Simple Question: What is Primary Care?

[AnArabiaNight]

What does primary care mean? I've read a few med college mission statements and they say that they are focused in primary care. Does that mean like internal med and family practice or can that inclue Emergency Medicine? Basically I want to go into Emergency Medicine and wanted to know if that would qualify.

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[HumidBeing]

Primary care specialties are the "personal physician" type doctors - family practice, Internal Med, pediatricians, gerontologists.

Some people seem to THINK that the ER docs are their primary caregivers, but that's not what the ER is there for.

 

[135892]

What does primary care mean? I've read a few med college mission statements and they say that they are focused in primary care. Does that mean like internal med and family practice or can that inclue Emergency Medicine? Basically I want to go into Emergency Medicine and wanted to know if that would qualify.

EM is NOT primary care

 

[smq123]

What does primary care mean? I've read a few med college mission statements and they say that they are focused in primary care. Does that mean like internal med and family practice or can that inclue Emergency Medicine? Basically I want to go into Emergency Medicine and wanted to know if that would qualify.

The definition of "primary care" depends on who you ask.

Universally, everyone agrees that Family medicine, Pediatrics, and Internal Medicine is primary care. They're basically specialties that are frequently used by all people, of all walks of life, and also offer long-term patient care.

The government, for its primary care scholarship, defines primary care as Family medicine, Pediatrics, Internal Medicine, Psychiatry, and OB/gyn.

Emergency medicine doesn't qualify. Sorry.

 

[brianmartin]

Although, if you are interested in EM you should probably be interested in primary care as well, since EM is the true generalist specialty. If you like a little of everything, EM is good.

 

[Law2Doc]

EM is NOT primary care

EM is not supposed to be primary care. However as mentioned above, far too many people do, in fact, go the the ED for their primary care needs. I wouldn't include EM in a definition of primary care, but bear in mind that there is this overlapping function in our system presently.

 

[AmoryBlaine]

EM is not supposed to be primary care. However as mentioned above, far too many people do, in fact, go the the ED for their primary care needs. I wouldn't include EM in a definition of primary care, but bear in mind that there is this overlapping function in our system presently.

Most of what people consider "ER primary care" is actually ambulatory medicine. Primary care is ambulatory medicine + preventative health and screening. No emergency physician is ordering DTaPs, checking lipids, or referring for routine colonoscopy.

To the OP: many, many schools claim to have a primary care focus. Don't let that be a deciding factor for you as it's not like they force you into FM residencies.

 

[Law2Doc]

Most of what people consider "ER primary care" is actually ambulatory medicine. Primary care is ambulatory medicine + preventative health and screening. No emergency physician is ordering DTaPs, checking lipids, or referring for routine colonoscopy.

No, but most ER docs will be regularly treating the flu and other non-emergency ailments that you are supposed to be seeing your FP for, rather than clogging up the ED.

 

[AmoryBlaine]

No, but most ER docs will be regularly treating the flu and other non-emergency ailments that you are supposed to be seeing your FP for, rather than clogging up the ED.

Totally, but my point was that that is really ambulatory medicine rather than PC...

Semantics... which I'm trying to argue with an attorney... so I should probably just stop...

 

[smq123]

No, but most ER docs will be regularly treating the flu and other non-emergency ailments that you are supposed to be seeing your FP for, rather than clogging up the ED.

This is actually one of my pet peeves when it comes to defining "primary care."

Everyone defines primary care solely on what TYPES of problems are being treated. Which is why everyone tries to justify EM as "primary care" - because they take care of the flu, sniffles, coughs, etc.

If that were true, then does a surgeon who manages his patient's blood sugar post-operatively become a "primary care" physician? What about the urologist who does a hernia exam or a DRE on a patient? Is that "primary care"?

AmoryBlaine is right when he talks about primary care being ambulatory medicine PLUS a focus on preventive medicine.

 

[Law2Doc]

This is actually one of my pet peeves when it comes to defining "primary care."

