Gardeners versus mechanics: a case for primary care.

B eorge F. Kennan, the diplomat who G devised the policy of "containment" to tight communism, was asked if he HSa resented not being a celebrity like Henry Kissinger while he was in the State Department. He replied resignedly that he knew himself to be a "gardener"—with a quiet, persevering, style—while Americans prefer "mechanics," flamboyant individuals who solve problems and fix things. Primary care physicians arc the gardeners of medicine, who take care of people unobtrusively. But specialists, especially surgeons, capture the imagination of the public and reap the economic rewards. All of us want a kindly personal physician—one who reminds us of our grandfathers or grandmothers—until we think we might be sick, and then we want immediate access to the most experienced specialist and the latest technology.