Episode 15: September 23, 2009
by Rob Lamberts, MD
I have had several listeners ask me for advice on how to find a good primary care physician. I am a primary care physician (or PCP), and I think that one of the keys to getting good overall care is to have a relationship with a good primary care physician. But finding the right doctor can be hard. How do you know they are good? How do you know you’ll get along with them?
To answer these questions, I first have to answer a more basic question: What exactly does a primary care physician do? I'll get to finding a good primary care physician in next week's episode, when you'll have the information to decide if you want to go that route.
Let me remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
What are Primary Care Physicians?
Primary care doctors are also referred to as generalists, meaning that they don’t have a single area of care. That isn’t entirely true, however, as there are three distinct types of PCP’s that differ based on their focus:
Pediatricians--who generally see children up to age 18
Internists--who take over at age 18
Family Practice Physicians--who see all ages.
It’s the training that makes each of these doctors unique. The common denominator among all physicians is that they completed four years of medical school. After medical school, doctors choose their field of interest within medicine and get more intense training. This training period is called residency.
How are Primary Care Physicians Trained?
Residency is by far the most rigorous training doctors go through, especially in the first year, which is called the internship year. First year residents are called interns. The joke about interns when I was training was that the main difference between a pile of dung and an intern was that people didn’t go out of their way to step on the pile of dung.
Anyway, when medical students graduate, they go to the residency of their choice to be trained in their specialty. All three residencies for primary care last three years. A small group of primary care physicians don’t think three years is painful enough; they spend four years in prison…I mean residency, and come out eligible to become board certified in both internal medicine and pediatrics. It’s called med/peds and it’s totally nuts. That’s why I chose it.
Nearly all family practice residents go on to practice primary care in an office setting. Internal medicine and pediatric residents can go on to do a fellowship in cardiology, gastroenterology, rheumatology, and a bunch more ologies. Their training goes on a very long time.
Why Should You See a Primary Care Physician?
Why should someone go to a primary care physician instead of a bunch of specialists? Wouldn’t it be better to see different “experts” for each problem? There are several reasons why having a primary care doctor is important:
1. One-stop shopping. Since they have expertise in a wide range of diseases, you can see your primary care doctor for most problems. Today in my office I took care of problems with the lungs, heart, endocrine system, and urinary tract, as well as issues related to infectious diseases and assorted other orthopedic issues. I handle a majority of these cases myself and pass on only those people who need the more in-depth care the subspecialist can give. It’s much easier to get an appointment with one PCP than a bunch of specialists, and the care for routine problems is basically the same.
2. Relationship. Since you see your PCP over a number of years, they get to know you and you get to know them. When I see a person in my office with a problem, I put it in the perspective of the 5, 10, or 15 years I have taken care of them. I know the personality, the past illnesses, emotional traumas, and the amount of worry most of my patients have. It is far easier to take care of people I know than someone I am meeting for the first time.
Let me add that taking care of many generations of the same family can give a very unique perspective on things. There are many instances when family dynamics plays a very large role in a person’s medical care. It’s a huge advantage to have one doctor who sees that big picture.
3. Coordinating care. When you see a surgeon, cardiologist, or other subspecialist, they send a note to your PCP explaining what they did. The goal is to have one person who knows the big picture of things– and sometimes a PCP coordinates the care between many specialists. Without a PCP, patients are left to be the ones coordinating that care. That can be nearly impossible for patients who have many complex problems.
4. Prevention. One of my main jobs as a PCP is to keep my patients out of the hospital and away from subspecialists. Subspecialist physicians focus on disease. A cardiologist won’t take care of you if you don’t have heart problems, and a rheumatologist will quickly lose interest if you don’t have joint or autoimmune problems. Primary care physicians, on the other hand, work to prevent disease and minimize the damage of any disease or illness. That is the main reason much of the talk about health care reform is focusing on promoting primary care, as its goal is to prevent disease and hence save money.
5. Trust. Having a PCP you trust is invaluable. It’s kind of like having a good friend who is a doctor. If you are confused about what you hear from a specialist, you can go to your PCP and have them decode it for you. Since our main job is to talk with patients in the exam room, it’s appropriate to sit and ask questions. Answering questions and giving advice is a central part of primary care. When you do need a specialist, your PCP should refer you to the best one possible. I never send my patients to someone I wouldn’t send a family member to.
So what is today’s quick and dirty tip? Get a primary care physician you trust. If you do have a good PCP, take advantage of them. Use them to coordinate your care and clear up confusion. You don’t have to be alone as you navigate through our confusing health care system. Primary care physicians are there to make getting good care easier.
So how do you find a good PCP? Sorry! You’ll have to wait until my next podcast to find that out.
That’s it for today’s podcast; thanks for listening.
If you have questions you want answered, send them to firstname.lastname@example.org. You can find me on Twitter as @housecalldoc and on Facebook under “House Call Doctor.”
Catch you next time! Stay Healthy!