Primary Care Physician

NARRATOR: THE PLAN
THAT IS SELECTED OFTEN INFLUENCES THE CHOICE OF A
PRIMARY CARE PHYSICIAN, USUALLY AN INTERNIST OR FAMILY
PRACTICE DOCTOR, WHO WILL PROVIDE PERIODIC CHECKUPS,
SUGGEST PREVENTIVE STRATEGIES, AND RESPOND WHEN
ILLNESS STRIKES. AS GENERAL INTERNISTS,
THERE IS A TREMENDOUS AMOUNT YOU CAN DO FOR YOUR
PATIENTS, BEFORE YOU NEED TO CALL IN SUBSPECIALISTS
OR SEND YOUR PATIENTS OUT AND PARCEL THEIR CARE
OUT TO OTHER PHYSICIANS. AND THAT HELPS YOU
TO BUILD TRUST. AND THAT MAKES IT A BIT
EASIER ON THE PATIENT’S. THEY ONLY HAVE TO COME TO
ONE PLACE, SEE ONE DOCTOR. BUT WHEN THE NEEDS ARISE
TO GET THEM ELSEWHERE, INITIALLY, IT IS
HANDLED THE SAME WAY, PHONE CALLS MADE FROM MY
NURSE, MY SOCIAL WORKER, MY MEDICAL ASSISTANT
TO THE PATIENT, TO THE SITE WHERE THEY
MAY HAVE AN APPOINTMENT. QUITE OFTEN, I
WILL SEE A PATIENT THAT’S BEEN REFERRED TO
ME BY ANOTHER DOCTOR. I’LL HAVE A
PULMONOLOGIST AND LUNG DOCTOR WHO WILL SEND ME
A PATIENT WHO HAS ASTHMA. AND THE PULMONOLOGIST WANTS
ME TO ASSESS WHETHER OR NOT THE SINUSES ARE CAUSING
THE ASTHMA PROBLEM. AND AFTER ASSESSING
THE PATIENT, GETTING THE RADIOLOGICAL STUDIES, AND
DETERMINING THAT THERE’S SINUS DISEASE. THEN I CALL THE PULMONOLOGIST. AND I CALL HIM ON THE PHONE. OR I CALL HER ON THE PHONE
AND SAY, WE HAVE THIS PROBLEM. PATIENT IS GOING
TO NEED SURGERY. PATIENT WILL NEED TO BE IN
THE HOSPITAL FOR A COUPLE DAYS BECAUSE OF THEIR
LUNG PROBLEM OR ASTHMA. AND WE WORK TOGETHER AS A TEAM
IN TAKING CARE OF THE PATIENT. NARRATOR: THIS KIND
OF COORDINATION HELPS PATIENTS NAVIGATE
THE MEDICAL MARKETPLACE. IT IS PARTICULARLY
CRITICAL FOR ANYONE WITH A CHRONIC CONDITION. IT’S SCARY TO BE FACED WITH
A DISEASE THAT MIGHT GO ON FOR 10, 15 YEARS, WHERE THERE
REALLY ISN’T HOPE FOR SOMEBODY GETTING BETTER FROM IT. THEN, I THINK WE NEED TO PROVIDE
ONGOING OFFICE VISITS, IN TERMS OF AVAILABILITY FOR PEOPLE,
THAT WE DON’T JUST GIVE THEM A DIAGNOSIS AND SAY,
SEE YOU IN A YEAR. I THINK FEAR IS THE MOST COMMON
DENOMINATOR AMONG PATIENTS. AND THE GOOD DOCTOR
IS THE DOCTOR WHO KNOWS THAT AND KNOWS
THAT THE WAY OUT OF FEAR IS TO GIVE HOPE. AND YOU GIVE HOPE BY
GIVING A PLAN OF ACTION. WE GIVE THEM THE
DIAGNOSIS AND SAY, I’M GOING TO SEE YOU IN SIX WEEKS,
TO SEE HOW THINGS ARE GOING, TO SEE IF YOU’VE BEEN
