At first contact between the public and medical care, most of the problems presented by the public seeking care are psychological or psychosocial in nature. Studies have shown that between 50 and 70 percent of initial physical symptoms are driven by psychological or social problems. Stress produces physical symptoms in the body. These problems can run the gamut of human behaviors from marital discord to problems at work to problems with children to financial worries and on and on down a long list of stresses and worries. The good primary care physician knows to listen and attend to these problems and at the same time to attend to the physical symptoms so as not to miss any medical disease of the body. In most cases the symptoms due to stress are eased by appropriate counseling. Only when clearly indicated does the primary care physician begin to order more intensive diagnostic tests.
This careful approach to the use of complex tests allows the probability of serious disease to increase before the test is ordered. By careful listening and doing this, the good primary care physician is avoiding the false positive problem. If instead or watching and waiting a bit, the physician jumps to complex testing, there will be a huge number of fasle postive results requiring more complex testing and then more complex testing and on and on until the false positive problem is resolved by extensive and some times dangerous tests. All of this will cost large amounts of money. Much of this can be avoided when a patient has a strong and trusting relationship with a good primary care physician who knows the patient as a person and knows how to listen and sort out the problems with the patient.
If instead of a primary care physician, the person goes directly to a specialist who is not tuned to the psychological and social nature of much of primary care then the chances of a false positive result increase greatly. The specialist too often moves into complex testing too early . And the costs go up proportionally and dramatically.
The demise of primary care needs to be reversed. Much of the high cost of medical care comes from the depletion of primary care physicians who know how to listen to their patients.