Did you see the hashtag #FatSideStories on Twitter last week? A very sad story about being treated cruelly by health care providers was quite common. This really broke my heart. As a health care provider, it can be tough to talk to patients about weight because it is a sensitive subject for so many people. It doesn’t have to be. Let me tell you- this is one reason I love being a Nurse Practitioner. I feel that we really approach healthcare from a team perspective and without judgement. While we have the “expert” opinion to share with patients, we still want to be on the same personal level with them in terms of mutual respect. So, if someone comes to me to with a desire to discuss weight loss, I want to sort out what their story is. What is their day to day lifestyle that is keeping them from losing weight? If they come in with diabetes or blood pressure that is out of control, and weight is a factor, we will be discussing weight and the positive effect of even mild weight loss on those disease states. But if someone comes in for a cough, or STD/STI testing, or anything else unrelated to weight, there will be no discussion of a patient’s weight. When it is appropriate to have a discussion about weight, there is no judgement. If someone needs to lose weight because it is contributing to a chronic condition, we will talk about it. But it is not from a place of lecturing or scorn. It is an opportunity to gather some information from both the patient and the provider, and together come up with some options for treatment that the patient feels will work with their lifestyle, their family, and their personal beliefs and culture. There is no room for judgement in an honest and open relationship between patient and provider. It serves no purpose- whether the touchy subject is weight, sex, drugs, self harm, or anything else that is sensitive to someone. Our goal is to help people achieve their best possible health. So please don’t put off healthcare because you don’t want to deal with the lectures. Come see us instead. No lectures, no judgement, just health.
Anthony, age 51, sees his cardiologist religiously and follows all of his recommendations- except for having a primary care provider. If he takes his medications as directed and his blood pressure is under control, why does he need primary care?
In our last post, we discussed the importance of primary care by using the example of Jessica, age 28 (a fictional patient to protect privacy). We used this patient as an example because she is a healthy young person, with only a few minor, sporadic illnesses. Once Jessica found a primary care provider, her health care was safer, less expensive, and more convenient for her and she had a person to turn to for future health concerns.
This time, we will look at a fictional patient, Anthony, age 51. Anthony is married, lives in the suburbs of Washington DC with his wife and children, and works in downtown Washington DC. A few years ago he saw a primary care doctor he didn’t like very much, and he had a physical where he was diagnosed with high blood pressure (hypertension). His wife, out of concern for her husband, encouraged him to see an expert for his condition, a cardiologist, in downtown Washington DC, near his workplace. Anthony likes his cardiologist and takes his medications as directed, and goes to follow up appointments there every 6 months as directed. His cardiologist has encouraged him to find a primary care provider, but Anthony has put this off and does not want to return to the provider he saw previously. No matter how attentive and smart his specialist is, it is not his role to provide primary care. While the cardiologist may be ordering labs pertinent to his heart health, like cholesterol and others, he is not ordering a full panel of labs that is recommended for a man over 50 years old. A primary care provider will look at Anthony’s blood pressure medications, receive reports from the cardiologist visits, and evaluate his past labs. But she will also order a complete blood count, liver and kidney function tests, thyroid function, iron, Vitamin D, and HIV and Hepatitis C (if he has not been tested for HIV and Hep C previously or if he has had a new sexual partner). She will also add other labs based on their discussion during his physical and any signs and symptoms he is experiencing. Given his high blood pressure, his family history, and the fact that he is overweight, his primary care provider adds a hemoglobin A1c to check his diabetes risk. She also adds a hormone panel when he mentions that he is having some erectile dysfunction symptoms. If these tests are normal she will prescribe an ED (erectile dysfunction) medication that best fits with his lifestyle. If they are abnormal she may order an MRI of his brain to look at his pituitary gland or she may refer him to an endocrinologist for further workup. He also has a history of aggressive prostate cancer in his family (his uncle died from it at 68). Therefore he and his provider decide to look at his PSA (prostate specific antigen) to monitor the possibility of this type of cancer. Finally, he receives a referral for a colonoscopy. Although no one enjoys the preparation for this procedure, nor the time off work, Anthony understands that colonoscopies save lives by finding cancer at more easily treatable stages.
So what does Anthony get out of seeing a primary care provider? Why can’t he just keep seeing his cardiologist as his main doctor? Because when Anthony has a primary care provider, he has someone to coordinate his care across specialists. He has someone he can trust who can help him prevent and if necessary treat illness across multiple body systems. Because while heart disease is the leading cause of death in the US, and is the cause of 1 in 4 deaths, it is not the only killer. Primary care is essential for the health of your entire body and mind.
I’ve heard many people say that since they are healthy they don’t need a primary care provider. They are wrong. Primary care is not just for people with chronic health conditions, although everyone with a chronic concern like high blood pressure or asthma should definitely have a primary care provider. Let’s look at a fictional typical young and healthy patient and see how they are cared for with and without primary care.
Jessica is 28 years old. She is in good health overall and moved to Washington, DC two years ago for a job. Since arriving she has gone to an Urgent Care twice for a UTI (urinary tract infection) and once for a sinus infection. She knows she is allergic to penicillin but can’t recall the names of the antibiotics she has taken for these infections. She has also seen a dermatologist for a skin issue twice. She has not been to a gynecologist since she moved here. She does not have a primary care provider. She relies on Google and Yelp reviews to find healthcare and so far this approach is working for her as far as she is concerned. Her copays are 75$ for each Urgent Care visit and $40 for the dermatologist or other specialists.
Let’s imagine Jessica begins to see a primary care provider (PCP). She schedules a physical every one to two years with a copay of $0 (it’s fully covered by insurance). These visits focus on preventative health and in addition to the physical exam, screening lab tests, and review of vaccination status her provider collects a family history, list of allergies and medications, and social history that includes her lifestyle. Jessica discusses her recent fatigue and the dietary changes she is making as she trains for a team triathlon. Her PCP orders a B12 test and the results show a low level of B12 and with supplementation she notices a significant improvement. She tells her provider about her healthcare visits from the past two years and signs a release to have her records transferred to her primary care office. Now all of her records are in one place. The PCP recommends a “well woman exam” for Jessica so she also has the recommended Pap smear and STD screening as her PCP takes care of her GYN needs as well. Her primary care provider is looking out for her overall physical and mental health.
Now, when she needs refills of her dermatologic cream, she requests them from her primary care office, saving $40. When she awakens one morning with symptoms of another UTI she calls her PCP and gets a same day appointment where she is prescribed an appropriate antibiotic given her allergy and the medications and culture results of her past infections, paying only $20 instead of $75. Further, she is screened for STDs regularly, protecting her fertility for when is ready to start a family. When she plans a vacation to Asia with her friends she is able to get the vaccines she needs to travel safely, and medications including antibiotics and motion sickness prevention to bring with her just in case.
So again, why does Jessica need primary care if she is a healthy young person? A good primary care provider offers holistic and preventative healthcare for people of all ages and in all states of health. Having a primary care office is the healthiest, most efficient, and cost effective way to take care of your health. At Promenade Primary Care we will take all of your past and current health issues into consideration as well as your lifestyle and health goals to provide you with the best care possible. Since we are a small private practice, we can truly personalize your care and establish close provider/patient relationships. And we will make it easy.