“Everyone should have a primary care physician,” said Steven R.Gambert, M.D., a geriatrician and physician-in-chief at Sinai Hospital of Baltimore .
“You need someone who understands your medical history and who can handle 90 percent of your health concerns.”
Part of doing your homework involves knowing the difference between the types of physicians who can become your primary care provider. Becoming more knowledgeable about what kinds of doctors there are will help you make better choices, Gambert said.
For people over the age of 18, the best choice might be an internist – or internal medicine specialist. This “doctor for adults” can diagnose and treat conditions, both common and complex, related to all the internal organs and systems.
Someone wanting a more broad-based medical approach might want to choose a family practitioner, said Tyler Cymet, D.O., who is a doctor of osteopathy. Cymet is head of the Division of Family Medicine at Sinai Hospital . Family practitioners see children and can take care of routine female problems as well, said Cymet.
“A family practitioner can continue to care for your family as it grows,” Cymet said. “They are also convenient because everyone in the family can see the same doctor.”
If you want a doctor just for your children, seek out a pediatrician with whom both you and your child feel comfortable. Senior adults, particularly the frail elderly, have medical issues that are different from other adults. In this case, you may want to visit a geriatrician. Investigate other physicians with medical specialties that best suit your present medical concerns.
Word-of-mouth and the recommendations of friends can also yield a list of possible primary care providers who may become the trusted centerpiece of your medical care. Make sure the doctors you see are board certified by their accrediting medical boards (for example, American Board of Internal Medicine, American Board of Pediatrics, etc.).
Once you’ve figured out what kind of doctor you want to visit, call his or her office and ask several key questions, Gambert said. It may seem silly, but ask if the doctor accepts new patients. Not all doctors take new patients all the time.
Next, find out if the doctor accepts your insurance. Your insurance company should be able to provide you with a list of doctors that accept your plan. If you do not have insurance, ask the office staff what other forms of payment they will take and if they have reduced fees for services based on income.
Find out in which hospitals your doctor is privileged to practice. Your doctor may not necessarily practice in the hospital that you prefer.
Once you’ve made your initial inquiry you are ready to pay your doctor a visit. Physicians can have just 15 or 20 minutes per appointment. Gambert urges patients to make the most of this time through proper preparation.
“Bring a diary of questions,” Gambert said. “And bring the medications you are currently taking—all the prescriptions, over-the-counter drugs, dietary supplements, herbs…everything.”
This way your physician can gain a better understanding of your health status.
Gambert added that you should have a goal for your visit. “Be very specific about what you want to accomplish during your appointment.”
These days, doctors are trained to ask their patients what their health care goals are, he said, and it will be to your benefit if you have an idea of what you need from your health care provider.
Obviously, because of pain or discomfort, you aren’t always going to know what you want up front from your visit to the doctor—except that you want to feel better. At those times, your doctor’s skills in investigation, listening and compassion will be tested.
“Sometimes it is just a matter of compatibility,” Gambert said.
Choosing a doctor is still a bit of trial and error.
Hopefully after your first visit, you will have a better idea whether this doctor is the right one for you.
An Ounce of Prevention
There are many things you can do yourself to maintain a healthy lifestyle and prevent illness. These include exercising daily, controlling your weight, eating right, avoiding smoking and drug abuse, limiting alcohol use, and taking your doctor- prescribed medications.
Sometimes, however, insight into your health status can only come from professional medical screenings offered by your health care provider. These may prove lifesaving in either preventing or minimizing disease.
Women
Pap smear
Screens for cervical cancer
Sexually active female adolescents and women over age 20 (regardless of sexual activity) should have an annual Pap smear. After three negative, consecutive, annual Pap smear tests, women who are celibate (not sexually active) or monogamous (have only one partner) and are younger than 35 to 40 years of age may decrease Pap smear testing to every two to three years. Women over 40, women with multiple sexual partners, and women who take oral contraceptives should have an annual Pap smear. Women with a medical history of HPV (genital warts) should have a Pap smear every six months.
Breast self examination (BSE)
Should be taught during adolescence and continued on a monthly basis throughout a woman's life.
Mammography—radiological (X-ray) evaluation of the breast tissue
A baseline mammogram is recommended for women between ages 35 and 40. Repeat mammograms every two years for women between 40 and 50 years old. An annual mammogram is recommended for women over 50. The mammogram may be done at an earlier age or at more frequent intervals, at any age, if problems are suspected or the woman is at increased risk (i.e., a family history of a first-degree relative—mother or sister—with breast cancer).
Men
Testicular self examination (TSE)
Should be taught during adolescence and continued on a regular basis throughout a man’s life as recommened by your physician.
Prostate cancer screening
Should be evaluated by digital rectal examination and PSA (prostate specific antigen) test annually for men over 40. Screening may begin earlier if there is a strong family history.
All Adults
Cholesterol screening
Ideally, a baseline total cholesterol measurement, both a measurement of bad (LDL) and good cholesterol (HDL), should be obtained for all adults between 18 and 20 years of age. If normal, the test should be repeated every five years. Individuals over 35 or at higher risk, including children with a strong family history of hyperlipidemia, may be screened earlier and at more frequent intervals.
Colon cancer screening
A stool guaiac or other test for occult (hidden) blood in the stool should be done every year after age 50 (or sooner if there is a family history of colon cancer).
Some physicians may recommend a flexible sigmoidoscopy every three years for patients 50 or older; colonoscopy, which is probably a better screening test than flexible sigmoidoscopy, need only be repeated every five to 10 years if normal.
Dental care - every six months or so for dental examinations and cleaning.
Unusual changes
See your primary health care provider right away if you experience any of the following symptoms:
a lump or persistent lesion appears on your body
a chronic cough (or if you begin to cough up blood)
continued body aches/pains
prolonged fever
unexplained weight loss
Immunization
Keep up-to-date on immunizations. Adults should receive periodic “boosters” for diseases such as tetanus. If you are either older than 65 or have significant heart or lung problems, you should consider receiving a pneumonia vaccine and influenza vaccine during the fall and winter seasons.
