Everyone should have a primary care physician or nurse practitioner. Primary care is vital and basic in our health care delivery system. It is the foundation of good health care; the gate-keeper that makes sure you are getting the proper and most effective/efficient/economically sound health care. Right? Oh, you didn’t realize that? Did you think that your primary care provider was just a back up plan of last resort because s/he is JUST a family doctor?
Primary means first.
Now that I am in the last six months of my nurse practitioner program, friends and family keep asking me for medical advice. I guess this is something that health care providers get used to, this requesting of advice with the most rudimentary of information, 99% of the time without any exam at all, and often over the phone. It pays to be very careful. I also notice that many of the requests start with the “patient’s” opinion of what is wrong and what they should do, and they are only seeking confirmation for their diagnosis and treatment plan.
Example: the wife of an elderly friend calls up and tells me that her husband woke up “in a pool of blood”. In the background I hear him say “It was only a little bit, don’t exaggerate” and she asks me if they should go to the urologist. I ask where the blood came from and she told me she wasn’t sure if it was from the penis or someplace else. “It came from my ass” I hear in the background. “Well, I think we should go to the urologist in case it was your prostate”. After determining that the bleeding had currently stopped, I suggested that they get an appointment with their primary care physician. “You don’t think I should go to the urologist, or how about the surgeon that did his colonoscopy, maybe he has cancer?” she asks. It takes a little while to convince her that the family doctor was the place to go. That he would be able to determine what the problem was and if a specialist was even needed. She finally agreed. It turned out to be a hemorrhoid.
The thing about specialists is, they specialize. Go to a gastro-enterologist with chest pain and he will look for an ulcer, a cardiologist looks for heart disease, a psychiatrist will look for panic attack. Specialty practices generally aren’t the place to go to for an initial diagnosis. Okay, if you are having crushing chest pain, or have a bone sticking out after you fall down, or you have vomited so much you are passing out, go to the emergency room. That is a specialty you can go to for an emergency. As I have stated previously, a sore throat or infected big toe are not emergencies. This is where the primary care provider fits in.
Another friend has had a history of triple bypass. He kept having chest pains after and popped nitro and aspirin like candy. It just didn’t seem to be helping. He kept going back to his cardiologist, had test after test, year after year. Everything seemed fine when he had his cardiac tests, but the chest pain continued. I finally asked him one day to describe when where how, etc. of the chest pain. It was when he was moving around, he couldn’t do anything without getting chest pain.
Okay, when exactly.
In the morning when he tried to wash dishes after breakfast (nice guy, huh? Washing the dishes).
Any other time?
When he took his walk after lunch.
Hmmm. After meals. Okay, did he have any other symptoms with his chest pain, sweating, dizziness, shortness of breath?
No, just a terrible burning pain in the middle of his chest. Oh, and feeling really tired.
Do you ever get it at night?
Well, yes, when laying down in bed watching TV after dinner.
Are you seeing the point yet? It turns out he had a hiatal hernia. I talked them into going to the primary care doctor for a workup and he was diagnosed, properly, with the hiatal hernia. He was tired because the nitro was dropping his blood pressure and the aspirin was also contributing to the stomach pain. It had nothing to do with his heart. A prescription for a PPI and he is in the pink (literally, his color is so much better, not pale anymore). No chest pains, no more fatigue, exercising without a problem…
So: the moral of the story is, don’t try to diagnose yourself. Let the primary care provider do it.
The ten commandments of primary care:
- Thou shall have no other doctors before your primary care provider.
- Thou shall not use the internet to diagnose thyself.
- Thou shall not call them at 4:45 PM on Friday because the itchy rash you got from poison ivy 3 days ago didn’t go away yet and you want something now.
- Thou shall not expect them to know by osmosis which other doctors you have seen and what medicine they gave you, and what you are being treated for. It is better to let her/him refer you to specialists, that way s/he knows what is going on and has a handle on your overall healthcare, and gets the records from the other physicians.
- Thou shall not use them as a last resort, remember they are primary care.
- Thou shall honor the annual physical and attend regularly.
- Thou shall not forget that each medical problem you have affects all the others, the primary care provider is the one that keeps the show moving in the right direction and directs the traffic.
- Thou shall not steal your primary care provider’s time by asking them to diagnose and treat you over the phone (okay, I am guilty of this one sometimes) You would never ask this of your cardiologist, would you?
- Thou shall not go to the emergency room to do what your primary care provider is perfectly capable of doing, such as sewing up a small laceration, treating a stomach virus, splinting a sprained ankle, etc.
- Thou shall remember you have a relationship with your family physician/nurse practitioner. They know you and your history, they follow up with you, they care for you on a long-term basis. Use that relationship to manage your health care in the best manner possible.
I just wish the insurance companies and the government realized the importance of primary care and reimbursed accordingly. Specialists are important, but primary care is more valuable in the general scheme of things: prevention, health maintenance, health screening, counseling and 98% of the health care the average person needs.