fundamentals
The Primary Care Practitioner
Introduction
Typically, the entry point into the health care system is a primary care practitioner (also known as a primary care physician [PCP], general doctor, or family doctor), usually a doctor but sometimes a nurse practitioner or physician’s assistant. The primary care practitioner provides general medical care and is responsible for overall care, including the coordination of medical specialists and supportive care. Some health insurance plans require an insured member to select a primary care practitioner. However, even if a person's medical insurance does not require it, having a primary care doctor has many advantages that can lead to better care. (See also Introduction to Making the Most of Health Care .) People who have a primary care doctor are less likely to go to an emergency department unnecessarily and less likely to be seen by a doctor they do not know. When people see a doctor they do not know, the doctor may not have all the background information necessary to diagnose and treat the problem. Consequently, the doctor may need to repeat or do unnecessary tests. Communication is often better and medical decisions are more easily made when people have an established relationship with a primary care doctor. People are more likely to trust a doctor they know and to experience less anxiety when a medical problem develops. Primary care doctors often have long-standing relationships with their patients and have established mutually acceptable lines of communication. They are familiar with what their patients want and value, how they best receive information, how they cope with adversity, whether they are able to purchase prescribed medications, and which family members they rely on. Primary care doctors explain what type of care is needed, why it is needed, and how often visits should be scheduled. They provide appropriate preventive health care including vaccinations and can refer people to specialists when needed and coordinate care with other health care practitioners. Some health care plans require people to see their primary care doctor to get a referral before they see a specialist. Although this practice may be seen as an obstacle to specialty care, it can be helpful. For example, having to obtain a referral ensures the primary care doctor is informed about all of a person's health care needs. It also ensures that people see the proper specialist and that specialist receives the appropriate background information. To find a primary care doctor, people can begin by asking friends and relatives for recommendations. Or they can call a medical school or local hospital and ask for a department, such as pediatrics, internal medicine, or family practice. Online survey data from patients regarding individual physicians are another source of information but should not be the only source or substitute for personal assessment. Many health insurance plans limit the choice of doctors and other practitioners. In such cases, people should consult the plan to obtain a list of participating practitioners. Sometimes people cannot see the doctor they have chosen because the practice no longer accepts new patients. When choosing a primary care doctor, people should consider what is most important to them (for example, friendliness, thoroughness, patience, or promptness). Some people prefer a doctor who spends extra time with them, even if doing so tends to make the doctor run late keeping office appointments. Other people prefer a doctor who keeps appointments on time, even though doing so may limit the time spent with them. Older people may want a primary care doctor who specializes in treatment of their age group (a geriatrician). People should look for a doctor they feel comfortable with and have confidence in. For some people, this means selecting a doctor who is comfortable using Using Telemedicine . For information about a doctor’s credentials, people can call the American Board of Medical Specialties (866-275-2267 toll-free) or check that organization’s web site (www.abms.org). Helpful questions to ask a doctor include the following: Does the doctor participate in my health insurance plan? What are the doctor’s normal office hours? What is the usual wait to obtain a routine visit? An urgent visit? Does the doctor respond to phone calls or e-mail (during office hours and after office hours)? If so, how quickly does the doctor respond? Does the doctor have an online portal for patient communications (such as requests for prescription renewal and seeing test results) and scheduling? Does the doctor provide convenient Using Telemedicine ? Is the doctor's electronic record system integrated with hospitals and other doctors to which I might be referred? Will the doctor take care of me if I need to be hospitalized, or will I be referred to another doctor? At what hospitals is the doctor on staff? Is the doctor board-certified? Is the doctor’s office easy to get in and out of? Does the doctor keep office appointments on time? Who takes care of the doctor’s patients when the office is closed (at night or on weekends) or when the doctor is away? When care is provided by another practitioner, does that practitioner know the patients or have access to the patients’ medical records? Who else is routinely involved in taking care of the doctor’s patients? For example, to what extent will my care be provided by nurses, nurse practitioners, or physician’s assistants? How are test results (normal and abnormal) communicated, and who (doctor or patient) initiates the communication? Helpful questions to ask the doctor’s patients include the following: Does the doctor take time to listen to concerns? Does the doctor adequately explain a diagnosis? Do you trust the doctor’s opinion? Before prescribing a medication, does the doctor discuss its benefits and risks? Before prescribing a medication, does the doctor discuss alternatives? 