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From: (Steve Harris
Subject: Re: Getting into the loop?
Date: 9 Jul 2004 15:57:31 -0700
Message-ID: <>

Brad Edwards <> wrote in message
> I'm confused as to how the whole healthcare social ring works. I've
> never had a central doctor and have just been going to whomever, urgent
> care, or specialists. But there's a flaw with this method. Every time I
> go somewhere they want to know who my primary doctor is, I think they
> refer to a family physician or something. I don't have one, so I never
> establish any kind of relationship with the physicians and they
> basically look at me and say, "What do you want?". Well, I thought that
> was the role of the physician, to figure out what I need. But they don't
> do that, they look at me and say, "I don't know what's wrong so how can
> I help you?"
> So what I need to know is, is there someone I can go to who will act as
> my central coordinator? I need someone who is knowledgeable about the
> overall system and able to use intelligent reasoning to help guide me.
> I asked a physician and he referred me to a list of their little club of
> "Internal Medicine" people. So I just called one to try and schedule a
> meeting, but the receptionist immediately asked me who my primary care
> family whatever is. Hmm, I thought that's what I was trying to get
> established by calling. He wasn't accepting new patients anyways and
> they were hanging up on me because they hadn't heard of my insurance
> provider.
> This whole thing is disorienting and it feels like this elaborate
> network of social connections that if you aren't a part of then you're
> kicked out the door. I suppose that you're supposed to get setup into
> this network through your family, but if you are an adult that isn't a
> part of it then how do you go about getting "accepted" into the club?


Here's your problem: they asked who your "family physician" was, and
you assumed that must be some guy your *family* had already hooked up
with. Wrong. "Family physician" is actually the *name* of a
subspecialty, just like internal medicine. It evolved from the old
"general practitioner", which was once upon a time what you were, if
you graduated from medical school and had spent a year as an intern at
a hospital (note: intern is NOT derived from "internal medicine"--
intern is derived from the fact that these people originally lived
inside the hospital, as als did, of course, the residents).

Some time ago the GPs wanted more respect and needed a lot more
knowledge to practice general medicine, which could cover everything
from delivering babies to taking out an appendix. So they did a couple
more years of training and now call themselves "family practitioners."
It's like a super GP. Marcus Welby, but only 28 years old. Now,
they're almost like regular old doctors in the old days when there
were regular old doctors <g>.

Okay, that's an inside joke. So called "Family Practioners" are spread
very thin but wide in knowledge. In practice they tend to know more
about kids, obstetrics, gyn problems, and also the kind of medical
care young, poor and growing families need. They are supposed to know
some geriatrics, but they're by nature not all that interested in it,
and (in my considerable experience) the "family practitioner" gets
less and less good, the older the patient gets. One problem is they
see so many low grade fevers in snotnosed kids, that they quit paying
attension to them in 80 year-olds (not good). Anyway, by the time you
the patient get to be middle aged, and certainly senior aged, you're
probably having (or trying to prevent) the kinds of obesity and
degenerative disease related problems that often need an internist or
some variety of internist subspecialty (cardiology, gastroenterology,
etc, etc) is better at treating.

So: does everybody NEED a "family practitioner" to be their "primary
care provider" (which is what you're really seeking as a coordinator).
NO. If you're over the age of 40, often a general internist works even
better, particularly if you're a man.  If you're a woman whose kids
are teenagers, often a gynecologist provides a fine "primary care"

Not every family needs a family practitioner. If you want to divide
things up so the gyn problems are taken care by the gyn, and the kids
see a pediatrician, and adults see general internists, that actually
works. Really. But if you want ONE doc who knows the whole (younger)
family like Marcus Welby, you're going to need a Family Practitioner
for a primary care provider.

So the correct thing for you to have done with the internal medicine
group, is to say you you're an X year old man, and you want an
internist for yourself alone, as your "primary care doctor." And do
they have any internists who are interested in acting as
care-coordinators, etc. You actually got good advice, but just got
flumoxed by terminology.


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