Know what else is good for us? Going to a primary care doctor. Not keeping him or her away. Yes, doctors can help heal us when we’re sick. But they can also help us stay healthy. Empower us with preparedness. Beat the bugs that can bother us before they have a chance to do so. Primary care doctors promise to be our health’s greatest advocate. Our partner in prevention. Our companion in care.
OurHealth Richmond is pleased to introduce a year-long series focusing on the role of primary care. In each edition throughout 2016, we will take a detailed look into the specialty, providing facts that further expand on some of what we may already know and much about what we may not. We will deliver insight from local doctors and providers. We will share personal stories of people living in our communities. We will confirm what is correct. We will dispel what is not.
Our commitment to you, our readers in the greater Richmond community, is this: we will help close the gap between your knowledge and desire to learn more about primary care with the hope that you and your loved ones can cross the bridge toward a healthier life.
ANGIE'S LESSON ON THE IMPORTANCE OF PRIMARY CARE
"I’m not going to a doctor unless I’m sick." That was Angie’s way of thinking. And why not? From the looks of her, she was more than the picture of good health – she was poster child. A weekend and WEEKDAY warrior. We’re talking five miles at the track every morning before most people tap the snooze button. Daily diet? Dynamite. Body fat? Best it could be. Aches and pains? Free and clear. Sneezes and sniffles? Forget about it.
It’s safe to say that Angie was fanatical about staying fit. She felt fantastic. Looked fantastic. Her formula was fool proof. This lady was in control of her life and she knew it.
Fast forward four months. Angie, who asked that her last name not be used to protect her privacy, still looks and feels as fabulous as ever. But her life has a taken a different direction. It all started over the course of a couple of weeks this past October.
“All of a sudden, I was just completely and utterly exhausted, so much so that I could hardly keep my eyes open on the drive home from work,” says Angie. “I found myself falling asleep at 7 in the evening and waking up at 5 in the morning, and I would still feel like I hadn’t slept for days.”
Angie’s lethargy lingered on for days. Next came nausea, followed by the start of a sore throat. While she hated to admit it, Angie says she felt like it was the flu.
“I hadn’t been sick since sixth grade,” Angie shouts.
She consulted her best friend, Evan, a nurse, to get some care advice. He told her to do exactly what she already knew.
“WelI, I always believed you only go to the doctor when you’re sick,” says Angie. “I couldn’t argue with myself, I supposed.”
Evan helped Angie get an appointment the next day with the doctor he works for in Short Pump.
“Evan had been on me for years to get a check-up,” says Angie. “I think he was a little excited I was sick so that I would finally go!”
So at age 28, and for the first time since middle school, Angie walked through the doors of a doctor’s office.
Following a thorough physical exam, complete with a battery of blood tests, Angie learned that being pregnant was the culprit of her constant tiredness.
“Ecstatic, overjoyed and still tired,” is how Angie says she felt after finding out her good news. “Honestly, after I got to the doctor’s office, it kind of crossed my mind that I might be pregnant. My husband and I had been trying to start a family. I wasn’t completely surprised, but I was super excited!”
She learned something else, however that did completely surprise her.
“My lab results came back showing that my cholesterol was through the roof,” she says. “At first, I thought it must have been a mistake. I mean, how could I have high cholesterol? I did everything the right way.”
Turns out that some things are out of our control. Even if you’re a super woman like Angie.
Additional testing revealed that Angie has a condition called familial hypercholesterolemia, an inherited genetic abnormality that can raise cholesterol levels despite maintaining a carefully managed diet and ample exercise. Left untreated, it can lead to serious heart disease and even death. Familial hypercholesterolemia affects about one in 500 people and is considered the most common type of inherited high cholesterol. It is treated with lifestyle changes and medication.
“I spent a lot of time discussing my family’s health history with the doctor, and after finding out some facts from my parents, I learned that heart disease is what killed my grandfather, aunt and cousin,” Angie explains. “I also found out that my dad has been on cholesterol medicine since he was 29 and his sister since she was 22. None of knew this heriatary condition was in our family until I was tested. It bothers me so much that it’s too late for those we’ve lost.”
