Family-Oriented Primary Care

I was a Medical Student in 1966 when the Millis Report on the training of the generalist physician was published,de?ning the concept of primary care. According to the Report, the primary provider has four major responsib- ities or roles. The ?rst role is that of initial contact care of the undiffer- tiated patient. The second is to provide comprehensive care based on the belief that the primary provider should be able to manage the overwhe- ing majority of problems with which patients present. Equally important is the third rolecontinuity and coordination of care within the health care system. Finally,the primary provider is responsible for demonstrating le- ership in the community. This Reports description of a primary provider seems as relevant today as it was when it was written. In 1994,the Institute of Medicines assessment of primary care added the responsibility of family and community integration of care to the Millis Report description. Without question there are many challenges to a contemporary imp- mentation of this comprehensive description of primary care, beginning with the level of individual patients who so often suffer from complex pr- lems, such as mental disorders and obesity. Treating these conditions in a brief primary care visit is dif?cult. At the level of the larger system, re- bursement is often inadequate and can represent policies that are uns- portive of primary care, such as those that compromise payment for preventive services that help patients to quit smoking or lose weight.