Healthcare's Front Line: Primary-Care Physicians
Unlike much of health care in the United States, which focuses on curing disease, the role of primary care physicians (PCP) is to focus on preventive medicine, on preventing the disease from developing in the first place. They do this by monitoring the health of their patients, educating them about dietary and exercise habits, and referring them to specialty care when necessary. The difference? Primary care physicians, trained in a number of different medical disciplines, practice preventive medicine, not crisis medicine.
Primary Care Physicians: Their role
Seeing the same patients and their families for much of their lives allows primary care physicians to develop a rapport with their patients and be especially familiar with the physical, psychological and lifestyle factors important to their health. It is therefore crucial that PCPs are given accurate information about the lives of their patients, ranging from emotional states and lifestyle choices, to marital status and dietary habits.
Armed with this information, PCPs seek to improve their patients’ health by recommending certain steps to be taken and educating them on why these steps are important. They can also refer you to a specialist when necessary, when they are not able to treat various conditions. When you are referred to a specialist, your PCP is kept abreast of the care and treatment you receive. For this reason, many people refer to the PCP as the patient’s gatekeeper.
The PCP was established by Health Maintenance Organizations (HMOs), which sought to replace the old health care system, which had no restrictions and was entirely fee-based. While PCPs and HMOs have seen some success, some patients believe that the cost-cutting measures introduced by HMOs tend to compromise their medical care, not permitting them to get proper emergency care or see physicians who are not part of the specific network.
Primary Care Physicians: Three Specialties
Don't wait for an illness to spurn you into finding a primary-care physician; this isn’t how it works. You should fine one first and develop some rapport with him or her, before getting sick. That way maybe they will be able to prevent it from happening.
Now, in medicine there are 24 different specialties. Only three, however, are regarded as primary care:
• Family Practice (or General Practice)
Family Practitioners specialize in general family care and are trained in a number of medical disciplines: internal medicine, pediatrics, obstetrics, gynecology, general surgery and psychiatry. They can be board-certified. General Practitioners are not as common but can provide care for the entire family.
• Internal medicine
internists diagnose and treat diseases in adults (without surgery) and they may have a subspecialty on a specific part of the body, like the heart or lungs, or on a specific disease, such as diabetes, or on a particular age group, like the elderly.
Pediatricians care for and treat children from birth through the teens and typically they have subspecialties in areas such as pediatric cardiology, perinatal medicine, or surgery.
Primary Care Physicians: How to Find One
Finding the right PCP is a process. Begin by collecting some names. Consider the following sources:
• Other Doctors
Doctors you know personally and respect, or doctors you respect who once treated you in another area (if you recently moved) may be able to provide you with a referral. The same holds true for a doctor you see on a regular basis, such as a gynecologist or pediatrician.
• Friends, relatives, associates
Friends and family members can provide referrals, but be wary, since it may have to do with rapport, and you won’t know if you have rapport until you actually meet the doctor.
• Local Hospitals
Reputable, local hospitals typically have a referral service, but they do not typically vouch for the physician's quality of care.
• A local medical society
Local medical societies can provide you with a set of names from their membership directory, but they may not vouch for the physician's quality of care.
• Your managed care plan
Managed care plans have a list of affiliated physicians to choose from, along with information on their background and services.
Primary Care Physicians: Considerations
Having put together a list of a few names, you should next use these guidelines in order to check out the doctors on your list.
Begin with the obvious: the physician must have graduated from an accredited medical school and completed their residencies in respected medical centers.
Next, make certain they are board-certified, meaning the doctor has completed a prescribed period of residency in a specialty, has passed oral and written examinations and has handled a minimum number of cases. Granted, being board-certified does not assure high quality care; however, according to the American Board of Medical Specialties (ABMS), doctors who have passed their boards have met standards above and beyond those required to get a medical license.
To determine whether a physician is board-certified, go to the ABMS web site at www.certifieddoctor.org or call their hotline at 1-800-776-2378.
The affiliations your doctor has are important to you: if they are affiliated with a large, well-equipped hospital—whether as a staff member or as an attending physician—this means that they have admitting privileges, and have met the hospital’s standards for affiliation. Lacking this affiliation means you can only be admitted if you see another doctor.
Affiliations are listed in the Directory of Medical Specialists, available in many libraries, but you can also learn this information by calling the doctor’s office and asking their staff.
Practice arrangements and location
Doctors practice alone as solo practitioner or in a group in group practice. Group practices tend to operate such that, if you call for the doctor over the weekend, you may have your call returned by one of the doctors in the group practice. Theses doctors may have the same specialty or different specialties.
Location and office hours are also important. If they aren't convenient for you, you may put off, cancel or avoid making regular appointments.
