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Primary care doctors play unique role as we age

Jul 11 2016

As we age, we may need to interact with the health care system more frequently than in years past. As a result, we tend to focus on specific symptoms and find specialists to help us with our ailments. But even the best team of specialists doesn’t take the place of one primary care physician (PCP).

In fact, your primary care physician can often play an important role among different treating physicians. “With one central care provider, other physicians and medical staff who may be treating you can get important information that might influence their own treatment choices,” explained Edmund Pezalla, M.D., M.P.H., vice president and national medical director of Pharmaceutical Policy and Strategy at Aetna.

A primary care physician serves as the primary point of contact for an individual by providing medical services for an extended period of time. This kind of doctor can treat most medical issues for patients who do not require assistance from a specialist.

“Having a central caregiver can help your entire care team detect patterns in your health and recommend lifestyle changes to prevent future complications with your care,” he said.  

Primary care: your go-to doctor

The primary care clinician is typically the doctor you visit for most of your medical needs, including prevention, non-emergency illnesses and wellness checkups. They also typically monitor a patient’s chronic disease or condition, such as diabetes and high blood pressure.

Primary care doctors are able to “drive your care where it needs to go,” said Gina Conflitti, M.D., vice president and national medical director of National Accounts at Aetna. “These care providers know what is within their area of expertise and when a situation warrants a specialist. Often they will work in tandem.”

Mental health gets its day

More doctors’ offices and walk-in clinics are including depression screening as part of their standard survey of visiting patients. This reflects a growing awareness that mental and physical health are intertwined, according to Hyong Un, M.D, chief psychiatric officer of Aetna Behavioral Health. “When a primary care doctor asks questions about how you are doing mentally and emotionally, they recognize the importance of making sure you are okay inside and out.”

Over time, these conversations knit together to create a picture of your mental health, he said. “With some historic context, it’s much more likely a primary care doctor will recognize warning signs earlier than someone who doesn’t have a sense of your history or typical state of health.”

Over 50? It may be time for new shots

Once we reach a certain age, experts recommend a series of immunizations and regular screenings to ward off or detect diseases that are particularly common (or dangerous) as we age.  A few of the most recommended screenings are for Type 2 diabetes, cholesterol and colorectal cancer.  These are typically included in the annual physical exams primary care doctors perform every year.  Blood pressure, depression and HIV screenings are also considered essential preventive measures by the Affordable Care Act and are covered in ACA-compliant health plans. Most of these services are only free if they are delivered by a doctor or other provider in your health plan’s network.

Speaking of health plans, make sure your primary care doctor and any specialists you plan to use are in your health plan’s network. Networks typically reflect arrangements between the doctor’s office and the health insurance payer that meet certain criteria for quality and cost. If you want to see a physician who is not in your plan’s network, you have three choices. You can ask them if they plan to join the network; you can find a different doctor who is in your network; or you can pay a greater share of the cost because your doctor would be considered “out of network.” It’s important to note that out-of-network costs can be much higher and take more out of your own pocket.

Editor’s note: Aetna offers its DocFind search tool to help identify primary care doctors, specialists and health care facilities in its network.