Everyone defines primary care solely on what TYPES of problems are being treated. Which is why everyone tries to justify EM as "primary care" - because they take care of the flu, sniffles, coughs, etc.

If that were true, then does a surgeon who manages his patient's blood sugar post-operatively become a "primary care" physician? What about the urologist who does a hernia exam or a DRE on a patient? Is that "primary care"?

AmoryBlaine is right when he talks about primary care being ambulatory medicine PLUS a focus on preventive medicine.

Not analogous. The difference is that nobody walks into a surgeon or urologists office without having previously been to some other doctor first. Those are referral fields. That is not the primary place you go for medical need, it is secondary, after you've already been seen by someone for intake. ED isn't the same as that. People walk in there having never seen a primary care doc -- they use the ED as their primary care. So that in fact is their "primary" intake. The ED may decide the person needs surgery or urology or whatever, and thus steps into the role of internist for purposes of that visit. Sure it's not going to be as comprehensive, but it is primary. So I continue to suggest that while it's not meant to be primary care, it unfortunately gets forced into that role by a great number of patients who ought to really be seeing FPs.

 

[smq123]

So that in fact is their "primary" intake. The ED may decide the person needs surgery or urology or whatever, and thus steps into the role of internist for purposes of that visit. Sure it's not going to be as comprehensive, but it is primary. So I continue to suggest that while it's not meant to be primary care, it unfortunately gets forced into that role by a great number of patients who ought to really be seeing FPs.

So if you go to the optho ER, and they inadvertently find that you have diabetic retinopathy, and therefore refer you to an internist, does that mean that the internist isn't a "primary care physician"? Because it wasn't the patient's "primary" intake?

Until the ED starts doing preventive care (breast cancer screenings, PSA, vaccinations, OCPs and Depo shots, etc.), then it doesn't count as primary care. It's acute care or ambulatory care, but it doesn't fill the role of "primary" care.

 

[Law2Doc]

So if you go to the optho ER, and they inadvertently find that you have diabetic retinopathy, and therefore refer you to an internist, does that mean that the internist isn't a "primary care physician"? Because it wasn't the patient's "primary" intake?

Until the ED starts doing preventive care (breast cancer screenings, PSA, vaccinations, OCPs and Depo shots, etc.), then it doesn't count as primary care. It's acute care or ambulatory care, but it doesn't fill the role of "primary" care.

No, I'm saying that the optho ER in your example is serving a "primary care function" in that instance. Once you start doing that regularly, it's not unfair to be calling it primary care. Again, I'm not saying ED is supposed to be primary care. But when a large of your patients are there for primary care purposes (the flu, feeling "off" etc), it's not a leap to start considering it primary care. It's not supposed to be, but it is.

And BTW, if you take a look at most hospital H&P forms used by EDs, they often have a fairly comprehensive breast exam section, so if they do the full exam on you as outlined on the form (which they often do in a teaching hospital), you absolutely will get breast cancer screening in the ED. You probably won't get a PSA unless your acute symptoms are something for which that might help rule stuff out, but if you are having issues with urination, you sure might. You won't get OCP or Depo shots, but you would get tetanus shots and perhaps other vaccinations as your symptoms warrant. There are quite a lot of hospitals that feel that when you get someone in the ED who likely doesn't get medical care elsewhere (eg the homeless), you work them up fairly completely because you are likely the only doctor they will ever see. Lots of teaching hospitals have this attitude (private hospitals probably not so much). As such, that is a primary care role.

 

[smq123]

No, I'm saying that the optho ER in your example is serving a "primary care function" in that instance. Once you start doing that regularly, it's not unfair to be calling it primary care. Again, I'm not saying ED is supposed to be primary care. But when a large of your patients are there for primary care purposes (the flu, feeling "off" etc), it's not a leap to start considering it primary care. It's not supposed to be, but it is.

