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Morton A. Scheinberg*
W h at is p rim ary care an y w ay ?
P rim a ry c a re is a fa v o u rite w ith in c e rta in c irc le s in to d a y 's p ra c tic e o f m e d ic in e . In p a rtic u la r H e a lth M a in te n a n c e O rg a n iz a tio n s (H M O s ) lo o k a t it a s o n e o f th e m a jo r s tre n g th s a g a in s t th e g ro w th o f te c h n o lo g y d riv e n in c re a s e in m e d ic a I c a re . It is a Is o s e e n a t c e rta in p o litic a l le v e Is a s o n e w a y to p ro v id e m e d ic a I c a re to e v e ry o n e in th e c o m m u n ity irre s p e c tiv e o f in c o m e o r s o c ia l le v e I.
M y p e rs o n a l v ie w is th a t th e p ro m o tio n o f p rim a ry c a re b y p o litic ia n s s h o u ld b e m e t w ith a m b iv a le n c e , s in c e th e y w o u ld lik e to e x p lo re th is a v e n u e a s a s o Iu tio n to h e a lth c a re p ro b le m s .
I b e lie v e a ls o th a t p rim a ry c a re a s a m e d ic a I d is c ip lin e m u s t e x e rt c o n tro l o v e r its o w n fu tu re a n d m is ta k e s .
W h a t is p rim a ry c a re a n y w a y ? M y u n d e rs ta n d in g is th a t e ffe c tiv e p rim a ry c a re re fe rs to th e e x te n t to w h ic h th e n e e d s o f th e p o p u la tio n a re m e l. O n e c a n s e e v a ria tio n s fro m c e rta in n o rm s in c lin ic a I p ro c e d u re s b u t n e v e r s h o u ld in te rv e n tio n b e e n c o u ra g e d w ith th e a im o f s a tis fy in g p a tie n ts d e m a n d s ra th e r th a n th e re a l n e e d s . T h e m a in th ru s t is th a t p rim a ry c a re m u s t b e d ire c te d a t th e .n e e d s ra th e r th a n th e d e m a n d s o f th e p a tie n ts . It is a Is o m y u n d e rs ta n d in g th a t th e c u rre n t le v e I o f tra in in g o f p rim a ry
* M.D., P.h.D., 'F.A.C.P. Ph.D - Boston University
Livre -Docente da Universidade de São Paulo.
d o c to rs in h e a lth c a re c a n n o t g iv e to th e m th e a b ility to c o p e w ith a lI h e a lth p ro b le m s in th e c o m m u n ity irre s p e c tiv e o f th e e c o n o m ic s o f th e p a tie n ts . A lth o u g h th e d is s e m in a tio n o f in fo rm a tio n c a n h e lp to im p ro v e th e d e c is io n m a k in g fo r g e n e ra l p ra c titio n e rs , s p e c ia liz e d m e d ic in e is th e o n ly p a th w a y to a s s u re p ro p e r c a re in c o m p lic a te d c a s e s a n d lo n g te rm c a re in c h ro n ic d is e a s e s . M y c u rre n t th in k in g o n th is m a tte r, s o m e tim e s a c tin g a s a p rim a ry c a re d o c to r a n d a t o th e r tim e s in s e c o n d a ry c a re , is th a t o n ly in te ra c tiv e m e d ic in e w ill g u a ra n te e e ffe c tiv e c a re . T h e p o litic a I a n d fin a n c ia I v ie w o f p rim a ry c a re d o c to rs a s " g a te k e e p e rs " o f th e le v e I o f p ra c tic e w ill o n ly a llo w c o s t re d u c tio n a t th e e x p e n s e o f p ro p e r c a re .
P rim a ry c a re d o c to rs tre a t a v a rie ty o f illn e s s in a n y o n e p a tie n t, in c o n tra s t to s e c o n d a ry c a re w h e re m a n y p a tie n ts a re tre a te d fo r th e s a m e illn e s s . H o w e v e r, th e p ro p e r le v e I o f tra in in g is n o t th e re to tre a t e v e ry th in g a n d th e re fo re o n e m ig h t c h o o s e th e w ro n g tre a tm e n t. P ro m o tio n o f p rim a ry c a re s h o u ld b e d o n e in p a ra lle I w ith s e c o n d a ry c a re a n d w e m a y h a v e d o c to rs w h o c a n p ra c tis e b o th .
