Medical specialists are needed for everything from delivering babies to treating cancers, but it’s the primary care doctors who are the quarterbacks of your health care. They catch the problems, coordinate the referrals and take into account lifestyle and medical history for a big-picture view of your health.
Having a primary care doctor and a patient-centered medical home is the standard of care, said Dr. Hugh Durrence, a primary care physician with Liberty Doctors on James Island.
“It’s a good idea for patients to establish a long-term relationship with a primary care doctor,” he added. “That doctor understands the patient’s entire medical needs and can be their advocate as they navigate our health system today.”
Dr. Durrence said primary care doctors can take care of patients from cradle to grave, coordinating with specialists, making referrals and guiding them through the emotional process of an illness.
“As health care gets more and more fragmented, you need an advocate for yourself and your family,” he commented.
Dr. Alec DeCastro, a family and sports medicine physician at the Medical University of South Carolina, pointed out that the doctor-patient relationship is about more than which medications you take or which disease you have. Primary care physicians get to know their patients, including their family, medical history, what they do for a living and their hobbies.
“Having that personal relationship with someone you trust is one of the most important things you can do,” Dr. DeCastro said.
He recommends seeing your primary care physician once a year. Even people who are healthy and don’t think they need to visit the doctor should get checked out. Your doctor can review your overall health, look at any possible risk factors and discuss recommended screenings, such as a mammogram or a colonoscopy.
A Push for Proactive Care
Dr. Kay Durst, a third-generation family physician with Durst Family Medicine on Sullivan’s Island, is a staunch advocate for primary care. It’s important, she said, to have someone who knows your family medical history and can look at your health with a big-picture view while reminding you about important routine and preventive care.
For example, Dr. Durst said she sees many young adults who aren’t up-to-date on their vaccines. Making sure patients get a tetanus shot every 10 years or knowing what travel-related vaccines they might need is the role of a family physician.
“It’s very frustrating how many patients have kids who never go see a pediatrician or family doctor. They think they’re kid is healthy, and, if they get sick, they run to urgent care. But you should try to be proactive and not reactive,” Dr. Durst commented.
Even people who are healthy should establish a medical home with a primary care doctor. Then, if something does happen, you’re not scrambling to find a doctor, Dr. Durst said.
In today’s complex health care system, focusing on preventive care and having that medical home can translate not only to better health but to a significant cost savings as well.
While 55 percent of all medical office visits are for primary care, only 4 to 7 percent of health care dollars are spent on primary care, according to “The Patient-Centered Medical Home's Impact on Cost and Quality,” published in 2016 by the Patient-Centered Primary Care Collaborative.
“For most Americans, primary care serves as the entry point and touchstone of the health care system, delivering and coordinating care for patients and families, with an emphasis on promoting population health and managing chronic illness. As such, primary care is well-positioned to help repair and optimize our broken care delivery system,” the report pointed out.
Better Health Through Technology
To encourage more people to visit a primary care doctor, physicians locally and around the country are taking advantage of technology, offering extended hours and using telemedicine to make visiting the doctor easier.
Dr. DeCastro said he uses MUSC’s patient portal, where patients can send secure electronic messages to him or to his nurse. He can respond in real time and has access to the patient’s file whether he’s in the office or on the beach in Florida, he said. The exchange is also recorded in the patient’s medical record for future reference.
The telehealth system at MUSC also allows doctors and patients to communicate by video chat in real time. It’s a creative way to free up appointments, and most people don’t really want to come into the office unless they absolutely have to, Dr. DeCastro said.
Dr. Durst offers her patients a secure online portal for sending emails, and her practice is open until 8 p.m. and on Saturdays to make appointments more convenient for patients.
But Dr. Durst cautioned patients against thinking they can simply text their doctor for a diagnosis or a prescription. Doctors have to be keenly aware of the privacy regulations of the Health Insurance Portability and Accountability Act, known as HIPAA. And there’s a greater chance for misdiagnosis, Dr. Durst pointed out.
What a patient thinks is a sinus infection may actually be allergies, pneumonia or even the flu, which all get different treatments, Dr. Durst said.
“Patients don’t always understand our point of view,” she commented. “They think, ‘Why can’t I just text my doctor a picture of that mole?’ Legally, we can’t do that. And it’s to protect the patient from misdiagnosis and so they have good overall care.”
Finding the Right Fit
Looking at how family doctors are using technology, their adherence to privacy policies and their overall health care philosophy are important when choosing that medical home.
Dr. Durrence said figuring out if you click with the doctor is key to that selection process. He will schedule a meet and greet with prospective new patients to see if there’s the potential for a long-term doctor-patient relationship.
“I discuss our philosophy and if it fits with their lifestyle and they are comfortable with it,” he said. “We want to keep you well and walking. We want to prevent disease, not treat it. I hope our relationship is such that we can grow old together.”