Getting to Know You
The importance of having a relationship with a primary care practitioner.
by Dr. James Skee with Cindy Donatelli, Silver Health CARE
In our lives, we enjoy relationships with friends and family, but when we fall ill and need to see a doctor, our relationship with our primary care physician comes into high relief. If you see any practitioner who happens to be available, thinking that doctors are all the same or that anyone who fits into your schedule will do, you are missing out on a whole host of health benefits that come only with having an established long-term relationship with a local primary care practitioner.
Over time, practitioner and patient get to know each other, which results in an openness and rapport so that you can state your health concerns openly and honestly, and get your questions about your health answered in clear, understandable terms. A practitioner who knows your health history and has a good idea of how you usually look and behave is also in a better position to assess changes, even minor ones, and to come up with the right diagnosis.
For example, I saw an elderly patient recently, well into his 90s. He came into the office requiring assistance. He spoke hesitantly, and had considerable difficulty in making his points and phrasing his questions. I knew instantly that something was drastically wrong, because, even though he was behaving in a way not unlike others of his advanced age, I knew this was not him! Indeed, his usual complaint when he came to my office was that he had cut back to working only nine-hour days. I hospitalized him immediately, and he is now recovering from his pneumonia, and returning to his usual remarkable vigor.
According to a 2007 study, primary care physicians are closely identified with preventative and proactive health benefits. The same study speaks of the effectiveness of primary care in the early detection of disease, specifically, breast cancer, colorectal cancer, cervical cancer and melanoma. With the advantages of primary care, there is less of a chance that you will be admitted to the hospital: "Geographic areas with more general and family physicians… have lower hospitalization rates for conditions that could be preventable or detected with good primary care, e.g. diabetes, congestive heart failure, hypertension and pneumonia."
Yet not everyone sees the benefits of preventative care. Men, in particular, seem to have a hard time coming in to a medical office. Our culture encourages men to be strong, independent and self-sufficient — in a word, not to be "wimps" — and to tough it out. Yet these very same traits can present challenges to their health, for they are less likely to seek preventative care for themselves.
Recently, I found myself trying to convince a middle-aged gentleman to get a screening colonoscopy. He resisted the idea and could not be convinced. So I changed tactics. I knew that he loved his truck and took meticulous care of it. So in the middle of a medical interview, we found ourselves talking about oil changes:
"Do you change your oil regularly?"
"Yup," he answered.
"Is there anything wrong with it?"
"So, then, why change the oil? Why not just wait until the truck breaks down?"
When his wife had finally stopped laughing, he agreed to have the colonoscopy. The results showed that an early cancer was found and it was removed uneventfully, with a complete cure expected.
The primary care practitioner's role in delivering preventative care raises yet another issue that is very much on the mind of healthcare consumers — the high cost of healthcare. With many people having lost their insurance coverage or finding themselves with high-deductible policies, we are all looking for ways to spend our healthcare dollars effectively and wisely. A primary care physician can prove to be a valuable ally in achieving your goal for a number of reasons.
First of all, someone who has an overview of your health records and lab tests results is less likely to order unnecessary tests and procedures that might be ordered by a practitioner who doesn't know you. To cite one example, I saw a patient recently who had been having chest pains. Having read some magazine articles and done a search on the Internet, she decided she should see a cardiologist, who dutifully did an echocardiogram, followed by a stress test, and then a cardiac catherization. After this last invasive test, the cardiologist came by to see her with a big smile on his face: "Your heart is fine; it is not the cause of your pain." "But then what is causing my pain?" she asked. He replied, "I don't know, but you can be sure it is not your heart."
So she went to see her primary doc. After a detailed history and exam, I was convinced it was simply GERD (gastroesophageal reflux disease). I prescribed appropriate medications and her problem was cured. Cost of the primary care work-up was about $100. The cost of the cardiology workup was about $20,000, not to mention her worry and discomfort!
Insofar as a primary care physician is able to address health issues as they come up, you have a better chance of not finding yourself in a hospital, where the cost of care, by comparison, is astronomical. This is especially true when it comes to emergency room visits. While emergency care has its place when there is a true medical emergency, those who resort to the emergency room when they have minor illnesses or injuries are misusing the facility, and paying dearly for it.
I saw a patient recently who also had some nagging chest pain. She went to the ER because, after speaking with her family at dinner, they convinced her that she should go, even though she had been feeling that way for weeks. In the ER, they did the usual poking and prodding, did EKGs, serial blood tests and finally a CAT scan to rule out blood clots. After seven hours, she was sent home with the assurance that "everything was fine" and she was given a bottle of pain pills. But she still had no clear understanding of what was going on inside of her.
She came to see me subsequently. After a history and an exam, it was clear that her chest pain was localized to the cartilage joining her ribs to her breast bone. She had costochondritis, probably caused by a virus, and felt much better after a few days' treatment with anti-inflammatories.
This case illustrates how turning to a primary care practitioner rather than the ER in the first instance might provide far more effective treatment. Indeed, recently studies estimate that between 27% and 56% of all visits to the emergency room are non-emergency visits; moreover, the costs of an ER visit were on average $580 higher than an office health care visit, and that doesn't include costly procedures and tests.
Human beings are very complex, with many things that can go wrong. Our healthcare delivery system is also complex. In the midst of all this complexity, having a relationship with a trusted healthcare advisor who knows you will bring multiple benefits to you as a patient: peace of mind, better health, savings to your pocketbook. It is a relationship that could even save your life.
The primary care provider can be a family practitioner, internist, pediatrician, nurse practitioner or a physician assistant. Moreover, there are indeed times when integrative medicine and alternative therapies can turn out to be a better fit for someone, and they are equally effective routes. The important thing is not the provider's title, but the relationship that has been built up over time. In the process of that relationship, you will learn more about yourself, your health, and what medical services are appropriate — in a word, you will become a more informed and wise consumer.
The leading physician of the 12th century was Maimonides, who sagely declared: "Live sensibly. Of a thousand people, only one dies a natural death. All the rest succumb to irrational modes of living." Be sensible.
Dr. James Skee is a board-certified internist at Silver Health CARE, who sees patients at the Silver City, Deming and Bayard locations. For appointments, call (575) 538-298, and in Deming, (575) 544-4422. Cindy Donatelli is in charge of advertising and marketing at Silver Health CARE.