Saturday, January 22, 2011

Fractured Medical Care



Medical care has become very fractured, as of late.  Patients are not seeing their primary care physicians for treatment of their ailments like they used to.  They are circumventing their primary care physician and going straight to the specialists for care that in some cases the primary care physician is quite capable of handling and at a lower cost to the patient. 
But cost is not the only issue to think about.  Patients need to remember that for them to have an effective patient/physician relationship, these sorts of relationships are not formed overnight.  It takes time to form a comfortable relationship with a primary care physician.  It takes time for the physician to come to know who you are, what you are about, what your preferences are for medical care, what your family is about, or what sort of family genes you could be dealing with which would necessitate a closer follow-up, or preventive care measures.  He/she doesn’t learn this in just one clinic visit, it is typically done over several years. 
And it is this comfort level that lends itself to a patient and their primary care physician feeling at ease and being willing to discuss some hard issues when the time arises, such as end of life decisions, referral for surgery or no surgery, aggressive treatment or comfort care, giving emotional support and encouragement to see a counselor over grief from a miscarriage or loss of a spouse, for instance.  When a patient and a primary care physician have a long standing professional relationship it can lead to less misunderstanding of what they physician is saying, or not saying and an intuitive knowledge that the physician is really on the patient’s side and trying to help.
And if patients would allow their primary care physicians to refer them out to the specialists when needed, this will also facilitate better follow-up care for the patient after they have seen the specialist.  This is due to the primary care physician receiving a follow-up letter from the specialist outlining what needs to be done and by whom. 
Patients need to have an understanding of this when they make their medical appointments with other providers. 
If patients would make their medical appointments and allow their primary care physicians to be involved in their care, over time they are going to find that they are happier with their medical care, as are their physicians.  Primary care physicians truly want to be the person of first contact, the one who provides medical care for acute and chronic medical conditions for their patients.  Patients can help to facilitate this partnership they have with their primary care physician by allowing their primary care to refer them out to specialists when necessary and then they can coordinate this care over the long-term.   
Yes, I realize there are circumstances where patients are unable to make appointments with their primary care physicians for an acute problem.  I also realize that there are women who would prefer having an OB/Gyn see them for their obstetrical and/or gynecology care.  Those are real concerns and real reasons for not seeing the primary care physician.
But what of your chronic condition of high blood pressure, or abnormal blood lipids, or your urinary tract infection, or your needing to lose weight, or your follow-up for diabetes?  Is there a reason to see someone else than your primary care physician for these visits?  Your primary care physician, to be most effective, and most able to help you in your medical care, needs to be involved in your care, needs to be the one that sees you, if at all possible. 
You, as a patient can most help yourself by seeing your primary care physician for almost all of your medical needs, if not all.  Don’t fracture off your care and see an orthopedic surgeon for an ankle sprain, a retail clinic provider for a upper respiratory infection, or a urinary tract infection, an allergist for your seasonal allergies, and a dermatologist for your skin rash.
You, as a patient are not only fracturing your medical care by seeing different providers but you are also taking a risk that these providers could give you different medications which you could have a drug reaction to, or suffer a side effect from.  Your primary care physician will know which medications you are allergic to, which medications you are on and will know which medications to avoid with you. 
Your primary care physician will also know if you come into the clinic with a urinary tract infection (for instance) that it is related to the urinary tract stone you had six months ago and he/she can re-order an urinalysis to assess for fluid status, and urinary calcium.  Fracturing your medical care by seeing different providers would not lend itself to having this work-up done, for instance.
Help yourself, by helping your primary care physician help you.  Facilitate this all so important relationship with your primary care physician, you’ll be glad you did.    



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