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Why isn’t primary care idolized?

Rebecca Divers
Policy
May 28, 2013
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The Baylor PCP chapter co-hosted a screening of Escape Fire at Rice University. I had heard about the film some time ago when it first came out and had always wanted to see it myself, but now I am convinced that it should be screened at every medical school orientation.

The film provided a poignant portrayal of several all-too-familiar stories: the overworked, underpaid primary care doctor who cannot afford to spend adequate time counseling her patients; the uninsured patient who cannot afford preventive health care and bounces in and out of hospitals with multiple acute exacerbations of his chronic illness; and the woman who, despite dozens of catheterizations and surgical procedures, still suffers from heart disease due to uncontrolled diabetes and high cholesterol.

I was moved to tears by their stories, but I was particularly inspired by the work of Dr. Dean Ornish, whose research addresses the potential for reversing chronic heart disease and cancer with intensive lifestyle changes. Ornish’s work is often disregarded by our system that values technology, pharmaceuticals, and procedures. But Dr. Ornish has provided the highest standard of evidence – the randomized controlled trial – in support of lifestyle change as a means to prevent and treat chronic disease better than standard medical approaches. His work, in fact, played a huge role in Medicare’s move to reimburse for heart-healthy lifestyle counseling.

Ornish was inspired to pursue this research after completing his surgical training in medical school under world-renowned pioneer in cardiac surgery Michael DeBakey. Here Ornish watched patients undergo extremely invasive cardiac procedures to treat the symptoms of their disease when they hadn’t received any counseling on the lifestyle choices that had contributed to it.

I knew who DeBakey was. He had been on faculty at Baylor College of Medicine – my own medical school – and before he died in 2008, he was chancellor. But if Ornish was a student of his, he might have gone to Baylor, so why hadn’t I ever heard of him?

I did a quick Google search and confirmed that Dr. Ornish is an alumnus of Baylor College of Medicine. In my four years here, I had never heard any mention of this phenomenal man or his many accomplishments in promoting preventive medicine and working for reimbursement reform. Meanwhile, in my time at Baylor I have witnessed the unveiling of a brand new statue of Dr. DeBakey, as well as the opening of a museum of his life in the atrium of our main school building. In fact, hardly a day goes by at Baylor that I don’t hear some mention of Dr. DeBakey. Baylor goes to great lengths to tout the accomplishments of DeBakey and claim him as their own, but is this to the exclusion of the accomplishments of other faculty and alumni?

As medical education evolves in an effort to produce a new generation of physicians that will be more mindful of prevention and value outcomes over volume, I think that part of the changing culture should include more recognition of figures such as Dr. Ornish as well as the countless primary care physicians who battle every day to provide high-quality health care in a broken system. After all, idolizing high-tech procedures and wonder drugs to the exclusion of patient-centered primary care is part of what got us into this mess in the first place.

Rebecca Divers is a medical student who blogs at Primary Care Progress.

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