Ellen Beth Levitt: Welcome to Maryland Health Today. I'm Ellen Beth Levitt. On the show today we'll discuss the role of primary care physicians and what you can do as a patient to make the most of your visit to the doctor. We'll also go into some of the most common infections primary care doctors treat. My guest is Dr. Richard Colgan. He’s a family medicine specialist at the University of Maryland Medical Center and also an associate professor of family and community medicine at the University of Maryland School of Medicine. Welcome to the show.
Richard Colgan, M.D.: Thanks, Ellen Beth.
Ellen Beth Levitt: First of all, could you tell us what a family medicine specialist is?
Richard Colgan, M.D.: Yes. A family medicine specialist is a physician who has been trained in the specialty of family medicine, typically nowadays it is a three-year residency after a medical school training program.
Ellen Beth Levitt: Is it a board certified specialty?
Richard Colgan, M.D.: It is. It is board certified, so all family medicine specialists you would see today would typically be somebody who has gone through a residency program and board certification. There was an article by john mcfee in the New Yorker, I believe entitled “heirs of family practice.”
Ellen Beth Levitt: Heir?
Richard Colgan, M.D.: Right.
Ellen Beth Levitt: How is family medicine different from internal medicine or if somebody's a general practitioner?
Richard Colgan, M.D.: That is a great question. We get asked that all the time. A family physician specialist is somebody who is trained in breadth. We take care of those between zero years of age and 100 or 110. We aren't bound by someone's gender. We see men and women, of course, children, boys and girls. Newborns, the elderly.
Ellen Beth Levitt: Children as well?
Richard Colgan, M.D.: Children as well, of course. Absolutely and we do other things as well. Some family physicians, such as those in our department through the years deliver babies, practice low risk obstetrics. Some physicians in our departments have other competence says or other qualifications, such as sports medicine, addictions medicine, behavioral medicine and the like of the for the most part I would look upon us as general practitioners who have extra training in general practice.
Ellen Beth Levitt: You love variety?
Richard Colgan, M.D.: Love variety. You have to in family medicine.
Ellen Beth Levitt: That enables you to for people in able stages of their life?
Richard Colgan, M.D.: Absolutely.
Ellen Beth Levitt: Do you really get to know families in that way?
Richard Colgan, M.D.: I think that is the idea of getting to know somebody, seeing somebody when they are well so they can better able help them when they are sick.
Ellen Beth Levitt: Is it important to have a relationship with the family doctor?
Richard Colgan, M.D.: Absolutely. It is ideal to get to know your doctor. To get to know that person when you are well, so that, god forbid, but should you get sick, if you'll have somebody aware of you and knows your history and background and can help you best.
There are people who don't have insurance, maybe they have lost a job or lose their insurance. Is it still important to keep connected with a primary care fiscal even if you are well? I can't right. It is very important. I was just hearing today about the patients going into emergency rooms for primary care. It is a very sad statement of the times, but a lot of patients don't have insurance, don't have health coverage. But i would urge those people who don't have insurance or health coverage to somehow get to know a primary care physician. Many practices throughout the state offer sliding scale fee schedules family doctors other doctors have been doing that for decades. Some communities have an outreach clinic or center where they can go and get care for little to no dollars.
Ellen Beth Levitt: That is important then to do that. How often should you see the primary care physician, if things are going well?
Richard Colgan, M.D.: That question comes up a lot to. First you should see them if you are sick and not feeling well. But then the question comes up when should you go otherwise? Well, for children it's easy. Typically those visits are scheduled around the time of immunization. As you get older, how often do you have to go to be seen in it is not as easily answered. Certainly women the answer is yearly for your pap, well woman exam. I would say that the idea of getting an annual physical is pretty much not being done as much any more. More important is a periodic health checkup. It is what i would refer to as the ideal time to see your doc. When would that be? If someone is over 50, I think it is pretty clear you should be getting a periodic health checkup every year or so. It is not rigid. But you want to see your physician periodically, so you can assess too, what should be done at my age? Now i hear mammograms should be done on a yearly basis. You'll likely need to go a request from that for your doctor.
