When you become a doctor, you get used to answering all sorts of questions from friends and family. Sometimes it’s a new bunion that’s appeared or a rash that won’t go away, but recently a friend asked me whether or not they really needed a family doctor. When I was growing up, having a family doctor was a no-brainer and your family had often been going to the same one for decades. But now, with so many specialists to choose from even within the primary-care fields, it can be tempting to think that having a primary-care doctor isn’t so necessary after all. I’d like to spend some time this week discussing why you need a primary provider and what sort of care you should look for.
Do I really need a family doctor?
Let’s break down this question. First, primary care has become a diverse field with both nurses and doctors certified to provide many of the roles your traditional family doctor used to provide. I’ll go through this more in depth later, but who you get your treatment from matters less than trusting where you get it. Second, you need a primary care provider. As a specialist, I’ve seen both referred patients and those who come on their own. I treat both equally, but it’s harder to provide the best care to those who come without a referral. Here’s why:
- I might not be the right specialist. Some people I see think their issue is related to their heart, but it turns out another specialist would have been more appropriate. Figuring out which person to go to is based on the most likely diagnoses, which takes training and experience to determine. That doesn’t mean I can’t help, but I might not be able to give you the help you most need.
- You don’t know your health conditions like a doctor would. That means it takes me longer to figure out what’s going on than it would if I had some background from a referring medical provider. I know that you’re an expert on your body, but I also know that it can be hard to remember what tests you’ve had and what other diagnoses might have been made in the past.
- I don’t know you well. You might feel like you’ve known me for years from watching the show, but each new patient in my office is a crash course in decades of health issues. It can be hard to figure out which conditions are new and relevant among the many you might have. I might think a mark on your body has always been there when it’s really only appeared recently, for example. You need someone who has watched the movie of your life rather than just seeing a snapshot. Long-term relationships allow providers to pick up on small details that might otherwise go unnoticed and nip them in the bud.
- I don’t have anyone to coordinate your follow-up care. It can be overwhelming to have multiple appointments with several specialists who order different tests and have different things to say. Even if you do have the records, it can be tough for you to cut through all the medical jargon to figure out who said what and why. Your primary-care provider gathers all of this information, makes sense of it, and coordinates the next steps for you. They simplify the process for you and for all of your specialists.
Who can care for me?
Primary-care providers are often specialists in family medicine, internal medicine, pediatrics, or obstetrics/gynecology. Each field has a slightly different bent and you should choose based on what seems most relevant to your situation.
- Family medicine: These docs get a broad training working with all ages and they’re also generally trained to be able to do some obstetrics (childbirth), gynecology (women’s health), and minor surgical procedures. These physicians are a one-stop shop for everyone in the family, young and old.
- Internal medicine: These docs train mostly in the hospital with adult patients, but have also trained in the clinic and are certified to provide care in both settings.
- Pediatrics: These docs have trained specifically to work with children up to 18 years old, both in and out of the hospital.
- Ob/gyn: These docs are trained primarily in women’s health, but can also address some of the usual, everyday health conditions.
Beyond these doctors, many nurses have also entered the field and may be the first people you work with in some practices. While some people had initial reservations about these new members of the workforce, many studies have shown that getting care from a nurse practitioner or physician’s assistant is just as good as getting care from a doctor. On top of that, they can help with many of the mundane tasks the doctor would otherwise have to do so that time with the doctor is more about you and less about paperwork.
Where can I get care?
Your only options used to be doctor’s offices, but private urgent care centers and even some big box retailers now offer opportunities to see a doctor or nurse. In a recent review of the different options for primary care, the American College of Physicians (which represents internal medicine physicians) recommended using these new options as a backup in urgent situations instead of as a primary care option. While going to your nearest Wal-Mart might be convenient, you’re likely to see a different person every time you go who may or may not know anything about you. On top of that, they may be much more restricted in the services they can provide depending on where they practice.
The main problem here as I mentioned above is that this provider has a snapshot of your health. They don’t know you well enough to help you make anything more than simple medical decisions. You have to ask yourself whether you’d feel comfortable sharing the details of your sex life or your deepest darkest thoughts with someone who’s never met you before. Sometimes this information is needed, but you might not give it without an established relationship. These clinics are great backup options, especially after hours when other clinics are closed, but they can’t replace the trust-based relationship you have with a regular primary care provider.
When should I go?
While most people might think the answer here is once a year, it’s actually more nuanced than that. There’s been a lot of debate in the primary care community about how often to go to the doctor if you’re healthy and the decision is one you and your provider should make together. Those with chronic conditions often need to go several times a year, while those who are healthy may not need such regular contact. What’s clear is that you need to see a doctor often enough to feel as though you have a trusting and up-to-date relationship with that person.