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Featured Stories

The Bridge To Better Health Starts With Primary Care

Written by  Jeanne Chitty and Stephen McClintic Jr.

Know Your Care - Understanding your health and how to maintain it. An apple a day keeps the doctor away. This age-old proverb certainly carries its share of credibility. It’s spawned several studies by researchers about the health benefits of apples. People around the world live by it by keeping their crispers crammed with the tasty treat. No doubt about it, loyalty to the apple is long lived because this proverb professes how good it is for us.

Know what else is good for us? Going to a primary care doctor. Not keeping him or her away.

Yes, doctors can help heal us when we’re sick. But they can also help us stay healthy. Empower us with preparedness. Beat the bugs that can bother us before they have a chance to do so. Primary care doctors promise to be our health’s greatest advocate. Our partner in prevention. Our companion in care.

OurHealth Southwest Virginia is pleased to introduce a year-long series focusing on the role of primary care. In each edition throughout 2016, we will take a detailed look into the specialty, providing facts that further expand on some of what we may already know and much about what we may not. We will deliver insight from local doctors and providers. We will share personal stories of people living in our communities. We will confirm what is correct. We will dispel what is not.

Our commitment to you, our readers in the Charlottesville and Shenandoah Valley communities, is this: we will help close the gap between your knowledge and desire to learn more about primary care with the hope that you and your loved ones can cross the bridge toward a healthier life.

ANGIE'S LESSON ON TEH IMPORTANCE OF PRIMARY CARE

'I'm not going to the doctor unless I'm sick.' That was Angie’s way of thinking. And why not? From the looks of her, she was more than the picture of good health – she was poster child. A weekend and WEEKDAY warrior. We’re talking twenty miles at the track every morning before most people tap the snooze button. Daily diet? Dynamite. Body fat? Best it could be. Aches and pains? Free and clear. Sneezes and sniffles? Forget about it.  

It’s safe to say that Angie was fanatical about staying fit. She felt fantastic. Looked fantastic. Her formula was fool proof. This lady was in control of her life and she knew it.

Fast forward four months. Angie still looks and feels as fabulous as ever. But her life has a taken a different direction. It all started over the course of a couple of weeks this past October.

“All of a sudden, I was just completely and utterly exhausted, so much so that I could hardly keep my eyes open on the drive home from work,” says Angie. “I found myself falling asleep at 7 in the evening and waking up at 5 in the morning, and I would still feel like I hadn’t slept for days.”  

Angie’s lethargy lingered on for days. Next came nausea, followed by the start of a sore throat. While she hated to admit it, Angie says she felt like it was the flu.

“I hadn’t been sick since sixth grade,” Angie shouts.

She consulted her best friend, Evan, a nurse, to get some care advice. He told her to do exactly what she already knew.

“Well, I always believed you only go to the doctor when you’re sick,” says Angie. “I couldn’t argue with myself, I supposed.”

Evan helped Angie get an appointment the next day with the doctor he works for in Blacksburg.

“Evan had been on me for years to get a check-up,” says Angie. “I think he was a little excited I was sick so that I would finally go!”

So at age 28, and for the first time since middle school, Angie walked through the doors of a doctor’s office.

Following a thorough physical exam, complete with a battery of blood tests, Angie learned that being pregnant was the culprit of her constant tiredness.

“Ecstatic, overjoyed and still tired,” is how Angie says she felt after finding out her good news. “Honestly, after I got to the doctor’s office, it kind of crossed my mind that I might be pregnant. My husband and I had been trying to start a family. I wasn’t completely surprised, but I was super excited!”

She learned something else, however that did completely surprise her.

“My lab results came back showing that my cholesterol was through the roof,” she says. “At first, I thought it must have been a mistake. I mean, how could I have high cholesterol? I did everything the right way.”

Turns out that some things are out of our control. Even if you’re a super woman like Angie.

Additional testing revealed that Angie has a condition called familial hypercholesterolemia, an inherited genetic abnormality that can raise cholesterol levels despite maintaining a carefully managed diet and ample exercise. Left untreated, it can lead to serious heart disease and even death. Familial hypercholesterolemia affects about one in 500 people and is considered the most common type of inherited high cholesterol. It is treated with lifestyle changes and medication.

“I spent a lot of time discussing my family’s health history with the doctor, and after finding out some facts from my parents, I learned that heart disease is what killed my grandfather, aunt and cousin,” Angie explains. “I also found out that my dad has been on cholesterol medicine since he was 29 and his sister since she was 22. None of knew this hereditary condition was in our family until I was tested. It bothers me so much that it’s too late for those we’ve lost.”

