Primary Care Today

A family from the kids on up to grandma and grandpa. Primary care for all ages.

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There are many ways of labeling that trusted physician we all see with just about every little ache or pain we can’t vanquish with time or over-the-counter nostrums – primary doctor; primary care doctor; family doctor.

And there are nearly as many sports analogies to describe this multitalented first responder to the ailments and disorders that afflict our bodies and minds.

Some primary doctors (we’ll stick with that term for simplicity) consider themselves to be the quarterback of their patient’s medical team. Others believe they play both offense and defense – promoting both preventive medicine to stave off disease and treating illnesses when they arise.

Yet another segment likens the primary physician to a coach, focusing on the health overview and recommending the best options to each patient to score big in the game of good health.

Dr. Hugh Durrence, whose practice is located on James Island, likes the quarterback model, emphasizing the primary doctor’s critical role in “coordinating not only the care of the individual patient but also the care of the specialists that the patient may need.”

In primary medicine, Dr. Durrence believes, “The doctor-patient relationship is the most important aspect of taking care of the patient. Our mission is to take care of our patients from the cradle to the grave.”

Match With These Providers

His colleague in the Liberty Doctors group, Dr. Donald Hurley, who practices in West Ashley, leans toward the coach role: “The primary doctor picks the players and the plays. He puts into action the best options for each patient’s success.”

In Dr. Hurley’s view, “We succeed by keeping our patients out of the hospital and out of the emergency room. We answer our phones at night. We even make house calls. And we use home health care aggressively.”

Putting aside a subtle difference in comparisons between primary doctors and sports role models, most primary physicians would agree with Drs. Durrence and Hurley that they are both required to master a wide range of medical knowledge and are rarely given as much credit – or compensation – as those doctors who narrowly focus on a specific specialty.

“We are the Rodney Dangerfields of medicine,” Dr. Hurley said. “We get no respect.”

“We recognize the importance of medical specialists,” Dr. Durrence concurred. “However, for continuity of care, I don’t believe there is anyone better than a good primary doctor.”

Both of these highly-regarded tri-county area primary physicians bring to their day-to-day practices significant additional medical wisdom. Dr. Durrence also has a degree in pharmacy and is on the Medical University of South Carolina faculty for that discipline. As a result, he is uniquely qualified to assess the appropriate medications for each patient’s condition, to understand the therapeutics of these medications and to flag any potential drug interactions. In a time of increasing criticism of “Big Pharma,” he understands the importance of the intensive and extensive research-and-development necessary to bring important new medications to market and the host of FDA regulations that impact their approval for use.

From his perspective, the major roadblock to getting the proper tests and medications for his patients is not the pharmaceutical companies themselves or the insurance companies that pick up the tab for pricey new medicines. It is the presence of a middleman – pharmacy benefit managers.

“By doing away with them,” he said, “we could save a lot of money and put that into the development of new and better medicines for all of our patients. Big Pharma is not always the ‘evil empire.’”

As a former commander in the U.S. Navy, Dr. Hurley brings to his practice a wealth of medical experience in the military. A doctor of Osteopathy who currently teaches at four university systems in South Carolina, he has served as a federal prison doctor, on the faculty of Walter Reed Hospital in Bethesda, Maryland, as primary doctor for the White House during the 2014 G8 meetings in Savannah and is also a certified medical investigator trained to examine crime scenes, collect evidence and conduct interviews.

According to Dr. Hurley, the military trains its doctors in multiple areas of medicine, thereby giving its primary doctors wide-ranging expertise.

“The military uses ‘family medicine’ much more efficiently than does the civilian sector. It truly recognizes the value of ‘family practice’ and uses those doctors interchangeably with many medical specialists,” he explained.

Although their academic backgrounds and experience differ, both of these primary doctors agree on virtually all of the salient aspects of serving as the trusted physicians patients turn to first.

“Primary doctors have to advise patients on many things,” Dr. Durrence said. “That’s why we have to develop a relationship with both the patient and his or her family, because there are a lot of social and economic issues that are very important and can affect their care. Medicine is not an assembly line or pulling up to a fast food window and ‘having it your way.’”

Dr. Durrence added, “Inside the examination room, it is the one-on-one relationship I have with each patient that will move the needle in the best interests of the patient, the community and anyone who reacts with that patient.”

Dr. Hurley observed, “First and foremost, patients need doctors who will talk to them and understand what their lives are about. Primary doctors are the best equipped and most versatile at this. That’s why emergency rooms and urgent care facilities are eager to employ primary doctors. They have experience in treating a wide range of problems within a broad cross section of patients – men and women, children and adults.”

In Dr. Durrence’s experience, preventive medicine is equally as important as the treatment of diseases and conditions. Plus, “We have to look at a patient’s care longitudinally for the rest of their life. Some patients may need to be seen only once a year. Others with chronic conditions may have to be seen twice a year or every quarter to keep their condition under control. And those conditions have to continue to be monitored over time.”

Dr. Hurley’s osteopathic training recognizes the human body not as a system of parts but as a totality.

“Much as I dislike the term ‘holistic,’ the reality is that I do have an integrative holistic approach to medicine, and these days everything seems to point in that direction,” Dr. Hurley said.

As for the medical landscape in the tri-county area, Dr. Hurley’s opinion is, “For the size of the community, Charleston has some of the best hospitals and specialists in the country. You cannot survive in Charleston as a bad physician.”

And, as to the most significant issue involving primary physicians both here in Charleston and across America, Dr. Durrence has the last and definitive word: “There just aren’t enough of us.”

By Bill Farley
INFOGRAPHIC: Primary Care by the Numbers

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