Amanda Wilde (Host): Effective primary care is beneficial for patients, families, and the community, but it's fair to say that this essential branch of Medicine is often underutilized. Next, Dr. Matthew A. Weissman, Chair, Department of Medicine at Maimonides Medical Center, highlights the vital importance of primary care and how it fits in the broader healthcare system.

This is Maimo MedTalk. I'm your host, Amanda Wilde. And welcome to you, Dr. Weissman. Thank you for being here.

Dr. Matthew Weissman: Thanks, Amanda. It's great to be here.

Host: Now, we do live in an urgent care kind of a world. So, let's start by understanding the difference between primary care and urgent care and clear up any misconceptions here at the outset about when we turn to one or the other.

Dr. Matthew Weissman: Wow. I'd like to think we live in both a primary care world and an urgent care world, and I think there's plenty of room for both. I mean, I think urgent care has done a great job of being available, being available to patients in the evenings and on the weekends, and being able to get things done at the point of care. Many of them have x-rays and other kinds of testing that are really important. But for most things, there's no substitute for primary care, for really having an ongoing relationship with somebody who knows you, who knows your family, who knows your situation and who's trained in that sort of longstanding ongoing kind of care that can be helpful both for preventive care, but also for acute illness.

Host: Yeah, there's more context, you might say, for the primary care physician. And then, urgent care versus primary care sounds to me like health maintenance in primary care versus an acute situation in urgent care. What are some of the long-term benefits of maintaining a relationship with a primary care physician? Because as you said, urgent care is taking care of some of those urgent needs, but we're talking about a longer term relationship and what looked like, like we said, a broader context of you and your family.

Dr. Matthew Weissman: I certainly think that it's beneficial to have a primary care relationship for all kinds of reasons. There's plenty of preventive care that happens in those visits, things like getting vaccinated, getting certain blood tests to test for high cholesterol, for example, getting your blood pressure checked. You know, they call high blood pressure the silent killer because people don't have symptoms, they don't know that it's an issue, and then it creates problems down the road. It increases a risk for heart attacks and strokes, for example. And so, doing things like some of that testing, getting vaccines is really important, counseling around exercising better, eating better, stress reduction. All those things that people don't always want to hear, but sometimes need to hear, I think is a big piece of that relationship.

But I think building the relationship goes beyond those specific tasks. It's really so that when there's a disruption, when an acute illness happens, or people lose their job, or something else happens that's disruptive in their life, that primary care medical home can be a way to deal with that acute medical issue, to get connected to resources, to get care in the context of what's going on in their life.

Host: Yeah. So, you get that follow up with a primary care physician.

Dr. Matthew Weissman: I think that's right. Even in the acute setting where somebody needs to go to an urgent care, I mean even in a cough and cold thing where people feel like they don't want to talk to their primary care doctor, it's the evening, it's the weekend, it's easier to go to urgent care. Even those acute illnesses often require some amount of follow up. It's two days later and I'm not getting better, I'm getting better, but I'm not all the way better. And then, your choice is either to go back to the urgent care and see potentially a different doctor who didn't see you the last time or to really maintain that follow up with your primary care doc and say like, "Well, this is what urgent care did, and does that make sense? What do I do now two days later?" And so, sometimes it's easier to just have those conversations from the beginning with primary care.

Host: So, there's a big role for continuity in care in patient health.

Dr. Matthew Weissman: Yes, I totally agree. I think how things evolve, obviously, there's chronic illness where people get seen over time for diabetes and high blood pressure over time. But there's lots of things that maybe feel like acute issues that are actually chronic issues. And so, when I think about something like 10-15% of patients who show up in the emergency room have underlying anxiety, and there are things that the emergency room can do about anxiety. But it's a lot easier to have some of those conversations in the primary care office, where you know it's not just a one-time visit. It's an ongoing followup. And so, we can do a certain amount of counseling here. We can start medication here. We can follow you up on those medications. And not necessarily do all of those things need follow up visits in person. Some of that is stuff we can do by telephone, by video visit, by portal messages. And how does that continuity across all those different platforms help you get better faster?