Angie learning she has familial hypercholesterolemia when she did was incredibly timely. During pregnancy, a women’s cholesterol levels can increase by 25 – 50 percent, and nearly all cholesterol lowering medications are not advised to be taken during this time. For women who have familial hypercholesterolemia, it’s especially important for them to have their cholesterol levels closely monitored throughout pregnancy.
Angie’s wake-up call has not only given her a new lease on life. It has also taught her one of the most important lessons in her life.
“Knowing what I do now, I am actually a little ashamed that I was being so shortsighted about the importance of having a relationship with a doctor,” Angie shares. “I looked at going to one as a weakness, as a result of me not taking care of myself. It was such an inaccurate way of thinking. I get it now, though, and fortunately, before it was too late. Going to the doctor is a part of a healthy routine. A physical gives you a baseline, an understanding of where you are in your health and where you need to be. It’s the most important information you need to know. I am so happy I learned such a valuable lesson that I can pass on to my child.”
Where do you place your personal care?
Going to the doctor for an annual check-up seems like a stretch for so many people. It really isn’t though. A check-up is the best way to measure health and make adjustments if needed. Surprisingly, most people are more structured about properly maintaining items they own than they are about themselves. This measuring stick shows just a few examples. Shouldn’t your personal health be measure as well?
Vehicles: Every year, vehicles are taken to a professional for state inspection. They are entrusted to an expert who ensures they are safe for the road. Oil changes every 3000 miles. Another check-up, another preventative step. On average, a car’s oil is changed five times a year to keep it running for the long term.
Tire rotation: Tires need tentative care too. To maximize their life, they get balanced and rotated by professionals every 5000 miles, or an average of three times a year.
Lawns: The grass is greener and weed-free than on the other side of the fence because it is entrusted to a lawn service professional to keep it that way through regular treatments. On average, lawns are serviced four times a year to remain picture perfect.
Pets: Annual shots and check ups for the family dog, cat and other critters are the norm to keep them healthy and active.
What are the different types of primary care providers?
The National Institutes of Health and the U.S. National Library of Medicine have designated these different types of primary care providers:
• Internal Medicine physicians: Board-certified or board-eligible doctors who have completed a residency in internal medicine. They provide care for adults of all ages with numerous medical conditions.
• Family Practice Physicians: Board-certified or board-eligible doctors who have completed a family practice residency. Their patients include children and adults of various age groups. They may also practice minor surgery and obstetrics.
• Pediatricians: Board-certified or board-eligible doctors who have completed a pediatric residency. Their patients include newborns, infants, children, and adolescents.
• Obstetricians/gynecologists: Board-certified or board-eligible doctors of this specialty may serve as a primary care physician for women.
• Geriatricians: Board-certified doctors who have completed a residency in either internal medicine or family practice. They may serve as primary care physicians for elderly adults with complicated problems related to the aging.
• Nurse practitioners (NPs) and physician assistants (PAs): These skilled health professionals go through different training and certification procedures than physicians do, but they are qualified to manage many of your health issues.
The importance of having a primary care provider who knows YOU and YOUR health.
Think about having to go to a physician or provider who knows nothing about you when you’re feeling tired more than usual. That physician or provider may not feel it’s anything urgent, but your regular doctor or provider may see that your thyroid medication may need adjusting. Equally, your primary care provider can reassure you in the event that you’re concerned about the freckles on your nose, since they haven’t changed in the past several years.
Simply put, a primary care provider watches over you for the long run in numerous healthcare settings, such as in his/her office, under the care of a specialist, critical care, long-term care, home care, etc. Knowing your health history, lifestyle, habits, and personality can help your primary care provider gain a more comprehensive overview of your health.
This kind of attentive relationship can make a big impact on the quality of your health because it establishes a continuity of care. Being able to deliver an accurate diagnosis and an appropriate treatment becomes much easier for a primary care physician when he or she has thorough information on their patient. Having adequate data also eliminates the need for unnecessary tests and procedures. If the patient’s condition should require a consultation with a specialist, then the primary care physician will be able to coordinate cost-effective healthcare services and keeps the patient efficiently updated.
