Choosing Primary Care Physician One of Most Important Health Care Decisions
Jan 29, 2016 05:23PM
● By North Hills Monthly magazine
Gregory L. Molter, DO, internal medicine physician, Steel City Internal Medicine–UPMC (left) and John T. Wisneski, Jr., MD, chairman, Department of Medicine, UPMC St. Margaret (right).
While urgent care centers are useful for taking care of acute conditions, such as colds and minor injuries, having a primary care physician that knows your history and lifestyle can make a big difference in the continuity of care—especially as you age. “The relationship between a person and their PCP is everything,” explains Gregory L. Molter, DO, internal medicine physician, Steel City Internal Medicine–UPMC. “I am more than just their doctor; I am their advocate, here to help them make decisions and guide them through difficult times.
“With all of the technology and specialization in medicine today, people have been reduced to a disease process, and we’ve lost sight of the bigger picture,” he adds. “The PCP’s job is to keep things in perspective; to know what our patients’ wishes are with respect to how they want to live their lives.”
“When you treat a patient, you have to make sure that you follow their philosophy,” agrees John T. Wisneski, Jr., MD, chairman, Department of Medicine, UPMC St. Margaret. “There are many different ways to treat disease, from non-aggressive to aggressive. It all depends on where your patient is at his or her stage of life.”
CONTINUITY OF CARE
One of the biggest benefits of having a primary care physician is that he or she gets to know you over time. This not only enables them to establish a physical baseline, but to detect changes that may not be so obvious.
“One of the biggest benefits for patients who have the same internal medicine doctor over many years is that the doctor is able to provide continuity of care,” says Dr. Wisneski. “We can establish a baseline of what a patient looks like over a period of time, which allows us to more easily detect changes. Physicians who only see a patient for a one-time visit will not have a good sense of that patient and how things may have changed.”
This long-term relationship is not only beneficial for the patient, but for his or her family as well. “When you’re treating multiple generations, you can spot conditions that run in families like heart disease, high blood pressure, and diabetes,” Dr. Wisneski continues. “You can monitor these conditions and intervene when necessary. For example, when I know that there’s a history of heart disease in a patient’s family, I may treat the 30-year-old son’s high blood pressure or cholesterol more aggressively to try to prevent bigger problems down the line.” Dr. Wisneski also recommends screening at an earlier age for patients who have a family history of colon or prostate cancer.
While medical tests and lab work can help establish how a patient’s body functions, they are only part of the tools that PCPs use to determine a person’s overall health. “I talk to my patients about what they eat, how they exercise, whether they work long hours, if they are exposed to industrial chemicals at work, what they do for wellness—these are all things I need to be aware of because they can affect my patients’ health,” says Dr. Wisneski.
Paul Del Vecchio, 68, of Shaler Township, has been seeing Dr. Wisneski since 1992 and credits the doctor’s dedication with saving his life. “In 2014, I spoke with Dr. Wisneski about some symptoms I’d been having, and he wouldn’t give up until he figured out what was going on,” Mr. Del Vecchio explains. “It turned out to be a slow-growing mass around my colon that was cancerous. Because he was so dedicated to finding the cause of the problem, I had the advantage of having my cancer discovered early, and getting treatment.
“He even held a consultation with my family the night before going on vacation,” adds Mr. Del Vecchio. “He hadn’t even packed! He got us references and took the time to explain what was going to happen, and though he won’t take credit, he’s one of the reasons that I’m here today. I wouldn’t trade him for the world—when my wife and I started going to him, we hit the lottery.”
Because primary care physicians spend so much time with their patients, they are better able to see changes that occur—both physical and mental.
“When you’re very familiar with a patient, you may be able to see things that maybe others don’t see,” says Dr. Molter. “For example, I had a patient that displayed a very subtle finding—
I noticed it right away when I was talking to her, but the specialist that I then sent her to said that he would have been hard-pressed to see it. But when you know the person—their living arrangements, their psychosocial situations—you can detect when there is something more going on.
“This is often the case with elderly patients, who are taking care of someone else who is elderly, like a spouse,” he continues. “They may need help, but they won’t ask for it. When you know them personally and know the situation that they’re in, you can usually get them to open up. They want to talk to someone, but they need to feel comfortable.”
Jamie Kohan, of Allison Park, knows this first-hand. A registered nurse, she has been taking her mother and father to see Dr. Molter for the past five years. “Both of my parents are in their 70s, and my father suffers from dementia,” she explains. “My mother is his primary caretaker, and it really helps that Dr. Molter understands the family dynamic. He has seen how my father’s condition has progressed, and he has been there to help my mother, myself and my brother. He has gotten the right people involved when we needed them, and he even came to the house when it got too hard to get my father to his office.
“He has saved us countless hours of stress and worry,” she adds. “For example, my dad had intermittent swelling in his leg about eight months ago. Normally, we would have had to go to the ER multiple times, but we were able to avoid all of that because Dr. Molter had a history with my dad. It made things so much simpler; it wasn’t like going to a different doctor each time where you have to get unneeded, unwarranted tests because they don’t know the patient.”
When Mrs. Kohan’s father did need to go to the hospital, the doctor’s office scheduled him at the end of the day when it was less busy so that he could be in and out in about an hour. “I’m sure that having Dr. Molter as my father’s PCP saved us multiple hospital visits over the years,” she said. “From a cost standpoint, this is huge.
“He is just so compassionate and so passionate about what he does,” she adds. “As an ICU nurse, I’ve seen a lot of doctors, and he is just a phenomenal physician.”
THE TRUST FACTOR
You wouldn’t take advice from a stranger, which is why it’s so important to establish a relationship with your doctor. With so much data out there, it’s hard to know what to believe, especially when it comes to making medical decisions.
“There is a ton of information on the Internet, and while some sites are reliable, many are not,” Dr. Wisneski explains. “Many times, I have patients bring me information that they’ve printed out, but they rely on me to make sense of it. Sometimes they’ve gotten two separate opinions about a procedure, and they want to know what I would recommend. Ultimately, it’s a matter of trust.
“This is especially true in the case of end-of-life discussions or talk about advance directives,” he adds. “What is their philosophy? What do they want to have done? How do they feel about hospice? These kinds of conversations are not done in a single setting. While they are uncomfortable conversations to have initially, when you’ve known each other for years, it becomes much easier.”
Communication is key to any relationship, and the patient-doctor bond is no different. “Older patients tend to require more time, as you need to go through their medications and make sure that their social situations are addressed,” says Dr. Molter. “A conversation about quality of life or end-of-life care can’t be done in 10 minutes. It might take 45 minutes or more, or need to take place over a couple of visits.
“You can’t be rushed or hurried, and you need to be willing to communicate with your patients in an understandable manner,” he adds. “A good PCP really enjoys what he or she is doing, and wants to be there.”
Dr. Molter shares the story of a patient who recently brought a book into his practice that was published in 1940. “The book was about choosing a doctor, and the first line read, ‘This is one of the most important decisions you will make in your entire life,’” he says. “I truly believe that.”
“I’m obviously biased, but it is my belief that being a primary care physician is the greatest profession out there,” adds Dr. Wisneski. “The simple fact that you get to build a rapport with patients, provide them with continuity of care, and get to know their families is an awesome experience. There are a lot of other wonderful specialties out there, but they don’t have that. There’s just something special about primary care medicine.”
To find a UPMC primary care physician near you, call 1-800-533-UPMC (8762).
This advertorial has been provided by UPMC.