The Impact of the Pandemic on Primary Care's Deterioration
In the latter part of his distinguished career, Dr. Steven H Miles, Professor Emeritus of Internal Medicine and Bioethics at the University of Minnesota, found his territory of patient care gradually constricting. This contraction was a reflection of a broader trend in the U.S. healthcare system, where primary care has taken a back seat to specialty-centered practices.
Dr. Miles, who worked in various medical settings including intensive care units, hospitals, clinics, and nursing homes, was a staunch advocate for a primary care system built on personal relationships. He believed that such a system would be instrumental in addressing public health crises, and his prediction proved prescient with the advent of the viral pandemic. The inevitable arrival of Omicron, along with future Pi, Rho, Sigma, and Tau variants, underscored the importance of a robust primary care system.
Throughout his career, Dr. Miles warned about the long-term effects of a high-stress career on healthcare providers. He burned out twice and, in his later years, focused on treating patients over 80 or 85. Despite this focus, administrative disappearances were facilitated because these persons were not personally known by primary care providers, potentially allowing the coronavirus to invisibly incubate in nursing homes, prisons, shelters, and welfare clinics.
New York concealed 8,000 nursing home deaths during the pandemic, and other states did the same in their prisons, nursing homes, and welfare clinics. This tragic reality underscores the need for a healthcare system that values primary care and nurtures long-term relationships. Higher vaccination rates and a more appropriate use of hospices, palliative care, and home care over ICUs could have been achieved with such a system.
In the twilight of his career, Dr. Miles made house calls to families in crisis and wrote his phone number on his business card for patients in need. He also taught Internal Medicine to residents, encouraging them to focus on psychiatry, hospice care, and long-term patient relationships. However, many residents were seduced by the high-technology drama of emergency medicine or critical care specialties, leaving primary care understaffed and underappreciated.
As Dr. Miles enters retirement, there is no relevant information available about his current or latest position regarding his work in primary care. However, his legacy lives on as a reminder of the importance of personal relationships in healthcare and the need for a primary care-focused system to confront future pandemics effectively. A pandemic cannot be confronted from ICUs alone.
