To the Editor: The article by Drs Grumbach
and Bodenheimer1 left me as a family physician
quite incensed. The authors state that "Primary care physicians do not appear
to properly manage chronic illness." The authors then provide a number of
references describing several deficiencies in care. Their references do not
contain any well-designed randomized trials comparing primary care with specialists
in reference to clinical outcomes. Instead, the reader is asked to make a
broad association that most patients being treated by primary care are not
reaching more favorable clinical outcomes due to the poor performance of primary
care. This is unfair. There are many confounders that determine a patients'
outcome, such as socioeconomic status, education, comorbidities, age, motivation,
family history, insurance status, access, and compliance.
Omonuwa S. Challenges Facing Family Practice and Primary CareChallenges Facing Family Practice and Primary Care. JAMA. 2003;289(3):297–300. doi:10.1001/jama.289.3.297-a
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