Primary care providers promote health and prevention, and strive to develop a sustained partnership and personal relationship with us. Each is highly educated in the treatment of common medical conditions and provides applicable medical tests and screenings to develop a baseline of your health. Based on their findings, they can recommend further testing, changes in medication, therapy, healthy diet and lifestyle choices; and safe health behavior. If additional tests and treatments are needed, they are skilled in assessing the importance of your medical conditions and can refer you to consulting specialists. Primary care providers provide long-term management of chronic conditions, which is important for patients whose conditions affect multiple organs, such as diabetes, hypertension, and cancer.
THE PRIMARY CARE PARTNERSHIP PROVIDES
Accessibility: Primary care providers are our first contact with the healthcare system.
Accountability: Primary care providers address a vast majority of health needs and help us stay on top of our overall health.
Coordination of care: primary care providers manage acute and chronic needs and refer to consulting specialists, such as cardiologists or orthopaedic surgeons, as needed. They work closely with consulting specialists and maintain records of our total care received throughout the healthcare system.
What are your needs when searching for a primary care provider?
• Would you feel more comfortable with a provider of the same or different sex as you? Someone older or younger?
• Would you like your primary care provider to utilize alternative medicine?
• How easily accessible should your primary care provider’s office be?
• How convenient should his/her office hours be for your schedule?
• Does the doctor fall within your health insurers “in-network’ providers?
Once you have analyzed your wants and needs in your health partner, you have several ways in which to select a primary care provider. The easiest is to ask your friends and family for their suggestions, as well as other doctors. Most insurance companies offer a full list of in-network and out-of-network local providers. You can also find providers that have been voted on by the community, such as in OurHealth’s Best Bedside Manner Awards edition that comes out every December.
Specialty Primary Care For Women
With the hectic lives we lead these days, many women are choosing their OB/GYN providers as their primary care providers. Wendy Bowman, MD, an OB/GYN specialist with Alliance Women’s Health in Richmond, optimizes her patients’ appointments by arranging annual screening mammograms for 40-year-old patients at the time of their annual exams.
“When patients turn 50, we discuss and schedule a screening colonoscopy,” she says.
Several people also like the convenience of having her conduct lipid testing and diabetes screening as part of their annual exam right in the office, as well as other tests for genetic types of breast, colon, ovarian, and other GI cancers.
As in any partnership, you have to be willing to make it work with full disclosure.
“The patient should be prepared to be completely open and honest about any health concerns or health needs, so that the provider can better customize the dialog and the focus of the annual exam to meet the patient’s individual needs. Open dialog between the patient and provider allows more time to be spent on strategic planning for the patient’s healthcare needs of the future,” concludes Dr. Bowman.
The Primary Care Partnership: it’s all about trust between you and your provider.
As in any partnership, there should be open communication between both people. When you first meet your primary care provider, he or she is going to need to know a lot of information about you, including your past and current health history, your family history, current and past lifestyle habits and medications. It is important to be completely open and honest with the doctor, no matter how private or embarrassing. While certain tests and labs, can provide a lot of details, the information in a person’s head is the most important for a doctor to know. Without honest and open dialogue, a treatment plan may not be as effective as possible. Remember: you can trust your doctor or provider with your personal information. It remains completely confidential between the two of you and any consulting specialist who is involved in your care.
By law, your health information cannot be disclosed to anyone else without your signed consent.
Along with regular checkups and screening tests, this data will provide a foundation upon which a continuity of care can be established over time.
What should you expect during a typical first time visit to a primary care provider?
Years ago, it was considered customary to have a yearly physical and to undergo a series of standardized tests. But now the current trend of thought is that because each person is unique and has different health requirements, it is not cost-effective, affordable, or sensible to have every patient see a physician or provider at the same time each year and take the same tests on the same schedule. Your physician or provider will now tailor your checkup and subsequent tests and/or treatments based exclusively on the factors that define your own life.
