‘This is what’s at stake’: Patients fall through the cracks of flawed primary care system

WASHINGTON — After 2 days of discussions about reforming primary care, Kavita Patel, MD, MS, closed out the Primary Care Collaborative annual meeting by getting “back to the heart” of why changes are needed.

The conference was centered around five recommendations from the National Academies of Sciences, Engineering and Medicine (NASEM) report on rebuilding the foundation of primary health care: payment, access, workforce, technology and accountability.

The discussions included HHS’s plan to put the NASEM recommendations into action, policies that transition the health system from fee-for-service to value-based care and new technology that will connect providers across networks.

To highlight the importance of these discussions, Patel, who is a primary care physician at Mary’s Center in Washington, D.C. and former director of policy for the Office of Intergovernmental Affairs and Public Engagement under the Obama administration, reflected on the challenges she has faced during her career.

Despite working in a team-based environment, Patel said “I didn’t really have a team.”

“I was told that I was part of a team. There was an organization chart where it looked like I was part of a team,” she said. “But at the end of the day, it all came down to me. Even though I had team-based care, 99.9% of the time, those teammates pushed everything to me.”

Burnout was an issue, but Patel said it was “more than just that, it was a multitude of things” that her primary care colleagues were also facing.

To illustrate this point, Patel shared a story about a patient who she inherited from another provider. For months, the patient’s radiologist tried calling the previous provider, who ordered CT scans for the patient before leaving the health system. Patel never received those messages.

“Because our system is such that it is large enough, the person on the other end of the calls would just keep taking messages for somebody who didn’t even exist in the system anymore,” Patel said. “They didn’t realize the messages were pinging back. They didn’t have the team or the training or the quality control to follow through to ensure the message was received.”

The patient had developed advanced lung cancer, Patel said.

“My medical assistant caught this as a fluke because she happened to see it printed out on a fax,” Patel said. “How do you make that phone call? I called the patient and said, ‘not only have I failed you, the system has failed you.’

“This woman had the most grace,” Patel added. “She said ‘thank you so much for calling. I know these things happen.’ And that brings me to the heart of primary care. This is why we do what we do. She actually said, ‘I feel like when I see you, you take really good care of me and listen to me.’ I still want to cry when I think about it.’”

From that point on, Patel personally coordinated the patient’s care, but the story serves as a reminder that “this is what’s at stake,” she said.

“This is what’s on the line,” she said. “I’m not going to be able to fix it by myself in my little setting. I am going to have to get very aggressive about it.”

Patel closed with three priority areas for PCPs. The first, she said, is for providers to find a better way to communicate with the real world about important issues facing health care.

“People in the real world don’t know AAP, ACP ... nobody cares about that,” she said. “Figure out a better way to communicate. Some people call it advocacy. It’s basic communication.”

The second priority is to be part of the conversation about financial changes that are needed to better support primary care.

“Most primary care leaders I know would never understand even the concept of sitting down with the CFO. They are all waiting for that person to come and get into touch with them,” Patel said. “We need to flip the conversation.”

The third priority “is to go back to the heart, and start with a story,” Patel said.

“Not a night goes by that I don’t think how many patients I may have missed something terrible on,” Patel said. “It certainly made me want to walk away from the profession at times. But bring it back to the heart.”