Community-oriented, preventive primary care, with less reliance on high-tech medical devices, may be the prescription for the nation's 43 million uninsured people, said a local health care official Thursday afternoon.
Dr. Evelyn Schmidt, director of the Lincoln Community Health Center in Durham, spoke on "Care for the Uninsured and Underinsured" in a University-sponsored event celebrating National Primary Care Day. Primary care disciplines include family medicine, pediatrics, general internal medicine and obstetrics. On National Primary Care Day, students at each of the nation's 141 medical schools hosted and participated in educational programs designed to raise awareness of the generalist disciplines. About 30 people, most of whom were medical students, assembled in the University's Bryan Neurosciences Auditorium to hear Schmidt speak.
Given the nation's current health care shortage, Schmidt questioned the importance placed on technology. "We excel in medical technology, but not in primary care," she said. "We are a wealthy country compared to many, but [in terms of health care coverage] we are behind many nations with less resources."
The purpose of a nation's health care system should be to ensure the health of all citizens, she said. To this end, disease prevention through education should be a large part of such an enterprise. "The philosophy behind primary care is prevention, educating the patient to be better able to take care of one's health," Schmidt said. "If everyone ate right, exercised, buckled up, stopped smoking, decided not to use weapons and guns and used condoms when appropriate, we would have a very healthy society. We want patients to take charge of their health."
Traditional insurance plans place little emphasis on preventative primary care services, such as immunizations, screening tests, health education and prenatal care. Of the $21 billion North Carolina spent on health care in 1994, only one percent was spent on population-based public health services, she said.
Policy makers should focus on ensuring access to quality, personalized care and early intervention in communities, rather than technology, Schmidt said. She noted the increasing incidence of AIDS and gonorrhea in Durham, famous for its biotechnological achievements, as evidence of an imbalance.
Addressing the medical students in the audience, Schmidt said that the nation's future primary care doctors would play an important role in the establishment of community. "You will have the opportunity to build relationships and be in partnership with patients," she said.
Schmidt also addressed recent political developments impacting the quality of care for disadvantaged groups, especially poor women and children. Proposed cuts in Medicaid, the national program that provides health care for the uninsured and underinsured, in the Republicans' "Contract with America" are unsound, she said. "To cope with proposed limits on Medicaid eligibility, states would have to reduce enrollment. You can't do more with less," she said.
Schmidt said that Medicaid services for children were tied to the nation's future. Lawmakers need to balance the budget "without jeopardizing the health and welfare of American children [who are] powerless," she said.
Following the speech, several audience members expressed support for Schmidt's ideas. Dr. Jonathan Sheline, assistant professor in community and family medicine, explained the need for more primary care physicians. "The appeal of primary care nationwide is that what you're hoping for is to have continuity of care. We want to get back to one doctor who knows the whole patient, who can decide if a referral is needed," he said.
Tiffiny Diers, a third-year medical student, echoed these sentiments. "[The] continuity of your relationship [with the patient] allows you to prevent illnesses," she said.
Dr. Barbara Sheline, assistant clinical professor in community and family medicine, supported Schmidt's position on community-oriented care. "The importance of the focus on the community when providing health care for populations is that you are directing health care towards who people are, the environment they live in, the economic situation of people and the common problems of a particular community, rather than having a generic approach to patients. I think managed care is forcing us to consider community and population issues, and ultimately, that's better for patients," she said.
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