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You make some excellent points in your post, but I have to disagree with this idea of health coaches and relying on mid level providers such as PA's and Nurse Practitioners. In my 4 years out of residency as a physician I have seen countless mismanagement of patients by mid level providers who I feel don't have the training or knowledge base to properly diagnose or manage common complaints and diseases. Just last week I was sent a patient for evaluation by a nurse practitioner from a primary care office for chief complaint of pruritis. The patient was in her 50s without visible rash, but severe pruritis causing her to visibly excoriate her legs in front of me as I obtained the history from her. The patient had not seen a physician in over 30 years and saw the nurse practitioner last month for work up. An allergy panel was ordered along with referral to our office. The allergy panel was unremarkable except for allergy to grasses. The patient had icteric sclera with slightly jaundiced skin. I immediately ordered a comprehensive metabolic panel and a hepatitis panel and it showed hepatitis C infection with high elevations in Bilirubin, Alk Phos, and AST/ALT. The nurse practitioner completely missed the eye and skin exam and jumped to an allergy panel that was essentially useless. I immediately referred her to GI/Hepatology for treatment of Hepatitis C in the setting of acute elevations in liver enzymes.More responsibility should be assigned to other health care professionals: Physician Assistants, Nurse Practitioners, Health Coaches etc in order for Primary Care Physicians to get help.
Primary Care Physicians are the point guards of the medical team and the complexity of our patient population continues to rise as patients are living longer and are becoming so dependent on medications and technology to stay alive. It is imperative that our brightest medical minds be in primary care as this is where disease and morbidity can be most effectively managed. Leaving the complexity of diagnosis and management to mid level providers without the knowledge and training to treat our evolving population will only lead to more health care waste. There is a reason we work 80 hours a week as interns and residents during our training. It is a rite of passage that our mentors and attendings went through and without it we wouldn't have the knowledge or skill to treat the most difficult cases that present to us.