When I started my graduate career at the Marshall University School of Medicine, in 1992, there was a big emphasis on primary care medicine. Primary care doctors include those who practice in family medicine, pediatrics, and even office-based internal medicine. Where I grew up, in West Virginia, there was a need for more physicians in these practice areas.
Over 25 years later, the medical education community continues to encourage new doctors to pursue a career in primary care. In Texas, at least, those efforts have come up short.
A 2017 study revealed that Texas ranks 47th out of all 50 states in the ratio of primary care doctors per person in population. To put it in real numbers, the Texas Department of State Health Services claims that the Lone Star State was short 2,002 primary care physicians in 2017, and that number will increase to 3,375 by 2030.
Why are primary care doctors important?
Having an ongoing physician-patient relationship with a primary care doctor is a good way to establish a health baseline. A baseline is what’s normal for you. It’s easier for you or your doctor to figure out if something is abnormal when you have a baseline that you can use for comparison.
Having regular check-ups—at least annually—with the same primary care doctor or at least the same practice group makes it easier to identify changes in your health that may require treatment or medication. Plus, having your primary care physician and office records available when there’s an emergency room visit or hospital admission may be helpful in the diagnosis process, again by providing insights into your baseline.
Primary care medical negligence
In my experience as a Houston, Texas, medical malpractice attorney, I’ve handled a lot of cases where mistakes by primary care providers were at issue.
To help fill the gaps caused by the primary care doctor shortage, some practices rely on extenders, like nurse practitioners (NP) and physician’s assistants (PA), to see patients. These mid-level providers are good for diagnosing and treating some conditions, like common colds and respiratory infections. Some may have even more advanced capabilities.
However, physician’s assistants and nurse practitioners simply don’t have the same expertise and training as physicians. I’ve seen situations where they allow patients to call them “doctor” and to continue in their mistaken belief that they’re physicians.
While I’m perfectly comfortable in seeing a NP or PA for some things, I recognize that sometimes there’s no acceptable substitute for seeing a fully-trained doctor. That’s why I recommend that patients make sure they’re aware of their providers’ education, training, and experience. If you have concerns about the answers or lack of answers you’re getting from a PA or NP, ask for a second opinion by a doctor.
Another area of concern that I’ve observed is information falling through the cracks at a primary care doctor’s office. By this I mean things like lab results and radiology study reports never being communicated to patients. In my view, if it was important enough to order blood work, an MRI scan, or CT scan, then it’s important enough to call the patient with the results. If that doesn’t happen, you should follow up yourself.
I’ve investigated several matters where there were critical abnormalities in radiology studies, for example, that the doctor’s office knew about, but the patients didn’t. This mean a delay of months to over a year in cancer treatment, with devastating injuries to the patients.
My recommendations to improve your safety in primary care are:
(1) start a relationship with a primary care doctor and have at least annual checkups
(2) if you see a nurse practitioner or physician’s assistant at a primary care group practice, don’t be shy about asking for a second opinion by the doctor
(3) make notes of any lab work or radiology tests that are ordered and follow up, if necessary, to get printed copies of the results
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. Also, in 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.
