More on the ‘P word’

A reader responds to a recent column on the term “primary care provider.”

The President's Message in the September 2019 ACP Internist by Robert M. McLean, MD, MACP, “Defining Our Identity Does Not Include the ‘P Word,’” had a lot of meaning for me, as I am sure it does for most of us physician “PCPs.”

When we first started using that term, it actually meant primary care physician. Then it morphed into primary care provider, a term I always objected to. I realize that I, too, have carried some resentment about this over the years. Dr. McLean articulated what many of us have felt but never expressed. For me, I never wanted to complain. I figured that “primary care provider” was coined to make it less unwieldy to refer to whomever is taking care of the patient, rather than the mouthful “physician, nurse practitioner, or physician's assistant,” so I accepted the term, not wanting to appear self-righteous. Dr. McLean made the excellent point that “provider” is a misnomer; it is a doctor-patient relationship, not a unilateral provision of services to a consumer.

What I really liked about the column was how Dr. McLean emphasized that it is virtually impossible for us to have those meaningful, trusting relationships with our patients when we are constrained in a system where the priority is profit, and where the primary goal of the EHR is to optimize documentation so that the highest and most ICD-10 codes can be billed in order to obtain the highest reimbursement. Our focus has shifted to typing and clicking instead of the eye contact fundamental for connecting with our patients. The current health care system has become complicit in the impersonalization of the office visit. This leads to what Simon G. Talbot, MD, and Wendy Dean, MD, described in the July 26, 2018, STAT as the moral injury physicians experience when we feel unable to provide high-quality care in a health system that is broken. It is not burnout as much as it is a feeling that our calling to heal others has been betrayed.

With a greater understanding of these things that so deeply affect us, we can encourage our physician leaders and administrators to make the kind of change that underscores the meaning in our roles as physicians, thereby leading to higher patient satisfaction, better outcomes, optimal health for our patients, and ultimately lower costs to society.

Deborah Wong, MD
Sonora, Calif.