With the talk of health care reform, many people are talking about the role of the primary care physician in helping to keep people healthy. But what should you expect from your primary care doctor and how do you know if he or she is the right doctor for you? I'm Sharon Boston, and in this edition of Medically Speaking, we're speaking with Dr. Richard Colgan, a family medicine specialist at the University of Maryland Medical Center. Dr. Colgan is also an associate professor of Family and Community Medicine at the University of Maryland School of Medicine.
Q: Dr. Colgan, this may sound like a basic question, but who are we talking about when we say a primary care physician?
We're talking about general internists, family physicians, and general pediatricians.
Q: What has been the traditional role of the primary care physician and how has it changed over the years?
Taking care of the whole patient, cradle to grave, womb to tomb, over the years, particularly after World War II, the general practitioner has been further subdivided into the residency trained family physician, internist, and pediatrician.
Q: We've heard a lot about the decline of the number of doctors choosing primary care and that's putting a squeeze on the doctors who remain in the field. I think for patients, they're concerned that they just don't have enough time with their doctor. What do you tell them?
I tell them I'd rather have them mad at me for not dealing with all of their concerns today than have them mad at me for going too fast for them. In other words, some patients bring in long laundry lists of their concerns and even this week I had a patient who brought in a list of seven or eight items that she wanted to discuss, which was going to be challenging since we only had fifteen minutes on my schedule to do so. So, what we did together was to prioritize those things which are most important to her and then set up a game plan so that I would meet her several more times over the next couple of months and kind of map out where do we go from here and get some studies started so that I could address all of her issues.
Q: What qualities do you think should someone look for in a primary care doctor?
The old axiom of the three A's I think still holds true. Someone who's available, affable, and able. And to that list I'd add someone who's board-certified, kind, has your interests at heart, and is willing to work with you as a team effort.
Q: Do you find that patients these days are more informed, that they come to you with information they've researched?
Oh, absolutely. And, you know, it reminds of the advertisement by Sy Syms. I have no stock in their company, but the advertisement for Sy Syms says, “An educated consumer is our best customer.” And I love it when patients show responsibility for being informed. I'm their consultant, I'm their helper, but it's their body and it's their health.
Q: You are very involved in the training of young doctors. Besides being good diagnosticians, what other skills do you teach them and why are these important?
I try to teach medical students and residents the art of medicine as often as I can. I've written a book on this topic entitled Advice to the Young Physician on the Art of Medicine. The subtitle might be called Making the Transition from Technician to Healer. I think teaching young physicians and medical students the art of medicine is critically important today because it's evolved into a highly technical and scientific helping profession. Yet, high tech has to be coupled with high touch. In my book, Advice to the Young Physician, I reveal some of the greatest lessons on the art of medicine as taught by some of history's giants. I have chapters on ancient times, including the Greeks, Hippocrates, medieval physicians, highlighting Rhazes, Avicenna, and Maimonides, twentieth century greats Schweitzer, Osler, and Peabody, as well as some more modern masters, Woodward, Farmer, and Pellegrino. The book also has many other chapters looking at excellence in the physician-patient relationship and ends with a chapter called The Healer, as I think that is what all good physicians aspire to be.
Q: How can a patient recognize if his or her doctor has these qualities?
I think you start by asking your friends and ultimately spending time with the physician. You will quickly get the feeling whether or not this relationship will be a good one. And if you don't, you should find another doctor.
Q: How can patients make their visits more productive?
I think patients can make their visits more productive by being informed, by reading up on health matters. Specifically, don't smoke, don't overeat, get regular exercise, don't overconsume alcohol and don't expect unreasonable things from medicine. I think patients could benefit by trying to make their visit more productive by prioritizing their concerns, by being open-minded to coming back in again if the number of issues are large or potentially very serious so that more time is needed. It may be helpful to bring a family member so a second set of ears can hear what's going on and assist.
Q: Do you have any final advice for people who may be searching for a primary care doctor or thinking about switching to a new doctor?
Yes, I think if you ask your friends, who do they see, who do they enjoy seeing, who do they trust, it's a good start. You should consider meeting a few different doctors if you can. You may not get the right view of a doctor from just one visit, so if after one visit, you think this may not be the right person for you, you might consider allowing there to be another couple of visits to get a feel for the type of relationship you two might enjoy. If you're thinking about switching doctors, I would recommend thinking it over a little bit longer. Perhaps discuss with your doctor the areas of concern that you have with your relationship. For example, you might bring up a discussion, such as, “I find it hard to get a hold of you,” “You didn't call me back,” “Your hours are not compatible with my schedule.” So I think to have an open dialogue with your physician about what your expectations are and then bringing those to the attention of your doctor can be very helpful.