2021 Namey/Burnett Preventive Medicine Writing Award Submission
By Athena Chatzigiannidis, DO; Kendall Harris, DO; and Dustin Beck, DO

When I chose to pursue a career in the field of osteopathic family medicine, I would have never imagined that my first year as a practicing physician in residency would be during a global pandemic. What has been more surprising is the number of new patients I have seen in my clinic who tell me they have never had a “regular doctor” before and receive most of their care from our urgent care and emergency department.

As a young physician, this started me thinking about the number of medical school classmates who shared similar stories about not having a primary care physician (PCP) of their own since high school. Therefore, I would like to expound on the importance of establishing with a PCP, what a PCP can do for you, and why this is especially important amidst the COVID-19 pandemic.

What Is a PCP?

A primary care physician is a healthcare professional who serves as the centralized source for your healthcare needs and specializes in practicing some degree of general medicine. Most primary care providers are physicians, but some nurse practitioners, general practitioners and physician assistants can also serve as a PCP often under the supervision of a physician.

As adults, most patients will see a family medicine or internal medicine physician for their primary care needs, but pediatricians can also fulfill this role for infants, children and teens. When we look at the types of physicians who specialize in primary care medicine, there are doctors of osteopathic medicine (DOs) and doctors who practice allopathic medicine (MDs).

In the book The Difference a D.O. Makes, author Bob Jones describes the difference by stating, “Osteopathic medicine is something extra, not something else,” which becomes especially true in the field of primary care given the complexity of patients which require a holistic treatment approach and the commonality of musculoskeletal complaints (Jones, 2001).

Both types of physicians become fully licensed and certified in their chosen field after completing a residency program usually in family medicine or internal medicine. In addition to four years of medical school and three years of residency, which both DOs and MDs complete, osteopathic physicians also complete 200–300 additional hours of osteopathic-specific instruction focused on the musculoskeletal system and a holistic approach to medicine (Wu, P. Siu, J., 2015).

Table 1-1. Steps to Family Medicine Board Certification in the United States DO vs. MD

The Importance of Establishing with a PCP

While the discussion of the field of primary care as a field of generalized medicine may seem vague, this is in reference to a provider who specializes in diagnosing, treating and screening for a wide variety of medical conditions. This is especially important because your PCP serves as the individual who is best in tune with the specifics of your overall health, wellness and medical history.

Even those in excellent health may require immunizations or health screenings to ensure conditions are caught early enough to effectively treat. While visiting an urgent care or emergency department can be helpful in times of an acute medical crisis, establishing a PCP can help prevent the crisis in the first place.

Regular annual checkups and follow-up appointments allow your doctor to fine-tune your medical care throughout the year, so that a concern or change can often be tackled before it becomes emergent. An often-overlooked component of primary care medicine is that your PCP is a physician who can get to know you well and personalize your care and treatment to your needs.

Making appropriate lifestyle modifications can be enough to save a patient’s life, and PCPs have the experience of hundreds of similar conversations with patients to coach and advise anyone ready to take control of their health. Additionally, most preventative care appointments are often completely covered by most health insurance plans, which can save you thousands of dollars in urgent care, emergency department and hospital bills in the long run. (Mayo Clinic Health System, 2015).

What a PCP Can Do for You

You may think to yourself that while a PCP may be beneficial for others, you may not personally need one. This is a common misconception, as primary care doctors manage all sorts of healthcare needs including the following:

  • Regular physical exams: These are often performed annually to ensure there has not been a change in your overall health status since your last visit. These are usually covered by insurance and include necessary lab work and a conversation with your doctor about your healthcare goals and challenges.
  • Prescribing medications: This can be for chronic health conditions, medical maintenance and acute illnesses. Some patients may benefit from talking to their doctor about over the counter medications and supplements they are using and collaborating on if there are more appropriate or cost-effective treatments your doctor may be able to provide.
  • Treating minor illnesses and injuries: This includes musculoskeletal complaints, viral and bacterial illnesses, and new onset medical concerns. Not all injuries or illnesses require evaluation in an emergency room or urgent care, and many primary care doctors reserve same-day appointments for these types of concerns. Visiting with your PCP means that you will be treated by someone who knows your health history and may be able to rely on what has worked well for you in the past.
  • Managing chronic conditions: These include diagnoses such as high blood pressure, diabetes, asthma and even seasonal allergies—to name a few. Managing these conditions is imperative to overall health even if the problems do not bother the patient on a daily basis. For example, strict control of blood pressure and blood sugars can help protect a patient’s kidneys and prevent serious issues including stroke and loss of vision. Additionally, common conditions such as seasonal allergies can benefit from the expert opinion of your PCP who may recommend nasal sprays, inhalers or other adjunct treatment on top of an over-the-counter daily allergy pill.
  • Screening for common health problems: This is usually done by ordering tests, such as regular lab work and screening exams including colonoscopies, mammograms and well-woman exams. Some PCPs seek out additional training in these screening tests and can even provide these services to you in their own office. They can also serve as an excellent resource to get you in contact with a general surgeon or gynecologist should you prefer to see one of these specialists for your screening exam. Many health conditions assessed by these screening exams are asymptomatic until it is too late, so it is essential to work with your PCP to establish a regular screening schedule before symptoms arise.
  • End-of-Life Discussion and Planning: At all stages of life, it is important to consider your wishes in the event that you are unable to make medical decisions for yourself. The ideal scenario is to have this discussion with a PCP that you know and trust while you are still in good health. This can include decisions regarding power of attorney, do not resuscitate/do not intubate orders and wishes about end-of-life care and placement. During a pandemic, a patient may require immediate medical decision making with acute change in health status making this especially relevant to the health climate of 2021 (Averbeck, 2019).

