Go See the Doc: The Battle to Take Back Primary Care
Kayla Flewelling and Utibe Effiong
August 13, 2020, Chronic Disease, Health Care, Health Care Access, Health Communication, Men's Health, Women's Health
Most of the diseases that kill us are incredibly sneaky, undetectably wearing our bodies down over many years. Heart disease, diabetes, stroke—diseases that in many patients cause symptoms years after they’ve been causing damage to the body.
The culture of health medicine in the United States has changed significantly in the last hundred years.
Your primary care provider (PCP)—when thoughtful, thorough, and paired with a patient willing to communicate—is in a unique position to catch these problems early and in doing so alter the courses of patients’ lives. The PCP’s role therefore cannot be understated.
The culture of health medicine in the United States has changed significantly in the last hundred years. Perceptions of primary care among physicians themselves have transitioned for the worse, now often being considered a last resort in terms of career choice. This has resulted in a huge shortage of primary care physicians and, more importantly, has translated to a devaluation of the medical doctoral degree and consequent increase in the number of non-physician practitioners. Some argue these providers deserve autonomy at the level of a physician, and while this may stand true in very specific cases, the representation that these providers are equally as knowledgeable as their physician counterparts, frankly, is incorrect.
People can no longer respond easily when asked the name of their PCP. Many do not know what a PCP is. This is probably due partially to the fact that Americans tend to be rather impatient where their health is concerned. We want what we want, right when we want it. Average people do not want the inconvenience of missing an afternoon of work to go to a doctor’s appointment. They do not want the nuisance of waiting around because the doctor is running a half-hour behind. They have places to be and things to be doing and may unabashedly tell you that those things are more important than this appointment. After all, why would the average person endure these annoyances if he believes himself to be completely healthy?
It is difficult to convince someone who looks and feels healthy that they should be subjected to the inconveniences of regularly scheduled appointments.
Within that question lies the root cause for patient disinterest in maintaining a relationship with PCPs. It is difficult to convince someone who looks and feels healthy that they should be subjected to the inconveniences of regularly scheduled appointments. However, the belief that subjectively feeling healthy equates to truly good health is a major (and potentially deadly) logical fallacy.
Any medical student worth their salt can rattle off the leading causes of death in the US. Heart disease, diabetes, and stroke were noted above. To them, we can add cancer and Alzheimer’s disease—all from the national top ten list—as conditions that do not always have presenting symptoms in patients who are already quite far along in the disease’s progression.
The commonality among these diseases, then, is their insidious nature. Patients cannot feel their high blood pressure, high cholesterol, or diabetes, and unfortunately, these diseases often do not present any downstream effects until they have already taken a major toll. A diabetic patient may not present until he has decided that pesky, painless foot ulcer has ruined too many of his socks while being devastatingly unaware that he may now lose a leg. The patient with high cholesterol likely couldn’t feel his arteries clogging before arriving at the emergency department amid a heart attack, and the patient with high blood pressure probably couldn’t feel the fluid roaring through her vasculature before half her body suddenly stopped working.
In a time when primary care is evolving providers must approach patients in earnest about the importance of regular care.
In a time when primary care is evolving—seemingly not in the favor of physicians—providers must approach patients in earnest about the importance of regular care. The doctor has to produce the extra effort to explain the pathophysiology of disease to interested patients, or to describe why a particular medication would better alleviate pain. The deep knowledge of these intricacies, the body’s best-kept secrets, is what sets medical doctors apart from other care providers. To keep this knowledge to ourselves is a disservice to our patients and the field of medicine, and arguably a sign of laziness on the physician’s behalf.
The ability to express such concepts in terms the patient will understand, thereby combining the culmination of medical school and residency with the basic humanism that drove doctors to pursue medicine, is what physicians need to strive for to demonstrate their worth to patients. Some may be offended or off-put by the insinuation that doctors should be required to prove their worth, but the unfortunate reality is that primary-care physicians are stuck in this very position. A mentor once said he chose internal medicine (and primary care) because it was the hardest specialty, and the more I consider this the more I am certain it is true. The difficulty lies in convincing patients and administrators of the same.
Fatigue is a good enough reason to see a doctor. Heartburn is a good enough reason to see a doctor.
Undoubtedly there are many more unspoken barriers to reestablishing the value of primary care, but it must begin within the field of medicine itself by changing the words spoken to medical students, colleagues, and patients. Primary-care physicians should encourage patients to see them even for the complaints that seem trivial. Fatigue is a good enough reason to see a doctor. Heartburn is a good enough reason to see a doctor. Patients need to know that their medical concerns are deserving of a doctor’s attention. If the PCP gives the impression that an appointment was a waste of time, then that is what it will become to the patient.
By empathically demonstrating the breadth of their knowledge in a patient-centered manner and consistently praising the role of the primary care physician, doctors can begin the journey to take back the field of primary care.
About the Authors
Kayla Flewelling holds a degree in research psychology from the University of Michigan-Flint (BS ’16) and is a fourth-year medical student at Central Michigan University. Her interests include surgery and improving medical education.
Utibe Effiong, MD, MPH is an internal medicine physician, public health scientist, and clinical assistant professor of medicine at Central Michigan University. He is also a Senior Fellow at the Aspen Institute.
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