Archivi del mese: Mag 2013


The Cochrane Reviews highlighted here are freely available while this Special Collection is featured on The Cochrane Library homepage.


The International Labour Organisation celebrates the World day for Safety and Health at Work on the 28th of April, with a theme for 2013 of prevention of occupational diseases ( Labour unions worldwide also commemorate workers who have died at work or as a result of exposure at work on this day.

Fortunately, many statistics indicate that workplace health and safety have improved over time. Occupational injury rates in the US show a steady decline over the past 100 years, and exposure to chemical agents in the US and Europe has also decreased considerably in the past forty odd years.[1] However, uncertainty about what specific interventions led to these improvements makes it difficult to select appropriate interventions in countries where rates remain high. Moreover, there are still occupational health statistics that are not favourable at all. Noise-induced hearing loss, work-related musculoskeletal disorders, stress-related complaints and skin disorders remain very prevalent. Other less prevalent conditions (for example HIV and Hepatitis C) have extremely serious consequences, and so protecting workers from these risks remains a high priority.

The Cochrane Occupational Safety & Health Review Group has selected a number of recent Cochrane Reviews that explore the evidence for interventions aimed at preventing occupational diseases. These can be used by employers to develop preventive policy and practice and achieve tangible health benefits for their employees.

[1] Creely KS, Cowie H, Van TM, Kromhout H, Tickner J, Cherrie JW. Trends in inhalation exposure–a review of the data in the published scientific literature. Ann Occup Hyg 2007;51(8):665-78.


Antibiotic prophylaxis for leptospirosis
Leptospira infection is a global zoonosis with significant health impact for agricultural workers and those persons whose work or recreation takes them into endemic areas. This systematic review assessed the current literature for evidence for or against use of antibiotic prophylaxis against Leptospira infection (leptospirosis).

Antibiotic prophylaxis for mammalian bites
Bites by mammals are a common problem and they account for up to 1% of all visits to hospital emergency rooms. Dog and cat bites are the most common and people are usually bitten by their own pets or by an animal known to them. School-age children make up almost a half of those bitten. Prevention of tetanus, rabies and wound infection are the priorities for staff in emergency rooms. The use of antibiotics may be useful to reduce the risk of developing a wound infection. This systematic review aimed to determine if the use of prophylactic antibiotics in mammalian bites is effective in preventing bite wound infection.

Antiretroviral post-exposure prophylaxis (PEP) for occupational HIV exposure
Populations such as healthcare workers (HCWs), injection drug users (IDUs), and people engaging in unprotected sex are all at risk of being infected with the human immunodeficiency virus (HIV). Animal models show that after initial exposure, HIV replicates within dendritic cells of the skin and mucosa before spreading through lymphatic vessels and developing into a systemic infection (CDC 2001). This delay in systemic spread leaves a “window of opportunity” for post-exposure prophylaxis (PEP) using antiretroviral drugs designed to block replication of HIV (CDC 2001). PEP aims to inhibit the replication of the initial inoculum of virus and thereby prevent establishment of chronic HIV infection. This systematic review aimed to evaluate the effects of antiretroviral PEP post-occupational exposure to HIV.

Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in high-income countries
Interventions to change behaviour among sex workers and their clients have been identified as a strategy to reduce HIV transmission. However, there has been no systematic review that has examined and summarized their effects. This systematic review aimed to identify and evaluate the effects of the studies performed on behavioural interventions to reduce the transmission of HIV infection among sex workers and their clients in high-income countries.

Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in low- and middle-income countries
Various interventions have been adopted to reduce HIV transmission among sex workers and their clients but the effectiveness of these strategies has yet to be investigated using meta-analytic techniques. This systematic review aimed to evaluate the effectiveness of behavioural interventions to reduce the transmission of HIV infection among sex workers and their clients in low- and middle-income countries.

