Importance of primary care
Urgent care offices are still relatively new in our healthcare infrastructure. However, I can remember as a kid, my mom taking me to the “walk-in clinic”. Although they were not nearly as common as they are today, they still served the exact same purpose, just with a different name. In any case, patients are still unfamiliar with their purpose.
Simply put, an urgent care visit is a physical doctor’s appointment to bridge the gap in seeing your primary care doctor or a specialist. Depending on a patient’s age and history, that may be confusing. The applications of an urgent care are therefore vast. A healthy 23 year old male for instance may see his primary care once every 2-3 years. If he is seen at an urgent care for bronchitis, he may not need to see another doctor for 2 years. On the other hand, if an 82 year old diabetic female is seen for a skin infection at an urgent care and receives adequate treatment, she likely should still follow up with her primary care doctor for resolution.
A primary care doctor is someone who practices preventative medicine, chronic care visits, and “sick” visits. An urgent care should be used for urgent matters, which likely are “sick” visits. Those sick visits may be for a cold, skin infection, laceration, ear wax removal, removing ticks, etc… An urgent care should never take the place of a primary care visit, especially when performing complete physical exams. Depending on the urgent care office policies, you may seen for something that may naturally fall under a primary care visit. Do not be fooled. You are only being seen by the urgent care for financial reasons. Most doctors will have no problem seeing you, but with patient outcome in mind, will likely have you follow up with your primary care, or refer you to one.
Image credit: Primary Care Progress
I often am asked in urgent care if I can become someone’s doctor. In short, my answer is no. Primary care serves a different purpose which I no longer practice. So why is it so important? Not long ago, maybe only 10 years ago, I remember there was a push in medicine for primary care. My medical school actually gave incentive to students to go into primary care by paying a year’s worth of tuition. Man, I should have capitalized on that opportunity.
The reason for this was in part because no one wanted to go into primary care (will likely discuss those reasons in a future post). It was also because preventative medicine is cheaper. For example, the healthcare costs of drawing a lipid (cholesterol) panel and treating a patient with diet/exercise is far cheaper than the costs of an emergent cardiac catheterization. Most patients would prefer being treated by the former. Wouldn’t you rather prevent disease through annual visits than risk treating something when it may be too late? As a young person you may not see the great benefits in preventative medicine. You are usually the ones that ask if I can be your doctor.
But, by instilling healthy choices and practices into your life at a young age, you likely are saving tons of money that you would be spending on treatment later on in life. You are also optimizing your life. Think if a doctor never discussed with you the benefits of the HPV vaccine, and later in life you developed cervical cancer, only to realize that it could have been prevented.
A primary care is also very important for chronic care visits. A chronic disease is something like diabetes, hypertension, hypercholesterolemia (high cholesterol), asthma, autoimmune disease, cancers, etc… While you may need to see a specialist for a chronic disease, it is the job of the primary care to quarterback your treatment. If you trust your primary care, you should trust them enough to disagree with a specialist. A patient likely will not go straight to an endocrinologist for diabetic management. They will likely first stop at their primary care for proper work up and diagnosis. Many times (way more than in the past) the primary care exclusively treats diabetes without a specialist.
What is also important to note, is that it is not practical to see a doctor once for a chronic disease and never again. It is also not fair to the doctor, or to you as the patient, to pop in whenever you feel like it, in order to treat your chronic disease. These conditions take time and many times lifelong management. An urgent care cannot provide you with that type of care. The doctor you saw today may not be the same one that is in the urgent care when you return.
Unfortunately primary care medicine is falling out of favor. Most likely this is secondary to healthcare systems generating more money in specialty visits. I hope the pendulum swings back the other way, because primary cares go away, the financial burden in healthcare will only worsen, and patients will suffer.