions locally as a surplus of many types of specialists exists.

The economic downturn was tough on the urban core of many U.S. cities. But Pomona got a booster shot from an unlikely source: Western University of Health Sciences. The institution constructed a new clinic and a classroom building as part of a $110-million expansion. The school had previously rehabilitated existing retail space in Pomona's once-blighted center. Its Health Professions Center, for example, is a renovated former Buffum's department store. Nearby, a building that once held a JCPenney houses the University Research Center.

Women who are just starting out in their medical careers earn less money than their male counterparts. And that's probably a good thing, according to a study published Thursday in the journal Health Affairs . Let me explain. It's well known that women tend to earn less than men even when they're in the same jobs. As of 2009, the so-called gender wage gap was nearly 23%, meaning that for each dollar earned by men, women earned only 77 cents. When it comes to doctors, there are several explanations for the pay gap. For instance, women are more likely to go into primary care fields such as internal medicine, family practice and pediatrics that pay less than specialties such as cardiology, radiology and orthopedic surgery.

Antidepressants, now the third-most commonly prescribed class of drugs in the United States, are routinely offered to patients with vague complaints of fatigue, pain and malaise but who are not classified as suffering from a mental disorder by the physician who recommends the treatment, says a new study. And among primary care provider as well as specialists who are not psychiatrists, the practice of prescribing these medications without diagnosing depression is rising steeply, the study finds.

The average adult fills about a dozen prescriptions and refills every year; after age 65, they fill more than 30 prescriptions annually. For many people, their local pharmacist may be as familiar as their doctor ? and often a lot easier to get time with. Some pharmacists are building on that position, expanding their role from drug dispenser to drug educator and chronic disease coach. By doing so, they may fill a void created by the shortage of primary-care physicians while boosting their business.

The Senate and House are inching closer to extending health insurance to millions of Americans. Access to insurance, however, does not necessarily mean access to healthcare. What is also needed is a sufficient supply of primary-care doctors. As an internal-medicine physician who works in multiple clinical settings, I repeatedly witness the consequences of patients not having that access. When I was working in an emergency room a few months ago, for example, a middle-aged man with hypertension came in with a paralyzing stroke.

"That's where the money is," Willie Sutton famously quipped when asked why he robbed banks. There's a similar rationale for employers who hope to improve employee health and contain costs with workplace health clinics: That's where the people are. Day in and day out, workers troop into the office, spending the better part of their waking hours there. What better place to have medical staff on hand, not only to treat sore throats and cut fingers but also to help employees stay healthy by offering on-site preventive tests and screenings, and health coaching to encourage healthful habits?

Re "Why the doctor won't see you now," Column One, Dec. 15 This is a timely article, as healthcare reform becomes more likely with the incoming Obama administration. However, any comprehensive effort to change our fragmented healthcare system will run aground if our primary care crisis is not dealt with. The American College of Physicians reports that from 1997 to 2005, the number of U.S. medical graduates entering family medicine residencies dropped by 50%. That is likely to continue as medical school debt increases well beyond $100,000 per graduate and primary care physicians continue to receive low payment rates from Medicare and other insurers.

If primary care doctors build intensive counseling programs to help their obese patients exercise, lose weight and get healthy, will they work? A new study finds that for half the population, at least, they will. For men and women alike, results will be modest. And for women, they won't last. The authors of the study, published Monday in the Archives of Internal Medicine, concluded that physicians' efforts to improve their obese patients' health by promoting lifestyle change might do better to embrace "a more realistic expectation": a modest reduction of patients' waist circumference and the prevention of further weight gain.

Retail giant Wal-Mart Stores Inc. is exploring ways to expand the kinds of healthcare services it offers at dozens of stores across the country, potentially setting the stage to turn the nation's largest retailer into a major primary care service provider and drive down costs for millions of Americans. The Arkansas retail giant is looking to partner with outside healthcare companies to treat and manage a range of serious medical conditions — including HIV, diabetes, arthritis and clinical depression — at 140 store clinics nationwide.

Antidepressants, now the third-most commonly prescribed class of drugs in the United States, are routinely offered to patients with vague complaints of fatigue, pain and malaise but who are not classified as suffering from a mental disorder by the physician who recommends the treatment, says a new study. And among primary care provider as well as specialists who are not psychiatrists, the practice of prescribing these medications without diagnosing depression is rising steeply, the study finds.

Thanks for the fantastic article you wrote on me ["Working Out Obesity Issues," June 27]. I will continue my quest to find a doctor who will repair my torn [anterior cruciate ligament] and remove the 40-plus pounds of skin at no cost. I am living in California now and still losing weight. Your weather is amazing! Dana C. Baker Anaheim Pay family doctors well I could have written Dr. Steve Dudley's Health section article on concierge medicine ["Select Care's High Price," June 27]

Spy, snoop, survey, assess, analyze, quantify — pick your favorite verb to describe the Obama administration's plan to send out fictitious patients, or "mystery shoppers," to try to get an appointment with a primary care doctor. Under the plan, mystery shoppers will call doctors in nine states to try to schedule an appointment first posing as someone with private insurance and another time as someone with public insurance, according to the New York Times. The administration says it’s important to know how difficult obtaining access to care is, especially as the healthcare system braces for millions more Medicaid patients in 2014.

The days of the old-fashioned family doctor who knows us intimately and treats our kids -- and our grandkids -- are fading fast. Instead, we're more likely to find ourselves searching for a doctor who will take our insurance, then waiting weeks for an appointment and hours in the waiting and exam rooms. Our doctor will rush in and rush through a series of pokes and prods and a checklist of questions, check off some codes on our record, then rush out again. None of this makes us very happy -- or, for that matter, the doctor either.

A new health center that emphasizes outpatient care has been dedicated at Los Angeles County Harbor-UCLA Medical Center near Torrance. The $16.6-million center is expected to ease the demand on the county hospital's busy emergency room. It houses the primary care and internal medicine clinics, the urgent ambulatory care clinic, outpatient diagnostics and procedures, and an outpatient surgery area.

"That's where the money is," Willie Sutton famously quipped when asked why he robbed banks. There's a similar rationale for employers who hope to improve employee health and contain costs with workplace health clinics: That's where the people are. Day in and day out, workers troop into the office, spending the better part of their waking hours there. What better place to have medical staff on hand, not only to treat sore throats and cut fingers but also to help employees stay healthy by offering on-site preventive tests and screenings, and health coaching to encourage healthful habits?