Steady, personal care by primary care physicians over time can often help people more than intensive interventions such as surgery, according to Harvard T.H. Chan School of Public Health’s Atul Gawande.
In a January 23, 2017 New Yorker article, Gawande, professor in the Department of Health Policy and Management and director of Ariadne Labs, wrote about how the day-by-day, year-by-year work of primary care doctors—managing their patients’ high blood pressure, diabetes, or other chronic conditions—can make a significant difference in lowering mortality, improving health, and reducing medical costs.
“Much of what ails us requires a more patient kind of skill,” Gawande wrote. Primary care doctors can work, little by little, to steer their patients toward taking their medicines correctly, losing weight, dealing with alcohol problems, or showing up for their annual physical. Gawande stressed the importance of the long-term relationship between doctor and patient. “Studies have established that having a regular source of medical care, from a doctor who knows you, has a powerful effect on your willingness to seek care for severe symptoms,” he wrote.
While it will always be important to provide patients with swift, “heroic” care—such as surgery to repair a ruptured spleen—Gawande urged a greater focus on incremental care. “We can give up an antiquated set of priorities and shift our focus from rescue medicine to lifelong incremental care. Or we can leave millions of people to suffer and die from conditions that, increasingly, can be predicted and managed,” he wrote. “This isn’t a bloodless policy choice; it’s a medical emergency.”
Read the New Yorker article: The Heroism of Incremental Care
Listen to an interview featuring Atul Gawande on NPR’s All Things Considered: For Many People, Medical Care Works Best When It’s Incremental
Watch Atul Gawande on PBS NewsHour: Reassessing the value of care for chronic health conditions
Learn more
Atul Gawande, President Obama discuss future of medicine (Harvard Chan School news)
‘Overkill’ in medical care (Harvard Chan School news)