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Posted by jonwilcox on 26 Aug 2013 at 19:16 GMT

The ability to comment is appreciated and the various works of Moynihan are quite important.
However (from my viewpoint in the primary care trenches)
1. Medicine is an ever changing science and we should be trying to maintain that momentum notwithstanding the costs of doing so in difficult times
2. We must try to avoid Balkanising our health services or we will end up with the nihilist approach that 'your condition will either get better, get worse or stay the same and your body will decide which of those directions to take'. Africa is trying hard to mover forward from that approach.
3. Pre-diseases are actually quite important (and I disagree with Moynihan about pre-diabetes) and in fact much of this information-for-review is discovered from primary care encounter databases. We have some 20-30 patients out of 3000 total patients with pre-diabetic nephropathy (from a pool of maybe 300 patients with pre-diabetes viz. HbA1C 40-50). These are actually high risk patients and need their hypertension and risk factors managed aggressively (where most others perhaps do not). We discovered this from our own database, not from from a committee of sages.
4. In primary care we move in our own directions and are not necessarily swayed by either committee guidelines or various opinions about the role of politics in healthcare such as this albeit important article - and nor by definitions (eg DSM 5) - and which while interesting do not change our approach to providing good primary healthcare.
5. We are well-used to the industry trying to "educate" us and we deal with that issue politely. We have our own experiences and a lot of common sense and providing there is no inappropriate coercion (rare these days) we tend to have the interests of our patients foremost. We reserve our cynicism for the role of Government in underfunding primary health care and under-appreciating the role of the primary care health team in New Zealand.

No competing interests declared.