Primary care is first-contact care



As Dr. Hickner noted in his editorial (“Have family physicians abandoned acute care?J Fam Pract. 2013;62:333), there is an increasing misconception that acute and chronic care—2 sides of the same coin—can be separated. Waning primary care capability for acute care has largely been a matter of a broken market, an overwhelmed and underfunded workforce, and decreasing skills among our newest residency graduates.1,2

Clinicians learn the phrase “acute on chronic” for a reason. Primary care needs to be there for breathlessness in asthma, foot wounds in diabetes, and suicidality in depression, as much as it needs to be ready with sutures, splints, and imaging. It is first-contact care.

The decentralization of health care is only beginning.3 Blood tests on a smartphone, elastomeric intravenous medication delivery, handheld ultrasound, and home monitoring—these are here, or nearly so. Primary care has the ability to address patients’ urgent needs as never before.

Acute care is another name for someone being sick or hurt. General practitioner and essayist Iona Heath put it best when she said: “It is time medicine got back to its core task of attempting to relieve suffering.”4 In a perfect world, acute care would be preventable. In our world, let’s be there to help.

Stephen A. Martin, MD
Barre, Mass

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