Today, let’s attempt to answer the age-old health care consumer question: Do I really need a primary care provider? Health care has changed so much, especially in the past two years. More and more retailers now offer health clinics inside their stores, so you can get your health care and your groceries in the same convienent location. With the COVID pandemic, we’ve seen the availability of virtual health care explode with on-line options available to seek care for both acute and chronic conditions. If you have a smart phone and a credit card, health care is just a few clicks away without leaving the comfort of your own home.

With all these options, having a primary care provider seems like an unnecessary extravagance, kind of like getting sprinkles on a hot fudge sundae. But health care can get incredibly complicated, and sometimes it helps to have someone to turn to who knows you and knows your health. Maybe not so much when you’re young, but chronic medical conditions can sneak up on us, especially past the age of 40. Make no mistake, retail clinics and virtual care will fill some of your health needs, but (to paraphrase the Beetles) will they still need you, will they still keep you well, when you’re 64? 

So how complicated can health care be?  To answer the question, let’s look at some representative health care numbers: 86; 72,752; 20,000 and 87

86. The number of currently published preventive health recommendations from the U.S. Preventive Services Task Force (USPSTF). This is the go-to organization for primary care providers that gives recommendations for which preventive health services are appropriate for patients and at what age. The USPSTF not only tells us what we should be doing to keep our patients healthy, they also tell us what we should not be doing, because doing something that doesn’t keep you healthy is just a waste of time and money. Their recommendations cover age ranges from adolescents to seniors, across 12 different health categories and are regularly updated as the medical evidence changes. A provider who knows you, your medical history and your family history can accurately apply these guidelines to ensure you’re receiving preventive services appropriate for you. Providers that don’t know you and don’t have access to your medical information won’t perform as well in their efforts at keeping you healthy.   

72,752. The number of medical conditions currently detailed in the 10th version of the International Classification of Diseases diagnostic code set (ICD-10). ICD-10 codes are what providers use to document your medical conditions to insurance companies so they can get paid for taking care of you. The point is, with over 72,000 potential medical conditions in the world, there are a lot of things that could go wrong with us. Fortunately, many of these conditions are not sudden; they come with warning signs. Unfortunately, the warning signs may not be signs that we can pick up on our own (like a new heart murmur or a lump in the abdomen). Regular visits with a primary care provider improve our odds of catching a warning sign early before it becomes big trouble. Virtual care can never pick up a heart murmur or lump in the abdomen.  

20,000. According to the Food and Drug Administration, this is the number of prescription drugs approved for marketing in the U.S. Of course, this number pales in comparison to the 300,000 over the counter drugs available in the U.S. The older we get, the better the odds we will be taking medications for something. Eventually, those chronic conditions multiply and so do the medications needed to treat them. And as the medications multiply, so do the chances of those medications interacting with each other, what we call drug-drug interactions. The experts tell us that if you take eight or more medications daily (which includes those over the counter medications), there is nearly a 100% chance that you will have a drug-drug interaction. And in some instances, the side effects from the drug-drug interactions can become worse than the disease the medications were originally supposed to be treating. A provider who isn’t familiar with you and your medical history, might misinterpret the drug-drug interactions as a separate, new condition and prescribe another medication to treat it—likely resulting in more interactions and more side effects. 

87.  The number of subspecialty categories recognized by the American Board of Medical Specialties (ABMS). The ABMS is the organization that oversees the board certification process for physicians, developing mechanisms to ensure that physicians can actually do what they’ve been trained to do. But unfortunately, the ABMS doesn’t uncomplicate the process for referring yourself to a specialist. There are 24 specialty categories, areas like cardiology, pulmonology and gastroenterology. But within each of those specialty areas, there are those 87 subspecialty areas.  So, in the above example of a new heart murmur, you decide to have it further evaluated. Do you need a cardiac imaging subspecialist or a heart valve subspecialist or an interventional cardiology subspecialist? Or do you need a cardiologist at all? A primary care provider who knows you and knows your medical history and has taken the time to review your symptoms can in many instances order a simple test to sort out the next best course of action.

Don’t underestimate the value gained from regular health care visits with a primary care provider over an extended period of time (what we call continuity of care). The knowledge gained from continuity of care is what allows a primary care provider to offer you better options for your health care; options that have a better chance of keeping you healthy way past the age of 64.  And really, admit it, familiairity makes you feel better, just like the theme song from Cheers: …sometimes you want to go where everybody knows your name and they’re always glad you came…

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