Spare a thought for embattled primary care practitioners in the United States, from whom all things are expected. Not only must they fully attend to the concerns of those who are healthy but worried and those who are sick, but they must also fulfill a robust checklist of quality measures within increasingly shrinking time slots—as little as 11 minutes per patient in hamster-on-wheel practices. These checklists include monitoring and counseling on obesity, diet and exercise, blood pressure, blood glucose, lipids, smoking, alcohol, drug use, seatbelts, sunscreen, guns, depression, anxiety, and less controversial cancer screening tests, including colonoscopy, Papanicolaou testing, and mammograms. Advocates of shared decision making regarding prostate cancer screening1 who seek an explanation for why this is difficult to accomplish may need to look no further than these fundamental realities for a starting point.2
Mathew P, Hachem H, Han P. Navigating Prostate Cancer Screening in the Real World of Primary Care: The Mirage and the Quicksand. JAMA Oncol. 2018;4(4):453–454. doi:https://doi.org/10.1001/jamaoncol.2017.5682
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