What is a primary care physician for?

izmai

New member
I have health insurance for the first time in years & years. Before I never used it for anything other than Gyno related issues & an occasional urgent care visit for tonsillitis. Now I want to get the most out of my coverage & also better myself however I can. But I just realized I don’t quite understand the purpose of having a Primary Care Doctor. What kinds of things do you go see them for? I’d like to select one & set up an appointment but I’m not sure what my office visit would even be for. I am a single F with no children or preexisting conditions.
 
@izmai Primary Care Physicians are there for general wellness visits like your annual check up/physical, which costs you $0 (unless you mention something else bothering you). They're also the first person you go to when having an issue. As others have mentioned, you first go to your Primary Care Physician to tell them what ails you. If it's just a cold or something relatively simple, they may be able to help you or prescribe a drug that will help. If it is a more specialized issue, they will refer you to a specialist (cardiologist, dermatologist, etc). For HMO's you will need to be referred prior to seeing a specialist.
 
@nathan1973 OP, additionally they may be able to write letters for you, complete health history/travel forms, and they will collect all your records from specialists you see, ER visit summaries, it’s really great!
 
@izmai In theory they are quarterbacks, coordinating care and helping you make decisions. In practice (working with insurance limits) they can be more like gatekeeper. So say you had a skin issue, they may handle it in house or send you to a dermatologist.
 
@izmai As ElectronGuru mentioned, in theory they are quarterbacks, coordinating care and helping you make decisions. Many insurance companies have codified this and have designated PCPs as "gatekeepers" that decide if you need to see a specialist (like a dermatologist or cardiologist).

In my opinion (I am a cardiologist), a good PCP is much more than that. He/she takes care of chronic illnesses like diabetes, high blood pressure and high cholesterol, they make sure you are up to date on all your preventive therapies (smoking cessation, exercise, vaccines, etc.) and they often can take care of some of the more acute issues, including the flu, depression and minor gastrointestinal issues.
 
@izmai Primary care treats over 80% of health issues. Think of them as a handyman. Handymen can fix some flooring issues, electrical, plumbing and appliance issues. But they will not replace a water heater and build a house.

Same way, primary care can treat almost all issues unless the complexity and complications require a specialist to go deep. Research is unequivocal, the more you use primary care, the less you will need the expensive part of healthcare.
 
@izmai I've worked in health care for some time. I'm a psychologist, but not YOUR psychologist, and I've worked for several years in helping people coordinate care in order to address high risk for suicide, recover, and build a life worth living. Here is my 2 cents from my experiencing in both rural and very large health care systems in the US. YMMV.

Primary care is amazing. IF, and this is critical, you have a good doctor and a well managed health care system. If you are fairly healthy and have a minute to be choosy, this is a great time to explore. I moved a year ago and worked quite hard to get a good primary care doctor in a well-managed health care system. I asked around, I read reviews, and I looked for systems that had a great electronic health care record, well integrated with speciality care, good billing, good front desks that answered the phone and made it as frictionless as possible. I picked a younger doctor with a good reputation that practiced in an office with one of the most respected later career primary care doctors in town. I also waited for an appointment because that office (being well run) does not cram doctor's panels full of patients, and leaves time in the schedule for care.

I am just entering the age where I need to start more screenings to detect cancer and heart disease risk early, as well as coordinate gyn care as I age. My primary care doctor is a good communicator and ordered what I know to be the correct kinds of labs and referred me to other offices. ONE office was NOT well run, and not well integrated with my electronic record and I IM'd him back and told him so. He may like the gyn in that office but if you don't have a speciality diagnostic need, you don't need Dr. House. You need a basically good doctor, who is on top of things, in a practice where the staff turnover isn't high, they answer the phone, they get the billing right, etc. He understood and sent me to a great office that was well run with a PA (I find there is more variability in physician's assistants, but the one I got was the best gyn I've seen in 15 years).

All of my info is rolled into my easy to use electronic record. I am middle-aged and have some emerging health issues I can get on top of and check annually, which my primary care doctor will do. And as we have a relationship, it is easier to be understood and seen for common things, as well as prevent urgent care and ED needs.

