Dear Shonda Rhimes, the brilliant mind behind my favorite television show, We need to talk about “Grey’s Anatomy.” I’m a fan. A really, really big fan. The kind of fan who — in the last 48 hours — rewatched all of last season’s episodes to prepare for the season premiere, and who has blocked off every Thursday night this fall to get lost in the drama at Grey Sloan Memorial. We all have our vices, and “Grey’s” is mine. But something occurred to me as I was bingeing on last season. From the lifesaving surgeries to the metastasized cancers, half of the plot lines and patients on “Grey’s Anatomy” should never have gotten to the emergency department. The cough that turned into fatal pneumonia? It should have been caught by the patient’s primary care physician. The mild urinary tract infection that became an aggressive kidney infection? A call to the woman’s nurse practitioner and a gallon of cranberry juice later, and she would have been fine. Or those two drinks a night that evolved into a devastating addiction? A primary care clinician would have seen the signs well before the family was forced to make a tough decision about treatment options. Shonda, where are the primary care teams? I realize that a show about primary care may not make for great television. It’s not sexy. Opening chests on an operating table in the middle of a raging hospital fire? Excising a tumor the size of a tennis ball? Dr. Jackson Avery? That’s sexy. Prevention? Not so much. Sadly, we’ve gotten so caught up in great stories — with their drama and impossible saves as the clock is running out — that our country has become normalized to fixing problems rather than preventing them. In America today, three common behaviors — poor diet, lack of exercise, and tobacco use — contribute to half of all preventable deaths. And the research is clear: Interventions for those three behaviors are most effective when administered in coordinated primary care clinical settings. It’s in these quiet clinics that we’re able to drastically reduce hospitalizations and those costly “Grey’s Anatomy” saves. Because it is designed for the very purpose of prevention, primary care has the capacity to put a tremendous dent in rates of chronic disease and preventable illness. Investment in primary care is especially important right now. Fewer and fewer medical students are choosing the field, even as an aging population requires more and more primary care. Students who do enter the field experience high rates of depression, burnout, and early exodus. Unless something changes, we’re approaching a crisis in primary care — and health care at large — as we struggle to attract more professionals into this vital work. So maybe that’s the drama we need to be airing: the crisis of primary care, a crisis that will affect every American. Lack of a strong primary care system has contributed to surging health care costs and soaring rates of chronic disease, not to mention an erosion of the provider-patient relationship. With the loss of effective, relationship-based primary care, patients are increasingly leaning on hospitals and specialists for treatment. That care is intentionally transactional. It’s about treating pain, not people, and packing wounds, not unpacking the social determinants of health. When care is transactional, doctors are more likely to overprescribe an opioid or focus on an algorithm from an electronic health record instead of listening to an important anecdote from a patient that offers insight into her or his health. I realize prevention isn’t sexy, but it should be. And not because it makes great television, but because it makes great health care. While my sauvignon blanc chills in anticipation of the long-awaited season premiere, I have a proposal for you. Shonda, if you haven’t already replaced Dr. Edwards, here’s an idea: How about picking a family physician or a pharmacist? Or, even better, a behavioral health specialist? Someone attractive with a great backstory — a traumatic crash or a broken heart that led him or her into primary care — and single, of course, but looking for love. We’re not going to start talking about the crisis of primary care until primary care gets sexy. And if anyone can do that, it’s you. Source
