For generations, family doctors have treated entire families, building long-term relationships built upon caring and trust. The physician-patient relationship endured for decades, and the doctor knew how a family lived, worked and played – and hence knew the potential for genetic diseases.
In the middle to late 20th century, it seemed that family medicine was about to become a relic of the past, and patients were just a number to be filed with an insurance company. Patients and physicians alike were unhappy with this turn of events.
Today, many physicians are returning to the roots planted by their predecessors decades ago. They are bringing back the “family” aspect of medicine and embracing the term family doctor.
HealthLinks Charleston wanted to explore how local physicians are handling the changing world of health care and what they would like their patients to know. To do this, we assembled a broad team of physicians who represent many different practices and medical fields in the Lowcountry. They were glad to discuss the ever-changing health care environment.
“I have worked in primary care medicine for five years now, but I have always known what I wanted to do,” explained Dr. J. Matthew Ferguson, who recently opened the East Cooper office of Palmetto Primary Care. “My father is a family physician, and I was familiar with the work that he did. I like seeing a whole family of patients over the years and getting to know them well.”
Multigenerational physicians are comfortable with every level of care, from pediatrics to geriatrics, which means they must have a broad range of medical science – and they must know when to refer their patients to specialists.
“We treat people of all ages. We truly are a bread-and-butter family practice,” said Dr. Stania DeJesus, owner of Family Wellness Center of Charleston, which sees patients in the office and in their homes as well. “It is important with our aging population that we do house calls, and at Family Wellness we allow direct pay as many people do not have insurance or are underinsured with a high deductible. We are going back to the routine of seeing patients in their own home. You can learn a lot about a patient by seeing them in their own environment.”
A personal relationship between a physician and his or her patients is critical, especially with a primary care doctor. Unlike with specialists, who may see a patient for a short period of time and treat a specific ailment, the primary care physician is the go-between for all aspects of a patient’s physical and mental health.
“Family physicians help you with an individualized plan of care,” said Dr. Dr. Jason Stroud, who works out of the Park West office of East Cooper Coastal Family Physicians. “The key to maintaining long-term good health is the patient-physician relationship, and family physicians understand this relationship. The family physician will ask questions about your family health history and lifestyle to determine your health risk factors.”
Dr. Anthony Yuen, who is enjoying his first year out of residency with Roper St. Francis Express Care in Summerville, points out that the personal relationship benefits both sides. “The relationship helps motivate the patients in caring about their own care,” he explained.
There’s a big difference between someone else talking about your health and well-being and you joining in the conversation. A primary care physician incorporates all the important studies and personal factors that help determine what is best for the patient.
“A primary care physician has a unique perspective. Our point-of-view allows us to see a global picture and observe conflicting interests in regards to a patient. We act as mediators and interpreters, which is one of our most important jobs,” explained Dr. Yuen.
With the emergence of e-practices and online medical sites, primary care physicians insist that face time is vitally important. “The amount of information I get from seeing a patient in person, even within the first five seconds, helps me categorize how they are feeling. With any acute illness, face-to-face is invaluable,” explained Dr. Ferguson.
Many of the physicians interviewed for this article agreed that 15 to 20 minutes is appropriate for an established patient to meet with their doctor, while a new patient, depending on age, requires about 30 minutes.
“It’s obvious that an older patient will have more complex issues,” said Dr. DeJesus. “Some will have a full list of questions, and I want to get to the root of their symptoms, too.”
You should be wary of a physician who is not willing to answer your questions, and, in that case, you might do well to start looking for a new doctor. In addition, it’s important that you feel comfortable with your primary doctor. If a caring bedside manner is what you are seeking, then look for a physician who is willing to hold your hand or simply make eye contact. Remember: If you aren’t comfortable sending your child to the same doctor, then that physician really might not be for you.
“Face time is so important because so much communication these days is communicated non-verbally,” said Dr. Yuen. “Face-to-face, being able to touch your patient, even a touch on the shoulder, really can’t be replaced.”
Researching symptoms online is regarded as a double-edged sword among physicians we interviewed.
“Researching online allows a patient to be more informed, but one must be careful about the source,” said Dr. Ferguson. “There are a couple of good sites out there, but really you should trust the experience of your doctor.”
Dr. Colleen James, a doctor of Osteopathy at MUSC Park West, feels online research is just an element of the world we live in today.
“Once a patient has seen me, I give my patients certain sites and encourage more research. However, prior to seeing your physician, sometimes what you find online can be scary and confusing for someone without a medical background, so be sure it is a credible site.”
“This is certainly a pet peeve of doctors, and it can actually be dangerous,” said Dr. DeJusus, who obviously is a bit more cautious. “We understand that there is information free to everyone today via the Internet, but we still recommend people to seek the advice of a board-certified physician over ‘Dr. Google.’ Physicians are trained to treat the person in front of them, not apply the same principles to all, which patients can mistake if they are simply Googling their symptoms. Trust your doctor – not Google.”
The special relationship between doctor and patient is established once a person chooses to seek guidance from a primary care doctor. It is important for the patient to be honest because that will help the doctor make appropriate decisions if further care is needed.
“Primary care physicians are the gatekeepers of the medical field,” said Dr. DeJesus. “Most conditions are easily treated in the primary care office. Consulting with a primary care physician also helps lower medical costs overall since primary doctors are well-versed on many medical conditions. I never know what’s waiting for me behind the exam door, and it keeps it interesting.”
Primary care physicians are trained to recognize complications with diabetes, blood pressure, cholesterol, cardiovascular issues, mental illness and many more issues. The list is quite extensive, but primary physicians have willingly taken on the task of learning about these issues because they care about their patients.
“The family physician is trained to care for you as a whole person, regardless of your age or sex. Family physicians are able to diagnose and treat both acute and chronic illnesses,” said Dr. Stroud. “Primary care physicians can also provide routine health screenings and counseling on lifestyle changes in an effort to prevent illnesses before they develop. If a health condition arises that requires care from a specialist, your family physician can guide you and coordinate all aspects of your care. Research shows that patients who have an ongoing relationship with a family physician have better overall health outcomes, lower death rates and more cost-effective care.”
All primary care physicians must maintain the highest standards of medical care. Once they begin practicing, the American Board of Family Medicine requires re-certification by examination every 10 years. To maintain board certification, family physicians are also required to complete a minimum of 150 hours of continuing medical education every three years.
“Family medicine is a nice melting pot of all the specialties. You need a wide breadth of knowledge to recognize many different conditions and know how to treat them, and you also have to know your limitations and when to refer,” reiterated Dr. DeJesus.
The future of family medicine appears optimistic through the eyes of local physicians.
“I see a change for the better, one more for quality rather than quantity. There are good things to come. It is looking good for primary care,” said Dr. James.