Blunt versus sharp suture needles for preventing percutaneous exposure incidents in surgical staff
Surgeons and their assistants are especially at risk of exposure to blood due to glove perforations and needle stick injuries during operations. The use of blunt needles can reduce this risk because they don’t penetrate skin easily but still perform sufficiently in other tissues. This systematic review aimed to determine the effectiveness of blunt needles compared to sharp needles for preventing percutaneous exposure incidents among surgical staff.

Influenza vaccination for healthcare workers who work with the elderly
Healthcare workers’ (HCWs) influenza rates are unknown, but may be similar to the general public and they may transmit influenza to patients. This systematic review aimed to identify studies of vaccinating HCWs and the incidence of influenza, its complications and influenza-like illness (ILI) in individuals aged ≥60 years in long-term care facilities (LTCFs).

Vaccines for preventing hepatitis B in health-care workers
Hepatitis B virus (HBV) causes acute and chronic liver diseases. Hepatitis B vaccination is recommended for health-care workers. This systematic review aimed to assess the beneficial and harmful effects of hepatitis B vaccination in health-care workers.


Preventing occupational stress in healthcare workers
Healthcare workers can suffer from occupational stress which may lead to serious mental and physical health problems. This systematic review aimed to evaluate the effectiveness of work and person-directed interventions in preventing stress at work in healthcare workers.

Preventive staff-support interventions for health workers
Healthcare workers need to be supported to maintain sufficient levels of motivation and productivity, and to prevent the debilitating effects of stress on mental and physical well-being. This systematic review aimed to assess the effects of preventive staff-support interventions to healthcare workers.

Psychological debriefing for preventing post traumatic stress disorder (PTSD)
Over approximately the last fifteen years, early psychological interventions, such as psychological ‘debriefing’, have been increasingly used following psychological trauma. Whilst this intervention has become popular and its use has spread to several settings, empirical evidence for its efficacy is noticeably lacking. This systematic review aimed to assess the effectiveness of brief psychological debriefing for the management of psychological distress after trauma, and the prevention of post traumatic stress disorder.

Psychosocial interventions for prevention of psychological disorders in law enforcement officers
Psychosocial interventions are widely used for the prevention of psychological disorders in law enforcement officers. This systematic review aimed to assess the effectiveness and comparative effectiveness of psychosocial interventions for the prevention of psychological disorders in law enforcement officers.


Interventions to prevent occupational noise-induced hearing loss
Millions of workers worldwide are exposed to noise levels that increase their risk of hearing impairment. Little is known about the effectiveness of hearing loss prevention interventions. This systematic review aimed to assess the effectiveness of non-pharmaceutical interventions for preventing occupational noise exposure or occupational hearing loss compared to no intervention or alternative interventions.

Interventions to promote the wearing of hearing protection
Noise-induced hearing loss can be prevented by eliminating or lowering noise exposure levels. Where the source of the noise cannot be eliminated, workers have to rely on hearing protection equipment. Several trials have been conducted to study the effectiveness of interventions to influence the wearing of hearing protection. This systematic review aimed to evaluate the effectiveness of interventions to enhance the wearing of hearing protection among persons regularly exposed to high noise levels.


Non-pharmacological interventions for preventing venous insufficiency in a standing worker population
Chronic venous insufficiency (CVI) is a common problem, affecting up to 50% of the population in industrialised countries. It is a chronic condition which, if untreated, can progress to serious complications that in turn can interfere with working ability. Standing at work is a known risk factor for CVI, yet the true effect of non-pharmacological preventive strategies remains unknown. This systematic review aimed to evaluate the efficacy of non-pharmacological strategies and devices to prevent CVI in a standing worker population.


Interventions for preventing voice disorders in adults
Poor voice quality due to a voice disorder can lead to a reduced quality of life. In occupations where voice use is substantial it can lead to periods of absence from work. This systematic review aimed to evaluate the effectiveness of interventions to prevent voice disorders in adults.

