Out of Practice: Fighting for Primary Care Medicine in America

Although this book provides an engrossing account of many issues common to the community practices of generalist physicians, reading it was a challenge. Whereas I like to reflect on the joys inherent in the work of primary care medicine,¹ Frederick Barken focuses on its frustrations. We clearly approach this work from 2 distinctly different perspectives: for one the glass is half full, for the other it is half empty.

However, Barken does an outstanding job of chronicling the challenges widespread in practicing primary care medicine in the early 21st century, especially in relation to the realities of an aging population. He notes clearly how issues such as polypharmacy, functional incapacity, and “the four horsemen of the geriatric apocalypse”—risk of falls, dementia, depression, and urinary incontinence (p 122)—make this practice complex and demanding. He insightfully demonstrates how social concerns, including family dynamics and community norms, are part and parcel of the work of attending to patients in primary care.