Ellen Beth Levitt: Having your blood pressure checked, cholesterol level.
Richard Colgan, M.D.: Exactly.
Ellen Beth Levitt: If you have gained a lot of weight or whatever?
Richard Colgan, M.D.: Exactly.
Ellen Beth Levitt: To see if you are at risk of diabetes.
Richard Colgan, M.D.: Exactly.
Ellen Beth Levitt: I suppose if someone is seeing a specialist you as a family medicine doctor or primary care doctor, you would like your patient to let you know if you are being treated by a specialist for something that you are not aware of? Or if they suddenly get admitted to a hospital?
Richard Colgan, M.D.: Right. Even better yet. You would like to know first and communicate with the specialist ‘hey, i understand you are going to be seeing my patient. Let me tell you about her, give you some background.’ ideally you would not to hear secondly from the specialist. Typically someone visits their family doctor and says i have a certain problem and family medicine we can take care of 90 odd percent of what ails you. But we don't place stents, we don't do chemotherapy. That is when i want to see a patient and i could coordinate the care and work together as a team.
Ellen Beth Levitt: Are infections something that you feel you are seeing a lot inpatients? Is that one of the big reasons why somebody would come to their primary care doctor?
Richard Colgan, M.D.: Absolutely. It is common for somebody to make an acute care visit. Up to 40% of visits to a family physician for acute care. I would say that outpatient infections, respiratory or otherwise, are on the top of that list.
Ellen Beth Levitt: Are upper respiratory infections pretty common?
Richard Colgan, M.D.: Very common. They are the most common reason why a patient will be prescribed an antibiotic in the united states. And i think conversely, they are the most common reason why a patient may be misprescribed an antibiotic in the united states. Antimicrobial prescribing is commonly done for respiratory tract infections.
Ellen Beth Levitt: And it is up to the doctor to help the patient realize that what they might have is a virus, versus a bacterial infection. Of course antibiotics don't help with viruses.
Richard Colgan, M.D.: That's right.
Ellen Beth Levitt: What are the symptoms of upper respiratory tract infections?
Richard Colgan, M.D.: Upper respiratory tract infections are sinusitis or bacterial colds. They could be chest cold or viral infection of the chest, bacterial infection of the lower respiratory tract, community-acquired pneumonia would be an upper respiratory tract infection as well. Sore throat, infection of the upper airways would be a respiratory tract infection.
Ellen Beth Levitt: What about influenza or the flu? How are concerns different for the flu?
Richard Colgan, M.D.: It is not coming up as commonly now because we are kind of getting out of flu season. But flu is different. If anybody has had it they'll tell you that was a lot worse than any cold I have had. Typically, what you'll see is patients complaining of cough, headache, they may typically have back ache. But what I find, often with flu, and what is commonly described is intense muscle pain. I have a couple of questions I'll ask patients who i think may be suffering from the flu. And the questions are do you feel like you have been hit by a truck? Usually the response I get first is their eyes grow wide and they are thinking how did you know? Or I'll ask my patients do you feel like you are going to die? And they said how did you know I feel that badly? Another characteristic complaint of somebody who has flu, because it is a viral infection that affects muscles, they are achy all over. Sometimes patients will tell you, if you ask, that if you avert your eyes to the left or the right quickly it actually hurts to move your eyes to the left or right and that is because the virus is in the muscles of the eyes. So it is different. Another thing it is not unusual to get a very high fever. A fever of 103, 104, on top of cough, aches and pains, back ache, headache, that is pretty typical of a respiratory tract flu infection.
Ellen Beth Levitt: I guess these symptoms of the flu are similar whether you have regular seasonal flu or the h1n1 flu, the so-called swine flu people have talked about?
Richard Colgan, M.D.: Exactly.
Ellen Beth Levitt: The symptoms are pretty much the same?
Richard Colgan, M.D.: Exactly. If you are suffering from intense body aches, high fever, coughs, those things could be seen with any type of flu, including the h1n1 we are seeing now.
Ellen Beth Levitt: How does the flu spread from one person to another?