Remediating buildings damaged by dampness and mould for preventing or reducing respiratory tract symptoms, infections and asthma
Dampness and mould in buildings have been associated with adverse respiratory symptoms, asthma and respiratory infections of inhabitants. Moisture damage is a very common problem in private houses, workplaces and public buildings such as schools. This systematic review aimed to determine the effectiveness of remediating buildings damaged by dampness and mould in order to reduce or prevent respiratory tract symptoms, infections and symptoms of asthma.


Interventions for preventing occupational irritant hand dermatitis
Occupational irritant hand dermatitis (OIHD) is an important cause of discomfort in the working population. Different preventive measures are in place but it is not clear how effective these are. This systematic review aimed to assess the effect of interventions for preventing OIHD in healthy people who work in occupations where the skin is at risk of damage.


Ergonomic design and training for preventing work-related musculoskeletal disorders of the upper limb and neck in adults
Work-related upper limb and neck musculoskeletal disorders (MSDs) are one of the most common occupational disorders around the world. Although ergonomic design and training are likely to reduce the risk of workers developing work-related upper limb and neck MSDs, the evidence is unclear. This systematic review aimed to assess the effects of workplace ergonomic design or training interventions, or both, for the prevention of work-related upper limb and neck MSDs in adults.

Exercises for prevention of recurrences of low-back pain
Back pain is a common disorder that has a tendency to recur. It is unclear if exercises, either as part of treatment or as a post-treatment programme, can reduce back pain recurrences. This systematic review aimed to investigate the effectiveness of exercises for preventing new episodes of low-back pain or low-back pain-associated disability.

Insoles for prevention and treatment of back pain
There is lack of theoretical and clinical knowledge of the use of insoles for prevention or treatment of back pain. The high incidence of back pain and the popularity of shoe insoles call for a systematic review of this practice. This systematic review aimed to determine the effectiveness of shoe insoles in the prevention and treatment of non-specific back pain compared to placebo, no intervention, or other interventions.

Lumbar supports for prevention and treatment of low back pain
Lumbar supports are used in the treatment of low-back pain patients, to prevent the onset of low-back pain (primary prevention) or to prevent recurrences of a low-back pain episode (secondary prevention). This systematic review aimed to assess the effects of lumbar supports for prevention and treatment of non-specific low-back pain.

Manual material handling advice and assistive devices for preventing and treating back pain in workers
Training and the provision of assistive devices are considered major interventions to prevent back pain and its related disability among workers exposed to manual material handling (MMH). This systematic review aimed to determine the effectiveness of MMH advice and training and the provision of assistive devices in preventing and treating back pain.


Pre-employment examinations for preventing occupational injury and disease in workers
Many employers and other stakeholders believe that health examinations of job applicants prevent occupational diseases and sickness absence. This systematic review aimed to evaluate the effectiveness of pre-employment examinations of job applicants in preventing occupational injury, disease and sickness absence compared to no intervention or alternative interventions.

Acknowledgements: Jos Verbeek, Thais Morata and Jani Ruotsalainen from the Cochrane Occupational Safety & Health Review Group for drafting the introductory text, providing the image, comments and edits, and for selecting the reviews included in this special collection.

Image credit: Iisakki Härmä

Date published: 22 April 2013

Contact: Cochrane Editorial Unit (

NIHR HTA Conference 2013 @SIHTA_Italia @Medici_Manager

The NIHR Health Technology Assessment (HTA) Programme is celebrating its impact in clinical and public health research by holding a milestone conference on 9-10 October 2013 in central London.

The emphasis of the conference will be to:

  • Examine the impact, nationally and internationally of the programme in clinical effectiveness research
  • Consider the influence of the HTA Programme within the NHS and on UK clinical research

This event celebrates the contribution made by the HTA Programme to the NIHR mission to improve the health and wealth of the nation. It will raise the national and international awareness and prestige of the programme, its projects and published research findings.

In conjunction with the conference The Lancet will be publishing a themed issue on clinical effectiveness research.

Who should attend?

