The Case for Having a Primary Care Physician

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You’re young, you’re healthy, and you’re very, very busy. Do you really need a primary care physician? The short answer is, “Yes, you do.”

If you’re satisfied with that response, you probably already have one. But maybe you–or your best friend or your kid brother–are not yet convinced. I can practically hear your voice rising two octaves in protest: You’re perfectly healthy and you always have been with the exception of that broken arm in third grade, the surgery on your wisdom teeth, and the occasional cold.

So, why should you get yourself a primary care physician? Is it because you need lots of tests and blood labs and all that jazz to make sure you don’t have a hidden cancer? No. You can breathe a sigh of relief – that is not the reason.

Put simply, having a primary care physician will keep you healthier as you age. Studies in numerous medical journals have confirmed this, including one in International Journal of Health Services which revealed that states with more primary care physicians per capita have better health outcomes, including fewer deaths from cancer, heart disease, or stroke. A separate study in the same journal suggests that an ample supply of primary care physicians is associated with a longer life span–if you add more primary care physicians to a community, the result is fewer premature deaths.

How is it that a primary care physician could have such a big impact on your health, you ask? The key is what’s known in the medical community as “continuity of care.” Continuity of care means that you establish a relationship with a health care provider and you enhance that relationship year after year. This provider gets to know you and your health goals, and helps you manage your overall progress. Continuity provides tangible benefits that have been proven to add up to better health. Here are just a few:

  • Someone to Watch Over You

In the short term, continuity of care dramatically increases the likelihood that you’ll receive a correct diagnosis and appropriate treatment. “The best diagnostic test available to a doctor is the test of time,” says One Medical Group physician Andrew Diamond. “Your primary care physician gains valuable information from tracking a problem over time –whether for a week, two weeks, or a month–and can make treatment decisions accordingly.” Think of the other extreme: If you go to the ER with a problem, the providers don’t expect they’ll ever see you again, so they’re likely to order extra tests and treatments to cover all the possible bases at once.

Over the long term, a provider who knows your health history, your habits, and your personality can more easily recognize signs that indicate a potential change in your health. For example, if you complain of fatigue to a doctor who doesn’t know you, you might not be taken seriously – but your primary care doctor will be able to see that you aren’t your usual self. On the flip side, that same provider will be able to reassure you when you’re not sick–they’ll know that the mole you’re worried about on your back isn’t a problem because it hasn’t changed in the six years they’ve observed it.

  • One Point Person

If you need to see a specialist, a skillful primary care physician will refer you to someone they know and with whom they have a collaborative relationship. If you have concerns about getting different suggestions from different specialists, your primary care physician can help you sort through and prioritize which suggestions to act on first. “This is the concept that’s known as the ‘medical home,’” says Richard Madden, MD, a family physician who serves on the board of directors of the American Academy of Family Physicians. “Your primary care physician has a working relationship with their referrals and keeps track of your care with them.”

  • Save Time Down the Line

Setting up a relationship with a consistent provider can help you get care more quickly should you get sick in the future–whether it’s a pesky sinus infection or something more serious. “When you’ve established care and set up that relationship, it’s much easier for us to help you down the line,” says One Medical Family and Nurse Practitioner Meg Scott. “We know your history, we know more about you, we can even help you resolve things over the phone or via email sometimes.”

  • Prevent Future Illness

And finally, if you come in for regular physicals instead of only coming in when you’re sick, your primary provider can help educate you about your health and prevent chronic illnesses down the line. “When we do a physical, we do a lot of routine, basic checks. But coming in regularly can be very valuable to your long-term health,” says Scott. She says she covers a lot of ground in a yearly physical, dispensing information tailored to the unique needs and goals of each patient. The range of topics may include education about high blood pressure, weight loss, STD prevention, alcohol and tobacco use, or stress and anxiety. “It’s proactive and preventive at the same time,” she says.

The Problem with Self Referrals

Still not convinced you need a point person to help you manage your health? Think it saves you time to go directly to a specialist when you sense something is wrong? Think again. When you refer yourself to a specialist without seeing a primary care physician first, says Madden, “You’ve already identified a certain part of your body as the source of the problem and chosen a specialist based on that.” Sometimes the problem is fairly obvious: You’re having a skin problem, so you go to a dermatologist. But what happens when you have chest pain? You might decide that you need to see a cardiologist, who will evaluate your problem through a cardiologist’s lens, looking for cardiac explanations and ordering tests of your cardiac function.