When I was younger and had the good health of the young, a good primary care doctor would not be as valuable as it is to me now. But at this stage, this can help me PREVENT or very effectively manage the kinds of health needs I'll have as I age. Longer life with better health are great goals.

Primary care doctors were also CRITICAL in helping me make a difference for my patients with high risk of suicide. Because almost always they had several health issues going on that, when much better managed, dramatically improved their mental health. Good sleep, well-managed diabetes, controlled migraines and blood pressure, etc work wonders for making it easier to regulate mood, and cope with stress in life.

A primary care doctor who knows you, listens, keeps on top of your routine care, responds to routine sickness effectively, and helps keep your medical record organized...and who has a practice that answers the phone well, makes it easy to schedule, send Rx, coordinate appts, and bills correctly is amazing. Good luck!
 
@atwhatcost A few people I know have a doctor like that. The two doctors I can think of like that however are past retirement age and keeping down for a few old patients...
 
@izmai If there is nothing wrong with you then just get your annual physical and well women care.

PCPs are only required for old-style HMO plans which have fallen out of favor in the last few decades. Even if your plan promotes the use of a primary care provider, they probably don't really require you to use them as a gatekeeper. Read the coverage docs of your plan to understand these types of requirements.
 
@aleon1220 Your statement that PVPs are only required for old style HMO does not conform to my experience that nearly every plan that I looked at on the marketplace requires a referral before seeing a specialist. I guess you could call the current plans new style HMO plans.

Furthermore even a few years ago when my plan was a little bit more liberal about letting me see a specialist on my own in some areas, the office of the specialist generally required me to get a referral from a PCP
 
@enoob57 The majority of plans on the marketplace are HMO's, and also have significantly stricter rules about referrals than plans through an employer or Medadvantage. At least in my state, that's been my observation.
 
@izmai i like the guy above added 'in theory'. because in theory that is correct.

i'm just calling for mad downvotes here but, in reality imho, they're just a stupid added layer to this extremely inefficient american healthcare system adding to the costs for patients.

go to any country where they actually have a working healthcare system - the PCPs mostly exist in the form of general practioners but they have specialists - lots of them and you go directly to them for your conditions, right there and then. your ears hurt? you go ENT. eurologist for anything related to that area, neurologist, cardiologist so on and so forth.

for general checkups you go 'straight' to a hospital who would do a thorough eval on all your exams and get you readings and recommendations.

i can def see a value of PCP for someone needing close attention and monitoring on a regular basis like elderly or special conditions but having it applied universally in america is just one prime example of how insanely inefficient this country is in many ways.
 
@getlostinthewild Well, In Europe (specifically Italy and belgium), if you want to take advantage of the public health care system, and especially for some kind of special exams, you always have to go to your GP who will assess whether you need those exams or not. You can’t just go straight to the hospital for general check up, you need to actually have that written by your GP. Sure, there are some private doctors where you can go to without passing by GP, such as gynaecologists, dentists, psychologists etc, but they are private, so you have to pay them after every visit, and I doubt you can do that with every specialty you need (I doubt you could go to a private neurologist without first having that written by your GP)
 
@getlostinthewild Seconding the other comment by /@jluponeage. There are a lot of countries that use PCPs in an effective way to re-direct patients from high cost, invasive care and towards alternative options (say PT instead of surgery), and to serve as a general public health resource (say vaccine education).

A good PCP will keep up to date on a broad spectrum of the latest medical research, and be able to explain it in layman's terms to their patients. To pretend that this is unimportant, a waste of medical resources, and the case only in the US is ignorant and incorrect.

The big problem in the US is that we undervalue primary care/public health, so folks interested in a medical career tend to target higher paying specialties.
 
@izmai They are your main point of contact in managing your health. If you feel sick and it can wait until their office is open then they are the person you should see. If you think you need a specialist then they should make the referral for you. If you take medication to manage a chronic condition like an inhaler, blood pressure medication, or antidepressant then they can often see you regularly and prescribe the medicine. If you need a wellness exam, for example for work or for a sport, you would see them.
 

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