  • Active HTA researchers
  • Prospective HTA researchers and trainees
  • NHS leaders and commissioners
  • NHS decision makers
  • Patient groups
  • Organisations who run trials nationally and internationally

View more information about the HTA Programme at

WFMM International Medical Leaders Forum, Vancouver, 2 June 2013 @Medici_Manager @pash22

The WFMM International Medical Leaders Forum is fast approaching. Register to attend the WFMM Forum and post forum tours at The Forum will focus on the theme of Medical Leadership and Engagement. With a quality program and a great mix of international speakers this year’s Forum is one not to miss!

Two optional tours will follow the Forum. Visit the Surrey Memorial Hospital in Vancouver or choose Three Education Tours in Seattle, USA. Details of the Forum program, post Forum tours, speaker profiles and registration fees can be found online by visiting the WFMM web page at

ICT in Sanità: perché il digitale non rimanga solo in agenda, Milano 7 maggio 2013

Aula Carlo De Carli del Politecnico di Milano, Campus Bovisa, Via Durando 10, Milano

Osservatorio: ICT in Sanità

Il Convegno di presentazione dei risultati della Ricerca 2013 dell’Osservatorio ICT in Sanità è promosso dalla School of Management del Politecnico di Milano.
L’intera giornata sarà dedicata all’incontro fra i principali attori delle Istituzioni e delle strutture sanitarie (Direzioni Sistemi Informativi, Generale, Sanitaria e Amministrativa), i fornitori del mercato IT, ricercatori e docenti della School of Management, e offre un’occasione di confronto e analisi della situazione attuale dell’utilizzo dell’ICT nel settore sanitario italiano.

Durante il Convegno saranno presentati i risultati della Ricerca che, attraverso casi di studio e questionari rivolti a CIO, Direttori Generali, Amministrativi, Sanitari delle principali realtà operanti nel nostro Paese e a un campione statisticamente significativo di Medici di Medicina Generale e di Cittadini italiani, si è posta i seguenti obiettivi:

  • comprendere gli impatti della spending review e le sfide che questa pone agli attori chiave della Sanità (Ministero, Regioni, strutture sanitarie, MMG);
  • stimare il valore complessivo della spesa ICT in Sanità, analizzando le priorità di investimento e il livello di sviluppo nei principali ambiti applicativi (Servizi Digitali al Cittadino, Dematerializzazione dei documenti clinici, Cartella Clinica Elettronica, Gestione Informatizzata dei Farmaci, Mobile Health, soluzioni a supporto della medicina sul territorio e dell’assistenza domiciliare, cloud computing, ecc.);
  • stimare i benefici ottenibili con l’introduzione di applicazioni in ambiti ICT chiave per l’innovazione;
  • rilevare la customer satisfaction dei cittadini in merito ai servizi sanitari delle strutture ospedaliere e degli MMG;
  • identificare le leve che consentono ai diversi attori, a tutti i livelli del sistema sanitario, di promuovere e mettere a fattor comune l’innovazione ICT.

Il Convegno si terrà Martedì 7 Maggio 2013, dalle ore 9.30 alle ore 13.00, presso l’Aula De Carli del Politecnico di Milano, Campus Bovisa, Via Durando 10, Milano.

Durante il Convegno sarà consegnato il “Premio Innovazione ICT in Sanità” alle aziende sanitarie che si sono distinte nella capacità di utilizzare le moderne tecnologie come leva per migliorare l’efficienza e l’efficacia dei processi clinico-sanitari e amministrativi.

Nel pomeriggio, dalle 14.00 alle 18.00, saranno organizzate alcune Sessioni Verticali gratuite che tratteranno le tematiche più significative ed attuali relative al ruolo dell’ICT in Sanità, con la possibilità di presentare alcune esperienze di maggior interesse analizzate durante la Ricerca. Le tematiche approfondite saranno le seguenti:

  • L’innovazione digitale per il miglioramento dei processi interni delle strutture sanitarie: dalla Cartella Clinica Elettronica alla Clinical Governance
    Per maggiori informazioni e iscrizioni clicchi qui
  • Semplificare e dematerializzare: le chiavi per rendere efficienti i processi sanitari
    Per maggiori informazioni e iscrizioni clicchi qui
  • Il controllo e la governance dei processi sanitari attraverso l’innovazione digitale
    Per maggiori informazioni e iscrizioni clicchi qui
  • Come migliorare i servizi ai cittadini e pazienti con le nuove tecnologie digitali
    Per maggiori informazioni e iscrizioni clicchi qui

La partecipazione a tutti gli eventi è gratuita.

