Walking into my exam room, I smiled at the patient in front of me and gently squeezed her shoulder in greeting.
I’ve been the primary care physician for this 85-year-old woman for eight years. She’s tough. A lean, little lady who is stoic but unfailingly honest with how she is feeling. She’s quietly navigated persistent back pain, difficult-to-control diabetes and, more recently, kidney failure on the verge of needing dialysis. She’s thin and frail but spunky — her name always sparks joy when it pops onto my calendar.
During this visit, I realized how long it had been since I had seen her. She sat in the office with her daughter for her first appointment with me since 2019. Where had she been? Why the disconnect? Her family responded in surprise, essentially saying, “We didn’t know we needed to see you since she has so many appointments and so many providers watching over her issues.”
This response is common. Many question whether a primary care provider is still needed or helpful when being treated for chronic disease or cancer.
I struggle with this. Obviously, I’m biased since I practice primary care. Still, this particular patient had a handful of issues that weren’t being monitored — including benign tumors in her brain and pancreas — concerns that weren’t on the radar of her nephrologist, cardiologist and endocrinologist. Similarly, patients with cancer can have other issues — such as high blood pressure, sinusitis or a thyroid disorder — that their oncologist does not have the bandwidth, nor often the up-to-date experience, to manage.
This predicament is not unique to patients with cancer or those with severe chronic disease. Young women who are receiving regular care from their obstetrician-gynecologists may also wonder if regular primary care appointments are really necessary. But women are more than the sum of pelvic organs and sex hormones, so they benefit from having a health care provider who views their health entirely, especially after completing their pregnancies.
And that’s what primary care is: whole-person, big-picture care. I tell patients that primary care providers are like quarterbacks — watching the input from the specialists and adjusting. We address and clarify discrepancies. Patients and primary care providers sit in the middle together — asking questions, receiving feedback and advice — which is consolidated to make or keep each person as healthy as possible.
The American College of Physicians, the preeminent medical society for general internal medicine physicians, states the following:
“Primary care involves first-contact care for people with an undiagnosed symptom, sign, or health concern; care for individuals which is not organ- or problem- specific; longitudinal or continuous care; and responsibility for coordinating other health services related to a patient’s care.”
I realized that my 85-year-old patient and her family may not know all this about primary care. I explained that while she is exceedingly well connected to the highest quality of disease care, she is disconnected from primary care for her overall health. I’m here to help optimize her whole-person care and well-being.
My patient and her family agreed. We promised more regularly schedule appointments. I’m glad we’re back together.
Dr. Millstine is a women’s health internist and integrative medicine specialist at Mayo Clinic in Scottsdale, Arizona, where she lives with her husband and twin sons. She serves on the Editorial Board for the Mayo Clinic Health Letter and is the Medical Director for the women’s health blog on Mayo Clinic Press. Find her on Twitter @drdmaz.