Dr. Julie here, writing my first real BLOG for sparkMD.
Number 1: thank you so very much to all of our passionate, kind, excited patients who have helped us have such a wonderful 9 months. Your care ‘wins’, and your satisfaction with this model of healthcare is rejuvenating our love for medicine.
There are so many different interesting topics I would like to address on this blog. I thought I’d start with a basic discussion about what I do. A few years ago, just starting out in my big system job I had the opportunity to work one day a week at an employee on-site clinic with a population of very busy, very hardworking, very smart people. I found that over, and over, and over again I was trying to explain why what I did had value beyond just the 8 minute thank-you-ma’am type of urgent care visit.
How to explain to somewhat healthy folks, in the face of an expensive and barrier-laden healthcare construct, that it really was a smart idea to have a REGULAR relationship with a REGULAR doctor? And, in a culture where we don’t really trust authority (that much) and we receive health care from people with all kinds of titles, how do you know what’s what?
So, here it is… in all of it’s grand verbosity. Hope it helps answer some questions about why primary care is good for you. 😉
The Value of Primary Care
(or: Why You Need a ‘Regular’ Doctor)
One of the many benefits of staying in good health is that you don’t have to spend an inordinate amount of time in your doctor’s office. I repeatedly meet people, particularly in their 40’s and 50’s, who have never established a long-term relationship with a physician mostly because they state, “I’m never sick”. This is wonderful!
However, not being sick does not mean you don’t need a physician.
1) What is a primary care physician?
MA, RN, LPN, PA, NP, MD, DO… who is a physician, who is a provider, who is a clinician, an assistant, a lab-tech, your neighbor??? The assorted titles, names and abbreviations don’t help anyone make any sense of their healthcare. Add to it the broad use of “clinician”, “provider”, “practitioner”, “generalist” and no one really knows what they’re getting.
Medical “provider” has taken on a broad range of meaning to include physicians, nurse practitioners, physician assistants and many other trained personnel. The degree of training and scope of practice differs substantially. Here we will discuss physicians (otherwise known as ‘doctors’).
A traditionally trained physician will always have either “MD” or “DO” after their name. Other people referred to as doctors in our culture may be those with PhD’s, nurse practitioners, chiropractors, dentists or physician assistants. Although these backgrounds can lead to patient-care professions, when most people say they need to go to the doctor they are usually referring to needing to see an MD or DO.
2) Are a GP (general practitioner) and a family doctor the same thing?
Historically, generalists and family physicians were one-in-the-same. However, the term generalist now refers to physicians who are capable of providing a broad range of medical care but who did not complete residency. This brings up another confusing issue: how physicians are trained.
3) How are physicians trained?
After college and medical school, physicians go on to residency. Residency is an intensive 3-10 years when physicians finalize their training and gain expertise in their specialty. Most residencies in the primary care specialties are 3 years. This includes family medicine, internal medicine and pediatrics. If a physician stops their training after 1 year of residency they are called a ‘generalist’.
When a physician finishes residency they often take the final of a long series of difficult exams called ‘the boards’. If a physician satisfactorily completes medical school, residency and all 4 of their certification exams, including the boards, they are called ‘board certified’. Assuring your physician is ‘board certified’ is one way you can assure they have completed all of the necessary training in their branch of medicine.
But let’s get back to primary care physicians.
There are traditionally 3 types of doctors who act as primary care physicians:
1) Family Physicians: trained to care for people from birth to death, often including obstetric (pregnancy) care, minor surgery and urgent care. Family physicians often work as ‘outpatient’ physicians and are part of the ‘front line’ of medical care.
2) Internists: trained to care for adults throughout their life. Internists have more in-hospital and ICU training than family physicians and often work both in the hospital and in an outpatient clinic. These physicians can go on for more training to become specialists in cardiology, endocrinology and a lot of other “–ologys”.
3) Pediatricians: generally care for newborns through young adults (usually ~18 years of age), not including obstetrical care.
4) Med/Peds*: trained in internal medicine and pediatrics and often work in the hospital or become specialists in pediatrics (like a pediatric heart physician)
5) OB/GYN*: many OB/GYNs provide comprehensive primary care for women of reproductive age through menopause including surgery and care during pregnancy.
