Huge health care bills, long emergency-room waits and the inability to find a primary care physician just scratch the surface of the problems that patients face daily.

Primary care should be the backbone of any health care system. Countries with appropriate primary care resources score highly when it comes to health outcomes and cost. The U.S. takes the opposite approach by emphasizing the specialist rather than the primary care physician.

A recent study analyzed the providers who treat Medicare beneficiaries (老年医保受惠人). The startling finding was that the average Medicare patient saw a total of seven doctors—two primary care physicians and five specialists—in a given year. Contrary to popular belief, the more physicians taking care of you don’t guarantee better care. Actually, increasing fragmentation of care results in a corresponding rise in cost and medical errors.

How did we let primary care slip so far? The key is how doctors are paid. Most physicians are paid whenever they perform a medical service. The more a physician does, regardless of quality or outcome, the better he’s reimbursed (返还费用). Moreover, the amount a physician receives leans heavily toward medical or surgical procedures. A specialist who performs a procedure in a 30-minute visit can be paid three times more than a primary care physician using that same 30 minutes to discuss a patient’s disease. Combining this fact with annual government threats to indiscriminately (任意地) cut reimbursements, physicians are faced with no choice but to increase quantity to boost income.

Primary care physicians who refuse to compromise quality are either driven out of business or to cash-only practices, further contributing to the decline of primary care.

Medical students are not blind to this scenario. They see how heavily the reimbursement deck is stacked against primary care. The recent numbers show that since 1997, newly graduated U. S. medical students who choose primary care as a career have declined by 50%. This trend results I emergency rooms being overwhelmed with patients without regular doctors.

It starts with reforming the physician reimbursement system. Remove the pressure for primary care physicians to squeeze in more patients per hour, and reward them for optimally (最佳的) managing their diseases and practicing evidence-based medicine. Make primary care more attractive to medical students by forgiving students loans for those who choose primary care as a career and reconciling the marked difference between specialist and primary care physician salaries.

We’re at a point where primary care is needed more than ever. Within a few years, the first wave of the 76 million Baby Boomers will become eligible for Medicare. Patients older than 85, who need chronic care most, will rise by 50% this decade.

Who will be there to treat them?

The great 18th-century author Montesquieu once put it, “I have never known any stress that an hour’s reading does not reduce." And now many argue for a return to this view of literature as therapy, even using the word “bibliotherapy"（阅读疗法）to describe it.

So what does literature provide, beyond entertainment? It can act as a guide.Those who show great respect for Shakespeare, Milton or Proust should keep in mind that even the most famous author was still a human being.In other words, great writers have been through the same things as you.Like you, they found themselves in this strange world and they tried to make sense of it.And this is what most literature consists of: people trying to make sense of the world.

No matter what your fears or concerns may be, chances are some great writer has written about them.Before seeking （寻求）suggestions, cither from a professional or a well-read friend, be clear about what is troubling you.For example, let's say you were raised in a religious （信仰宗教的）family but now, in later life, have lost your faith （信仰）.This is painful to you and you feel empty and alone.Countless writers have gone down this path before you and have found a way out — the German poet and novelist Hermann Hesse, for example, wrote the wonderful little novel Siddartha about this search for spiritual peace.

It would also help to consider your particular life stage.Someone from a poor background about to set off for a great college will want a different set of reading from a retired woman whose husband has died.To take another example, let's imagine you had a childhood of abuse （虐待）.For years you have suffered from depression.In that case, you could try Edward St Aubyn's The Patrick Melrose Novels.St Aubyn's father abused him, while his mother escaped into drink, but Aubyn wrote a series of splendid novels based on his life, charting a man's journey through the hard situation of abuse and out the other end.

Gene therapy (基因治疗) is a revolutionary new technique for treating people with health problems. Up until very recently, the most commonly available methods for treating patients were either through drugs or operations. Gene therapy provides a third option for treatment by transforming or replacing cells with new genetic materials and instructions. Scientists can be very precise in the kinds of changes they make in patients.

Gene therapy works by using a delivery system, such as a virus, to enter a patient's body. Once inside the body, the virus combines with a host cell and delivers the new DNA. The proteins then begin to repair the affected cells. New techniques have focused on removing cells from the patients and transforming them outside the body before reintroducing them to the patients.

The two types of gene therapy are called somatic and germline. Somatic therapy refers to changing or replacing a body cell. In this case, the treatment is restricted to the patient only. This will not affect the patient's future children because the patient's germ (生殖) cells are unaffected. In germline therapy, the patient germ cells are treated, which may affect the patient's future generation.This is highly controversial (有争议的) because it is not clear exactly how this might affect them and further generations. For this reason, many countries have passed laws that prohibit this kind of treatment.

Despite the promise of gene therapy, there are still many barriers that need to be overcome before it comes into widespread use. One of the issues is that the use of viruses to deliver DNA may actually cause unexpected problems in patients if the virus grows and attacks the body. Another problem is the nature of many diseases is very complex and spread throughout multiple genes. The use of gene therapy to change a single gene in the body would probably not be sufficient as a cure. Finally, the costs of gene therapy are high. Some gene therapy procedures may cost over$1 million to undertake and require specialized doctors and equipment.