Patients in Peril
The Demise of Primary Care in America
Once, Americans could count on having a personal or primary care physician who would see patients for new or chronic problems, whether in the office or the hospital. The appeal of such a system is more than psychological, for both primary care and continuity of care with a physician over time are associated with improved patient care, greater patient satisfaction, and lower overall costs.
These days are ending as primary care in the United States is rapidly disappearing. Where once 80% of American doctors were in primary care, now perhaps only a quarter of new graduates enter the field. Existing primary care doctors are retiring prematurely while many of those remaining feel demoralized, dispirited, and defeated. Experts predict increasing shortages of primary care doctors. The collapse of primary care will increase overall costs, hurt hospitals and insurers, but most of all damage the care of patients.
Patients in Peril explains the roots of the problem, the travails of primary care in America, the role of medical schools, hospitals, insurers and government, and how this all affects patients. Patients in Peril also offers practical achievable reforms that would improve care, reduce costs, and potentially avert this disaster.
Editorial Reviews
"In Patients in Peril: The Demise of Primary Care in America, Gregg Coodley examines the state of healthcare in the United States, drawing comparisons, pointing out the mishaps in the medical field, and expounding on how things came to be. Not too long ago, most Americans could count on having a personal or primary care physician. The availability of physicians made it easy for every American to access affordable healthcare, but not anymore. Gregg Coodley is comprehensive in his writing, starting from the root of the problem, highlighting the causes of the decline, and offering practical solutions.
The author introduces the reader to his work by giving them an idea of how it started. Then, he writes about the background of primary care in America, sharing historical details not known by many. I applaud him for how he chronicled the historical events and the progress made during the period American colonies gained independence. It is interesting to learn that doctors have been viewed in a different light through various periods in history. For example, I was awed to learn of doctors during the Jacksonian period in the 1830-the 1840s and how they were generally regarded in the 1800s. Gregg Coodley is great at penning historical tales, picking the most fascinating facts to write on. This informative book has 21 chapters, all manageable in length. The author is clear, uses recognizable terms, and engages the reader in his writing. Although the content of this book is about healthcare and medicine, the writing is engaging, using descriptions and case studies to get his points across. Every chapter is distinct, and the topics are diverse. I also like the fact that the author added images of ancient paintings and modern pictures in between the chapters, as it made the book more appealing to read.
In Patients in Peril: The Demise of Primary Care in America, you will learn about the dangers of ignoring primary healthcare, the benefits of primary healthcare, insurance, the rise of hospitalists, vaccines, and medical training, among other issues. The use of data and statistics by Gregg Coodley was an excellent concept for readers that appreciate factual information. The highlight for me was the appendix, where the author listed proposed reforms. I recommend this illuminating book to medical professionals and readers who are conscious about their health and the state of healthcare in America. "
- Posted by Literary Titan
"Evidence that consolidation has improved quality is scant."
Written by a primary care physician, this book gives critical insights into the strengths and breakdowns in the United States healthcare system. The book is well written, well organized, and well referenced, including studies from The Lancet and JAMA. Coodley writes an easily readable text for almost anyone. The strongest case the author makes is that primary care physicians are the cornerstone of quality care, yet the field is diminishing for a myriad of reasons. He furthermore outlines what care model (HMO, private practice, etc.) lends itself to the most satisfaction by patients, "Safran et al. compared Primary care performance and patient satisfaction in five different models of care. Contrary to the academic expectations, the model that paid physicians on a fee-for-service basis had their highest scores from patients." Coodley writes of a plethora of good fixes for healthcare's current shortcomings, including how to increase the ratio of primary care physicians to specialists and how to increase patient satisfaction, "It comes down to insurance companies being willing to give up some control with the possible reward of increased profits." He compares the system in the USA to those in other countries so that rather than starting from scratch, one can take what is best from every system in curing the American healthcare system dilemma. Perhaps those who need to read this book most are future administrators, public policy students, and, more broadly, life's students. This book belongs on the required reading list for college because every single human needs healthcare, and the system must not keep patients imperiled."
-Toby Berry, The United States Review of Books
"Patients in Peril: The Demise of Primary Care in America by Gregg Coodley M.D. is a non-fiction medical book that details the history of general practice and primary healthcare in the United States. He describes how the decline in primary care is detrimental to doctors, patients, the healthcare system as a whole, and even insurers. Coodley begins by showing us how primary care has been managed for centuries and the series of transitions that have occurred to get to where we are now. He points out that almost every doctor is a stranger to the patient and how ineffective this practice is, as well as how much more it costs. Coodley provides references, verifiable facts, a clear understanding of the economics, and his experience
as an MD who has worked with primary care physicians for
decades. His revelations are terrifying and compelling.
