Thursday, June 16, 2011

FP Blog Roundup: Remembering Barbara Starfield

The recent passing of legendary primary care researcher Barbara Starfield, MD, MPH was the subject of many Family Medicine blog posts this week. At Medicine and Social Justice, Josh Freeman, MD called Dr. Starfield "the pre-eminent scholar on health workforce policy." At Family Medicine Rocks, Mike Sevilla, MD posted a video of her receiving the Family Medicine Education Consortium's Lifetime Achievement Award and commented on the surprising silence from family medicine organizations about Dr. Starfield, who, though a pediatrician by training, "gave this specialty [of family medicine] a voice." Finally, at The Singing Pen of Doctor Jen, Jennifer Middleton, MD, MPH pondered, "With all of the national chatter about [unsustainable] heath care costs, why hasn't the media broadcasted the message of primary care's cost-saving and health-prolonging benefits?"

Through her research, Dr. Starfield did more than perhaps any other individual to establish the essential role of family medicine in improving population health outcomes in the U.S. and abroad. In a 2009 interview for AAFP News Now, she observed:

The thing that is wrong with our current health care system is that it is not designed to produce the best effectiveness, efficiency and equity in health services because it is too focused on things that are unnecessary and of high cost rather than arranging services so that the most needed services are provided when needed and with high quality. [This] is the case because the country has not put sufficient emphasis during the past 50 years on a good infrastructure of primary care. Primary care everywhere in the world is most of the care, for most of the people, most of the time. We have done a reasonably good job at making subspecialty care available, but a lot of subspecialty care is not necessary if you have good primary care. So we end up with a very expensive system that does things unnecessarily. If we followed what the evidence shows, we could do a whole lot better with a much better infrastructure of what we call primary health care.

Earlier that year, in a provocative editorial published in Family Practice Managment, Dr. Starfield had argued that the timeless principles of family medicine - first-contact care; comprehensive care; person-focused care over time; and care coordination - should be driving practice reforms such as the Patient-Centered Medical Home, rather than the other way around. To honor Dr. Starfield's career, Health Affairs is offering free access until June 28th to four landmark articles that she previously wrote in their journal.

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