Who is my Primary Care Doctor?

By Corey Booker, MD

By Corey Booker, MD

Let us travel down memory lane to a time when a general practitioner was an extension of family…a time when your doctor knew your history and quirks without review of an incomplete 4-page questionnaire filled with poorly recalled medical history, hastily checked boxes and slightly embellished "good" health behaviors.

Our physician was our first call with a variety of ailments and perhaps, even, readily offered a house-call straight to our bedside in the comfort of our own home.

We saw our doctor out and about in the neighborhood, at the corner grocery store or at the local high school football game. He knew our family members by name and asked, genuinely, “How are you? How are the kids?” And he small talked of community events, activities and shared hobbies.
 

Flash forward to today - when I received an interesting question by our client, “Sue.” Sue’s family was frustrated and confused with the ongoing scheduled and rescheduled surgeries and ever changing medications she was taking to treat her pain and depression. In addition, she had an over whelming frequency of office visits and conflicting management plans.  Over the last three years, we counted a tangled web of 12 medical providers!

At present, Sue was recently discharged from surgery and visited by a home health nurse. While discussing her medical history, her nurse asked, “Who is your primary care doctor?”

Almost an echo of disorientation occurred for Sue.

“Who is my primary care doctor?”

In relaying her recent realization, she asked me the same question. She said, “I really don’t know what to say because I talk to you more...Your team is leading my care and you really know what’s going on with me. Dr. Booker, can you tell me how I am supposed to answer this question?”

Just as bewildered as Sue was, when I started OnPulse, it never crossed my mind that we would answer this question or that our clients would feel confused on how to answer this question.

While she knew our roles and her physicians’ titles, we were functioning at a level in her life that we had unknowingly met her expectations for primary care.

Prior to seeking our services, Sue’s medical care was chaotic and complex.  Her primary care physician and psychiatrist had never had a conversation or exchanged information regarding her care plans. They were located on separate corners of the city and had no reason beside Sue to ever engage.  Within one month, three OnPulse team members and every physician involved in managing her health were connected and on the same page (literally) in the OnPulse care management platform. She saw them all and was actively involved in her own care.

What does Sue’s current team look like?

  • OnPulse Physician (Me) – to lead the care team
  • OnPulse Nurse Advocate – to act as a point-person for Sue and a liaison between Sue, her family and the care team
  • OnPulse Benefits Specialist –  to oversee and solve insurance issues and concerns
  • Primary Care Physician – to manage existing preventative care and health maintenance needs
  • Pain Management Specialist – to monitor and manage her pain 
  • Clinical Pharmacist – to educate, advise and coordinate her medications
  • Psychiatrist – to guide treatment and management of her depression and anxiety
  • Clinical Psychologist – to administer regularly scheduled psychotherapy sessions

With our support, Sue knows the individual names of her care team and knows how to relay information to all involved in her care. She knows where to go to solve the problems that traverse her life and health.  She also knows the difference between us and her primary care physician (PCP). Unlike her PCP we have had time to know her family and they know us. We also know her personal ambitions. We know that with consistency, medical compliance and time, she wants to return to work.  Our role now is to put Sue's life at the center of her health and the entire care team appreciates that. 

Out of curiosity, I mentioned Sue's comment to the care team hoping that I didn't offend anyone. It didn't. They all mentioned how times have changed and that more and more there is less time to get to know people beyond the 10- 15 minute visit, especially the PCP. They have come to see us as peers that function to keep them connected to Sue's life and health- "there is just too little time" they said.

We never set out with a goal to hear the "Sues" of the worlds' question: who their primary care provider was. Our aim was to ensure that Sue always had access to guidance and advocacy when she needed it.  With so little face to face time with a clinician for Sue, it was hard to know.  Maybe that is what has changed for Sue - she feels that we have more time to sit and talk and get to know her. Nevertheless, Sue knows that her PCP is actively involved in managing her existing preventative care  and health maintenance needs. She also knows that she has a team, and we plan to keep it that way.  

Sue said, "Maybe it is time you invited me too?" I said "Sue, you are probably right."