What is a Primary-Care Physician Anyway?

While everyone speaks of primary-care physicians (PCPs), few truly understand what we do. Many think a PCP is just a source of referrals to go see specialists. Many patients are often surprised at procedures and diseases I can treat because they didn't know PCPs did those tasks. Others think we are just there for routine things like colds and sore throats, but that couldn't be further from the truth.

On one hospital website, it states the role of PCPs is to treat routine and non-urgent conditions. While we are not equipped like an emergency room, we are quite capable of handling emergencies that walk in to or arise in our office.  In my practice, I have seen patients with acute myocardial infractions, patients who suddenly stopped breathing, patients who had syncope in the parking lot and even one who walked in carrying his finger that he accidentally cut off. While these conditions probably do not belong in my office, PCPs are trained to handle emergencies and stabilize patients until the EMTs arrive.

So, what is the scope of practice of PCPs?

-PREVENTION: As PCPs, we like to prevent diseases before they start. Sure, others may be more capable of handling medical catastrophes, but we work hard to stop them before they happen. PCPs do a whole gamut of cancer screening tests, such as PAP smears, prostate cancer screenings, and mammograms and colorectal cancer screening tests. If there is a test to screen for cancer, we do it. Vaccines are another big prevention tool we utilize. We don't do it because we like sticking people with needles or taking their money (there is little profit in vaccines despite what others may claim). We do it to prevent deadly and devastating infectious diseases.

-EARLY DISEASE DETECTION: If we are not able to prevent a disease, then we like to diagnose it at its earliest stages. This is the reasoning for doing most of those cancer screenings mentioned above. A mammogram, for example, is not going to prevent breast cancer but it helps diagnose it at the earliest possible stage when it has a much greater chance of being cured. This doesn't just apply for cancer detection but to other chronic disease such as diabetes, hypertension, and heart disease as well.  If we detect "pre-diabetes," we work hard with patients to stop its progression to full-blown diabetes. This may be just diet and exercise advice but can also include medications. When we see high cholesterol levels, we don't just treat them so a patient has good numbers but to prevent its progression to other diseases, such as heart disease and other vascular diseases.

-DIAGNOSIS:  PCPs need to be able to diagnose the whole range of diseases. I may not be able to cardiovert an irregular heart rhythm, but chances are that I was the one who diagnosed it.  PCPs are not just sitting in our offices deciding which specialists we need to send patients to, we need to make the diagnosis to know which specialist is the right one. Chest pain is not always cardiac but can be gastrointestinal and headaches may not always be neurological but can be ophthalmologic. Sometimes, we can't make the diagnosis but when the patient sees the specialists, they have had all the preliminary testing done making it easier for the specialist.

-DISEASE MANAGEMENT: We treat and manage many chronic diseases; just about any that you can name. For most chronic diseases, the PCP is qualified to manage it. I refer out when those diseases start to become uncontrolled, when I am not sure what is going on, or when the patient needs more specialized care (such as cardiac cath) than I am able to provide. No, we are not just there to refill all the medication prescribed by the specialists. Unless the specialist informs me why they prescribed something, I may not know as well as what is the long-term plan for that medication.

-PHYSICALS: PCPs do a whole host of physicals and wellness exams. And we complete the paperwork that goes with it. We do not complete the paperwork without doing the exam as many people request. 

-CARE PLAN OVERSIGHT: As PCPs, one of our tasks is to oversee all the care a patient is receiving from others, from specialists to visiting nurses. However, this is often not such an easy task without receiving records from those others. We do request all of it, and as such, a PCP's records are probably one of the completest records on a patient. 

-END OF LIFE CARE: Another role of the PCP is to discuss end-of-life issues with patients. We should know their wishes in case they are ever incapacitated and should encourage them to sign or living will and/or assign a health care proxy. This should be done when patients are healthy, not at the end of life.

-PROCEDURES: We also do many procedures but this is often physician specific. We can drain abscesses and do minor skin surgeries. As a family doctor, I pretty much do cradle to grave medicine, not in the same patient. I also do many gynecologic procedures (PAP smears, IUD insertions), which I know some of my colleagues do not. Some PCPs deliver babies whereas I do not.

The role of the PCP is not an easy one and it is often underestimated. PCPs are the hub of healthcare these days and need to be constantly current. While we may not have the most respect or greatest pay, without us the healthcare wheel would not continue to spin.