How important are a doctor's communication and interpersonal skills? A 1993 survey of 2,500 women and 1,000 men conducted by Louis Harris and Associates found that 41 percent of women and 27 percent of men had switched doctors because they were dissatisfied with the care they were given; 25 percent of women and 12 percent of men felt their doctor talked down to them; and 17 percent of women and 7 percent of men were at least once told by their doctor that what they were feeling was "all in their head".
A good doctor regards you as a partner in your own health care: they explain diagnoses, procedures, test results, medications and more. They answer your questions without making you feel like you’re wasting their time.
Additionally, a doctor who shares your cultural background, religion and/or ethical views may be very important to you as well.
To determine all these things, you will have to schedule an initial visit.
Primary Care Physicians: The Initial Visit
Your first visit with a potential PCP is the best time to show that doctor how determined you are to be that partner in your own health care. To that end, here are ways of showing it:
• Come prepared with your full medical history, including childhood diseases, chronic illnesses, hospitalizations, and medications. Know the medical history of your immediate family and bring copies of reports of any recent diagnostic tests, such as x-rays and blood workups.
• Be up front about your health and habits, so that the doctor can make accurate diagnoses and prescribe effective treatments. Doing otherwise compromises your health as well as your relationship with the doctor. Remember: any information is confidential.
• Ask questions specific to your health and your habits, not general questions that might apply to wider society.
• Take notes on what the doctor tells you because the odds are very good that you will forget much of what you’re told.
Remember, you and your doctor are a team. Don’t sabotage treatment by not bothering to follow the instructions of your doctor, such as skipping medication doses, or doing things that can compromise your health and treatment as prescribed or recommended.
However, if you have any doubts about a treatment regimen, say something to the doctor immediately. Doctors do not always know best. The ideal patient-doctor relationship is one in which decisions are made together..
Primary Care Physicians: Giving Your Doctor a Checkup Doctors are well-educated but this doesn’t assure competence and trustworthiness. You need to determine whether or not your doctor has faced any legal or professional difficulties related to practicing medicine. Doctors disciplined for unprofessional practice and/or behavior, or who who have malpractice payment reports on file, will be listed in the National Practitioner Data Bank. Hospitals must check the Data Bank every two years to make certain none of their affiliated doctors have been listed there, but the Data Bank is not open to consumers. They can, however, use other resources to give their doctors a checkup, such as:
The State Medical Board
The Federation of State Medical Boards claims that about 0.5 of all US doctors have faced serious disciplinary actions (in 1995, there were 3,375 such doctors). Call the Federation of State Medical Boards at 1-817-868-4000 and ask them for the number to call in your state to reach the agency that licenses physicians. That agency can tell you about disciplinary actions against doctors in their particular state.
Questionable Doctors is a publication issued by the Public Citizens' Health Research Group in Washington, D.C.. The publication can be found in public libraries, and you can order a state supplement by calling 1-202-588-1000.
Primary Care Physicians: The Physician’s Practice Having narrowed your list of primary care physicians down to no more than three, it is time to call their office and speak with the office manager, receptionist or nurse to determine some important information. Use this list of questions to get yourself started.
• What should I expect on the first visit?
An initial visit should feature a complete medical history and a complete physical examination of skin, eyes, ears, tongue, mouth, glands, heart and breasts (for women). Other diagnostic tests should include: blood pressure, an electrocardiogram (EKG), a chest x-ray, a rectal exam and blood tests.
• Does the doctor have a subspecialty?
If you have a chronic heart problem, for example, an internist with a subspecialty in cardiology will be your best bet. Keep in mind though that a subspecialty may not be necessary.
• Where is the doctor affiliated?
The physician should be affiliated with at least one reputable local hospital.
• What are the fees and billing procedures?
You may be required to pay at the time of your visit, so you should know the forms of payment they accept (i.e. check, credit card).
• Who covers when the doctor is absent?
It is important to know who this physician is so you can check his or her credentials.
• Does the doctor talk to patients on the phone?
Some don’t, and if the answer is no, strike this doctor from the list.
• Does the doctor make house calls?
Sounds silly and antiquated by some doctors do provide house calls. If you have an elderly or handicapped person at home, this could be crucial.
Primary Care Physicians: Knowing When You’ve Found the Right One
You will probably feel it in your gut when you have found the right doctor, but the following offers other tips that should tell you the same thing.
• The physician’s staff is friendly, courteous and helpful.
• The physician sees you in a reasonable time of your appointment (or they give you a reasonable explanation for the delay).
• The physician does not take phone calls during your consultation, unless it is an emergency.
• The physician doesn’t make you feel rushed and the staff doesn’t make you feel like you’re part of an assembly line.
• The physician treats you like a responsible, intelligent individual.
• The physician is a good listener who does not interrupt you and encourages you to air your concerns about treatment.
• The physician is up-to-date on preventive medicine like nutrition, exercise and screening tests.
• The physician explains to you the good and bad about procedures, therapies, treatments and the implications of the results of tests.
• The physician encourages you to call with questions concerning your treatment.