Richard Colgan, M.D.: Typically by aerosol droplet. So a cough, a sneeze, also by contact. You know, perhaps touching somebody's hand who has been coughing himself. But it's respiratory spread is typical.
Ellen Beth Levitt: So with someone who is ill, sneezes or coughs these little droplets we don't really see get released in the air and someone he else can breathe them in?
Richard Colgan, M.D.: Exactly. Step back a good three to six feet.
Ellen Beth Levitt: Also I understand that flu viruses can live on surfaces for several hours. So if somebody blew their nose and put their tissue down on a table or touched a doorknob and then you come along, then you could also contract it that way if you put your hand in your mouth or eye or nose?
Richard Colgan, M.D.: It is a good idea to wash your hands frequently.
Ellen Beth Levitt: Right.
Richard Colgan, M.D.: To be careful what you are touching. That should help you.
Ellen Beth Levitt: You talked about antibiotics.
Richard Colgan, M.D.: Uh-huh.
Ellen Beth Levitt: Do you find a lot of people, even if they have a viral infection, they still want to get antibiotics? Or are there some people for whom you recommend antibiotics who could go on and get a bacterial problem like pneumonia, for example?
Richard Colgan, M.D.: I want to make sure I get both parts. It's difficult oftentimes to identify who, when they have a respiratory tract infection is actually suffering from one.
Ellen Beth Levitt: Sure.
Richard Colgan, M.D.: An older person with chronic bronchitis, if that person is a big time smoker, last year they were in the intensive care unit, on a respirator, we know that if that person describes a cough that is recently increased sputum volume or that junk they cough up. Or they describe increased sputum, the nature of the sputum has changed -f somebody were to tell me those three simple to understand, there is an 80% likelihood that person is suffering from a bacterial examination probation of chronic bronchitis. Another example is a sore throat. If someone is of school age, winner months, they have a sore throat, white in the back of their tonsils, tender lymph glands, known strep contact, these are things i would add up on a strop score card. The likely hood of it being bacterial is higher. A patient with bacterial or strep pharyngitis, they would be great candidates for antibiotic theory. I wouldn't prescribe antibiotics for somebody in hopes of preventing a bacterial infection. That comes up a lot. That comes when they have been sick for two days and they believe an antibiotic would help them not get worse later. Typically with a head cold, that plays out over five, seven, maybe even ten days. I won't prescribe an antibiotic in that situation because i know it won't help them.
Ellen Beth Levitt: But if they get worse, they should let you know.
Richard Colgan, M.D.: If they develop right cheek pain, or their teeth are hurting on the right side, a high fever, infection is getting dramatically worse, i might consider treating them with an antibiotic.
Ellen Beth Levitt: Urinary tract infections are also very common. I know that is sort of a special interest of yours?
Richard Colgan, M.D.: It is.
Ellen Beth Levitt: What are some of the things you think people should know? I guess they affect women, mostly?
Richard Colgan, M.D.: A lot of things i could talk for a long time but i won't. I think they are a quick win. A woman can identify when she has a urinary tract infection with very high predictability.
Ellen Beth Levitt: What are the symptoms?
Richard Colgan, M.D.: The symptoms would be urinary frequency. I have to go to the bathroom a lot. Frequency. Burning or discomfort with urination. If someone has a higher infection such as up to their kidneys, they may have low back pain. They may have fever. It is not unusual for a woman with a urinary tract infection to have discomfort around the area of her bladder.
Ellen Beth Levitt: It sounds like something the person should talk to their doctor right away?
Richard Colgan, M.D.: I think so. I did a study at the University of Maryland looking at symptoms of urinary tract infections and the burden, and we found on average, it takes about a week, seven days from when the woman first starts noticing simple to understand to when she is seen by a physician. So women are suffering in silence.
Ellen Beth Levitt: Are they delaying? Or they can't get an appointment?
Richard Colgan, M.D.: That is a great question. Probably several days of wondering should I go? Should I go? I think it is not unusual for someone to say I want to be seen Monday morning and they are put off. We do know it is about seven days from when a woman notices symptoms to when she is finally seen by her doctor.
Ellen Beth Levitt: Can this be treated?
