Larry Green, a leading US Academic interviewed at the North American Primary Care Research Group meeting.
Watch the interview and enjoy the conversation
Larry Green shares his thoughts...
Where is Primary Care at present?
It’s in a state of irregularity and confusion. We are not even agreeing about what it is, it’s underlying ontology is confused, but it’s not Primary Care’s fault necessarily. Medicine as it developed in the 17, 18 and 1900s is pretty much over and, going from the Industrial Age to the Information age, a lot of primary care principles are finally actually achievable such as continuity (of care).
Continuity is now totally plausible and possible and, despite human migration and human movement and that sort of stuff. But, the main problem is (that) primary care doesn’t have its ‘Essence’ figured out well enough to know how to measure it and, until we can measure it, research about Primary Care is going to struggle. It’s always going to be partial and it’s being mostly used right now to study someone else’s formulation of what constitutes an important issue. Disease is way more overrated. Diagnosis is overrated.
Primary Care is mostly about prognostic decisions, about helping people make decisions that improve their lives, just (to) help them be a little healthier. We’ve got ways to go on that but the really good news is when you sit down and talk to young people that are populating the field, there’s more than hope. There’s optimism, the facts support the fact that primary care is about to get a lot better.
DMacA: If you were to set the agenda for Primary Care what would you prioritize?
LG: Number one thing is to figure out how to measure it.
DMacA: Anything else?
LG: No. That’s a priority. I’ve spent a lot of my career building infrastructures, systems that permit Primary Care to be delivered, taught, and investigated, like practice based research networks, their methods, working on classification schemes, taxonomies, trying to create the systems in which it can be done.
DMacA: One of the great things that people with you experience can do is to warn the current generation of researchers about mistakes. What kind of mistakes do you think you made or you would advise them to avoid?
LG: I think the mistake I made was, I think, overestimating the size of the challenges and believing that each, individual Family Physician, and each practice could address the big the big problems, fundamental problems. I wish I’d spent more time in just helping people get together. It takes working together across tribes, disciplines, professions, economic sectors, to fulfill the primary care function and we’re still tied up in our own identity too much.
The mistake was thinking that we were supposed to promote ourselves, that Family Medicine was going to heal the world. The aims, goals, and values of Family Medicine are as valuable today, and as essential, as they’ve ever been. But the way we went about implementing those values is like deciding you’re going to destroy a house and what you’ve got is a toothpick. You better go get a bulldozer and someone who can drive it, and work with other people if you’re going to build something. The word ‘together’ is a really really super good word that I wish I had put more emphasis on throughout my career.
DMacA: I like the word ‘together’. Tell me a little bit more about it who would you bring into your ‘together’ family.
LG: One of the urgent issues is to, at least, penetrate the walls, if not tear them down, between Public Health, Primary Care, and Mental Health. The way those things are organized now are artifacts of the 18 and 1900s and they don’t, haven’t worked well, and there’s no reason to keep trying to develop them separated from each other. It’s one plus one plus one equals a hundred and eleven (111), not three (3). They’ve got to blend together into something that is much superior to the way they operated in the last couple of centuries.
This gets (to ) the issues of what it means to be human. Humans spend a lot of calories, our parents spend a lot of time, our genetics has a big chunk of it devoted to – differentiating ourselves from everyone else and becoming who we are and what we are. It’s fundamental to survival. We have to get over that so that we can work in groups and we’re not very good at that. Instead of resisting one world view, I see Primary Care being at its best when it selectively chooses the parts of world view that makes it better. And to reject the biomedical model, I think, is hugely dumb. And to create a battleground there where we’re trying to justify our alternative view, to justify the biomedical view.
Why do that when we can have it all. We can have the biomedical view, we can have the individual psychological view, and we can have that environmental view of interacting. This is the big message of genetics so far. Do you remember when people thought there’d be 250 000 human genes ,and then at least 200, and then at least a hundred thousand, and then 100, and then it settled in now around 27 000 to maybe 29.5 some. But the real message just is that you and I don’t have the same number of genes, that this is not a fixed solid thing, and it’s not the gene, it’s the interaction that gene is capable of having with the way we think, what we do, how we live, where we are, our environment sort of stuff. So it is an interactions that we create off four nucleotides.
We create the infinite variety of humans, and then those humans create infinite interactions. Primary care just needs to calm down and accept the fact that all the sciences, the humanities, history, especially economics, have things to contribute to help us to be all that we can be. Widen up. Get over ourselves. If someone knows something that helps us be better. If you can’t sell it give it away. If it’s free, take it and use it. If it works, great. If it doesn’t, you know. Test it, measure it, see if it gets better. And, if it’s not a good idea, jettison it. Get the hell…. Don’t adopt it as part of our identity.
I don’t have strong feelings about that!