In the interests of full disclosure, I live in a country with national
healthcare and have had the same primary care physician for close to thirty years. My doctor knows my name without reviewing a file, asks about my dad, and sends us Christmas cards. A for-profit healthcare system is foreign to me and for this reason, Gregg Coodley's Patients in Peril consumed me for days. It is difficult not to feel angry once we have the crystal clear picture that Coodley paints. Imagine a doctor being paid more for not treating a patient in need with everything they require. Imagine everyone but the doctor getting lab results first and a patient finding out they have cancer from a screen print mailed to their home. Imagine a patient in need of time-critical treatment and their doctor's hands being tied until an insurance company approves it. The problem is that all
of this is happening right now. It's going to take a whole lot more of Dr. Coodley's teaching before we finally fight for change, but this book is an excellent place to start. Highly recommended."
-Asher Syed, Readers' Favorite
"Once upon a time, the family doctor was the central force in medical treatment. 'Specialists' were only for very specific ailments, and the family physician was a bigger gateway to medical care than anything we experience today in America. Patients in Peril: The Demise of Primary Care in America pinpoints the history and peril of healthcare changes which have increasingly picked apart the role of the traditional family physician. It's a study that needs to be in the hands of anyone interested in modern healthcare, whether they are doctors or patients. The demise of the primary care physician is evident not just in the current services provided (or not), but in the majority of medical school graduates who choose specialization over generalization.
Primary care is becoming an industry shortage and a rarity as primary care physicians retire and are replaced not by new generations of doctors, but by medical processing centers designed to reduce cost, eliminate wasteful approaches, and devote a minimum of or limited amount of time to the patient. Gregg Coodley charts the history of this trend, identifying economic, social, political, and medical influences on its incarnation and, more importantly, investigating the problems created by the demise of the primary care doctor in America. When insurers take over doctoring, real healthcare wanes—including the compassion of the physician for his patients, home visits, and ultimately the quality of care. Replacing and second-guessing physicians are administrative processes that tax healthcare efforts instead of enhancing or improving them. As Coodley tackles the subjects of prior authorizations, medical training dysfunction, the rise of fee-for-service arrangements, and the disparities created between physician and patient by systems put in place to oversee both, readers gain a solid insight into the problem, its history, and, in conclusion, some possible solutions.
The latter is not the focus of this book. Its attention to the details of how this demise happened and is incarnated in modern medical services and patient/physician relationships provides an invaluable look at a bigger picture of problems than most realize. This makes Patients in Peril a top recommendation for health libraries, whether in public library or medical school settings. Ideally, Patients in Peril will be assigned reading to medical school students and would-be healthcare professionals in present and future generations. Its food for thought should ideally spark debates, discussions, and active changes and considerations beyond individual enlightenment."
-D. Donovan, Senior Reviewer, Midwest Book Review
"Gregg Coodley, author and physician, has arrayed statistics and suggestions in this wide-ranging look at a disturbing change that has taken place in American medical care in recent years. Coodley's book begins with the general history of becoming a doctor in the US. Once considered a rather lowly and often maligned profession, medical practitioners have risen to a level of high respect as education expanded to tighten requirements and allow for established certifications. The major basis for doctors was traditionally the personal care physician (PCP) model: someone who would take care of most or all a patient's medical needs, even visiting them in the hospital, communicating directly with the patients and family and recommending any outside care needed. This model has gradually altered, as insurance, government, and private industry have intervened in the realm of American medical practice. The current model for patient care has changed so that now a patient in the hospital may see a "hospitalist" - sometimes a different one every day - and far more of his/her care will be siphoned off to a wide variety of specialists. Change of insurance can result in mandatory change of PCP, the poor will see only the often-changing group of caregivers in public facilities, and only the very wealthy can afford to engage one doctor for all care. One result of this is that far fewer medical students opt to become PCPs, and that patients are no longer treated directly by someone who knows them, will have observed them for a long period of time, and can offer greater comfort and healing because of the relationship. America is unique in this model, with proportionately far fewer PCPs than elsewhere in the world. Coodley, who boldly established a PCP clinic to benefit his local community, sets forth various possible changes that would offer a better template for medical care, with a reversion to the traditional "family care" doctor being the goal. Coodley, who has authored/co-authored other factual materials, presents his case here in an intelligent, well-organized forum, so that almost any sensible reader will, from the first page of this extensive exploration, feel a kinship with the author's clear treatise, his ideals and cogent suggestions for change. He supports his thesis with a vast number of references, factual data and telling statistics, casting light on financial dealings and governmental interventions that have made simple medical care almost too complex for ordinary citizens to comprehend. Quill says: Gregg Coodley's book, Patients in Peril: The Demise of Primary Care in America, should be given serious attention and his ideas widely propagated so that Americans needing medical care can feel that they are being offered the best possible options."
-Barbara Bamberger Scott, The Feathered Quill
Patients in Peril
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