So sorry, I can’t be your PCP

I recommend for all of my patients to have their own primary care physicians and some ask whether I ever want to be “that guy.” So I thought I’d type an answer today. The short answer is no, not in the traditional sense, in part because it’s not my skill set. Also, I’m up to my eyeballs in parenthood lately, so learning more about best cholesterol management is off the table. But there’s more to it.

I think it’s important first to define “primary care.” When I suggest that everyone have a PCP, what I’m really saying is that I think medical care is best (and most efficient) when one person is well known to a single caregiver, and when those two people actually like and respect one another. DO, MD, NP, PA doesn’t matter to me. More important is the relationship. Conversation alone can be therapeutic. It’s nice also when that caregiver will call in a refill for Synthroid and Ventolin (albuterol) without chasing you across town for an in person visit.

On the level of efficiency, that relationship saves from having to repeat insurance and demographic info with every visit. It also limits redundant questioning about your vaccinations, allergies, whether you use street drugs or are a victim of domestic violence. (Amazing to me to hear these questions asked in ERs over and over to patients with ankle sprains.)

To me a primary caregiver is someone who will answer a question when you call, without putting you on the meter for every moment of conversation, and also someone who will do a little research to try to solve whatever problem may be posed. That level of primary care physician I can be.

Harder for me is accepting responsibility for longevity. Plus, being a bit of a medical heretic, I think I’d struggle with making sense of today’s “best practices.” I find myself questioning many primary care practices, from yearly mammograms, to polypharmacy in the elderly, to the need for annual physicals… everything down to an apple a day.

The world of Lipitor, Ritalin, Abilify and Lyrica just doesn’t grab me. I’m sure these work for some, but hard to know, especially when positive studies are published far more than negative ones. (Unfortunately, exercise isn’t pill shaped.)

With Pre-R, the medicine I offer is what I’m convinced will work, and if I happen to be out of town on occasion, there’s no hard feelings. Yesterday I drained a 3 week old hematoma. No debate. Patient was psyched and I’m sure it was the right thing to do. I pulled a bug out of some guy’s ear the night before. Definitely useful. Saline in vomiting pregnant women… no doubt.

For my whole career I’ve looked for gaps in emergency medicine, and now I guess I’m just taking that into people’s homes. If my patients want to talk about smoking cessation, I’m happy to chat, but I won’t be chasing them with a stick.


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