Per maggiori informazioni sul Convegno e sulle Sessioni Verticali contattare l’Ing. Chiara Sgarbossa (
Come raggiungere le sedi dei nostri Eventi

Iscrizione all’evento


Obama su Bush: “Un brav’uomo”. E’ questa la differenza tra noi e loro? @Medici_Manager

Il testo del discorso di Barack Obama in onore di George W. Bush, dove spiega perché lo stima (benché sia un ladro di dinosauri)

Giovedì 25 aprile, tutti e cinque gli ultimi presidenti degli Stati Uniti (compreso l’attuale) si sono incontrati a Dallas in Texas, per l’inaugurazione della Presidential Library dedicata a George W. Bush. Durante la cerimonia di apertura, Barack Obama ha tenuto un discorso in onore del suo predecessore, raccontando il presidente – ma soprattutto l’uomo – che guidò il paese per otto anni.

Grazie, grazie molte. Prego, accomodatevi. Al presidente Bush e alla signora Bush; al presidente Clinton e alla ex Segretario di stato Clinton; al presidente George H. W. Bush e alla signora Bush; al presidente e alla signora Carter; agli attuali leader del mondo e a quelli che lo sono stati, e a tutti gli illustri ospiti qui oggi: Michelle e io siamo onorati di essere con voi in questa storica occasione. Questa è proprio una festa da texani. Ed è all’altezza di ciò che siamo venuti a fare qui oggi: rendere omaggio alla vita e all’eredità del 43esimo presidente degli Stati Uniti, George W. Bush.

Quando tutti gli ex presidenti sono riuniti insieme, è anche un giorno speciale per la democrazia. Siamo stati chiamati “il club più esclusivo del mondo”, e in effetti abbiamo un gran bel circolo. Ma la verità è che il nostro club è soprattutto un gruppo di sostegno. L’ultima volta che ci siamo visti è stato poco prima che iniziassi il mio primo mandato. E ne ho avuto bisogno. Perché come potrà dirvi ognuno di questi leader, anche se pensi di essere pronto a fare il presidente, è impossibile capire fino in fondo la natura di questo lavoro fino a quando non sarà diventato il tuo, fino a quando non sarai seduto alla scrivania.

È per questo motivo che ogni presidente impara sempre a nutrire una grande e crescente stima per tutti quelli che lo hanno preceduto; per i leader di entrambi i partiti che hanno affrontato per un periodo di tempo le sfide e l’enorme peso di una nazione sulle loro spalle. E per me, questa stima va molto al presidente Bush.

La prima cosa che ho trovato su quella scrivania quando ho iniziato il mio mandato fu una lettera di George, che mostrava la sua sensibilità e la sua generosità. Sapeva che avrei imparato ciò che lui aveva imparato: che essere presidente è prima di tutto un lavoro che ti rende umile. A volte fai degli errori. A volte vorresti portare indietro le lancette dell’orologio. Quello che so del presidente Bush, spero il mio successore possa dirlo anche per me: abbiamo amato questo paese e abbiamo fatto del nostro meglio.

In passato il presidente Bush ha detto che sarà impossibile giudicare la sua presidenza finché lui sarà ancora vivo. Quindi ciò che dico è forse un po’ prematuro. Ma anche adesso, ci sono alcune cose chiare che possiamo dare per certe.

