This is not news: your primary care provider (PCP) has been listed on the endangered species list. Harvard Medical School has decided to no longer train primary care physicians – they are too quaint and old fashioned. Estimates show that for every seasoned PCP leaving primary care (which they are doing in larger numbers), it will take 1.7 PCPs to replace them due to expectations of shortened work hours and believing that life style and balance are deservedly theirs over a grinding 60+ hour work week.
Nothing PCPs do to reinvent ourselves frees us from the singular patient question on which the entire primary care patient-doctor relationship hinges: “Doc, are you still a ‘preferred provider’?” Perhaps it’s time to reconsider the plight of the PCP and even our day-to- day health care under a “family system” lens and re-examine the relationships from the perspective of the family therapist.
Setting The Stage
All marriages have their challenges and the current PCP’s medical home is no different. Like many dysfunctional family systems, most family members keep their secrets, some think they have done nothing wrong or have no fault. Some are extremely resentful at the merest implication that they’ve done anything wrong and refuse to participate in therapy at all. This little family drama is one of the most expensive dysfunctional American families of all time. All indicators point to the PCP as begging for help while simultaneously feeling trapped and trying to do her best to keep the relationships working.
Here are the players:
- Mrs. “Doctor” who feels hassled, overworked, underpaid, underappreciated and day dreams about quitting. She is in the midst of a mid-life crisis and is exhibiting signs of depression and anxiety.
- Mr. “Insurance” who’s having troubles balancing the family check book every year and therefore needs to increase earnings 10-15% each year to pay the bills. Mr. Insurance feels that he doesn’t have any issues, but everything is “Mrs. Doctor’s” fault. He tells her she wants too much, and is needy and wasteful. Mr. Insurance doesn’t want to go to therapy or family counseling and sees nothing wrong with him.
- “The Patients” the adult children of “Insurance” and “Doctor” who looks to their parents to protect their health and pocket book. For them, staying healthy, and not worrying about the price that might cost are expectations in some cases, demands of the family relationship.
What could be a more perfect family? The couple, Mrs. Doctor and Mr. Insurance, who are in charge of protecting The Patients. Like the traditional family, Mrs. Doctor will do the caring and Mr. Insurance will take care of the paying.
What an ideal family! But behind closed doors, this perfect family is in trouble. For some reason Mrs. Doctor is angry and resentful and feels under appreciated and is thinking about abandoning the family. Mr. Insurance is working hard to pay all the bills but keeps being accused that he’s stealing all the money and has no appreciation for the needs of his patients. Lastly The Patients feel threatened and worry that Mrs. Doctor has no time to see them, seems hurried all the time and gives very little quality time to each of them. Meanwhile they have heard rumors that Mr. Insurance may no longer be able to pay all the bills and might start demanding more and more money from The Patients to pay more of their fair share for their needs and demands. This could get ugly, real quick.
Stay tuned … we’ll watch this family drama play out under therapy.
Until then, I remain yours in primary care,
Alan Dappen, MD