Primary Care Physicians Are of Primary Importance

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I had a young woman come to me as a new patient not too long ago. She found a lump in her breast. But this is not why she came to see me. She already had an appropriate and thorough workup and thankfully her lump was benign. She was waiting to see the breast surgeon to discuss the long-term implications.

During her workup, someone at the Radiology facility had asked, "Who should I send this to?" My patient hesitated. Her previous practice was a large Primary Care group with an excellent reputation, but she could not easily identify a single physician she could say was her primary provider. This is why she came to see me: She wanted a Primary Care doctor who knew her, and who she could turn to when she had questions to help lead her through this process.

There was a NY Times Opinion piece a few years back written by an oncologist that suggested patients skip their annual physical exam. The doctor argued that patients would be doing the health care system a favor by saving money on what he deemed a useless exam, citing a negative Cochrane review and a lack of United States Preventive Services Task Force (USPSTF) endorsement of annual wellness examinations. As a Primary Care physician, I find this argument to be too simplistic. While annual physicals may not decrease mortality, they have huge benefits. There are numerous other screening tests that are endorsed by USPSTF which have unquestionable benefit, such as colorectal cancer screening, blood pressure screening, depression screening, counseling on healthy diet and exercise, and the list goes on.

When are we as Primary Care doctors supposed to get this preventative screening and counseling in if patients are being instructed to only go to the doctor's office for sick visits? What about when your family health changes? For example, your dad had an aneurysm and you now need screening. Or your aunt found out she had BRCA, a high-risk gene mutation for breast and ovarian cancer, and you want information on your own breast cancer risk. A Google search will not suffice; you deserve better. You can't get this from just going into Urgent Care when you cut yourself or have a cold. Please make sure you have someone you trust to guide you when life throws health challenges your way.

Even more importantly, there is an intangible and priceless value of the doctor patient-relationship that develops over time. With each yearly annual exam, we strengthen the relationship foundation. Over time, I found that it is the trust that is built which directly leads to increased uptake on screening, shots, and other preventative care. Before Thanksgiving, I had a family who was previously vaccine hesitant to come in for flu shots. And I somehow miraculously convinced an osteoporotic patient who leans heavily on vitamins and natural cures to attempt a bisphosphonate trial. All it took was a detailed discussion at her physical exam laid over a backdrop of years of care and the knowledge that I had her best interests in mind after also accompanying her mother to her visits with me as well. I had another patient who was seen in the emergency department for a needlestick from someone known to use IV drugs. When the physician assistant told her she didn't need preventative HIV medication, she called me to get my input about this urgent issue. And while I certainly didn't know the answer right away, there was a trust that I would fully look into it and explain to her why or why not medication was needed.

The health benefits of a strong relationship with a competent Primary Care doctor are invaluable. Please follow up regularly with your Primary Care doctor, whom you can trust to do the cognitive work you need to stay healthy and to navigate any unexpected changes in health. For a physician to suggest people forego this important visit is ill-considered and careless when that same physician could simply pick up the phone and call a specialist if he faced any number of health challenges. For the average patient, regular follow up with their trusted physician can be just as much of an "insurance" as their health insurance card.

For most people, knowing someone you trust who is willing to put in the work you need to stay healthy offers much more reassurance than a huge systematic review of literature. This is my holiday wish for all people: that they currently have or find Primary Care doctors they trust to work hard for their health.

Dr. Lauren Kuwik is a medicine/pediatrics physician as well as a 2018–19 Doximity Author.

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