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Dr Brian Weiss: All right. Greetings. Hey, this is Dr. Brian Weiss with the Get Wise with Weiss podcast. As we've talked about, our goal with this podcast is to bring to you things that you can change in your daily life that will make a difference in your health and wellbeing.

So it is my great pleasure today to have Dr. Crystal Stewart, who is one of our Northwest Texas Physician Group doctors. And I want to talk to her today about some of her thoughts on primary care. So kind of give us a little bit of your background.

Dr Crystal Stewart: I am a family medicine doctor. I went to medical school at Texas A&M and trained there in Temple at Scott and White. And then a residency actually brought me up to Amarillo. I'm originally from Eastern New Mexico, West Texas, but residency for the last part of my training brought me all the way up here to Amarillo. I fell in love with the area and decided to stick around a while.

Dr Brian Weiss: Great. So when did you first decide to become a doctor and then why family medicine?

Dr Crystal Stewart: So my earliest recollection or record that I ever said that I wanted to be a doctor was, I was in the second grade and I had a little interview piece of paper, you know, project. I obviously had no idea what that actually meant. But as I grew up, I really love sciences and math, things like that. I really loved people. I shadowed a lot of people in the healthcare system really and found out that my role to help people, to show up in people's very vulnerable situations is to be the physician on the team.

And family medicine specifically, I really thought I was going to be a pediatrician my whole life and then I got to medical school and I found out I really loved so much about medicine. I loved adults. I love children. I really loved procedures. I really loved the OR as well. At some point, you've got to find out what you can give up, which was just so difficult to do at all. Family medicine being kind of a family's first line of care, their first call, kind of their home base, that's what I hope to provide to the community.

Dr Brian Weiss: Fantastic. You know, I'm pretty sure in second grade, all I thought about was lunch and recess. That's cool. So let's talk a little bit. One of the critiques in American medicine, so we have a reactive medicine system as opposed to preventive. What's the difference?

Dr Crystal Stewart: So reactive medicine is focused on treating symptoms after they show up. So you're trying to mitigate disease after it's already presented in your body. Sometimes we can offer cures. But more often, we're just trying to slow progression or manage symptoms because permanent damage has already happened in your body. So for instance, we have chest pain and now we're, for the first time, presenting to the doctor to see where it's coming from.

Dr Brian Weiss: Fantastic. So why is preventive care so important? You know, right now in the United States, we deal with really high cost of healthcare. Is preventive care cheaper than reactive care?

Dr Crystal Stewart: Absolutely. So with our really biomedical advances and clear understanding of what causes diseases, we have, first of all, more targeted cures, but we also have the opportunity to diagnose disease and conditions maybe before they cause significant or any symptoms at all, and may be prevent it altogether. So these things include healthy lifestyle choices, vaccines, tests from your doctor described as screening, which means we're looking for something before you have any symptoms.

For kiddos, this includes newborn blood tests at birth and then again, at two weeks. We are discussing lead or anemia screens throughout childhood. We're looking at appropriate growth and development. As you get older, we're looking at your blood pressure, things that you've heard of like mammograms and colonoscopies.

So for instance, I don't have any symptoms of breast cancer, but I get what's called a screening mammogram to try to catch any potential abnormalities early in the course of the condition, or maybe I've been going to my doctor and I see my weight has gone up 10 pounds this year. And whoa, if I keep that trend up, I'm at risk for diabetes, high blood pressure. So I'm going to discuss healthier EDR options with my doctor and find a more sustainable lifestyle.

So as you can imagine, preventing disease altogether or diagnosing it early in its course promotes longitudinal wellness. We're potentially avoiding medications, invasive tests, hospitalization. And obviously, our ultimate goal is failing health and we want to keep our function throughout our lifetime. So it's much cheaper to prevent disease than it is to treat it. Practically, it's easier and cheaper to eat a well-balanced diet, move your body, take a medication maybe if you need to and see a doctor a few times a year than it is to go to the emergency room in a crisis, maybe have a stent placed in your heart, now you're having heart surgery a few years later, and maybe even something like dialysis, because your kidneys have been irreparably damaged.

So when physician leaders are making recommendations about these preventative modalities or these preventative tests that we can use, we're looking at the cost of the tests versus treatment later in the disease. How reliable is the test? If we do this test, can we actually change the trajectory of a patient's health? And these all have financial implications for patients personally, as well as across the community in a health system.

