The ‘do-it-all’ doctors
AS physicians, my husband and I are constantly fielding calls from friends and family who have health-related questions. He answers those in his area of expertise, orthopedic surgery, and I’m generally left to respond to everything else. One of the most frequent questions I get, and one of the toughest to answer, is: Do you know the name of a good primary care doctor?”
An estimated 35% of adults in the United States do not have a usual primary care physician, such as an internist or family practitioner, according to a national survey performed in 2004 by the Agency for Healthcare Research and Quality.
Their medical care is put together piecemeal fashion. Those who can afford to do so -- or who have insurance that will allow it -- frequently jump from one medical specialist to the next; others resort to the emergency room whenever they are ill or injured.
Although they may have their immediate medical needs met in this fashion, these free agents miss out on many of the important benefits of a primary care doctor. And, I would argue, they might even jeopardize their health over the long haul.
Without a physician to coordinate care, their health problems are treated as isolated events. A dermatologist tends to their rash, an orthopedist sets their fracture and an ophthalmologist prescribes their glasses.
In the meantime, their overall care falls short. Blood pressure and cholesterol levels often go unmeasured, chronic problems are largely ignored and symptoms of new and potentially serious disorders pass unnoticed.
That’s where a primary care physician comes in. By providing comprehensive care, they can eliminate these “care gaps.” “We don’t simply address acute problems but deal with preventive care and chronic conditions as well,” says Rick Kellerman, president of the American Academy of Family Physicians. They are, to sum it up, the “do-it-all” doctors.
Studies show that people who have a primary care physician are more likely to receive preventive interventions, such as cancer screenings and immunizations. They are also more likely to be screened for mental health conditions such as depression and dementia and drug and alcohol use.
Close monitoring of chronic conditions by primary care doctors allows for more effective treatment. If you have a doctor who sees you regularly for these kinds of conditions, you’re more likely to get them under control and less likely to develop complications.
In spite of the clear benefits primary care offers, some people worry that primary care doctors may not be trained to treat specific medical conditions; specialists, they believe, would have more expertise. So, when a problem develops, they bypass the primary care doctor and head straight for the “expert.”
But it doesn’t have to be an either-or decision -- specialists and primary care doctors can, and should, work collaboratively. Primary care doctors generally manage straightforward medical problems quite well. Specialists should be consulted, however, when serious, complex or confusing medical problems arise or when appropriate therapy is not clear-cut.
Here again, having a primary care doctor offers advantages. He or she can help identify the best possible specialists and ensure that any subsequent recommendations are consistent and compatible with other care.
Unfortunately, finding a primary care physician that suits you can be difficult. Although experience and competency are the most important factors, I encourage people to be pragmatic too.
Make sure the doctor is covered under your insurance plan, that the office is conveniently located and that you are able to schedule an appointment within a reasonable amount of time. Even the best doctor won’t work out if visits are expensive, inconvenient or too hard to come by.
A physician’s communication skills are also critically important, particularly in primary care. Look for a doctor who takes time to explain things to you and is an attentive listener.
The search for primary care doctors is likely to only get harder as fewer physicians elect to go into the field. In 2003, the Journal of the American Medical Assn. reported that interest in primary care careers among medical students had declined from more than 35% in 1999 to less than 22% three years later, and that fewer students were entering training programs in internal medicine and family medicine.
I imagine that means my phone is unlikely to stop ringing anytime soon with people searching for the ideal primary care doctor. Unfortunately, there is not one right answer to their question. There are many excellent physicians, each with his or her own approach and personal bedside manner.
Although I have a few names I’ll share with people, the most important thing I have to offer is the encouragement to keep looking until they find one they like.
Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. She can be reached at themd@att.net. The MD appears the first Monday of the month.
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Someone to count on
Relationships with a primary care physician also offer the advantage of familiarity. Primary care doctors come to know their patients’ health histories as well as their personal preferences.
“They understand their patients’ values and their approach to life,” says Lynne Kirk, president of the American College of Physicians. In this way, they are better able to determine not only what their patients need -- but what they want as well.
Many of the benefits of having a good relationship with a primary care doctor are intangible. “When you have it, you simply know it and it works for you,” Kirk says.
Knowing someone trustworthy and capable is available should something go wrong offers peace of mind; having a nonjudgmental person with whom to discuss physical and emotional concerns provides comfort.
-- Valerie Ulene