And BTW, if you take a look at most hospital H&P forms used by EDs, they often have a fairly comprehensive breast exam section, so if they do the full exam on you as outlined on the form (which they often do in a teaching hospital), you absolutely will get breast cancer screening in the ED. You probably won't get a PSA unless your acute symptoms are something for which that might help rule stuff out, but if you are having issues with urination, you sure might. You won't get OCP or Depo shots, but you would get tetanus shots and perhaps other vaccinations as your symptoms warrant. There are quite a lot of hospitals that feel that when you get someone in the ED who likely doesn't get medical care elsewhere (eg the homeless), you work them up fairly completely because you are likely the only doctor they will ever see. Lots of teaching hospitals have this attitude (private hospitals probably not so much). As such, that is a primary care role.

No, no - look, I think that people forget what primary care is supposed to be about.

When you did your family med rotation, what did they stress, over and over again? Health MAINTENANCE and disease PREVENTION. This is what distinguishes primary care from acute care - long term, continuity of care, that focuses on keeping your current level of health, and doing your best to prevent acute episodes of disease.

The ER might fill that role occasionally. To be fair, endocrinologists, urologists, ophthalmologists, neurologists, and oncologists all technically fill that role occasionally as well. But just by incidentally filling that role does not make it a "primary care specialty."

Yeah, you might get a breast cancer screening in the ED. So what? Will they follow up with you to see what that ultrasound/mammogram showed? Will they follow up with you after your mastectomy to see how you're doing? Will they continue to do routine pap smears, and focus on other aspects of your health? (Which begs the question - what's the point of doing a breast cancer screening in the ED if you never follow up on it?)

If you do the screening, but not the followup, it is, in my mind, VERY difficult to call that a primary care specialty.

P.S. I love how the thread is titled "Simple Question," and it's already turning out to be more than just a simple question.

 

[Law2Doc]

No, no - look, I think that people forget what primary care is supposed to be about.

When you did your family med rotation, what did they stress, over and over again? Health MAINTENANCE and disease PREVENTION. This is what distinguishes primary care from acute care - long term, continuity of care, that focuses on keeping your current level of health, and doing your best to prevent acute episodes of disease.

The ER might fill that role occasionally. To be fair, endocrinologists, urologists, ophthalmologists, neurologists, and oncologists all technically fill that role occasionally as well. But just by incidentally filling that role does not make it a "primary care specialty."

Yeah, you might get a breast cancer screening in the ED. So what? Will they follow up with you to see what that ultrasound/mammogram showed? Will they follow up with you after your mastectomy to see how you're doing? Will they continue to do routine pap smears, and focus on other aspects of your health? (Which begs the question - what's the point of doing a breast cancer screening in the ED if you never follow up on it?)

If you do the screening, but not the followup, it is, in my mind, VERY difficult to call that a primary care specialty.

P.S. I love how the thread is titled "Simple Question," and it's already turning out to be more than just a simple question.

While I agree that in the ideal situation primary care includes follow up, for the hordes of patients who only go to the doctor when they are sick, and when they go to the doctor they go to the ED, that person is, for all intents and purposes their primary care doctor. They won't have any follow up, but they wouldn't regardless of where they went. This is the only doctor they go to. If they are going to be referred to a specialist, it will be via consult from the ED. Primary care is "primary" because it is the intake function of healthcare. Which in a perfect world is your FP or internist, or in the case of women's health, your OBGYN. But because the uninsured, illegals, homeless, etc use the ED as their only physician point of contact, that is a primary care role. It's a crummy one, admittedly -- you get no follow up, your care isn't as comprehensive as if you had a PCP, and in terms of disease prevention, at best you are going to get a tetanus shot, some antibiotics and a suggestion to stop smoking. But, although not by intention, the ED has become a situs of primary care. For a lot of people the only situs of care. It shouldn't be, but it is. These folks will never see an FP, a PCP, an internist. Their ED is their primary care doctor, and probably the only doctor they see until the next time they find their way into the ED. It's a bad system, but it is the system that exists for many.

