Choosing a primary care provider
Alternative names:
doctor - how to choose a family doctor; family doctor - how to choose one; primary care provider - how to choose one
Information:
Choosing a primary health care provider requires a good understanding of the various health care professions and their respective scopes of practice. It is important for one to have a "primary care provider" to collaborate with in identifying and addressing comprehensive health care needs. "Primary care" represents the first level into the health care system. It encompasses preventive care, health maintenance, identification and management of common conditions, and coordination of consultations and referrals. Primary care is provided in outpatient or ambulatory care settings, but the scope of the "primary care provider" may extend into the hospital setting.
Having a primary care provider allows one to establish a trusting relationship with the provider over time, maintain continuity in personal health care, and move from crisis-oriented or acute health care towards preventive care and health promotion and maintenance activities. Understanding the various types of primary care providers is only a start in choosing a provider. Many insurance plans either limit the provider selection or provide financial incentives for clients to seek care from a select list of providers. The consumer must know if such conditions apply.
Until the 1960s, Doctors of Medicine or Osteopathy (M.D.s or D.O.s) were usually the only primary care providers recognized within the orthodox health care system. These "primary care doctors" include general practitioners, family practice specialists, pediatricians (specialists in children, birth through adolescence), and internists (internal medicine specialists serving the adult population, especially those with multiple medical problems). Physicians who are OB/GYN (obstetrics and gynecology) specialists are frequently considered primary care providers. This is because many women do not have any other provider and see their gynecologists initially for whatever health care problems they may encounter. Many people typically think of doctors when considering health care providers. Throughout the twentieth century, doctors have been the "gold standard" in American health care, against which all other providers are compared. This is exemplified by terms (such as, "nonphysician provider" or "alternative provider") that are used to describe other providers.
With advances in medical research, knowledge, and technology, the roles for most physicians have moved from that of a generalist to that of a specialist. Since a single person cannot absorb, synthesize, maintain, and use the vast health information data base, many physicians choose a specific area of interest (specialty or subspecialty area) in which to master knowledge and practice.
During the mid-to-late 1960s (with the prediction of a shortage of primary care physicians), two new professions entered the ranks of primary health care: nurse practitioners (NPs) and physician assistants (PAs). Despite distinct differences in preparation, licensure, certification, and scopes of independent practice, NPs and PAs are frequently grouped together and referred to as "mid-level providers," "nonphysician providers," or "physician extenders." "Alternative" or "nontraditional providers" (used for chiropractors, naturopathic practitioners, acupuncturists, medicine men, and other providers) are also terms frequently used to denote NPs and/or PAs. Nurse practitioners and physician assistants have documented exceptional abilities to provide competent, cost-effective primary care for 75 to 88% of patient visits in a primary care setting, plus a high degree of patient acceptance and satisfaction. In fact, many health care consumers choose a nurse practitioner or a physician assistant as their primary care provider.
A 1986 study conducted by the Congressional Office of Technology Assessment (OTA) concluded that care (provided within their respective areas of expertise) by nurse practitioners, physician assistants, and certified nurse midwives* is equivalent to the care provided by physicians for the same conditions. The OTA study reported additional findings that NPs and CNMs were found to be "more adept than physicians" in the areas of preventive care and patient communication. The OTA study also reported evidence that PAs were "more adept than physicians" in the areas of supportive care and health promotion. NPs, PAs, and CNMs all consult with or refer to physicians as needed for problems encountered outside their scopes of practice.
*Similar to the manner in which OB/GYNs are sometimes considered primary care providers, certified nurse midwives (CNMs) may be the only providers that some women see on a routine basis.
Finally, choosing the optimal person or group from which to receive health care requires even further information gathereing. You may consider perceived traits such as philosophy of care (disease-oriented vs. wellness-oriented), therapeutic approaches (conservative vs. aggressive), competency, availability, "style" or communication patterns (informal, warm vs. formal, detached), and degree of inviting client involvement attributed to a specific provider. Such provider descriptions may be requested from friends, neighbors, or relatives (particularly those linked to the health care system); previous provider(s); state level professional organizations (such as, state medical associations, state nursing associations, state associations for physician assistants); and other health care professionals (such as, dentist, pharmacist, optometrist). If you or a dependent have specialized health care needs for a specific chronic condition or disability, advocate groups may be a good source of information regarding providers adept at managing such unique concerns. Another option for the consumer is to request an appointment to "interview" potential providers. This technique allows the consumer to ask specific questions related to expectations of both parties for coordination and management of personal health care. Some providers offer this type of "interview" at no cost to potential clients.
In the event that one does not have a primary health care provider and an acute health care concern arises, it is usually best to seek nonemergency care from an "urgent care center" rather than a hospital emergency room. Such centers offer care from appropriate providers at much less expense than one will incur in an emergency room. In recent years, many emergency rooms have expanded their services to include reasonably priced urgent care within the emergency room setting or an adjoining area.
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The information provided herein should not be used for diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Copyright 2000 adam.com, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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