Want to take control of your health in 2021? A good place to start is a visit with a primary care physician. In a 10-year study, researchers found that greater access to primary care was directly related to a longer life expectancy.
Patients who make regular visits with their primary care doctor are more likely to stay up-to-date on preventive care, and better manage chronic conditions like diabetes and hypertension.
“In the past the philosophy has been, ‘I’ll go see my doctor when I’m sick.’ And now we actually say, ‘We want you to see your doctor when you’re healthy to help keep you healthy, not wait for a problem,’” says Jonathan Fialkow, M.D., chief of cardiology at Miami Cardiac & Vascular Institute and chief population health officer for Baptist Health South Florida.
Dr. Fialkow hosted a Resource Live discussion on the essential role played by primary care doctors, with guests Kamaljit Kaur, M.D. and Maria L. Ordonez, M.D., both primary care physicians with Baptist Health South Florida. Highlights of their conversation are in the Q&A below.
Dr. Fialkow: “How has primary care adapted to continue caring for patients during the pandemic?”
Dr. Ordonez: “One of the big things is we’ve made the effort and the change to being able to see patients via telemedicine. So, they have the option of seeing us via video or even via phone.”
Dr. Fialkow: “In your experience, do the patients feel like they’ve accomplished a good medical evaluation with the provider?”
Dr. Ordonez: “I think patients really are satisfied and pleased that they can access telemedicine. The convenience of doing (visits), either in their home or their place of work, has been really great for them. We can even order labs and then they go do them in the lab, and we can send their medications to their pharmacy.”
Dr. Fialkow: “What are the kinds of visits that maybe wouldn’t be appropriate for telemedicine?”
Dr. Kaur: “As much as we want to do telemedicine — and not only for their convenience, but to help reduce risk of transmission and contracting the virus — there are times when we need to see them in person, such as if they’re having significant respiratory or cardiac complaints or even gastrointestinal symptoms, or sometimes even if they have a rash and unfortunately the video quality isn’t great. So instead of continuing the visit over telemedicine, bringing them into the office for a thorough evaluation is more appropriate.”
Dr. Fialkow: “Let’s talk about the importance of a primary care doctor relationship from a continuity of care standpoint. What do people get in that relationship that would be missed otherwise by using ad hoc (health services) like urgent cares?”
Dr. Kaur: “I think I can best describe it by referring to that old saying that the best treatment is prevention. Most of the conditions and problems that arise in health care are preventable either by simple means like a healthy diet, healthy exercise, routine blood tests and routine screenings. If we do those as indicated, then a lot of times we can prevent those diseases and those ad hoc visits to urgent care or to the emergency room, which sometimes not only are unnecessary, but can also be very expensive for the patient as well.”
Dr. Fialkow: “Can we talk about how when a patient trusts you and you know about that patient more than just the medical conditions, you can better make decisions for that person, better support any kind of medical issues that might come into play?”
Dr. Ordonez: “As primary care, we have the benefit of seeing them many times. I always like to say we’re working as a team, making decisions together. So not only catching their early symptoms, if we’re trying to prevent disease or detect disease early, but also getting to know them. Also, many of us see family members. So you also get to know their family structure, anxiety or stressors that they have at home, what they do for their jobs or exposures. Getting to know the patient as a whole really plays a big role in their health and for us to work as a team with them in their overall health.”
Dr. Fialkow: “Let’s talk about chronic disease management, things like diabetes and hypertension, and let’s also pull in COVID a little bit. There are a lot of reports that these chronic conditions make a person more likely to have a bad course if they contract COVID. Is this something that you’re bringing into your conversations with your patients?”
Dr. Kaur: “One of the first and foremost things that we like to advise our patients is that no matter what the chronic condition is, especially if you’re taking medications for it and you’re requiring routine blood work to monitor the stability of the condition, it’s important to make sure that it is well controlled so that if you do contract the coronavirus or even the flu virus, your system is optimized. It’s optimized and ready to fight that infection. We encourage our patients to please continue connecting with us. And as we mentioned, telemedicine is a great way to do it. It’s convenient. And we can do it as often as the patient likes and make sure that we’re both going in the right direction.”
Dr. Fialkow: “What should people know about the precautions taken to keep them protected in our facilities?”
Dr. Kaur: “We’ve taken every protocol set forth by the CDC and Florida Department of Health. At this point in time, nine months later, we’re pretty much pros at it. We have hand sanitizers almost every couple of feet. We have social distancing markers on the floor where patients can guide themselves as far as how to stand from each other. We have plexiglass in front of the reception areas. And then, once they come back into the clinical areas and the rooms, everybody has the appropriate PPE on. We do ask our patients to wear masks that we provide for them. They can certainly come to the office with their own masks, but we do also provide masks for them to wear while they’re in the facility.
“And all those protocols are being taken as well as screening questions as well so that we make sure that patients who, though we still want to care for them, but if they’re having symptoms of COVID or if they’ve been recently exposed then we can guide them to a more appropriate center for care.”
Dr. Fialkow: “How do you approach prevention and early detection with your patients?”
Dr. Ordonez: “We look at their ages and the different prevention testing and procedures that we do. But the big thing, we start with diet, exercise, lifestyle, how are they doing with stress, their overall picture. We take a good medical history, so their family history is important, what their parents have or if there’s any cancer, high blood pressure, diabetes in the family. Everybody gets their vitals taken, so we look at your blood pressure, your heart rate, your oxygen levels, so just baseline.
“We’re going to do basic blood tests. And so that helps guide us through talking about all the preventive things. Let’s say, when you’re getting closer to 50, do you need a colonoscopy? For females, always, the pap smear, mammograms, so all the preventive things that we can do proactively to keep you healthy.”
Dr. Kaur: “Another thing patients should understand is that medicine is dynamic. Guidelines change, recommendations change every few years. Patients need to be educated about that. And then of course, prevention is the best treatment. So, when we do these screening tests and diagnostics, we can pick up on disease hopefully in the early stages and treat it so it doesn’t progress.”
Dr. Fialkow: “As part of a regular primary care visit, as well as the relationship with the primary care doctor, can you talk about the importance of screening for various mental health issues?”
Dr. Ordonez: “As part of every visit, we do a screening for depression. It’s called the PHQ-2. It’s just two simple questions that they answer of how they’ve been feeling. And I think during this time, especially during COVID, we have seen a rise in anxiety, depression, a lot of people feeling lonely that they had to stay at home, a lot of stress and worry. So, I think a lot of people have allowed themselves during COVID to say, “You know, I need some help,” and that allows us to ask more questions and talk about different options. Can we do behavioral therapy? Can we do some changes at home with sleep and stressors? Are we going to talk about medication and get started with medication? Are we going to enlist the help of a psychiatrist or consultant? So, there are many things we can do.”