Primary care as form or content?

Abstract

This article advocates revisiting the notion of primary care to include these dimensions: the physician-patient relationship, the notion of principal care, and the patient as validating the primary care relationship. The quality of primary care rests squarely on these three characteristics. From a systems perspective, the quality of primary care encompasses more than the right assortment of clinical competencies; quality has to be grounded in and realized at the individual level where physician and patient meet and interact over time. The discussion thus rests on the assumption that primary care is a process of care rather than a collection of skills. This study was stimulated by two factors: the claim of subspecialists to at times provide primary care and L. H. Aiken et al.'s article on the contribution of specialists to primary care. The author of the present article surveyed 467 internists and subspecialists and asked if they equated principal care with general internal medicine (IM) care-a primary care competency. The percentage of IM in their practice was also surveyed. The 160 responses revealed that the percentage of subspecialist care to primary care was similar to that described in Aiken et al.'s article. The notion of principal care thus appears to better reflect the realities of clinical practice.