Richard Colgan, M.D.: The woman knows and she is usually accurate. She says I have got burning with urination she is 50% right. So if I were to see someone like that, I would do a very focused exam in the office and we would typically do urine dip stick testing a urinalysis with an automated machine and there can be confirmatory evidence on that dip stick test. Within really a shore course of time 10, 12 minutes of just sitting down and talking with a woman in the office, you can know exactly what she has, what she is suffering from and you know that this condition is typically bacterial.
Ellen Beth Levitt: Do these medicines usually work right away?
Richard Colgan, M.D.: Yes. That was another study we did which showed that on average upon receipt of antibiotics most women will feel better in 36 hours. Is a great situation to have. So often in medicine, we are seeing patients for whom there is little we can do and the old saying is for care always to cure rarely. But to make better often. With urinary tract infections, it is a great deal in 36 hours time your patient will likely be better.
Ellen Beth Levitt: We have to take a break.
Richard Colgan, M.D.: Okay.
Ellen Beth Levitt: But when we come back, we'll talk about what to consider when choosing a primary care doctor and whether you really need an annual physical. So stay with us. We'll be right back.
Ellen Beth Levitt: Welcome back to Maryland Health Today. I’m Ellen Beth Levitt. My guest is Dr. Richard Colgan. He’s a family medicine specialist at the university of Maryland medical center and also an associate professor of family and community medicine at the University of Maryland School of medicine. How often should adults get an annual checkup? Is that recommended these days?
Richard Colgan, M.D.: I think if someone's over 50 years of age it makes sense to go in and be seen at least yearly. Get your blood pressure checked and weight checked and be sure you are up to date on health maintenance issues such a colonoscopy and mammograms and the like.
Ellen Beth Levitt: What are some of the things you are trying to find out from a medical history?
Richard Colgan, M.D.: I think you like to know what past medical history they had. Previous surgeries, previous operations, injuries, what medicines are they currently taking? Are they allergic to any medications? If they have a complaint, when does it begin? What is the nature of the complaint? How long has it been going on for? Typical questions.
Ellen Beth Levitt: Are you also interested in whether they are taking vitamins and herbal supplements?
Richard Colgan, M.D.: Sometimes. If they are taking vitamin and herbal supplements it may be important information if someone were suffering from a certain complaint. Taking something and were suffering from palpitations or taking supplements that could help explain their complaint. Most doctors are not getting into it that much, probably because it is not regulated by the FDA and we are trained in medicinals, but it is becoming more popular and more important to ask.
Ellen Beth Levitt: Do you find sometimes patients are embarrassed to talk about some of their symptoms?
Richard Colgan, M.D.: Yeah. I had a lady I saw yesterday who told me she was quite frankly embarrassed to talk to me about her urinary tract infection and it was income table for her to urinate. Patients can vary and feel comfortable or uncomfortable with their fiscal. Surgery if they are the opposite gender and talking about something sensitive and private.
Ellen Beth Levitt: I guess we should get over that, right?
Ellen Beth Levitt: Or try, anyway.
Richard Colgan, M.D.: Try, anyway.
Ellen Beth Levitt: What are some of the qualities we should look for when we are trying to choose a primary care doctor?
Richard Colgan, M.D.: Patients typically pick a primary care physicians based upon someone who is affable, available, and able. I think that rule of thumb is still pretty good. I would advocate for somebody board certified and somebody who you can have a dialog with and feel like you can have a good relationship with and get along with that you respect this person and would like to have this person be your helper when you are not doing well.
Ellen Beth Levitt: I know you are involved in training residents as well as medical students. What are some of the qualities you try to instill in them?
Richard Colgan, M.D.: It is a great question. Not just myself but the University of Maryland School of Medicine and all the residency programs in the hospital I know are very much want to go make sure that our residents and our students have the characteristics of a superb clinician. One thing I mentioned I asked the students this regularly. Do they know what university of Maryland graduates are known for around the country? They are known for being superb clinicians. Great clinicians.
Ellen Beth Levitt: Does that mean they are able to diagnose things very accurately? Or are there also some human qualities that go along with being a great doctor?
