Primary Care: What it Should Embrace – A Review of A World of Health

This Spring NWEI was featured twice (stay tuned for the second piece next week!) in the Journal of Sustainability Education.  Below is an excerpt from a review of NWEI’s discussion guide A World of Health:  Connecting People, Place and Planet, written by brothers Larry Frolich and Alan Frolich (Larry is faculty in Biology at Yavapai College in Prescott Arizona and Editor of the Journal of Sustainability Education and Alan practices medicine at the Southern Arizona VA Health Care System in Tucson).  For the complete article, click here.

“Everyone in the U.S. knows the ritual:  the primary care health visit. First, the phone call for an appointment several weeks in advance. On the anointed day, several pages of forms to be filled out across a high plastic counter-top.  Then the wait in a vinyl chair, a wall-mounted TV showing kids programs or cable news, the provider running at least 30 minutes late. Finally, the appointment begins with a call from a door beside the check-in counter:  “Mr. F______.”

A medical assistant documents weight, height, temperature, and blood pressure. A now-growing card-board folder is deposited into a plastic door-cubby, and after another 10 or more minutes a nurse enters and asks “the list,” in a fully non-committal fashion:  family health history, smoking, drinking, sexual habits and a number of mental-health indicators.  A recent addition to the ritual in the last five years has been the intense concentration on the computer screen as the answers are filled in.

Then, just as the questions end, as if choreographed, the provider waltzes in for the 20 minute annual allotment of “primary care” covered by your insurance company. The folder is reviewed, favorites from the list of questions are repeated, this time with empathy, a perfunctory exam is performed, and medications and test are ordered as indicated.   Finally, reflecting the more preventive philosophy that has permeated primary care medicine in recent years, the visit is closed with a number of relatively holistic concerns (which sometimes seem to change with the latest news):   “Everyone in the family wears a seat-belt all the time, right?”  “We’re cooking from scratch at home at least three times a week, is that true?”  “Get yourself a good bike helmet and wear it all the time.”  “Do you buy organic produce?  It’s a good idea.”  “And be sure to include a good source of Omega-3’s.”

This, only mildly caricaturized, is the state of the primary care ritual in America today…But if “primary care” is to live up to all that those beautiful two words promise, then it must change, and it must come to include a full picture of an individual, embedded within a family, a home, a community, an eco-system, and even a world-wide web of virtual and digital connections.

This is the premise for “A World of Health:  Connecting People, Place and Planet.” The book is, at its core, a highly informative collection of articles about people, the environment, and health.  The publisher, the Northwest Earth Institute, provides an enticing discussion-group-based framework for the articles, which are thematically organized into chapters, each of which addresses one of the key environmental factors that should be part of our ‘primary care’…”

To read the complete review, click here.


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