Tuesday, July 21, 2009

Primary Care Provider

I am ashamed to admit that I actually felt annoyed tonight over being referred to as a "primary care provider." It is hard to explain that after 21 years of education and another 23 years of practice as a specialist in Internal Medicine, I would be bothered by this.

One of my patients that I have cared for for 20 years was admitted to the hospital after going to the ER with abdominal pain. I was not informed of his admission and the "hospitalist" became the attending physician. The patient called me today from his hospital bed to inform me. He actually had a previously scheduled appointment with me in the office today and, good patient that he is, was calling to say he couldn't make it. He assumed I already knew he was admitted to the hospital.

I asked him to have the attending doctor call me as soon as he/she made rounds. I got the call from a young sounding hospitalist physician who did not know my name and wondered if I was the "primary care provider". She then said "Oh I don't usually call the primary care provider."

That phrase just stopped me cold. It is so "insurance" sounding. So contrived and replaceable. Primary care provider...delivery man....vacuum cleaner salesman...roto-rooter man. It's the doctor you can dismiss if you are a hospitalist one or two years out of training.

"I don't usually call the primary care provider."

Guess I better get thicker skin.


KM said...

I know a situation where the hospital didn't even inform the physician that the patient of 10 years had died. The doctor found out 2 weeks later from a family member calling the office thinking the doctor knew.

I would be extremely upset if I couldn't contact my doctor if I was in the hospital and they never informed my Internist that I was there. I would want the hosptialist to have to make sure my care was approved and coordinated by my doctor and the hospitalist should respect that my physician knows my medical history much more extensively and personaly then the hospitalist does.

There is a very special relationship and bond that is build over time with trust that works along with the many years of education, training and skills that is what goes into this partenership and makes it go well in working together on whatever comes up in life.
As the Hospitalist refers to "The Primary Care" that is exactly who is the most important to me that I want on my side deciding what happens that will affect my health and rest of my life.

Michael Kirsch, M.D. said...

Agree. The term 'provider' is dehumanizing and is applied to specialists like me as well. I don't think the term hospitalist is much better. Of course, they're not patients either but health care consumers.

JJ said...

My mom was recently taken to an ER after fainting at the Red Cross blood donation center (why the ARC allowed an 86-year-old woman to donate is another issue). After they gave her some fluids and oxygen and she was being discharged, I asked if her doctor would automatically receive a copy of her encounter summary. No. If she wanted her doctor to have a copy, she would have to call her doctor's office and ask them to call the hospital's med rec department during business hours and request a copy. This is just dumb. Shouldn't the default be that you DO inform the patient's doctor? It's as if the system was designed by folks who said "let's see what we can do to make sure that those who provide care to a patient DON'T communicate with each other."

tracy said...

Oh, Dr. Brayer, that made me soooo angry for you! i am really sorry that happened. i have been admitted to the hospital on a few occasions and my excellent, wonderful I n t e r n a l M e d i c i n e S p e c i a l i s t was never notified.

Anonymous said...

Dr. Brayer,
I agree with your comment-" you need to grow a thicker skin". As a " Hospitalist" when admitting a patient I ask the patient " Do you have an internist or family doctor you see?" Frequently the patient states " an intern?, no I don't see an intern, but my cardiologist is Dr. X". I think hospitalists use the term " primary care provider" because patients are familiar with that term, not as a derogatory statement. Remember, almost all " Hospitalists" are general internists who enjoy the Hospital environment more than the office, for a multitude of reasons, not the least of which are poor office reimbursement and paperwork hassles. I highly respect what you do, it is truly the hardest task in medicine in my opinion. Also our group always faxes a copy of the H & P and discharge summary to the " PCP" within 24 hrs of the event. I only call the PCP when I need to clarify information or solidify follow up plans ( eg. I'm starting the patient on coumadin, will you be following?) If I called every " PCP" for every admit/discharge/daily progress note I would develop some sort of repetitive finger injury scrolling through the myriad of phone menu's on every office's telephone !!! Keep up the good work, maybe someday more of us can help take care of patients in the office, but right now my kids like to eat everyday!!

Alvin said...

Dr. Brayer,
Congratulations on your blog against the term provider. We are not venders, bound only by business expediency; but Health Care Professionals bound by the ethics of professionalism which place the interests of the patient above our own. We espouse a body of knowledge and skills, but we are not union trade persons.

The use of the term provider is a deliberate semantic device to degrade the physician, akin to the propogation of the term democrat party, instead of Democratic Party.

Thiry years ago I was the co-founder of the Washington State Association of Black Professionals in Health Care. I have repeatedly objected to the use of the term provider in many venues, including the ACP. the University of Washington School of Medicine, and the Institute of Medicine.
The knowledge and commitment of Health Care Professionals, not venders, is critical to Health Care Reform.

Please continue your education not only of administrators but of physicians, who have supinely allowed themselves to be degraded

Alvin J. Thompson. M.D. MACP

Toni Brayer MD said...

Anon:"...right now my kids like to eat every day." hahaha. Well put.

Dr. Alvin Thompson: Thank you. We will fight the good fight!

Jane Chretien, MD said...

Thank you Dr. Brayer for this post, and thank you Dr. Thompson for your stand. I AM NOT A PROVIDER. After more than three decades in medicine I have developed pretty thick skin - I don't chastise patients who call me by first name unless they are younger than my children, and I don't react to the occasional yahoo patient who calls me "sweetie" because that's part of his vocabulary. BUT - I go ballistic with the term provider and am so distressed to see that younger physicians accept it, not realizing it was developed by the health insurance industry to purposely denigrate physicians and make everyone equal so they can pay less for services by midlevel providers.
Our local ACP chapter has advanced a proposal to the national group that the word provider we banned in any official written material from the ACP. After I registered a complaint, The Maryland State Med.Society has actually retracted an announcement in which they inadvertently used the word provider. And I routinely return, unsigned, any health insurance letters addressed to Dear Provider, with the correction demanded. Small stuff - but we all need to be vigilant and active on this topic. (Maybe we should also boycott drugs which advertise on TV, "ask YOUR PRESCRIBER if this drug is right for you").
Jane H. Chretien, MD, FACP