But what if those tests are inconclusive? Will you seek out a different cardiologist who will repeat the same tests, hoping for an answer this time? What if your chest pain isn’t caused by a cardiac problem? What if it’s coming from your gastrointestinal system, or from your lungs? Will you take yourself to a gastroenterologist, or a pulmonologist, and go through all the specialized tests they recommend, too?

All those visits take time, delaying your diagnosis. And all that testing can be dangerous. “There can be harm in overtesting,” says Madden. “There can be complications or pain, and lots of costs that could have been avoided.” Diamond agrees, “Many tests involve radiation, toxins, or invasive procedures that carry significant risks. Tests can give ‘false positive’ results, prompting treatment for an illness that you don’t have. And tests can detect miscellaneous irregularities unrelated to your complaint – leaving you stuck with even more testing to prove those are benign.”

In contrast, when you go to a primary care physician whose goal is to consider the whole of the person, says Madden, “You avoid a narrow approach to your problem and the unnecessary tests that go with that.”

The Big Picture

The point Madden makes is key: Everyone should have a provider who can step back and look at the “big picture” of their health–especially during times when a diagnosis is needed. This is what primary care physicians are trained to do. In medical terms this approach is called a “a broad differential diagnosis.” As Diamond explains it, “Any set of symptoms can have a lot of possible explanations. A primary care physician has to have an open mind, listen carefully, and consider all the possibilities.”

What to Look For

What should you look for in a primary care provider? Along with feeling a sense of safety, rapport, and trust, Madden recommends finding a practitioner who conveys a sense of thoroughness and a depth of knowledge. He also recommends finding a provider who values your input and opinion. “You want to feel like you’re involved in the process of decision-making.” For example, if your doctor recommends tests she might then ask, ‘How do you feel about that? Is this what you’re looking for? Does it seem reasonable? Is it affordable?’ Meg Scott agrees. “It’s not a one-directional relationship, it’s bi-directional,” she says. “The goal of each visit should be to have a level playing field, where you can voice your concerns openly and you walk out the door feeling like you were really listened to and you’ve got a plan that’s going to work for you.”

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comments:

  1. Gokul says:

    you need a Family GP. Intoday’s fast changing world – with more specialities and technologies, family physician concept is eroding. This causes lack of ‘Meaningful Use’. It is better to have a family Physician (a national level ratio of 1:2000) would be good. From GP’s perspective, they need to be enabled with technologies to handle 2000 patients. I have a strong indiciation this would result in cost reduction in healthcare – at least prvenet cost escalation

  2. Kristy says:

    Good article. Very easy to understand. Now I have an additional question. Some patients prefer to coordinate their own healthcare (not sure if this is what you all talk about in the article about self-referral) and would rather the PCP not do that for them. So my question is this: why do patients need a Primary Care Physician to coordinate care when it comes to dealing with specialists?

    • Editor says:

      Hi Kristy,

      Thanks for commenting, and for your question. Patients are free to coordinate their own care when it comes to seeing a specialist, if that’s what they’d prefer to do.

      But at One Medical, we believe there are several important reasons to consult your primary care provider before scheduling a visit with a specialist. For example, your PCP can help ensure that you need to see a specialist in the first place; that you don’t undergo unnecessary testing, which may end up being time-consuming, expensive, and ultimately, harmful; and that you get scheduled to see the right specialist for your particular health concern — and that’s just to name a few reasons. The reasons for coordinating specialist care through your PCP are many and varied, and frankly, depend to some degree on each individual patient’s symptoms. But we feel the author has done a nice job summarizing the main points in the sections “The Problem with Self-Referrals” and “The Big Picture.”

      I hope this answers your question!

      Best,
      Nikki Jong
      Managing Editor
      One Medical Group

  3. Jordan says:

    I would have loved to have had a primary care physician or most of my adult life, but unfortunately due to frequent job changes / layoffs and moving to other cities, it just wasn’t a possibility. I now live in Los Angeles and work freelance and have a PPO with s $3,000 deductable I will NEVER use since the last time I had a cold was in 2009. Now any time I go in for a sprained thumb or a check up, I have to pay just as much as my monthly insurance bill – so what is the point?? I have heard of some affordable health care here in Los Angeles, called LACARE. But I am still looking into it to see if I qualify with my income.

