Saturday, September 17, 2011

Why do you need a primary care doctor?

Why not see a specialist for everything?  After all, they're the experts, right?

Wrong.

It's vital for everyone to have a primary care physician.  Your PCP should always be your first point of contact with the medical world.  A good relationship with a good PCP can save you time and money, but most importantly, can save your health.  I'm going to tell you why...

An internist does more than diagnose your strep throat, take care of colds, and do your yearly physical.  Internists are specifically trained to take care of medically complex patients.  The most import skill an internist learns in medical school and residency is to create what is called a "differential diagnosis."  This is a list of all of the possible things that could be causing an illness.  It takes years of experience and practice to be able to develop a comprehensive differential diagnosis, but it's vital that your doctor be skilled in doing this.  Otherwise, important illnesses can be missed.

It's a bad idea to try to "self-diagnose" and then self-refer to a specialist.  Here's an example of a common scenario:

Let's say a patient, we'll call him Joe, starts to have some chest pain when he lifts things.  He doesn't have any problems that he knows of, but his father had heart disease, so he's worried.  His wife is also worried.  They go to see a cardiologist.  He has an ECG done, which is normal.  His cholesterol is also checked, and is normal.  Because he still has chest pain, the cardiologist does a stress test.  It's normal.  The cardiologist says, "Your heart's fine."  And that's it.  The cardiologist is done.  But Joe still has chest pain.

Now, let's say that Joe went to see his internist first.  The doctor gets a history and performs a physical exam.  The physical exam shows that Joe's chest pain is reproduced when certain areas of his chest are pressed.  The internist diagnoses Joe with costochondritis- an inflammation of the cartilage of the ribs.  He's treated with ibuprofen and the pain goes away.

What Joe needed in the first place was someone to look at the "big picture."  And that's what your internist does.  A good internist will be able to treat many, many things right away, but will be able to steer you to the appropriate specialist when necessary.

So, even if your insurance says you don't "need" a primary care physician, it's still important to have one!

1 comment:

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