 

[smq123]

While I agree that in the ideal situation primary care includes follow up, for the hordes of patients who only go to the doctor when they are sick, and when they go to the doctor they go to the ED, that person is, for all intents and purposes their primary care doctor. They won't have any follow up, but they wouldn't regardless of where they went. This is the only doctor they go to.

But, although not by intention, the ED has become a situs of primary care. For a lot of people the only situs of care.

I really disagree with calling EM "primary care" for a couple of reasons:

1) Calling it "primary care" because of an accident of the system doesn't seem like a good enough justification for me. If you accidentally rip your scrubs one morning, and you use a 2-0 vicryl to temporarily sew it up, that doesn't turn a suture needle into a sewing needle, and that vicryl into thread.

Sadly, yes, EM serves as a primary point of care for many patients, because the system is broken...but that does NOT make it "primary care."

2) The purpose of primary care, nowadays, is to create a situation where, through health maintenance and prevention, we can decrease the incidence of disease. The purpose of primary care is NOT to temporarily fix a problem until it flares up again. In order to do that, primary care needs to rely on long-term followup and that ever-important concept of "continuity of care."

The ED is just inherently not designed to serve that role. It isn't. It doesn't routinely offer health screenings - and even if it did, it has no way of following up those patients anyway.

If the ED really DID serve as primary care, the government would be recruiting people to specialize in EM. But the point is - they need primary care for the long term care that PCPs can provide.

I'm not saying that the ED doesn't serve an important purpose - because it does. But it just isn't set up to be called primary care. And I don't think that EM should be considered a "primary care" specialty, regardless of how the system's been abused.

 

[Law2Doc]

I really disagree with calling EM "primary care" for a couple of reasons:

1) Calling it "primary care" because of an accident of the system doesn't seem like a good enough justification for me. If you accidentally rip your scrubs one morning, and you use a 2-0 vicryl to temporarily sew it up, that doesn't turn a suture needle into a sewing needle, and that vicryl into thread.

Sadly, yes, EM serves as a primary point of care for many patients, because the system is broken...but that does NOT make it "primary care."

2) The purpose of primary care, nowadays, is to create a situation where, through health maintenance and prevention, we can decrease the incidence of disease. The purpose of primary care is NOT to temporarily fix a problem until it flares up again. In order to do that, primary care needs to rely on long-term followup and that ever-important concept of "continuity of care."

The ED is just inherently not designed to serve that role. It isn't. It doesn't routinely offer health screenings - and even if it did, it has no way of following up those patients anyway.

If the ED really DID serve as primary care, the government would be recruiting people to specialize in EM. But the point is - they need primary care for the long term care that PCPs can provide.

I'm not saying that the ED doesn't serve an important purpose - because it does. But it just isn't set up to be called primary care. And I don't think that EM should be considered a "primary care" specialty, regardless of how the system's been abused.

I completely agree with your post, but still think that as EM unfortunately is serving a primary care role it is not set up for, it is, for all intents and purposes, primary care, whether it was designed to be or not. If it walks like a duck and quacks like a duck...

 

[smq123]

I completely agree with your post, but still think that as EM unfortunately is serving a primary care role it is not set up for, it is, for all intents and purposes, primary care, whether it was designed to be or not. If it walks like a duck and quacks like a duck...

I'd still argue that EM cannot be considered "primary care," because it isn't really adequately meeting the primary care needs of the patients.

It's adequately meeting the short term, acute care needs of the patients...but that's not really "primary care." Like I said, if it isn't meeting the health maintenance and disease prevention goals of primary care, then it isn't really primary care.

Oh well. Whatever - OP, for the purposes of any scholarships or essays that you might be looking at, don't include EM as "primary care." As you can see, it can set off quite a discussion!

 

[Nevadanteater]

I'd still argue that EM cannot be considered "primary care," because it isn't really adequately meeting the primary care needs of the patients.

Perhaps, but it IS meeting the PC needs of patients who have nowhere else to go. We may not define it as PC, but these patients often do. Until coverage is expanded to all/most people, ER will have at least some level of PC.