Choosing a PCP

Since a PCP is your first-line resource for non-emergent healthcare needs and somebody you will build a long-lasting relationship with, selecting the right PCP for you is an important decision. Some considerations you may want to focus on include the location of the provider and ease of access to their care, how easy it is to reach and communicate with your physician and their staff, recommendations from friends and family, and if the provider invites and allows you to be involved in your care.

When deciding between a family medicine physician and an internal medicine physician, age and comorbidities may play a factor. While both specialists can provide generalized care for their patients, internal medicine physicians are trained specifically to treat adults and receive more training in hospital medicine, as opposed to family medicine physicians who most often practice in an outpatient setting.

Those with significant comorbidities requiring frequent hospitalization may prefer to establish with an internalist who is more likely to provide their care in both an inpatient and outpatient setting. Most patients, however, will benefit from establishing with a family medicine physician who can care for the patient’s own health needs and serve as a medical hub for their family members as well, including children and elderly members of the household. (Vorvick, 2020).

Once you make the decision on whether to establish with a family medicine physician or internal medicine physician, you should consider if you would prefer to be seen and treated by a DO or an MD. As mentioned previously, these two branches of medicine are identical in their training and practice with a few exceptions.

Finding a DO may prove to be more difficult in northern states—such as North Dakota, South Dakota, Montana and Nebraska—as each of these states are home to less than 400 osteopathic physicians. In their Osteopathic Medical Profession Report from 2019, the American Osteopathic Association (AOA) breaks this data down further, but while finding a DO to establish care within these states may be a bit more difficult, it can certainly pay off.

Figure 1: Created for the purpose of this article with data from the AOA OMP 2019 Report

Osteopathic physicians are trained in osteopathic manipulative therapy and osteopathic principles and practices, which allows them to treat patients in both a traditional sense and with a more holistic hands-on approach. According to the AOA, “DOs strive to help you be truly healthy in mind, body, and spirit—not just free of symptoms” (AOA, 2020). This means that as a DO, my colleagues and I may offer alternative treatments to our patients’ healthcare concerns. For example, a patient with COPD, an obstructive lung disease, may see an MD PCP and be prescribed medications and inhalers which will help treat some of their symptoms and disease; they may also be instructed to incorporate some lifestyle modifications into their daily activities to help slow the progression of the disease or improve their overall health. If that same patient sees a DO for care, they will likely receive the same medications and lifestyle modification recommendations but may also be offered treatment with an osteopathic technique, such as rib raising which is a hands-on approach that can help improve a patient’s work of breathing (Chin et al., 2019).

While there are many choices for selecting the right PCP for you, the only wrong choice is choosing not to establish care at all. Those without a primary care physician should do their research on providers in their area and set up an appointment with the doctor that they believe will provide them with the best opportunity to meet their own healthcare goals—whether that is treating illness or simply preventing it!

The Importance Amid a Pandemic

In the midst of the COVID-19 pandemic, urgent care centers and emergency rooms have not only become overwhelmed with the influx of patients causing potentially long wait times, but are also another potential location for virus exposure. By establishing with a primary care provider, if you have not already done so, you provide yourself with several immediate benefits. You can call and schedule appointments for regular concerns with a physician who knows your health history and can request same-day appointments for new onset illness or injury. You avoid the long lines and lengthy triage of an urgent care or emergency room and can show up to your appointment at your pre-scheduled time ready to be seen. You have immediate access to immunizations including the flu vaccination and pneumonia vaccinations for certain age groups; these are essential this year as contracting COVID-19, as well as flu or pneumonia, at the same time could be devastating.

Most PCP offices have a nurse line or will put you in contact with your physician’s nurses if you have a question or concern; this is unique to clinics and is not a standard practice in all urgent cares and emergency rooms. The ability to speak with your physician’s nurse about your concerns can help you make decisions about your health, inform you if your concern is emergent or can be managed on an outpatient basis, and provide you with recommendations for managing your symptoms and concerns at home.

Finally, an establish care visit with a new doctor allows you to establish a baseline for your health which can be an important tool for comparison if you do become ill in the future. This can help shape the way your own physician and emergency physicians treat and triage you if you do become ill with COVID-19 or another condition. Establishing with a PCP and maintaining regular follow up appointments will always be an important component of taking control of your health, but this year—more than ever—it is imperative for patients to find their health home.

References

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