Dr Brian Weiss: Thank you. You pointed out a lot of great truths. I think anyone that's ever had an invasive procedure, a surgery, a catheterization, things like that, know how much more expensive those procedures are than doing the work ahead of time to try to prevent the disease that got them there. So, excellent. You know, it's interesting in United States right now, we have all these choices as to where to get healthcare. I mean, everything from a primary care physician's office to now we have urgent cares everywhere. Every corner has a freestanding emergency room. a lot of people say, "Well, I'll just get my care urgent care or the freestanding emergency room when I need it." What's so important about having a primary care physician and establishing that relationship?

Dr Crystal Stewart: If it's okay, I would love to talk about what exactly each of those places are for. They're so important and they're so helpful tools in our healthcare system, but having each of these and using them appropriately is also so, so important. So specifically, urgent cares, these are our walk-in clinics. They typically have extended hours. They're not always open 24/7. Here at Northwest, ours are not open 24/7, and these are for problems that you need to be seen quickly or within about 24 hours, but your concern is not life-threatening. So maybe you have a cold that's lingering or worsening over a week or so, or a small laceration. You fell and have a swollen, painful ankle now and you need an x-ray. Maybe your kiddo's had a fever for a few days and is drinking well still, but is just more fussy. Bring them over to urgent care, they'd be happy to evaluate. And if your issue turns out that you do need a higher level of care, then they can safely provide. They'll certainly direct you where you need to go. On the outside of urgent care, it will all be say clearly "Urgent Care." It will never say emergency, it'll always just say urgent.

And then, we have an emergency department and these are for your serious and life-threatening issues. If you call an ambulance, they're going to take you to the emergency room. If you need testing like a CT or lab tests of your blood quickly to diagnose or treat you, then the emergency room is for you. If you need an IV for treatment or testing, You're probably going to need to be at the emergency room. So if you have things like chest pain, new numbness or tingling, slurred speech, if your kiddo is struggling to breathe or is exceptionally lethargic, these are all reasons to seek care at the emergency room.

The Northwest system specifically has three emergency rooms in town. One is physically attached to the hospital and the other two are described as freestanding emergency rooms. And they're not physically attached to the hospital. They're situated out in the community, close to home. But they have full capacity to care for you emergently. And they have the support and the relationship with the bigger hospital that if you need to be admitted, they can get you in, they can get you hooked in with specialists, whatever you need.

Certainly, you don't have to be an expert and choose perfectly. But emergency, if it says emergency on the outside, it's an emergency room and you will be charged as such. If it says urgent care on the outside, then that's urgent care. Both of those settings are designed to care for today's symptoms ruling in or out life-threatening issues for that moment in time. Primary care, on the other hand, saw you yesterday, I'm looking at you today and we're trying to make decisions for you in the future as well. So if you'll indulge me with an incomplete analogy, when a provider only gets to see snapshots of your health, it's like expecting to know the whole rich story from a handful of Polaroids, maybe instead of seeing a movie with dialogue and video and music to set the scene. It's just an incomplete picture of your health as a whole.

Dr Brian Weiss: Excellent point. I think people have to realize that it is their history, their family's history and their history that's so important in helping care for them into the future. And you made some great points about trying to seek the proper level of care. And an emergency room, as you pointed out, is an emergency room.

Now, there's an interesting distinction. A number of years ago, the state of Texas allowed these freestanding emergency rooms and you've seen a number of companies bring up these emergency rooms. Now, the Northwest Texas EDs are actually a little more what we call satellite emergency rooms in a sense of, even though they are separated from the hospital, they are still under the hospital license, which means there are freestanding emergency rooms that can take Medicare, Medicaid, and are network with most insurance programs. That's not necessarily true of these true freestanding independent ones. So simply being important, either way your point's well taken, it is an expensive visit no matter how you look at it. So really, it should be reserved for those points high need.

Now, what if I need specialty care? Let's say I need a heart doctor or lung doctor, a kidney doctor. How does the primary care physician coordinate with those specialists?

Dr Crystal Stewart: So in the clinic, just administratively, we have what we call a referral system. So if your primary care doctor doesn't know the answer to the question, you maybe need treatment with the medicine that physician doesn't often use, or you need a procedure that they don't perform, you need workup that's more specialized, we will get you hooked in with a physician who's done extended training in that specific organ system. And so we will get you hooked in with those doctors. And then, on the other end of that appointment, we are looking to pull back that documentation from that physician so that we can help and support implement that treatment plan that that specialist has recommended.

Dr Brian Weiss: Great. You know, I think what might be kind of a goofy analogy, you think about a football team, you've got the offensive coordinator, you have the defensive coordinator, but you need the coach to coordinate everything, to be the big overview. And that's actually the role that primary care physician is to coordinate the care of all those specialists, who really are only looking at maybe a very specific part of your healthcare. And yet, it's that primary care physician's job to coordinate all that and put that all together into what's best for you as a patient.