Angie learning she has familial hypercholesterolemia when she did was incredibly timely. During pregnancy, a women’s cholesterol levels can increase by 25 – 50 percent, and nearly all cholesterol lowering medications are not advised to be taken during this time. For women who have familial hypercholesterolemia, it’s especially important for them to have their cholesterol levels closely monitored throughout pregnancy.

Angie’s wake-up call has not only given her a new lease on life. It has also taught her one of the most important lessons in her life.

“Knowing what I do now, I am actually a little ashamed that I was being so shortsighted about the importance of having a relationship with a doctor,” Angie shares. “I looked at going to one as a weakness, as a result of me not taking care of myself. It was such an inaccurate way of thinking. I get it now, though, and fortunately, before it was too late. Going to the doctor is a part of a healthy routine. A physical gives you a baseline, an understanding of where you are in your health and where you need to be. It’s the most important information you need to know. I am so happy I learned such a valuable lesson that I can pass on to my child.”

icon questionWhere do you place your personal care?
Going to the doctor for an annual check-up seems like a stretch for so many people. It really isn’t though. A check-up is the best way to measure health and make adjustments if needed. Surprisingly, most people are more structured about properly maintaining items they own than they are about themselves. This measuring stick shows just a few examples. Shouldn’t your personal health be measure as well?  

Vehicles: Every year, vehicles are taken to a professional for state inspection. They are entrusted to an expert who ensures they are safe for the road. Oil changes every 3000 miles. Another check-up, another preventative step. On average, a car’s oil is changed five times a year to keep it running for the long term.

Tire rotation: Tires need tentative care too. To maximize their life, they get balanced and rotated by professionals every 5000 miles, or an average of three times a year.

Lawns: The grass is greener and weed-free than on the other side of the fence because it is entrusted to a lawn service professional to keep it that way through regular treatments. On average, lawns are serviced four times a year to remain picture perfect.

Pets: Annual shots and check ups for the family dog, cat and other critters are the norm to keep them healthy and active.

icon stethoscopeWhat are the different types of primary care providers?
The National Institutes of Health and the U.S. National Library of Medicine have designated these different types of primary care providers:

•    Internal Medicine physicians:  Board-certified or board-eligible doctors who have completed a residency in internal medicine. They provide care for adults of all ages with numerous medical conditions.

•    Family Practice Physicians:  Board-certified or board-eligible doctors who have completed a family practice residency. Their patients include children and adults of various age groups. They may also practice minor surgery and obstetrics.

•    Pediatricians:  Board-certified or board-eligible doctors who have completed a pediatric residency. Their patients include newborns, infants, children, and adolescents.

•    Obstetricians/gynecologists:  Board-certified or board-eligible doctors of this specialty may serve as a primary care physician for women.

•    Geriatricians: Board-certified and board-eligible doctors who have completed a residency in either internal medicine or family practice. They may serve as primary care physicians for elderly adults with complicated problems related to the aging.

•    Nurse practitioners (NPs) and physician assistants (PAs): These skilled health professionals go through different training and certification procedures than physicians do, but they are qualified to manage many of your health issues.

 

icon togetherThe importance of having a primary care provider who knows YOU and YOUR health.

 

Think about having to go to a physician or healthcare provider who knows nothing about you when you’re feeling more tired than usual. That provider might not think it’s anything urgent, but your regular doctor would be more likely to see that your thyroid medication needs adjusting. Similarly, your primary care provider can reassure you in the event that you’re concerned about the freckles on your nose because they haven’t changed in the past several years.

This kind of attentive relationship can make a big impact on the quality of your health because it establishes a continuity of care. Being able to deliver an accurate diagnosis and an appropriate treatment plan becomes much easier for a primary care provider who has thorough information about a patient. Having adequate data also eliminates the need for unnecessary tests and procedures. If the patient’s condition requires a consultation with a specialist, the primary care provider will be able to coordinate cost-effective healthcare services for patients.

Primary care providers promote health and prevention and strive to develop a sustained partnership with their patients. They are highly educated in the treatment of common medical conditions and offer long-term management of chronic conditions, which is important for patients whose conditions affect multiple organs, such as diabetes, hypertension and cancer. They also provide appropriate medical tests and screenings to develop a baseline of your health. Using their findings, they can recommend further testing, changes in medication, therapy, healthy diet and lifestyle choices and safe health behavior. If additional tests and treatments are needed, primary care providers are skilled in assessing the severity of medical conditions and can refer their patients to consulting specialists.


