Heart of Medicine
Primary Care: The Heart of MedicinePrint This Post
According to my Mother, I wanted to be a doctor since the time I could speak. My role models were docs such as Marcus Welby and Doc Baker. I loved how they helped people when people were most desperate. I loved their compassion, bedside manner, and refusal to give up when folks had fallen ill. There was no such thing as insurance-mandated limitations on care. Doctors and patients decided on health care together. Patients did not have a whole lot of choice of whom their doctor would be, but on the flip side, doctors were able to care for any patient who called upon them.
Where is primary care today? We seem to have veered far from the country doc approach. Or maybe we haven’t veered as far as we think. Just like in the old days, we still have the opportunity to affect lives, help patients create change, and be there for people in their times of need. Family Physicians, Internists and Pediatricians are the front line of care. We are the physicians who see patients first when they are sick, and the physicians who have the opportunity to work with patients to prevent illness.
We take a preventive moment at each and every visit, regardless of how mundane or inconsequential it may seem. “Oh, I just noticed that you have not been here for a physical in a while, let’s schedule that on the way to check out. “ Or perhaps, “Have you had your Tdap in the past ten years, or your flu shot this season?” We should be asking about chest pain, shortness of breath, use of supplements, guns in the home, use of alcohol, seatbelts, weight issues, diet and nutrition habits, a living will. We should approach the subjects of erectile dysfunction, marital strife, underlying anxiety or depression, and desires to change alcohol and tobacco habits. We should be cognizant of the last time the patient has visited our gastrointestinal colleagues for a screening colonoscopy, or of the diabetic patient who does not have a note in the chart about his retinal exam.
My staff does not like it when I “put the brakes on” for a patient who may be depressed, or is grieving, or has a concern about their daughter who is beginning to recognize that boys make her feel special. Unfortunately, that’s what we do as Family Physicians, and it is what primary care and primary prevention is all about.
The landscape of medicine is changing, and it is changing rapidly. We must be creative in our practice so as to not become victims of a political, government bureaucracy that does not value the work we do to protect, enhance and improve the lives of so many. The bureaucracy does not value the increase in quality of life and the extra years that are attained when we promote healthy habits through a focus on smart reactive care and preventive care. But our patients surely do.
No other specialties can do what Family Physicians, Internists and Pediatricians can do. Primary care specialties are the creator of the patient-centered medical home, the home visit, the coordinator of care for the ill. We are there at the birth, and we are there when hospice is called. We are not far from that country doc model. We just have to remember who our patient is. It is still the individual, not the insurance companies nor the government. Like the country docs, I am invested in the health of my patients. I am honored every day that my patients allow me to help them create health in their lives.
Brian K. Nadolne, MD, FAAFP
Published on February 26, 2013
Brian K. Nadolne, MD, FAAFP is a Family Physician in Marietta, Georgia. He is the current President-elect of the Georgia Academy of Family Physicians, Chair of Family Medicine at Northside Hospital, and Medical Director of Nadolne Family Medicine & Preventive Care.