Dr Crystal Stewart: I love being, like I said earlier, just the home base of the patient's care, that we're trained to micromanage details, but also see all the moving parts working together. It's sincerely one of my favorite things when a patient comes back from a specialist and says, "Dr. Stewart, I don't understand what this medicine was for. I really don't know what that test they ordered," and I get to educate and I get to reiterate what the specialist had discussed and taught, and ultimately build trust in your care team.

Dr Brian Weiss: Fantastic. Great. In the old days, doctors used to do both inpatient and outpatient. You went to their office and then you're going to the hospital, that doctor would admit you to the hospital. Is that the system today, or I've heard this term hospitalist and what is a hospitalist and how do these doctors coordinate with the primary care physicians or providers in the outpatient setting?

Dr Crystal Stewart: At Northwest, we have our group of primary care doctors in the clinic, and then we have a great group of doctors that strictly work in the hospital, caring for admitted patients. So we call them hospitalists. And we, as clinic doctors, we are available for any questions that the hospitalists may have for us regarding your care. And when you're discharged, we want to see you within about a week to review all that happened in the hospital, go through results, go through your medications. But it's a coordinated healthcare team. And we rely on each other. I trust that my patients are getting great care when they're in the hospital and the hospitalist trusts that you're going to follow up with a primary care physician when you get out of the hospital to continue your care, to change any medications that need to be changed, and hopefully keep you out of the hospital, keep you out from returning to the hospital again.

So similar to urgent care and emergency care, the hospital doctor, the hospitalist, is taking care of you there, is taking care of you for that very specific, very important time in your life, but it's only a a snapshot. So it's so, so important to come back to your home base so we can review everything in light of the full picture.

Dr Brian Weiss: So these hospitalists are these specialists and absolutely just like you would coordinate with a cardiologist or a lung doctor, the primary care doc is going to coordinate with that hospitalist to make sure that you get in and out of the hospital safely and then followed as an outpatient.

Dr Crystal Stewart: Absolutely. And that you have the resources that you need once you get home, whether that's a home healthcare support or if that is other durable medical equipment, if you need new equipment at the house, whatever it is, we want to be a part of that.

Dr Brian Weiss: Yeah. So let's say I'm a patient of yours and I'm coming to see you. What can I bring with me that makes it the most useful for that visit? Are there things that I can help you with in terms of my health care and things like that that will make that visit really worthwhile?

Dr Crystal Stewart: Absolutely. The very first thing that I would encourage you to do, honestly, every time you go see your primary care doctor, anytime you see any doctor really, take your bottles of medicines. Have that in a special spot and take all of those bottles. We can look straight at the bottle at the dose, how frequent you're taking those, all of those things. Those details are really, really important. After that, if you do have any specialists that you have, knowing their names, knowing when the last time you saw them, I don't expect you to be a medical expert about every procedure that you've had or anything like that, but certainly being honest and open about as much information as you do understand that has gone on in your lifetime is really, really important.

And really, maybe even more than all of those things, just being open and honest, asking questions, being willing to get to know your physician and building that trust, is really the ultimate foundation. All of those other details certainly will be filled in over time, but having the relationship is really the foundation of this teamwork of promoting your health.

Dr Brian Weiss: Fantastic. Well, you have me sold. I think I'm going to go out and get a primary care doc immediately.

Dr Crystal Stewart: Great.

Dr Brian Weiss: But I think it's important. You know, you've made some great points today. A lot of these other parts of our healthcare system, the EDs, the urgent cares are adjunctive to really should be that primary care relationship. And, you know, I think a lot of doctors like yourself go into that because they want that relationship, a long-term relationship with their patients. And I can tell you from the patient side, it's just as important and just as fulfilling to know that you have a doctor that knows who you are when you come in, get to know your family and things like that. So, yeah, a critical relationship. So anything else you want to bring up today about this topic? Certainly, we appreciate your time and all your effort on this.

Dr Crystal Stewart: I would just invite you to call in and make an appointment. We've got lots of availabilities. if you feel perfectly fine, maybe especially if you feel perfectly fine, find that home base. When we ask why you're here, just say, "I'm here to establish care," and we'll guide the conversation from there. Whether you're in college, you're starting your family, or elderly, we'd be happy to take care of you.

Dr Brian Weiss: Oh, very good. Well, thank you again. And this has been another edition of the Get Wise with Weiss. Thank you.