Is Primary Care at Grave Risk of Collapse?

A recent article in the New England Journal of Medicine asks a question: Primary care-will it survive? While the demand for primary care doctors is increasing, fewer US medical students are choosing careers in primary care. Between 1997 and 2005, the number of US graduates entering family practice residencies dropped by 50 percent, according to this article.
A primary care physician is an extremely important link in the health care chain for several reasons including:
1. A primary doctor has the ability to see the patient as a whole rather than seeing him in terms of different systems (cardiology, neurology etc.).
2. An important aspect of medical care, preventive care is typically provided by primary providers
3. Several different problems can cause many common symptoms like fatigue, shortness of breath or chest pain. The dizziness, for example, may be caused by problems with blood pressure, ears, brain circulation etc. In the absence of a primary provider, a patient may have to go to several different specialists before a proper diagnosis can be made.
This recent very well written article states that primary care based health care system can reduce costs while maintaining quality. A strong primary care based system not only makes fiscal sense, but is also the right thing for proper patient care. For the sake of our medical needs as well as those of our future generations, we have to do what ever we need to attract the best into this profession.
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Have you seen generic Plavix®?

Two pharmaceutical companies Bristol-Myers Squibb and Sanofi-Aventis recently won a preliminary injunction halting sales of generic form of Plavix. The judge however did not order recall of the generic Plavix® that had already hit the market.
Has anyone come across generic product called Clopidogrel? What about asking your pharmacists if they know?
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Good News for Coffee Drinkers

Have you ever had a stress test called adenosine nuclear scan? This test is done to look for blockages of the heart arteries. The heart is stressed by chemical means with the help of a medicine called adenosine. The caffeine interferes with the effect of this medicine. Because of that, patients undergoing this test are asked not to consume caffeine 12-24 hours prior to the test. To some of you coffee drinkers out there, the very thought of this probably sent a chill down your spine.
There might be good news for the coffee drinkers after all. A study published in the Journal of American College of Cardiology (J Am Coll Cardiol 2006;47:2296-2302)* suggests that drinking eight ounces of regular coffee as late as just one hour prior to adenosine nuclear scan may not affect accuracy of the test.
The present practice guidelines suggest that the adenosine stress test be cancelled if a patient for some reason ends up consuming caffeine before the test. If some more research studies with similar results as above were to come along, this will make both physicians’ and patients’ life much easier.

*In case you are wondering what these numbers in parenthesis mean, this is the information that can be used to locate the actual article.
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