In medical school, I planned to be a primary care doctor. I started residency at a Harvard teaching hospital, caring for patients that included multigenerational Armenian and Irish families as well as students from nearby colleges. I quickly saw the reality of the primary care system: rushed, fragmented, impersonal, and often inaccessible. My patients arrived in the exam room frustrated after waiting over an hour, and their frustration was justified; I had to see so many people so quickly that I could barely keep track of their names.
For decades, insurance and health-system pressures have required doctors to see more patients in less time. Visits narrow to whatever symptom is in front of you, and the view of the whole person is forgotten. Physicians learn to signal that their time is scarce. Questions are hurried, at best. Patients, sensing or experiencing judgment or dismissal, grow quiet. Many end up avoiding anything but the most urgent medical visits altogether.
Primary care doctors are supposed to be medicine’s first line of defense. A doctor familiar with your medical history can understand the entire state of your health, not just the problem you came in with. That influences whether you get preventive screening, early disease detection, and a thoughtful approach for further treatment. Yet most people spend almost no time thinking critically about choosing a primary care provider; they open the insurance directory and pick whoever is available. Their experience of primary care is often so negative that they can’t see how it matters.
