The viability of the concept of a primary health care team: A view from the medical humanities

To question the viability of the concept of a primary health care team implies at least the possibility that something about the nature of primary care, and about the nature of giving care in terms, places the two in conflict. In fact, a number of interesting and provocative questions concerning primary health care teams are in the areas of ethics and professional values. Primary care is inherently a 'moral notion', and when the concept of the health care team is yoked to that of primary care, the team takes on the normative coloration of primary care. This occurs at two levels. At a societal and professional level, the concept of a primary health care team depends on extra-professional values (e.g. a society's understanding of the requirements of social justice, funding priorities for health services, or the perceived worth of particular patient populations), and professional values such as autonomy and authority. At the level of face-to-face clinical encounters, questions arise as to a team's ability to maintain interpersonal and moral accountability to patients and society. Future research on the functioning of health care teams should focus more on these normative issues, rather than on the bureaucratic and logistical dimensions of team care that currently predominate in the professional literature.