Roots of the Present Primary Care Crisis

John L. Graner, MD
Arch Intern Med. 1986;146(1):42-43. doi:10.1001/archinte.1986.00360130052004.
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America's medical establishment is experiencing a "primary care crisis'—an extreme dissatisfaction with existing methods of primary patient care.1 No doubt this crisis is partly the result of an expansion of the definition of disease to include aspects of life, such as job failure and unhappiness, which are not well addressed in scientific medical terms. This trend has extended the social role of the physician and has led to the development of new specialties, eg, family practice.2 Another factor leading to the current "crisis" is the latest in a series of antiscience movements.3

American medicine has from its inception chosen the abstract concept of "science" as a means of obtaining social recognition. Benjamin Rush's early attempt to substitute "the simplicity of science" for (English) autocratic tradition is an example of this effort.4

The profession's early struggle for legitimacy through science met with strong social resistance, primarily due


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