ABLE TO FOLLOW UP WITH ANY OF THESE RESOURCES. THIS IS AN AREA
WHERE PHYSICIANS NEED TO INTERACT VERY CLOSELY WITH
SOCIAL WORKERS, PSYCHOLOGISTS, OCCUPATIONAL THERAPISTS,
PHYSICAL THERAPISTS, THE WHOLE HEALTH TEAM. BECAUSE AT SOME POINT IN TIME,
PEOPLE OR THEIR LOVED ONES ARE GOING TO NEED THAT HELP
FROM THESE DIFFERENT HEALTH CARE PROFESSIONALS. I’VE EVEN HAD PHYSICIANS
CALL ME AND SAY, I HAVE A GROUP OF PEOPLE WHO ARE
GETTING THIS KIND OF TREATMENT, WHICH I KNOW IS A
VERY TOUGH TREATMENT. WHAT CAN YOU OFFER THEM? AND WE’LL TALK ABOUT HOW DO
WE SET UP A GROUP FOR THEM? OR HOW DO WE MAKE SURE THAT
THEY GET REFERRED TO US, SO THAT WE CAN PROVIDE THE
COMPREHENSIVE PSYCHOSOCIAL CARE? I NEED YOU TO SIGN IT RIGHT
HERE, RIGHT HERE, RIGHT HERE. NARRATOR: PHYSICIANS WHO
PLAY THIS CRITICAL ROLE ADMIT THEIR FRUSTRATION WITH
RULES AND REGULATIONS THAT LIMIT THEIR ABILITY
TO SERVE PATIENTS. I FEEL THERE’S SOME
PRESSURE TO HAVE LESS ACCESS TO SPECIALISTS, TO DECREASE
THE NUMBER OF SPECIALISTS. THAT CAN BE
FRUSTRATING AT TIMES, BECAUSE THERE ARE
CERTAINLY COMPLEX PROBLEMS THAT I’M NOT EQUIPPED
TO DEAL WITH. AND I WANT A PATIENT TO
SEE A SPECIALIST QUICKLY AND PROMPTLY, TO HAVE
A THOROUGH EVALUATION. NOBODY CAN BE THE MASTER
OF ALL THOSE TECHNOLOGIES. YOU CAN LEARN THEM, BUT YOU
CAN’T BE THE MASTERS OF THEM. AT LEAST GET THE
PATIENT THE BEST CARE. SO INTEGRITY IS REALLY
IMPORTANT ISSUE. AND THE INTEGRITY OF OUR PAYERS,
OF OUR INSURANCE COMPANIES NEEDS TO BE HELD UP THERE. ALL RIGHT? WE’RE GOING TO BE
IN THE OTHER ROOM. OK, FINE. ALL RIGHT, SEE YOU THERE. GREAT. GOOD. WE HAVE A TRAUMA CENTER HERE. THE TRAUMA SURGERY, HE WILL
HAVE A PATIENT WITH A GUNSHOT WOUND TO THE HEAD AND NECK. HE’LL HAVE A PATIENT WITH A
MOTOR VEHICLE ACCIDENT, WHERE THEY HAVE ABDOMINAL CHEST
INJURIES, FACIAL INJURIES. AND HE’LL SAY, I NEED
THE THORACIC SURGEON. I’LL NEED THE ORTHOPEDIST. I NEED THE OTOLARYGOLOGIST. I NEED THE FACIAL PLASTIC
SURGEON, WHICH IS WHAT I DO. AND I GET CALLED IN. AND I WILL COORDINATE
WITH THE OTHER DOCTORS. I SAID, OK, WHO’S GOING TO
THE OPERATING ROOM FIRST? CAN WE DO THIS AT THE SAME TIME? WHAT CAN BE STAGED? WHAT NEEDS TO BE DONE? AND IT WORKS AS A TEAM. AND IT CAN WORK EXTREMELY WELL.

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