Author Sanghavi has written an article that clearly has its truths, but it is a rather narrow-minded (perhaps uninformed) description and opinion of how medical practitioners think and or practice. The author argues that physicians tend to fixate on diagnosis and largely miss intervention. However, Sanghavi has taken what is moderatly true of family practice, pediactrics and internal medicine and generalized it across all areas of medicine to include the more specialized areas of medicine--surgery, gastroenterology, anesthesiology, cardiology, interventional radiology and others which focus on treatment. The fact is family practitioners (FPs) and the like are there for the purpose of diagnosing...and then referring patients to the appropriate speciality for the appropriate treatment or intervention. Essentially, FPs are experts of knowing who to consult for treatment of, say, severe aortic stenosis with resultant left ventricular hypertrophy (which would be a cardiologist, who then might refer the patient to a cardiothoracic surgeon). There are many, many specialities in medicine outside of family practice and pediactrics which are filled by many, many specialty physicians and nurse practitioners. To say that most family practice and pediactric practitioners focus on diagnosis rather than treatment would make a sound argument. But to say medicine as a whole takes the same approach would be a rather uninformed statment.

Pediatricians and family-practitioners as a whole spend a much larger proportion of their workday in preventive-type endeavors than in either diagnosis or treatment. And since you could argue that prevention is really just treatment-in-advance, that would turn your view on its head. But then, prevention didn't get any real attention from this article, as pointed out elsewhere on this page.

And in terms of strictly diagnosis-vs.-treatment time spent, I don't think the comparison holds up either. Perhaps for a strictly surgical or interventional specialty yes, but not for, say a cardiologist or an oncologist. And to be honest, the guys in the most interventionally-oriented specialties got their spots in those specialties partly because as medical students / residents they were good at the game of intellectual wankery that the article describes.

Oh yeah? Check this out, then talk to me:

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ah I think these guys make some good points. Especially regarding prevention.

True, many family practitioners (FP) do focus much on prevention and education--a key aspect the author of the main article clearly missed. Prevention is perhaps the most imprtant thing a health care provider can do. But there is no reward, no payment in prevention. Procedures pay, not prevention. This is one of the reasons there has been somewhat of an exodous from primary care: FPs make little compared to other speciality physicians. FP nurse practitioners and physician assistants are now moving into the spots FP physicians have left open as these physicians specialize (and even NPs and PAs are specializing, too).

In the end, there is a reason that Americans have poorer health overall than people of rich European nations in spite of the fact we have the most "technologically advanced" healthcare society. It is because we don't harp on prevention the way they do. New and exorbitantly expensive gamma knive technology can destroy a tumor without conventional surgery, but preventative measures could have prevented the tumor in the first place.

Oncologists are constantly in the business of treatment: chemo regmins, mitigation of chemo side effects, blood transfusions. Oncologists are usually consulted when cancer or hematological problems are suspected or diagnosed (usually "diagnosed" by a pathologist--not an family practitioner or oncologist).

Cardiologists treat existing health problems--congestive heart failure, aortic insufficiency, coronary heart disease--with drugs or procedures.

Sure they do also provide education, but so as to help keep patients for getting worse than they already are, unlike FPs who often are in the business of keeping healthy people healthy among other things.

I'm quite familiar with how they work. And the proportion of time in her day spent on treatment is quite similar to the proportion of time I spend as a general pediatrician.

You hit the nail on the head; but I don't think you reached the correct conclusion viz. GPs vs. specialists when you said

ruzylacm:

Procedures pay, not prevention.

As a member of a "cognitive services"- based specialty who does NOT perform diagnostic OR therapeutic procedures, it is my observation that the great divide in medical economics is between those who "think" for a living and those who "do." Cognitive specialty services (e.g., Neurology, Psychiatry, Endocrinology, Immunology, etc.) routinely are reimbursed at a lower rate by both federal (Medicare/Medicaid) and private payers. Until that disparity is addressed, among others I've already mentioned elsewhere in this discussion thread, I don't have much hope that things will change.