Primary care describes your ongoing relationship with your family doctor, the person who has the most comprehensive view of your medical history. A specialist, internist, or nurse practitioner might fill this role. For example, some women consider their OB-GYN doctor their primary care physician.
Your primary care provider should be your first stop for routine check-ups and preventive care, such as vaccinations, family planning services, and management of common, chronic conditions such as arthritis, asthma, and high blood pressure. To address more serious ailments, your primary care provider will refer you to specialists and then take the lead in coordinating your care.
If you are insured, your insurance company probably encourages you to develop a relationship with a primary care physician in order to avoid emergency room (ER) visits and hospitalizations. While this makes good sense in terms of your overall health, it has the additional benefit of lowering healthcare spending overall. Nationally, the average cost of an ER visit for a minor event (that does not require hospitalization) is $1,233.1 The average cost for an existing patient to visit their primary care doctor is only $158.00.2
Time is money, too. Nationally, the average wait time in the ER is over 55 minutes according to the Centers for Disease Control and Prevention. A recent study puts the average ER visit, from admittance to discharge, at more than 11 hours.
The days when primary care physicians made hospital visits are gone in most communities. If you are hospitalized, it is increasingly likely that your day-to-day care will be provided by a new kind of specialist that emerged in the 1990s, the hospitalist. Hospitalists are physicians based in the hospital, but who consult your personal physician about your health history.
There are efficiencies in this system, but you may find it disappointing if you have a long relationship with your primary care physician. You’ll be starting over with someone who has familiarized herself with your medical record, but doesn’t know you and all the details of your medical history. You and your family will need to be vigilant that your hospitalist has all of the relevant facts in your history correct. This becomes even more important during a prolonged hospital stay because you will be under the care of several hospitalists who are simultaneously overseeing dozens of patients.
The good news is that hospitalists are typically paid by insurance (including Medicare) as part of hospital services.
The not-so-good news is that the flow of information between your primary care physician and a hospitalist, or anyone else in the hospital, may not be timely or complete. You must serve as a clear and reliable source of information about your medical history and condition. Once information is entered into an electronic patient record, you could be unaware of misinformation that continues to influence your care.
Do not take it for granted that your doctor has all the facts. Communication helps ensure you receive safe, competent care. Whether you are seeing your primary care physician in the office or dealing with a hospitalist, there are three important reasons to communicate clearly with whoever provides your primary care:
- They are the guardians of your medical history.
- They are an informed source of referrals to specialists. This is the person you can ask: If your mother had my condition, where would you send her? What do you know about this specialist’s success record?
- They have the greatest opportunity to coach you on wellness and prevention strategies and monitor your progress.
Here are five tips to improve communication between primary care and the hospital:
- Write down any questions and concerns so you remember to discuss them.
- Get your questions answered to your satisfaction.
- Ask your doctor to repeat what you tell them to verify you have been clear.
- Repeat what the doctor says to you to verify you understand what you are told.
- Invite a trusted friend or family member to be present and take notes.
The stories in this chapter will help you understand how hospitals and medical teams function so you will be prepared to ask better questions, recognize and address risks to your safety as a patient, and safeguard loved ones when they are hospitalized.