THE PRIMARY CARE PARTNERSHIP PROVIDES

Accessibility: Primary care providers are our first contact with the healthcare system.
Accountability: Primary care providers address a vast majority of health needs and help us stay on top of our overall health.
Coordination of care: primary care providers manage acute and chronic needs and refer to consulting specialists, such as cardiologists or orthopaedic surgeons, as needed. They work closely with consulting specialists and maintain records of our total care received throughout the healthcare system.


icon magnifyWhat are your needs when searching for a primary care provider?

•    Would you feel more comfortable with a provider of the same or different sex as you? Someone older or younger?
•    Would you like your primary care provider to utilize alternative medicine?     
•    How easily accessible should your primary care provider’s office be?
•    How convenient should his/her office hours be for your schedule?
•    Does the doctor fall within your health insurers “in-network’ providers?

Once you have analyzed your wants and needs in your health partner, you have several ways in which to select a primary care provider. The easiest is to ask your friends and family for their suggestions, as well as other doctors. Most insurance companies offer a full list of in-network and out-of-network local providers. You can also find providers that have been voted on by the community, such as in OurHealth’s Best Bedside Manner Awards edition that comes out every December.

icon handshake

 

Your primary care provider and specialist

 

If you happen to require a consultation with an outside specialist for a new or chronic condition, your primary care provider has access to a vast network of highly qualified specialists who can give you a second opinion and the benefit of their expertise.
What qualifies a doctor as a specialist? To be certified in a medical specialty, a physician must complete the traditional four years of medical school, followed by up to seven years of concentrated study in a specific field and a certification exam in that field.

Joe Baum, MD, with Carilion Clinic Family Medicine in Floyd stresses the importance of board certification as a key factor when evaluating physicians. “Physicians who undergo board certification improve their core competencies for quality care by acquiring extensive clinical knowledge, mastering new skills, refining their communication abilities and participating in coordinated team care. This type of focused learning improves the outcome of your experience,” he says.

In the event that you require additional testing, your primary care physician will make sure that you are promptly informed of your test results. The specialist typically communicates the findings to the primary care provider within two to seven days of the visit. “Doctors should work as a team,” says Roy Habib, MD, internal medicine specialist with LewisGale Physicians in Salem. “We communicate directly by phone or through electronic medical records. If a patient requires hospitalization, I will be directly involved in his care at the hospital where I have admission privileges,” he says.

“Primary care physicians will communicate with specialists when their patients are hospitalized, along with the hospitalist caring for them," says Brian Dickens, DO, with Academic Primary Care Associates in Blacksburg. “Care coordinators are a fairly new member of the medical team who have significantly helped the transition from hospitalization to outpatient follow-up and restoration of health, acting as a liaison and advocate for patients as they make this transition.”

Thus, the chain of communication is strengthened by a network of health professionals dedicated to supporting, maintaining and improving your health.

 

The Primary Care Partnership: it’s all about trust between you and your provider.

As in any partnership, there should be open communication between the patient and primary care provider. Most doctors will ask you to bring in the bottles for any medications you take (also any herbs or alternative medical products), in addition to asking you about the medical conditions, procedures, surgeries and hospitalizations you have had. In order to gain a better understanding of your lifestyle, they will question you about your use of drugs, alcohol and tobacco; your sexual preferences; and your exercise, diet and sleep habits. Your provider will listen to your specific concerns and conduct a thorough physical exam.

Dr. Dickens adds, “Ideally, the physician should elicit from the patient a list of health goals and concerns from which to work on subsequent visits.”

Honesty when it comes to one’s private health matters can be quite difficult for people of all ages. “Some patients don’t want to admit that they have a problem; some don’t believe in modern medicine; and some are afraid of what their families will think when they reveal what they’ve been doing," says Dr. Joe Baum of Floyd. Whatever the case, the physician needs to find the best way to overcome misperceptions and establish a comfort level for a truthful dialogue.”

By law, your health information cannot be disclosed to anyone else without your signed consent.

During the first visit, Dr. Habib suggests touching on a sensitive subject that many people are reticent to discuss, saying, "I would recommend a discussion about end of life wishes such as resuscitation and intensive care. Not everybody shares the same views. For example, a 98-year-old patient or somebody with a terminal condition may not want to be resuscitated or treated in an intensive care unit but would rather spend the end of their life at home with their family.”

Along with regular checkups and screening tests, this data will provide a foundation upon which a continuity of care can be established over time.

icon primarycareWhat to expect during a first time visit to a primary care provider?

“During the initial visit, the patient and physician get to know each other. It is important for the physician to know about the patient’s job, habits and personal and family history because this will help him to screen for certain diseases and to recommend specific treatment," says Dr. Habib. Screenings and diagnostic labs may also be recommended.

