Certainly with survey data, one is never sure whether the responses truly charactorize the respondent's true experience. But in this case, I've no reason to think that it does not.
At Harbor-UCLA, our patient population is an extremely difficult one. In general, they are poor, speak little English and have very poor educations. Yet with all of these difficulties, chart reviews of our health screening indices stack up extremely well when compared to national averages.
In other words, despite all the obstacles to care that our patients experience because of their socioeconomic status (and by the fact that their doctors are doctors in training), in many instances, they are followed more meticulously by their physicians then the average suburbanite by his or her private doctor! To me this suggests that nationally, primary care providers (PCP's) just aren't doing their job even under far more optimal conditions than those of our disadvantaged patients.
Yet, there's no magic here. At Harbor-UCLA (presumably as in most residency programs), prevention is hammered into our residents throughout their outpatient clinic experience. Health screening is part of each attending's (supervising physicians) assessment of virtually every intern and resident clinic encounter.
When one of our female patients hasn't been scheduled for her Pap, pelvic and breast exam her resident's attending is surely going to ask why. Likewise, we routinely check our diabetics for the quality of their blood sugar control, kidney function, lipid profiles, etc. They are routinely sent to the ophthalmologist for diabetic eye checks and/or retinal photos. With every clinic visit, we make sure we've talked to them about smoking cessation or checking their feet for diabetic ulcers and whatever else they need to stay healthy. This goes on in a manner tailored to each patient's medical conditions.
These are things all PCP's should be doing for all of their patients.
This survey points to a particularly poignant failing on our roles as healers. We should be encouraging Pap smears in all appropriate patients (not all women need them). Essentially no one in the United States need die from cervical cancer. Pap smear screening has been proven to be just that good.
All of us PCP's need to get our acts together!