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.