Host: Yeah, I see now primary care through what you've said is counseling, giving medical advice, and also support because of the continuity and seeing an illness or disease through. And it seems to me family docs have a broader lens and a lens also more specific to each individual.

Dr. Matthew Weissman: Right. And, just to be specific, we're talking about people who went through, when you say family docs, some folks in primary care are Family Medicine trained, some are Internal Medicine trained, some people like me trained in both Internal Medicine and Pediatrics. Obviously, there are nurse practitioners and physician assistants and other folks who are doing primary care. And you're right that it's that ongoing relationship that I think differentiates and helps both identify the challenges in an acute problem and also helps in that process provide that ongoing counseling.

And when I think about primary care, I also think about another role, which is the sort of quarterbacking of care role, which is how do you coordinate which specialists you should see? How do you make sure that that information gets back? And to your point about a sort of broader perspective, how do you take that cardiologist's input or that nephrologist's input in the bigger context of somebody's overall health or their life.

Host: And other than acute care, that I think that's the most important thing you can do for your health. Can you explain how primary care can improve health outcomes in the broader community?

Dr. Matthew Weissman: So, there are a couple of interesting population studies that looked at how many primary care docs are in a community and how that correlates with overall health. And so, there's actually a pretty impressive correlation that, for example, there was a study in JAMA in 2019, which said that for every 10 additional primary care docs per 100,000 population. It was associated with a 51-day increase in life expectancy. So just by having more primary care docs actually helps people live longer, and in fact, that increase was not correlated with an increase in specialty docs in those communities. And so, just having more primary care available, it's a correlation, not causation, but it seems to have a correlation with increased life expectancy. And I think we have some ways where we can hypothesize why that might be true. Because there's all these guidelines out there about how often people should get colon cancer testing, flu shots, cholesterol screening, mammograms, all these kinds of things. And by having people have primary care docs who are reminding, suggesting, pushing people to do some of that testing, patients are able to have much more guideline-concordant care.

Now, that may be a downside, too. I mean, I think sometimes patients say they like going to urgent care because they can get their asthma exacerbation treated, and nobody's saying to them, like, hey, you should remember to get your mammogram. But I would argue that's one of the joys in primary care is somebody comes in for a cough and cold, and we can also talk about all the other things going on, the other testing they need, sometimes we can take care of it right there.

Host: It's more whole person-centered, rather than treating symptoms. What advice do you have on how to choose a primary care doctor?

Dr. Matthew Weissman: I am a primary care doctor and I have a primary care doctor, and I think choosing one is like one of the hardest things that people have to do. I ask for opinions, especially from nurses and other healthcare providers. And then for primary care docs, to the extent that I can ask a specialist who they recommend, I often, I think it's telling, because the specialists know who's a primary care doctor, who's thoughtful about the care, who does a bunch of the workup, who doesn't send unnecessary referrals.

 course, I look at their credentials. I'd like to know that they're board-certified. That's often a sign of somebody who's studied and have gotten that level of credential. And I like to talk to people. I like to have a first visit at a time when there's nothing acute going on and try to get a sense of if their style of care matches what I need as a patient. And so, in an acute illness, are they going to be available to me? If I get admitted to a hospital, are they going to take care of me? If they're not going to take care of me, do they have connections with the people who are going to take care of me? How do they pick specialists that I would want to go to? And then, there's sometimes subtler things about, you know, there are some people who every time they have a cough and cold insist on antibiotics. There's obviously a lot of data that says for viral illnesses, antibiotics don't help. But if there are things that are important to me, I might, when I'm well, want to ask a doctor, like, "How do you handle people with viral illnesses? How do you handle people who need a form filled out? How do you handle this circumstance or that circumstance that comes up? My last doctor did this. Will you do that or do you refer that out?" And so, sometimes having those conversations in the context of a visit, but when there's not an immediate need for a refill or an illness or something, could help make sure that you and your regular doctor are on the same page.

Host: And if you're not, it's okay to switch.

