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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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