What you should know about your primary care physician

If you haven’t already, you will someday see a primary care physician (PCP).

It’s practically unavoidable.

The reason for this self-declared truth is that PCPs are the shape shifters of medicine, assuming various roles at different stages of an adult’s life and wellbeing.

These responsibilities range from treating various health conditions, ushering patients in and out of hospitals, coordinating long-term medical decisions, and consulting with other specialists to better optimize patient care.

Given that you are either currently seeing a PCP or are likely to see one in the future, there are a few things you should know about the career of a PCP that may help improve communication between you and your doctor and provide insight into this extraordinary field of medicine.

1. Primary care physicians want to spend more time with you. Fact.  Even if you are in a grouchy mood or perhaps forgot to shower that week, PCPs definitely want to see more of you.  The reason for this is twofold. First, they signed up for this career specifically to develop a lasting relationship with their patients.  Second, the more time spent with each patient, the better a PCP can truly understand his or her health needs.

Take this simple case as an example:  a 60-year old male patient who is obese, smokes, and has diabetes comes in for a 15 minute visit with the complaint of toe pain from stubbing it last night while getting into bed.  Where a PCP can invariably handle this one complaint visit in the appropriately slotted time, he or she may have missed the opportunity to uncover through conversation the low-grade chest pain on exertion that this patient may have been experiencing but reluctant to disclose.

Many reasons exist why many PCPs have limited time to see patients, including various incentives and competing roles (some of which we will cover below).  Regardless, I guarantee that most PCPs would ideally like to see their patients more frequently.

What simple steps can you do as a patient to promote adequate time with your PCP?

When calling for an appointment, let the scheduler know if you have more than one complaint to discuss so they can carve out adequate time (whether it be one longer visit or a series of smaller visits).  Remember to bring in a list of complaints to present to your PCP so he or she can adequately prioritize the visit.

2. Primary care physicians have to do more administrative work than any medical specialty. One of the most common complaints of a primary care provider is the vast amount of extra work required beyond the scope of direct patient care.  Most of these obligations revolve around clinical documentation, coding/billing and filling out various forms (work, disability, home health needs).

Despite the fact that the direction of primary care practices in this country are moving towards a cooperative and integrative care system where physicians, nurses and other ancillary staff work in coordinated effort to take care of many of these needs, many health care providers may be experiencing an even higher demand for more precise documentation and billing that presumably will require even more time away from the patient.

What can you do to help minimize this extra effort spent away from the examination room?

Truthfully, not much.  However, making sure to fax/email all paperwork from outside hospitals, specialists and former primary care practices to your current clinic office can help the flow of your future PCP visits.  Bringing a list of current medications to any and every visit is imperative as it shaves off unnecessary time spent searching for prescriptions and also prevents medication errors.

3. The field of primary care is in flux. The classic structure of primary care and the foundational concepts of what it should represent and how it should be delivered are acutely being put into question, and for good reason.

Our health care system has historically focused on treating late-stage disease and acute illness in comparison to preventative care and the management of chronic health conditions.  In order to better treat our populace, it is imperative that more resources are allocated to treating disease as early as possible in their manifestation and avoided altogether through well-researched public health measures such as universal screening and vaccination programs.

This movement of highlighting comprehensive care away from the hospital in an efficient and financially solvent manner is currently creating a massive experimentation phase in our country with regard to just about ever aspect of primary care.

Given that many primary care practices across the country are involved in these novel care structures, you should be aware that your experiences in outpatient medicine might become completely different from your expectations based on previous encounters in primary care.  You should be open to these new care structures and find one that best fits your preferences.

Take home point

The practice of primary care medicine is not an easy one.  In fact, it is often characterized as one of the most challenging careers within the field of medicine.  Despite this, the immense pleasure and personal reward that is intrinsically involved in longitudinal and holistic patient care is what often drives future PCPs into the field.

How would you describe your experiences with primary care and outpatient medicine?

Hopefully, they have been positive ones.  If not, I hope the few insights and unsolicited suggestions provided above will help better facilitate an improved patient experience.

Brian J. Secemsky is an internal medicine resident who blogs at the Huffington Post.  He can be reached on Twitter @BrianSecemskyMD

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  • guest

    Excellent suggestions. I might add that I actually spend time emphasizing to patients and their families how important it is, and how helpful to doctors, for the patient to maintain his or her own health file, with copies of consultation reports, lab work, reports on studies, etc., etc.
    In my opinion, one of the biggest things contributing to waste in our medical system today is the fact that most doctors don’t have complete histories on their patients most of the time, because we continue to work according to an outdated notion that talking to the patient to get his or her history should be sufficient.

    The fact is that medical treatment has become so complex that even the most sophisticated patient will not be able to give an accurate or complete history of their treatment if they have any sort of chronic illness.

    • rbthe4th2

      Wish I could say the same for mine. My PCP got upset because I went over the 20 min. (the previous visit they told the nurse to schedule me for a long visit) limit and I asked a couple of questions on the email. I’ll just use the internet as my doc … its been great so far and doesn’t get upset when I ask. That way the doc doesn’t have to worry about paperwork, lab reports, etc. but when stuff hits the fan, I’ll be like … pointing the fingers.
      {shrug} sometimes there’s no point to helping

      • Kristy Sokoloski

        One of my relatives had a doctor one time that we thought would be good to go back to. Well, this doctor got involved with the teaching of residents in the Family Medicine program that was at this hospital. And when this relative asked a couple more questions that went over the time limit the doctor got very upset. She never went back to that doctor.

        • rbthe4th2

          Thank you Kristy. Oddly enough, this doctor is also teaching residents in the FP program. Maybe that’s something in common?

          I think part of it had to do with the fact she couldn’t justify her actions. Docs, if there is anything to be learned, if a patient who can truly read medical literature comes across your desk, make sure you have your ducks in a row and don’t throw whatever on their charts.

          When they prove you wrong, its not going to look good. Its going to make a great case for blacklisting and a few other items. Not smart.

          • Kristy Sokoloski

            Wow, that could very well be. I think it’s worse when they can’t justify their actions or the reasons for those actions. And what makes it worse is this kind of attitude gets noticed by the doctors in training who then think it’s all right to apply the same thing in their own practices. Unfortunately, this also further validates my thought about the patients who prefer to coordinate their own care, and no one has been able to explain to me what all is so complicated about coordination of care as far as what all is involved that it is absolutely necessary to have a Primary Care Physician coordinate the care. As we have seen in other threads there has been a lot of frustration because at times when the care is coordinated by the Primary Care Physician things go wrong. Unfortunately, this is something I have experienced myself a time or two.

          • rbthe4th2

            I’ve seen the ‘cant justify’ or ‘give reasons’ LOTS of times. You are absolutely, 100% correct on the attitude and training. I say not only coordinate but the issue is more that then the doctor can’t steer you to another doctor to confirm the dx. I specifically chose a specialist because of her credentials. They compete with the previous PCP’s group. He didn’t like it and noted it in my chart. LOL … I get EXCELLENT care from this doc.
            So yes, you are on the money. I find it telling when I can’t get docs to comment on such things. Just an attempt to keep control and avoid anything so that changes are made.
            Randy

  • Kristy Sokoloski

    Interesting article. I have seen plenty of my Primary Care Physician this year because of various things that my body decided to give him to do. I would gladly like to see less of him. lol I am glad that so far he doesn’t seem to mind seeing more of me as he has done this year.