How to choose a primary care physician

Debra L. Glasser, M.D.

PHOTO BY GLORIA TOWNE

A jolt of health

Your view, the doctor’s and how to advocate for yourself

One of the most important ways to advocate for yourself in healthcare is to have a primary care physician (PCP). The corporate healthcare system has changed this acronym to primary care “provider,” now bundling physicians (M.D. and D.O.s), nurse practitioners (N.P.s) and physician assistants (P.A.s) under one term. Each can serve as your primary care professional, though they have vastly different training. All are professionals.

Provider is a corporate term for “income producing employee.” This term is non-specific and leads to confusion, not clarity.

Your PCP is the only one who looks at the whole of you. He is a gatekeeper to evaluations and specialists. Specialists see you from the narrow perspective of their field, which is appropriate when the referral is appropriate. Your PCP is where you should start with nearly any healthcare concern, from headaches to plantar warts, hypertension to diabetes, most of which she can treat.

The importance of primary care is a topic close to my heart. I attended a new medical school established by the State of Massachusetts in the late 1970s to train primary care physicians. It was the only one of four medical schools in the state with such focus as Boston's other three established schools were highly regarded for training specialists. Think Harvard. All my fellow students were required to do primary care rotations in the 2^nd year of the four it takes to get an M.D. after a college degree, with hopes that many of us would choose primary care. It turns out that over half of my class did. The general practice doctor I was assigned to work with for my primary care rotation treated people experiencing poverty in downtown Springfield; this influenced my decision to become a primary care physician.

I was grateful it was a time when one had the opportunity to train to become a primary care internist (internal medicine physicians are called internists and treat adolescents and adults only) because there were residency training programs with this focus. Family practice was a brand-new specialty then, which included general adult medicine plus pediatrics and obstetrics. I learned in medical school that caring for children and women in the process of delivering them were not where I was most drawn.  

Currently, it is a rare internist who chooses primary care. Internists become hospitalists and specialists. Most primary care by is exceptionally delivered by family practice physicians, NPs and PAs.  

I started practicing in the era of Marcus Welby, M.D. I wanted to establish enduring connections with patients, fostering profound trust through long-term commitments.

How we delivered medical care

There were excellent cardiologists and orthopedists in the community, all skilled but with vastly different personalities and approaches. Sometimes my patient needed an intervention-focused approach, other times conservative and thoughtful, so I tailored my referrals accordingly. I wanted to follow “my” (ownership matters as it equates to commitment and caring) patients over time, in and out of the hospital (this was before hospitalists) and thru life’s ups and downs.

I particularly enjoyed caring for multiple family members. In a four-generation family, I cared for the matriarch at home as she was dying of COPD (yes, I made house calls) while assisting her daughter to manage COPD, granddaughter and great-grandson with asthma. A grieving mother and I supported each other after her adult daughter (also my patient) was brutally murdered by her estranged spouse.

These were rich and rewarding times when I cared for patients during most of my working hours when physician career satisfaction was high, and patients felt they had a medical home. I was not sitting at a computer screen typing notes and entering orders for hours. I dictated my chart notes on each visit. My transcriptionist typed them. My medical assistant arranged for all the tests I wanted to order and communicated the nuance of this plan to my patients. 

What’s happened since the 1980s

The patient-physician relationship structure broke down when physicians relinquished control of medicine to institutions. I watched it begin in the early 1980s at St. Vincent Hospital in Portland, Oregon,  now part of Providence, when physicians began to sell their practices to the hospital. The writing was on the wall for what’s become the state of today’s healthcare woes. Few heeded the warnings of the few voices loudly objecting. I warned my Infectious Disease teacher to no avail, as he sincerely believed these changes would be better for us all, patients and physicians. Other powerful factors contributed to physicians’ willingness to let go of their autonomy. They included increasing complexity of insurance billing, growing government regulation and malpractice insurance premiums. Physicians wanted to take care of patients and were willing to own and manage their practices when it was less complex than what was coming down the pike.

I feel personally fortunate to have an excellent primary care physician at Providence* who took over from my second wonderful PCP in the five years before her and after my first PCP retired. Three PCPs in 13 years is not ideal or as it was, but is better than for most. Turnover in primary care is frequent in every system, from private to the VA and Kaiser. Turnover is not only expensive; it interferes with patient continuity and access to primary care, which directly impacts the quality of care and safety.  

[*While editing this column, I received a letter announcing she is leaving, albeit to follow her military physician husband, who is being reassigned. I am feeling very sad about this, though will continue to advocate for my healthcare.]

Can you find a primary care physician to care for you in this way in 2023? Maybe. You are worth the effort to advocate for yourself.

How do you choose a PCP if you have a choice? Consider these important qualities:

• Do they listen?
• Do you feel they care about you?
• Does their staff make you feel welcome as an individual (vs a number or cog in the wheel)?
• Are you impressed with their knowledge, experience and credentials? You can look this up online.
• Is their license clean? That means he/she has had no board “enforcement actions?” You can look this up at the Washington State Department of Health’s website.
• Are they available (or a delegate) to see you in a timely manner and in an acute situation?
• Do they communicate clearly? Can he/she explain what is going on in language you can understand?
• Do they have enough time to listen and explain things in an unrushed manner?
• What is the prospect for them staying and continuing to care for you over time?
• Do you prefer an M.D., D.O., N.P. or P.A.? Educate yourself on the differences, pros and cons.

If you are not getting what you need, advocate for yourself:

• Ask your PCP for what you need. For example, “Would you explain that using simpler words that I can understand and would you go slower?” for instance.
• If your PCP keeps changing, be prepared to educate your new PCP. Bring a complete list of your medical conditions, medications, allergies, history of surgeries and what you want to focus on that day.
• If not satisfied, ask to change PCPs.
• If the organization is not accommodating, change venue if you can.

Hopefully this guide will be helpful to the readers in setting up their best healthcare team, starting with primary care.

I always welcome comments on this or any other topic I have written about as well as requests for future topics.

Debra L. Glasser, M.D., is a retired internal medicine physician who lives in Olympia. Got a question for her? Write drdebra@theJOLTnews.com