Improving Primary Care: Strategies and Tools for a Better Practice

America’s embattled primary care system is nearing the breaking point. Primary care clinicians are expected to provide continuity of care for patients within an increasingly fractionated medical environment. They face ever-expanding hours with no corresponding rise in reimbursement rates, leading to high levels of job-related dissatisfaction. And while much of the work of primary care involves managing complex chronic illnesses such as diabetes and hypertension, such important long-term clinical issues are often forced to the back burner in favor of addressing patients’ more acute medical problems within the space of a rushed 15-minute office visit, resulting in frustration for both patients and providers. Perhaps it is no surprise, then, that medical students in recent years have increasingly turned to specialties other than primary care for their residency training, further shrinking the supply of available clinicians on the frontlines of American medical care. It is in light of this grim situation that the excellent book, Improving Primary Care: Strategies and Tools for a Better Practice, was written. The authors, both faculty in the Department of Family and Community Medicine at UCSF, together boast 50 years of primary care experience in a variety of clinical settings. This extensive firsthand knowledge is abundantly evident in their facile and authoritative command of the many challenges facing primary care. Yet rather than bemoaning the trends in medicine and society that have given rise to the current plight of their field, Bodenheimer and Grumbach devote the bulk of their text to outlining practical suggestions for adapting primary care to the changing medical climate. The authors expertly weave together history, personal experience, and extensive evidence from the medical literature to put forth their suggestions for building the “New Practice Model” for primary care. And it is difficult not to be convinced by their pragmatic approach. While Improving Primary Care seems mostly to be geared at primary care doctors — particularly those in private practice — the book is written in an accessible way that will be appreciated by a variety of caregivers, not just physicians. Indeed, the authors take special care to point out that much of the primary care need in the United States is increasingly being filled by allied health professionals such as nurse practitioners and physician assistants. One of this book’s most appealing features is its clever use of fictional vignettes to illustrate particular topics. For example, in a discussion about improving care for patients with chronic illnesses, the authors contrast two hypothetical doctors’ offices to highlight the benefits that would be achieved by implementing planned chronic diseasemanagement visits. These vignettes are scattered throughout the text, and they go a long way toward enlivening what might otherwise be a somewhat dry, jargon-heavy discussion. Another attractive feature is the extensive set of tools located in the book’s appendices that include everything from worksheets to sample dialogues designed to help primary care clinicians implement the strategies outlined in the preceding chapters. Despite some minor organizational flaws, Bodenheimer and Grumbach’s new text is an informative, practical guide that adds a much-needed perspective on how to adapt primary care to the modern medical environment.