Each physician or provider has his or her own strategy for getting to know you by using guidelines to define your parameters. Judith McKenzie, MD, an internal medicine physician with Bon Secours Memorial Regional Medical Center in Mechanicsville says, “A new patient visit is extremely important. It is a longer, more in-depth visit during which the healthcare team and patient get to know each other. This is the beginning of our relationship and therefore, it is critical for establishing our goals.” Dr. McKenzie continues, “Initially, a nurse will gather information on past history, medications, and current concerns, then the physician or provider will review pertinent history and go over current conditions in depth.”
The examination will vary from patient to patient depending on his or her needs.
“After a thorough review of the medications with the patient, the examination is tailored to the specific issues to be addressed,” says Dr. McKenzie. “In-office testing, like laboratory studies, may be performed if required. At the end of the new patient visit, all information is summarized for the patient, and plans are made for our next visit.”
When establishing a baseline for new patients, Lynn Woodcock, NP, a nurse practitioner with Family Practice Specialists of Richmond, takes into account a patient’s current symptoms or concerns, previous medical history, family history and social history.
“These factors influence what tests will be performed,” Woodcock explains. “For example, if a patient has never had elevated blood sugar, but has a family history of diabetes, I will order more specific screening tests.”
Woodcock also advises patients of specialty services and procedures that are offered in-house such as colonoscopy and endoscopy, bone density testing, and cosmetic procedures. Depending on the practice, more and more services are being offered under one roof.
“We draw labs in house, perform dermatologic procedures, X-rays, and minor surgeries. While we do provide generalized care for patients, each of us also has a specialty that we are passionate about. This way, we can provide better and multi-focused care,” says Woodcock.
In order to gain a better understanding of your lifestyle, your primary care provider will also ask you about your use of drugs, alcohol, tobacco, sexual preferences, exercise, diet, and sleep.
I try to convey respect and compasion to my patients. This is what they deserve." - Lynn Woodcock, NP with Family Practice Specialists of Richmond
What are some of the types of screenings performed during a check-up to establish a patient’s baseline of care?
• Blood pressure screening
• Cholesterol screening (for adults of certain ages or higher risk)
• Colorectal cancer screening (adults over age 50)
• Depression screening
• Diabetes (Type 2) screening (for adults with high blood pressure)
• Lung cancer screening (for adults 55-80 at high risk for lung cancer)
• Obesity screening
Additional screening, testing or labs may include:
• Complete blood count (may identify conditions such as anemia, infection, and other disorders)
• Comprehensive metabolic profile (a broad screening test used to check for conditions such as diabetes, and liver or kidney disease and provide an overall picture of your body’s metabolism and chemical balance)
• Thyroid studies
What can you do to best prepare in advance of your first visit to a primary care provider?
Your primary care provider will need the following information to best develop your care plan. Going to your doctor with this information already in hand is a good way to be ahead of the curve.
• A list of all prescribed and over-the counter (OTC) medications and supplements you are currently taking. Bring the bottles of medications and supplements with you so the doctor can note all information needed, such as number of milligrams of the medication and OTC supplements, how often it is taken, etc.
• A list of your family’s health history – parents, grandparents and other immediate family members – who have or had conditions such as heart disease, cancer, arthritis, depression, etc. This may require you to do some research. Asking your family members is the best way to get started gathering this information.
• A list of all known medical conditions, as well as procedures you have had, such as surgeries, and hospitalizations.
Build your bridge to better health with OurHealth’s Primary Care Series
The bridge to better health starts with Knowing Your Care and the options available to you. The information and resources available in this article hopefully help you start your journey. Throughout this series, we will provide additional information on each series’ section on our website, ourhealthrichmond.com.
National Institutes of Health – www.nih.gov
Wendy Bowman, MD, an OB/GYN specialist with Alliance Women’s Health in Richmond.
Judith McKenzie, MD, an internal medicine specialist with Bon Secours Memorial Regional Medical Center in Mechanicsville.
Lynn Woodcock, FNP, a nurse practitioner with Family Practice Specialists of Richmond in Midlothian.