Sappiamo del ragazzino che fu cresciuto da due genitori determinati e amorevoli a Midland, in Texas, e che ereditò – come è solito dire – “gli occhi del padre e la bocca della madre”. Il giovane ragazzo che una volta tornò a casa dopo una visita a un museo e che mostrò fiero a sua madre inorridita un piccolo fossile di dinosauro che si era messo di nascosto in tasca. Scommetto che fu una cosa accolta alla grande da Barbara. Sappiamo del giovane uomo che incontrò l’amore della sua vita a una festa, rinunciando ad andare a letto presto per restare a parlare con Laura Welch, intelligente e affascinante, fino a tarda notte.

Sappiamo del padre che ha cresciuto due notevoli, affettuose e bellissime figlie, anche quando cercarono di dissuaderlo dal fare il presidente dicendogli: “Papà, non sei poi così figo come credi di essere”. Signor presidente, ha la mia comprensione: è successo anche a me. E ora vediamo il presidente Bush da nonno, mentre inizia a viziare la sua nuova nipote.

Lo conosciamo così, l’uomo Bush. E quello che ha detto il presidente Clinton è assolutamente vero: conoscere l’uomo vuol dire apprezzarlo, perché è a proprio agio con se stesso. Sa chi è. Non ha pretese. Prende sul serio il suo lavoro, ma non si prende troppo sul serio. È un brav’uomo.

Ma sappiamo anche qualcosa su Bush come leader. Mentre percorriamo la biblioteca, è impossibile non ricordare la forza e la determinazione che attraversò quel megafono mentre lui stava tra le macerie e le rovine di Ground Zero, promettendo di consegnare alla giustizia coloro che avevano cercato di distruggere il nostro modo di vivere. Ricordiamo la sensibilità che mostrò guidando la lotta globale contro l’AIDS e la malaria, aiutando a salvare milioni di vite e ricordando alle persone di alcuni dei posti più poveri al mondo che all’America importa e che siamo lì per aiutarli.

Ricordiamo il suo impegno per trovare un punto di contatto con alleati insoliti come Ted Kennedy, perché credeva che fosse necessario riformare le nostre scuole in modo da aiutare tutti i bambini a imparare, non solo alcuni; perché credeva fosse necessario fare qualcosa per rimettere in sesto il sistema dell’immigrazione, che non funziona; perché credeva che questi passi avanti sono possibili solo quando c’è collaborazione.

Sette anni fa il presidente Bush avviò un’importante discussione politica parlando al popolo americano della nostra storia come una nazione di leggi e di immigrati. E anche se la riforma dell’immigrazione ha richiesto più tempo di quanto ognuno di noi si fosse aspettato, sono fiducioso che quest’anno – con l’aiuto del presidente della Camera Boehner, con alcuni senatori e membri del Congresso che sono qui oggi – riusciremo a portarla a conclusione, per le nostre famiglie, per la nostra economia, per la nostra sicurezza e per questo paese incredibile che amiamo. E se lo faremo, sarà in buona parte merito del duro lavoro del presidente George W. Bush.

Infine, un presidente ha il compito solenne e unico di servire come comandante in capo della più grande forza militare che il mondo abbia mai conosciuto. Come ha detto lo stesso presidente Bush: “L’America deve mantenere e manterrà la propria parola con gli uomini e le donne che le hanno dato così tanto”. Quindi, anche se noi americani a volte non siamo stati d’accordo con tutte le questioni di politica estera, condividiamo un profondo rispetto per gli uomini e le donne del nostro esercito e per le loro famiglie. E siamo uniti e determinati nel dare conforto alle famiglie di chi è morto e nel prenderci cura di chi indossa l’uniforme degli Stati Uniti.

Sul volo di ritorno dalla Russia, dopo avere discusso con Nikita Krusciov nel momento di massimo confronto della Guerra Fredda, il segretario di John Fitzgerald Kennedy trovò un piccolo pezzo di carta su cui il presidente aveva scritto una delle sue citazioni preferite: “So che c’è Dio. E vedo una tempesta avvicinarsi. Se Egli ha un posto per me, penso di essere pronto”.

