By Timothy Wollner, DO
I truly enjoy being a family doctor practicing primary care medicine. Being a primary care physician allows me to care for the entire person, and entire families. I get to see people “on the front lines” of health — in their community, when they are well, and when they are ill. My patients are males and females, young and old.
Primary care physicians, specifically, are doctors who are the first to see a patient for general health concerns, provide ongoing care for a variety of medical conditions and provide referrals to medical specialists as needed. Most physicians specializing in family medicine and general internal medicine are primary care physicians, and many pediatricians and gynecologist/obstetricians are as well.
It is a special responsibility and privilege to be the first contact person to help care for a person’s needs; to be sensitive to their needs; to help them navigate through the healthcare system; to communicate effectively with them, their families, and other healthcare team members; and to build relationships and to advocate for every patient.
The goals of primary care
As a primary care physician, I have several goals that are very important to me. The first is to be accessible, meaning that I have plenty of office hours available, so people can easily see me when they need to. It also means that they can see me in a location and in an environment that is user friendly and patient centered.
The importance of accessibility is a big part of the reason I’m excited to be part of the group of physicians who have opened Rush’s new practice in Chicago’s River North neighborhood, making Rush’s care easily available to the people who live and work there. A patient-centered approach in primary care today involves everyone on the office team and the patient’s team working closely together, which is what we do at Rush River North and in collaboration with our Rush colleagues.
Another important goal is that patients and I build working relationships, so I can provide comprehensive and coordinated long-term care in which the patient is actively engaged, along with any family members. I want to get to know each person the best that I possibly can, so they have continuity of care. With continuity, patients have someone on their side who knows and understands them, has empathy for what they may be going through and where they are in their life.
As patient advocates, primary care physicians are there with the patient virtually every step of the way: through wellness, prevention, or any illness. That is not to say that various specialists, such as cardiologists, neurologists and oncologists, are not treating every person with the same level of advocacy and empathy. In fact the level of care, attention, and expertise given by the Rush specialty physicians is what excites me the most about being a new assistant professor of family medicine at Rush University Medical Center.
Even when these outstanding specialists are involved, though, I see it as my responsibility to be the central point where any and all care a person receives is coordinated and communicated for the patient’s well-being. Every person deserves the best possible care in a timely, safe, cost effective, efficient and satisfactory manner.
Promoting wellness as well as treating illness
In providing care for my patients, keeping them well is as important as my role in treating illness. I sometimes tell people that as a primary care physician, I live for prevention. Prevention in medicine has many facets — in fact there are four categories, or levels, of preventive medicine.
- Primary prevention includes, among other things, promoting immunizations (such as flu shots, tetanus shots, and whooping cough vaccines) to prevent or minimize an illness before a person is exposed. It is estimated that 50,000 adult lives in the United States could be saved per year if almost everyone received the immunizations that are recommended. Therefore, we make a considerable effort to make people comfortable with getting vaccines as indicated.Helping people to not smoke is an even more important preventive task. Smoking is the most preventable cause of premature death in the U.S., greatly increasing the risk of lung cancer and other cancers and coronary heart disease.
- Secondary prevention involves screening measures to find and treat a problem in an early stage in order to enable the best possible outcome, or even to stop a disease from even getting started. The best examples of this type of prevention are mammogram screening for breast cancer and screening colonoscopies for colon polyps and cancer.
- Tertiary prevention is the practice of working with patients who already have an illness such as diabetes mellitus or congestive heart failure to prevent or minimize complications of their disease. This effort includes motivating people to diet and exercise and to take their medications when and as prescribed.
- Quaternary prevention is a set of health activities that aim to mitigate or to avoid the consequences of unnecessary or excessive interventions of the health system. It is following the adage of the ancient Greek physician Hippocrates, “first do no harm.” Good examples of this important responsibility are avoiding indiscriminate use of antibiotics, avoiding unnecessary medications in general – especially with our older population, and avoiding unnecessary exams and procedures.
The forefront of population health
As you can see, the work of primary care physicians is not just a general concept, but of very specific and practical importance for our community of patients. Its value is particularly relevant these days, when population health — that is, the effort to improve the health of an entire demographic portion of our population — is receiving a great deal of attention in the medical profession.
I believe that that the best way to accomplish improved health outcomes will be by promoting preventive care, which largely will be shouldered by primary providers. In the long term, the attention, support and resources put toward access to care and continuity of care will be very well worth promoting the practical work that primary care physicians do every day. It will demonstrate the wisdom of the old saying, “an ounce of prevention is worth a pound of cure.”