Richard Colgan, M.D.: I think the two go hand in hand. It has been said medicine is an art based upon a science. Certainly we want them to learn the science very well but without knowing the art it done make for very good relationship between a fiscal and a patient.
Ellen Beth Levitt: And you are writing a book, is that right?
Richard Colgan, M.D.: I am.
Ellen Beth Levitt: What is it about?
Richard Colgan, M.D.: It is advice for a young physician. It will be published by Springer this holiday season. And the subtitle is making the transition from technician to healer. It is about the art of medicine as taught by some of the greatest physician teachers through the ages over the past 4000 years what type of lessons did they have to teach us or teach our students and residents and young physicians about the art of medicine? And how to get the most out of the physician/patient relationship.
Ellen Beth Levitt: Has that changed in recent years? Do you think medicine has changed and you need to get back to some of these qualities?
Richard Colgan, M.D.: Well, I think we were seeing greater technology for sure. We have got cloning and bone marrow transplant and stem cells and shock trauma and all kinds of high-tech. I'm not saying the high touch has been lost or dismissed but it's still very important and I think any of us who have been around for awhile have seen medicine change in the last if you years. It certainly has. Patients as a group would say their doctor, somebody who done pay attention, generally speaking when asked what about and you your doctor? I have a good one. When polled patients typically say doctors in general or medicine in general I happen to be one of the good ones.
Ellen Beth Levitt: That is interesting. It is good that people are happy with their own personal physicians.
Richard Colgan, M.D.: I believe they are.
Ellen Beth Levitt: Do you find that patients are better informed these days when they come to see you, do they bring information from like the internet or other places?
Richard Colgan, M.D.: Absolutely. I saw somebody this past week as well who was not, did not have higher education. This person had a sore throat and she asked me questions about strep, and she went to search on the web about more information about her ailment before she saw me.
Ellen Beth Levitt: I guess it is good as long as people are going to trusted sites on the internet.
Richard Colgan, M.D.: Yes I’m not sure which ones those are. An educated consumer is the best customer. I love it when patients have done their homework so they can better understand what they have.
Ellen Beth Levitt: Because people do need to be their own advocate right?
Richard Colgan, M.D.: Absolutely. We are consultants. Really a patient is their own best doctor. I think amongst other things is to educate our patient as to how they can best help themselves.
Ellen Beth Levitt: I guess sometimes medicine can be kind of fragmented. That is why it is so important to have a primary care doctor to pull everything together for you, is that true?
Richard Colgan, M.D.: Absolutely I like to think that is what we do best is help our patients navigate through the maze. If somebody comes into our office with a complex problem the need thing to do we do in the department of family medicine and the other good primary care testimony is his help to get that person to the place of ultimate rescue. If it is something you can't do yourself in your office, at least we can get somebody to be admitted to directly to university get in to see one of our good cardiologists or whomever if that was what they need.
Ellen Beth Levitt: I wanted to ask you on a couple of tips on how we should stay healthy? What are some of things to enable us to stay healthy as we age?
Richard Colgan, M.D.: Diet, exercise, certainly avoiding tobacco, not drinking to excess, keeping your weight down. I think keeping a positive frame of mind are all very important.
Ellen Beth Levitt: Right. And keeping check on your blood pressure?
Richard Colgan, M.D.: Absolutely.
Ellen Beth Levitt: And your weight and so forth?
Richard Colgan, M.D.: Very important.
Ellen Beth Levitt: Any other advice that you might have for people out there who really want to stay healthy?
Richard Colgan, M.D.: I think first a desire to stay healthy and who doesn't want to stay healthy and develop a relationship with your primary care fiscal and together form a nice plan so you can proceed forward.
Ellen Beth Levitt: Thank you so much.
Richard Colgan, M.D.: My pleasure.
Ellen Beth Levitt: My guest has been Dr. Richard Colgan. He’s a family medicine specialist at the University of Maryland Medical Center and he is also an associate professor of family and community medicine at the University of Maryland School of medicine. If you have any comments or questions about this program, please send me an e-mail. That address is eblevitt@umm.edu. Again take good care of yourself and we'll see you next time for Maryland Health Today.
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