Nessuno può essere completamente pronto per questo lavoro. Ma l’America ha bisogno di leader pronti ad affrontare la tempesta che sta arrivando, anche se pregano Dio per avere forza e lungimiranza così da poter fare ciò che ritengono giusto. Ed è ciò che hanno fatto i leader con cui condivido questo palco. È ciò che il presidente Bush scelse di fare. E questo è il motivo per cui sono onorato di fare parte di questa cerimonia.

Signor presidente, per il suo impegno, per il suo coraggio, per il suo senso dell’umorismo e, soprattutto, per il suo amore per questo paese, grazie. Da tutti i cittadini degli Stati Uniti, che Dio la benedica. E che Dio benedica questi Stati Uniti d’America.

An excellent primary care doctor is your trusted health care advisor @Medici_Manager @kevinmd


Assembling the right medical team is important to keeping you healthy and saving money. Besides you, one of the most important people on this team is your regular doctor. For many people, this is their primary care physician (PCP) or primary medical doctor (PMD). A highly trained and well-qualified primary care doctor can advise you on what preventive tests and treatments are truly necessary to stay healthy.

If you view your primary care doctor as a person to simply get referrals from to get better care, think again.

One health insurance plan focused on having patients see primary care doctors first to help them figure out how to proceed. Without primary care doctors helping patients, 60 percent of the time patients chose the wrong specialist. Selecting the wrong doctor wasn’t the only issue. On average, $1,500 was spent on various tests and diagnostic services visits over an eleven-month period before patients were told that the specialist could not help them. Result? Wasted time and money. By pairing patients with primary care doctors, the use of specialists fell by 14 percent, emergency room use decreased by 16 percent, prescriptions declined by 11 percent, and patients received the right care. Less time and money wasted.

Because of differences in training, primary care doctors, like family physicians, internists, pediatricians, and obstetricians, are not the same. Family medicine physicians have trained to care for patients as young as newborns and as old as their grandparents. Internists care for adults as well as seniors. Pediatricians, not surprisingly see patients age eighteen and younger. Obstetricians-gynecologists (ob/gyns) often are considered primary care doctors, but, unlike the other three specialties, these doctors also do surgeries such as C-sections, hysterectomies, and bladder lifts or suspension repairs.

The trait that they all share is that an excellent primary care doctor can make a difference between mediocre care and great care. One report found that “adults with a primary care physician rather than a specialist had 33 percent lower cost of care and were 19 percent less likely to die” after controlling for age, gender, and health condition. An excellent primary care doctor can help you stay up-to-date on your immunizations and preventive screening tests, as well as diagnose problems that bother you.

Should your care require more expertise, your primary care doctor can determine which specialist to send you to and coordinate the care among many specialists if needed. Specialists often work in a vacuum, focused exclusively on their field. To ensure that all of them are on the same page, it is helpful to have one person oversee the overall treatment plan to maximize the benefit and minimize duplication of tests and procedures. While you might be that person, wouldn’t it also be nice if you also had someone else help you? It might be your regular doctor, who knows you and sees the whole person rather than a set of specific organs or diseases.

An excellent primary care doctor is your trusted health care advisor.

The challenge is finding a stellar primary care doctor. This could be harder, as fewer medical students are choosing the fields of internal medicine and family medicine due to increasing administrative hassles, decreasing compensation relative to specialists, and high medical school debt. Of those about to complete a three-year internal medicine residency program in 2003, only 27 percent planned to be internists, down sharply from 54 percent in 1998.  Those already practicing medicine are leaving for similar reasons. As more baby boomers age and require additional medical care, there will be fewer primary care doctors available despite the increase in demand for their services. It’s expected that in 2020, the nation will need about 147,000 internists, up 38 percent from 106,000, yet the number of doctors in training will be inadequate to close the gap.

Davis Liu is a family physician who blogs at Saving Money and Surviving the Healthcare Crisis and is the author of The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy and Stay Healthy, Live Longer, Spend Wisely.