Bridging the gap between primary care and public health

In August 2007, a registrar of our general practitioner training program in The Netherlands diagnosed pneumonia in a young, otherwise healthy, male patient. The registrar established that the patient was in a stable condition and had no risk factors for respiratory tract disease. After consulting the GP supervisor, the patient was treated in the community. This consultation illustrates the place of primary care in the 'ecology of medical care' - most patients contact primary health care professionals for most health problems, most of the time. Through primary care, the use of medical care facilities is navigated, and patients' needs are taken into account. The personalised decision was to treat him at home, the navigation decision that no referral or hospital admittance was needed.