Primary care is coordinated, comprehensive, and personal care, available on both a first-contact and a continuous basis. It incorporates several tasks: medical diagnosis and treatment, psychological assessment and management, personal support, communication of information about illness, prevention, and health maintenance.
This book addresses the clinical problems encountered by primary care physicians in the office practice of adult medicine. In this setting, the physician's responsibilities and tasks extend beyond the narrow technologic confines of medical diagnosis and treatment. Although a great deal of effort must be focused on accurate diagnosis and technically sound therapy, the other clinical tasks that complete the very definition of primary care also assume major importance.
Alongside this clinical definition of primary care stands a plethora of other definitions; these derive from organizational, functional, professional, and academic perspectives. For example, policy planners have defined primary care as a level of medical services, one that is provided outside the hospital. Presumably, primary care (community-based services) is, then, a less technical practice in comparison with secondary care (consultant or specialty services) and tertiary care (hospital services). This organizational definition provides a scheme for the allocation of public resources among these health services, each of which has a distinct professional, economic, institutional, and political structure. For another definition, Alpert and Charney have looked at important patient care functions of doctors—namely, to provide access, continuity, and integration. Although this view is useful in describing the functions performed by practitioners for their patients within organized health services, it does not define the content of their clinical work. From the standpoint of professionalism, primary care has been defined as a specialty concentrating on general medicine practiced outside the hospital but devoid of the special procedures and technology that typically characterize specialization. This definition has been useful in organizing general internal medicine, general pediatrics, and family practice and in designing a new curriculum for the education and training of doctors. From the university comes still another definition of primary care as an academic discipline concerned with the expansion of knowledge unique to primary practice and personal care, a definition that contains the promise of a departmental position for primary care in the medical school.
Although each of these definitions presents a particular perspective about primary care and serves some special purpose, none explains the primary care physician's day-to-day work with patients.
Chapter 1: Primary Care Medicine