November 14th, 2022

Prairie Doc® Perspective for the week of  November 13th, 2022
“Looking out for all of you”
By Debra Johnston, MD
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Recently, while visiting from out of state, my father had a “health hiccup.” As we navigated getting this problem investigated and addressed, he was very concerned that we keep his primary care doctor informed. As my dad has said repeatedly, “I give him more grief than any of my other doctors, but I also listen to him more than any of my other doctors. He’s the only one looking out for all of me!”
Like many Americans, particularly older Americans, my dad has a whole host of specialists he sees on a regular basis. One of my friends recently teased, what do primary care providers do, anyway? It seems that there is a specialist for pretty much any problem you can imagine! 

If I see a cardiologist, an electrophysiologist, a urologist, an endocrinologist, a gastroenterologist, a rheumatologist, a nephrologist and maybe even an oncologist, why do I need one more doctor, who doesn’t seem to be handling anything?

Established readers of this column know that I, like Dr Holm before me, am a proponent of the annual wellness visit. It’s a chance to step back and look at the big picture, to review screenings, immunizations, and health promotion recommendations. Many factors can influence these recommendations, beyond age and gender. Did you know that older men who have smoked should be screened for aortic aneurysms, and that diabetes in pregnancy increases diabetes risk going forward?

The origin of a symptom is not always straightforward. For example, abdominal pain can originate not just from the digestive system, but from many other systems, and from causes that might surprise you, such as blood or metabolic diseases and poisonings. Some people, women especially, get their gallbladders removed, only to discover that the problem was, in fact, their heart. A primary care doctor can help sort things out in a more efficient way. 

A primary care doctor looks at the big picture, In fact, all of us answering questions tonight are primary care doctors. We commonly say we are specialties of breadth, not depth. My father says the specialist studies one 1000 page book on their topic, while the generalist studies the 10 page summary for 100 different topics. We may ask for assistance from our specialist colleagues for more unusual, treatment resistant, or advanced diseases, but every day we help patients manage their health problems. We coordinate care between specialists, and watch for signs that the treatment for one problem is worsening another. In fact, I would argue that the more specialists you have, the more important it becomes to have someone “looking out for all of you.

Everyone deserves a primary care provider!