Dr. Matthew Weissman: Absolutely. I mean, this has to work in both directions, and you have to feel comfortable relating to your doctor. And so, look, if they're not available at night, or they insist that you do something that you don't think is the right thing to do, it's your prerogative to pick somebody who does fit with you.

I think it's not great to have a primary care doctor that when you're sick, you feel like you can't call them, or they won't take your call, or something, and you're going to the urgent care somewhere out of necessity. "Look, I just went to urgent care for an illness that I had, and I did it for very specific reasons, and I talked to my doctor about it. There's lots of times where urgent care is the right choice, but I hate it when it's because your doctor can't or won't help you out. That's probably a time to interview some other primary care doctors.

Host: And then once you have someone, it can be just hard for people if they don't have something emergent to get to visit their physician regularly. How often should we see our primary care physician? And what would you say to anyone who's hesitant about visiting a primary care physician regularly?

Dr. Matthew Weissman: For most preventive care, people probably, healthy people probably need to go every year or so. I guess when people are hesitant about going, I try to figure out why they're hesitant. Sometimes it's a cost thing, although usually visiting a primary care doc is cheaper than going to urgent care or some other sources of care. Sometimes there are barriers to going. They have to take time off of work, they have to find babysitting, they have to find parking. And so, sometimes there are things that we could do to make some of those things easier. And to the extent that we can take care of things through a video visit or through a portal message or through seeing somebody in their community rather than coming in to me. I try to work with people to help coordinate some of those things.

If somebody is hesitant about visiting their primary care doc because they get reminded every time about the importance of mammograms and pap smears and colorectal screening, I do think that's an important job of a primary care doc, and it's also important for the primary care doc to realize for each individual patient, this person needs to prioritize one thing at a time or can't focus on those things right now while they're dealing with some outside stressors. And so, the visits shouldn't be automatically reminders and patients should never feel bad about not having done anything. With all these barriers, we need to strategize what's keeping you from doing the things that you need to stay healthy, and how do we navigate around those.

Host: Yeah. I think that's why people have stress around seeing the doctor.

Dr. Matthew Weissman: That they'll be told something they don't want to hear.

Host: Yeah. And that they might be ignoring something

Dr. Matthew Weissman: Yeah.

Host: That's talking to them. Like you said, we don't always want to hear, "Well, have you had your annual mammogram?"

Dr. Matthew Weissman: You know, as a doctor, it's hard to balance that.

Host: But this is actually self care. So, it's Important, and I feel convinced of the importance of seeing a primary care physician.

Dr. Matthew Weissman: I'm happy to hear you say that. I do think, we as doctors need to work on that. But I think sometimes people make people feel bad about. how much or how little they're exercising, or what they're eating, or what some of their numbers show, or what tests they've done or haven't done. And I think you don't want to make people feel bad, and we need to strategize around what it takes to get some of those things that are data-driven, guideline-driven done, because they really do help people live longer. And in medical school now, we teach a lot of stuff around motivational interviewing. And it's really getting at what the patient wants and how to get the patient to realize what they want and then how to take action to get there.

And so, we should be in this together. I mean, I'm just coaching people through stuff, but the patients are the ones who actually have to take off time to get their mammogram and find babysitting to get their mammogram and deal with the discomfort of getting a mammogram. And so, we got to find a way to make it work for them.

Host: Dr. Weissman, thank you so much for the valuable advice and for highlighting all these angles from which primary care plays a critical role in our individual health and the health of our community.

Dr. Matthew Weissman: Thanks for having me. I really do believe in primary care. And I hope that people listening, if they don't have a primary care doc, will go find one and find one that fits with their needs.

Host: That was Dr. Matthew A. Weissman, Chair, Department of Medicine at Maimonides Medical Center. To make an appointment, call 718-283-9055. Visit maimo.org for more information. Follow up on social media @maimohealth. If you found this Maimo MedTalk podcast helpful, please share it on your social media channels. To listen to additional episodes of Maimo MedTalk, please visit maimo.org.