When it comes to these screenings and diagnostic labs, they “should always be patient-specific. Having said that, certain baselines only need to be established for certain patients,” says Wallisa Vaughn, MD, with Virginia Premier Health Plan Medical Home in Roanoke.

“For example, an 18-year-old living in a college dorm will benefit from a vaccine for meningitis, while a 65-year-old adult or an asthmatic adult may need a vaccine for pneumonia," says Dr. Habib. "A retired mine worker may need a screening for lung disease, while a person with a family history of colon cancer will need a referral for a colonoscopy at a younger age than the usual recommended age for this test.”


According to Brain Dickens, DO, “Baseline tests will vary depending on age group and risk factors. Some of the more common tests are a complete blood count, which checks for anemia; a comprehensive metabolic panel, which checks blood sugar, electrolytes, liver and kidney function; and a lipid (cholesterol) profile.”

Years ago, it was considered customary to have a yearly physical and to undergo a series of standardized tests. But the current thought is that because each person is unique and has different health requirements, it is not cost-effective, affordable or sensible to have every patient see a doctor at the same time each year and take the same tests on the same schedule. Consequently, your primary care provider will tailor your checkup and subsequent tests and/or treatments based exclusively on the factors that define your life.

What types of screenings are performed during a checkup to establish a patient’s baseline of care?
•    Blood pressure screening.
•    Cholesterol screening (for adults of certain ages or with higher risk).
•    Colorectal cancer screening (adults over age 50).
•    Depression screening.
•    Type 2 diabetes screening (for adults with high blood glucose).
•    Lung cancer screening (for adults 55-80 at high risk for lung cancer).
•    Obesity screening.

Additional tests can include:
•    Complete blood count (can identify conditions such as anemia, infection and other disorders).
•    Comprehensive metabolic profile (a broad screening test used to check for conditions such as diabetes and liver or kidney disease and provide an overall picture of your body’s metabolism and chemical balance).
•    Thyroid studies.
icon clipboardBe Prepared.

Your primary care provider will need the following information to best develop your care plan. Going to your doctor with this information already in hand is a good way to be ahead of the curve.

•    A list of all prescribed and over-the-counter medications and supplements you are currently taking. Bring the bottles of medications and supplements with you so the doctor can note all information needed, such as the number of milligrams for each, how often each is taken, etc.

•    A list of your family’s health history — parents, grandparents and other immediate family members — who have or had conditions such as heart disease, cancer, arthritis, depression, etc. This can require you to do some research. Asking your family members is the best way to start gathering this information.

•    A list of all known medical conditions and procedures you have had, such as surgeries and hospitalizations.

Come prepared with a list of questions about your general health, diet, exercise, sleep, medications, alcohol or drug use, etc. This is how you establish yourself as a partner in your healthcare, and it also helps you develop your relationship with your physician by demonstrating your willingness to learn and share. “Patients should feel free to ask the doctor anything and everything that is important to their health,” Dr. Vaughn, with VA Premier Health Plan, states. “Health begins and ends with the individual patient, not the work done by others. So it is important for patients to be ‘in the know’ regarding their own circumstances.”

icon bridgeBuild bridges to better health with OurHealth’s Primary Care Series
The bridge to better health starts with Knowing Your Care and the options available to you. The information and resources available in this article hopefully help you start your journey. Throughout this series, we will provide additional information on each series’ section on our website, www.ourhealthswva.com.

If you have additional questions that you would like to see highlighted in our series, please reach out to us anytime by email at This email address is being protected from spambots. You need JavaScript enabled to view it.. We are proud to be a resource in your plan for better health.

 

Sources:
National Institutes of Health – www.nih.gov

Expert Contributors:

Wallisa Vaughn, MD with VA Premier Health Plan in Roanoke.

Joseph Baum, MD with Carilion Clinic Family Medicine in Floyd.

Brian Dickens, DO with Academic Primary Care Associates in Blacksburg.

Roy Habib, MD with LewisGale Physicians in Salem.

 

 

 

 

 

 

 

 

During the first visit, Dr. Habib suggests touching on a sensitive subject that many people are reticent to discuss, saying, "I would recommend a discussion about end of life wishes such as resuscitation and intensive care. Not everybody shares the same views. For example, a 98-year-old patient or somebody with a terminal condition may not want to be resuscitated or treated in an intensive care unit but would rather spend the end of their life at home with their family.”

 

Along with regular checkups and screening tests, this data will provide a foundation upon which a continuity of care can be established over time.

SWVA