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Future Visions of Primary Care

The next “Silicon Valley” will occur in the biomedical technology field

  • Date: 12/20/2001
  • BIDMC Contact: Valerie Hope Goldstein
  • Phone: 617-632-8056

The next "Silicon Valley" will occur in the biomedical technology field - possibly in Boston, Harvard University President Lawrence H. Summers, Ph.D., told a packed auditorium at a Beth Israel Deaconess Medical Center symposium on the future of primary care.

The symposium celebrated 30 years of primary care at Healthcare Associates (HCA), BIDMC's hospital-based primary care practice. Its goal was to bring together doctors and patients "to discuss - and think creatively - about how primary care could become more patient-centered," said organizer Tom Delbanco, M.D., chief of BIDMC's division of general medicine and primary care.

Dean of the Harvard University Faculty of Medicine Joseph B. Martin, M.D., Ph.D., introduced keynote speaker Summers, who described how academic medical centers have become places that not only care for patients, but export their learning, knowledge and expertise worldwide.

Summers praised the efforts of BIDMC and other Harvard Medical School teaching hospitals in training the next generation of primary care specialists. He predicted that these new doctors will be on the "front lines" of translating research into pioneering care that focuses on the patient, not just the patient's disease.

Summers cautioned that with 45 million Americans still uninsured, the battle to make health care accessible to all remains far from over. "Today, a child born in New York City is less likely to live to the age of five than a child in Shanghai," he said. "That should be a challenge to you as physicians, and to us as a country."

Eleven physician- and patient-led interactive workshops followed Summers' speech. Topics ranged from race and culture in primary care to how patients, families and health care professionals can work together. To further address the future of primary care, the attendees then regrouped for a panel of speakers that included novelist Gish Jen; rural primary care doctor Roger Fox, M.B., M.R.C.P., one of the early faculty members in the practice founded by Delbanco in 1971; Sir Brian Jarman, a renowned British physician who spent a year training at the former Beth Israel Hospital in the late 1960s; David Blumenthal, M.D., professor of medicine and health policy at Massachusetts General Hospital; and poet Mark Doty.

Doctors will have to be "cultural brokers" who are knowledgeable about diverse groups here and in the rest of the world, Jen told the audience, suggesting, "it will become part of standard medical education that doctors will spend a year overseas."

Blumenthal described his vision of future primary care providers as "information technologists" who will help their patients locate the latest information about their conditions online. "There is more information than most of us can process. Partnering with patients, primary care clinicians will coordinate care and help patients make decisions," he said.

Doty described a futuristic primary care practice where patients will meet with an adviser (this term would replace 'doctor') "to help them articulate the condition of their body and mind and place in the community...[this will] replace an authority telling us what we need." Doty felt that such a focus "could help us to face, in a deeper and more dignified way, those mysteries that we can confront with dignity."

Continuing the celebration at a fundraising gala that evening at the Museum of Fine Arts - attended by 300 guests, including hospital staff and patients of the practice - Delbanco announced that visions like Doty's may come closer to reality through BIDMC's new Drane Center. Established with a substantial gift from Douglas, Alexandra and Randell Drane, the center will advance patient-centered care by supporting "out of the box" primary care initiatives.

Other gifts that will help BIDMC's primary care practice, educational and research initiatives include those from the Shaevel family to promote educational and research activities; from the Fortin family to support the new, experimental HCA inpatient unit; and from the Male family to further develop an electronic medical record shared by patients and clinicians; and a gift from the Carter family, fostering new nursing programs in primary care.

The evening concluded with a speech by former U.S. Surgeon General C. Everett Koop, M.D., who noted that smoking constitutes the number one future health threat.

"Five hundred million people...will die a smoker's death by 2030," he predicted. "It's the same as though we had the World Trade Center disaster every 1 1/2 hours for the next 23 years." He urged primary care teams to encourage patients to quit smoking, saying that doing so "can lead to [disease] prevention and prolonged longevity...and that will fulfill the promise that is primary care medicine."