*Med/Peds and OB/GYN physicians encompass part of the ‘front line’ of medical care for many people and so are listed her as primary care physicians. Often ‘PCP’ refers to just the first 3 types of physicians listed above.
4) Why do you need a primary care physician?
While we live in a DIY culture and I am certainly very independent and strong proponent of doing-it-yourself, there are a few things that a person simply should not do on their own. We’ve all had an example in our lives of something we tried to do by ourselves and, in the end, if we just would have hired a professional we would have saved time, money, effort and suffered far less trouble!
This includes coordination of your medical care. Your body and your health is your single best asset to securing you and your family’s future. And being proactive and taking wellness guidelines seriously will help you protect that asset for a very long time. This is why you need a primary care physician.
5) What can a primary care physician do for you?
- Be a home base: You may have heard of the patient centered medical home. This refers to having a home-base for all of your medical care. This is coordinated by your primary care physician. Primary care physicians can care for most people and most problems most of the time. In any one given day, I do pap smears, prescribe birth control, discuss and treat depression, refill medications for blood pressure, remove moles that are concerning for cancer and diagnose and treat pneumonia (among many other things). I joke that I am like Wal-mart (or Target, since its fancier): a one-stop shop that can take care of most things, most of the time.
When a primary care physician encounters a problem that she cannot resolve, she should happily refer you onward to a specialty trained physician. Sub-specialist physicians have extra training in a focused area of expertise and help patients address a specific problem (like performing the surgical repair of a torn meniscus or treating severe seasonal allergies previously unresponsive to four medications). Your primary care doctor then coordinates care and provides a home base to keep track of medications, medical problems and, in general, keep tabs with what is going on with you.
- Translate: I am often asked to be a translator for ‘what is going on with me’ situations. If you scatter your medical care, medical information and evaluations all around town at various ER’s and immediate need clinics, it is expensive, inefficient and, frankly, dangerous to you. It is also almost impossible for a primary care doctor to comprehensively figure out what has happened. Medical records remain shamefully difficult to track down, they are timely to review and challenging to synthesize in a productive manner. So, often, we start from scratch and repeat much of what has already been done. This leads to redundancy, increased expense and delay in your medical care. This is not good for you or for our medical system.
While I do not mind de-coding or offering a fresh perspective to a medical problem, you will do yourself and your physician a tremendous favor by keeping all of your medical care (and records) housed in the same place.
3) Provide continuity: Continuity is cost effective, it’s convenient, and it improves your care. It makes my job easier and more enjoyable. Continuity lets me learn about your family, your life, your job and the contextual information that explains a lot about your health. You don’t have to re-tell your story over and over again. You can, hopefully, develop a level of comfort with your physician that makes you at-ease and able to be yourself during your visit. When patients are comfortable, they often unintentionally disclose that final piece of information that is the ‘key’ that unlocks a diagnosis.
4) Monitor wellness: I met a disability insurance man who stated, “death… death is not the problem. Disability is the problem.” A very interesting point! One of my essential jobs as a primary care physician is to help you stay well and to prevent unnecessary disability. Regular wellness exams allow us to monitor problems like high blood pressure, high cholesterol, thyroid issues, cervical cancer, colon cancer, osteoporosis, diabetes, lung disease, weight gain and other medical problems that cause irreversible disability if they are not recognized and treated appropriately. I will dispel another medical myth: YOU WILL NOT ‘KNOW’ IF YOU HAVE MANY OF THESE PROBLEMS. Time and again patients tell me that if they had high blood pressure, they would know. This is simply not true. High blood pressure, elevated cholesterol, diabetes and other problems are insidious. They wreck havoc slowly. By the time you realize they are a problem, it may be too late to reverse the damage they have done.
You need a primary care physician.
Find someone you trust, who takes the time to listen to you, who is Board Certified and who is honest with you about your health care. See them at least once a year for a wellness visit and address just that – wellness. Try to not use that protected time for a cough, cold, or to address a short-term problem; schedule shorter focused appointments when these issues arise. Help your primary care physician take care of you by addressing your most pressing concerns first. Be organized with your medical records. Be honest about your body and your prior medical history. And if you meet a physician that you don’t feel comfortable with, let her know (it makes us better at our job) and move on to find someone with whom you can have a long-standing relationship.
Your health, your medical care and our medical system will be better for your efforts.