Primary care can not be reduced to a brief office visit model of
practice or to an alternative to hospital care or, in some context, to a
health care model for low resources setting. Primary care attention is a
philosophy where its heart is the individual, –not necessarily the sick
person- their family and their community, where well educated, skilled and
motivated actors –doctors, nurses, social workers, others professionals,
etc- working together --in friendly connection with peoples and with the
society-- have the appropriate technology to promote health, to prevent
diseases and to treat patients. This model could receive the support of
the new technologies such as Scherger is proposing (1) but never that new
technologies will substitute the human warm that this special relationship
need to operate adequately. I know that this is a lot work, sometime
ungrateful, but it has been a challenger since Sculapio to the present
time.
Dr. Scherger is calling us to change. I don’t sure how feasible and
acceptable could be this “type of care” –electronic mediated- to US and UK
citizens but as others calling from the North it is ignoring again that
the world is more than a few set of richest countries. Africa and Latin
America have together fewer computers and phone lines than US. However, I
agree with Dr. Scherger: now is the time to radically change how primary
care is delivered. Now and from the South is the time to extent the
coverage of the primary care, to achieve better accessibility and quality
of care. A new primary care for all can help us to reach a healthy
nutrition, to stop the tobacco spread, to reduce the infant mortality, to
eliminate some pre-historical diseases, to control HIV/AIDS pandemic, to
prevent the coming epidemic of cardiovascular diseases. Primary care
might be a success technology to accomplish the Millennium Goals (2) and
to solve our debts with Alma Ata. (3) Several aspects of the Cuban
practice which has been centered on primary care (31 000 family
physician/68 000 medical doctors, total population = 11 million) ,
political prejudices apart, provide as realistic demonstrations of the
value of that strategic approach. (4)
References:
1. Scherger JE. Primary care needs a new model of office practice. BMJ
2005; 330: 358-359
2. “Global Health Problems, Millennium Development Goals and the World
Bank’s Role.”
http://www.worldbank.org/oed/gppp/case_studies/health/global_health.html?goog=3099
(Accessed May 12, 2005).
3. “The Declaration of Alma Ata”.
www.who.int/hpr/NPH/docs/declaration_almaata.pdf
4. Spiegel JM, Yassi A. Lessons from the margins of globalization:
appreciating the Cuban health paradox. J Public Health Policy. 2004;25:85-
110.
Rapid Response:
Primary care: changes but not for all
Editor:
Primary care can not be reduced to a brief office visit model of practice or to an alternative to hospital care or, in some context, to a health care model for low resources setting. Primary care attention is a philosophy where its heart is the individual, –not necessarily the sick person- their family and their community, where well educated, skilled and motivated actors –doctors, nurses, social workers, others professionals, etc- working together --in friendly connection with peoples and with the society-- have the appropriate technology to promote health, to prevent diseases and to treat patients. This model could receive the support of the new technologies such as Scherger is proposing (1) but never that new technologies will substitute the human warm that this special relationship need to operate adequately. I know that this is a lot work, sometime ungrateful, but it has been a challenger since Sculapio to the present time.
Dr. Scherger is calling us to change. I don’t sure how feasible and acceptable could be this “type of care” –electronic mediated- to US and UK citizens but as others calling from the North it is ignoring again that the world is more than a few set of richest countries. Africa and Latin America have together fewer computers and phone lines than US. However, I agree with Dr. Scherger: now is the time to radically change how primary care is delivered. Now and from the South is the time to extent the coverage of the primary care, to achieve better accessibility and quality of care. A new primary care for all can help us to reach a healthy nutrition, to stop the tobacco spread, to reduce the infant mortality, to eliminate some pre-historical diseases, to control HIV/AIDS pandemic, to prevent the coming epidemic of cardiovascular diseases. Primary care might be a success technology to accomplish the Millennium Goals (2) and to solve our debts with Alma Ata. (3) Several aspects of the Cuban practice which has been centered on primary care (31 000 family physician/68 000 medical doctors, total population = 11 million) , political prejudices apart, provide as realistic demonstrations of the value of that strategic approach. (4)
References: 1. Scherger JE. Primary care needs a new model of office practice. BMJ 2005; 330: 358-359 2. “Global Health Problems, Millennium Development Goals and the World Bank’s Role.” http://www.worldbank.org/oed/gppp/case_studies/health/global_health.html?goog=3099 (Accessed May 12, 2005). 3. “The Declaration of Alma Ata”. www.who.int/hpr/NPH/docs/declaration_almaata.pdf 4. Spiegel JM, Yassi A. Lessons from the margins of globalization: appreciating the Cuban health paradox. J Public Health Policy. 2004;25:85- 110.
Competing interests: None declared
Competing interests: No competing interests