  4. susan emmick says:

    amlooking for a P.A. but I know of a medical center that treats emergency cases..with M.D and P.As and nurse pract…caan they be a Primary Care center? Are they able to qualify with my insurance or is there a legal problem for this kind of medical care?

  5. Carol Holmes says:

    Do these doctors have privlileges at UC San Francisco?

  6. B.L. Ochman says:

    Are your primary care drs able to visit patients in the hospital or are patients forced to deal with the new specialist “hospitalists”?

    • Hi there,

      Thanks for your comment. We work closely with local hospitals to ensure seamless transition for hospitalizations. We typically schedule follow-ups after the patient is released, but we don’t provide hospital visits. Feel free to give us a call if you have any additional questions–we’re here to help!

  7. Sherry R says:

    One important attribute of patients who are full partners in our own care team is the ability to read and understand basic statistical analysis and or let our subject matter experts (One Medical) tease the information out for us.

    Although I am a strong supporter of primary care (and have an amazing one at OneMedical) the article suggests that “states with more primary care physicians per capita have better health outcomes” but I am surprised that this conclusion was drawn since I don’t see the evidence that this is a cause and effect vs causal relationship?

    IE perhaps primary care doctors simply chose to practice more often in those States (Colorado, Oregon, Utah etc) that have healthier populations? They true test is if you increase the number of primary care doc’s in a population does that impact outcomes?

    I also imagine that your patient population will have better outcomes partly because we have self-selected by joining in the first place.

  8. Dolores Sebastian says:

    At an initial PCP visit, Don’t you think it is unusual that they don’t request blood work to see if your numbers are in a good range and also if you are having numbness between the shoulder blades and when extending your arms out for a few minutes gives you experience extreme pain (sort of like a pinched nerve) that they not recommend a CT scan or an MRI to see if there is a problem. A particular PCP for my son recently on his initial 1st visit did not even recommend blood work or any kind of imaging..The PCP only prescribed meds..This I think would only tend to mask the underlying cause of any problem…I need some advice…Help and answer soon.

  9. shellycemt says:

    Do you think by any chance if your pcp says to you he has sent you a referral to the pain clinic, that the you may have an in with the clinic vs someone who walks in off the street? I was hoping this referral would/could be a beginning of being taken care of seriously?

    • Hey Shelley,

      Great question–this really depends on your PCP, the clinic, and your insurance plan. At One Medical, we have close relationships with all of the doctors, clinics, and other services that we refer patients to visit outside our practice. These specialists are within our trusted network and we’ll take care of the hassle/paperwork to make sure we match you with a clinic that accepts your insurance plan.

  10. Aline Henderson says:

    I recently went through a nightmare situation that I’m wondering if joining this group could have prevented. This past summer I fell an broke my ankle really badly; I was taken by ambulance to the closest ER that, although attached to a hospital and medical school, had no board-certified orthopedic surgeon on staff. So one of the trauma surgeons did emergency surgery to attach an “external fixator” to my leg, telling me that because I had a bad “fracture blister,” I couldn’t get the ankle surgically fixed until that blood blister healed. But then, and here’s the nightmare part, neither he, nor anyone else in the hospital or at the rehab center they sent me to a week later when the blister had healed, would find an ankle surgeon for me. So I was on my own to do that. It took me 10 days of asking friends for names of surgeons and then calling them, to find an ankle surgeon who was in town, took my Blue Cross insurance and could see me quickly. By this time I had an infection where one of the pins entered my foot (and I’m a diabetic). By sheer luck, I finally found a surgeon who saw me right away, and told me if another week or two had gone by I might have lost my foot. He operated on me right away, and now I am healing, but my ankle will never recover as well as it would have had I bee able to have surgery as soon as the blood blister had healed. So, what I want to know is, if I were a patient at One Medical, would my primary care doctor there have promptly made all these arrangements for me? Or would it still have been up to me to do the best I could? Thanks

    • Hi Aline,

      Great question—the short answer is yes. As a One Medical member, our providers will work with you to refer you to a trusted outside specialist that fits with your needs. We’ll do all the paperwork and make sure they work with your insurance plan. Feel free to give us a ring at 202-660-0005 if you like to chat further about this.

      P.S. Wishing you a speedy recovery!

      Kameron Kitajima
      Community Manager
      One Medical Group

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