How To Save Primary Care

Lisa Rosenbaum is a Harvard cardiologist and a wonderful writer for the New England Journal of Medicine. I didn't know her, but she was a student of my classmate Lloyd Axelrod, and I talked with her on the phone maybe a year ago as she was walking around Manhattan. I wanted to know if we were related, since my paternal grandmother's name was Rose Rosenbaum. It turned out that probably not – we were the Philadelphia Rosenbaum's, and Lisa was the Portland Oregon Rosenbaum's. And I told her how great her writing is – true! – and I told her some of the things I'm up to with my class vis-a-vis humanistic care. People in authority must get calls like that all the time, and if they aren't from esteemed professors or someone otherwise distinguished, they shrug it off. C'est la vie.

She wrote a really great article in the New England Journal of Medicine earlier this month. (https://www.nejm.org/doi/full/10.1056/NEJMms2510425). What is primary care worth, and what can we do to save it, and should we save it? She bemoans the need to defend primary care and the personal relationships of all doctors with their patients, and the fact that there are no measures for this.

But she kind of ends it there. What to do?

Well, I have ideas, and I've written them in an article that few will read. But even though I'm pretty sure the NEJM won't accept the letter, I was moved to write it. Because, not to hide my light under a basket, I really do know what needs to be done. And here it is. You won't be able to read it in the NEJM, so you might as well read it here.

Lisa Rosenbaum's observations of the vexatious problems of evaluating primary care, and humanistic medicine (HM) in general, are correct. She knows deeply how important it is, and so do patients. If standard measures and endpoints are not revelatory, it is due to the weakness of the measurements, not the unimportance of relationships. As William Bruce Cameron has famously observed, "Not everything that counts can be counted, and not everything that can be counted counts."ⁱ

Humanistic medicine needs to be treated as a corporate goal, just as much as biomedical excellence and fiscal positivity.ⁱⁱ Clinically experienced and social sciences trained physicians need to be in high positions of authority in the corporations that run health care. Part of their burden will be to develop methods to assess the effectiveness of the organization in this sphere. These might not be exact measures, but as Lord Keynes observed, “It is better to be roughly right than precisely wrong.”ⁱⁱⁱ

iCameron WB. Informal Sociology: A Casual Introduction to Sociological Thinking. Random House, 1963.

iiShenkin BN. Open Notes in the Context of Humanistic Medicine, The Journal of Pediartrics: Clinical Practice 2025; 17: 200155

iiiKeynes JM. Origin obscure.