The Forgotten Purpose of a Primary Care Doctor

If you can't connect with your primary care doctor the same day, you may not have a primary care doctor. Let's define primary care medicine.

Welcome to the Healthy Aging Newsletter, a free publication translating trustworthy medical research into simple habits to age well, free of chronic disease. I’m Dr. Ashori, a family medicine doctor turned health coach. 

At a recent get-together a friend told me about this peculiar new pain she was dealing with. Instinctively, I asked what her doctor thought about it. She said she didn’t have one, not a PCP, not a gynecologist, nothing. Others listening in chimed in and said “Who has a PCP these days? You see whoever is first available.”

My private medical practice is unique in that I have a small panel of patients and everyone texts me or emails. We’re in perpetual contact. And I am their primary contact - aka, their primary doctor. How can anyone safely navigate this behemoth modern healthcare system without one?

Doctors Are Humans - For Now

Until real-world AI catches up with hype-AI, the human primary care doctor you see will be human - a highly trained human, but a human, nevertheless. They’ll have good and bad days, mood changes, personality quirks, blind spots, great skills in one area and subpar skills in another.

If you can understand this about your doctor you’ll be able to compensate for any ‘flaws’ they have. That relationship you and that doctor build will be that much stronger because you are both aware of your strengths and weaknesses.

The Most Important Characteristics of a Great Primary Care Doctor

So let’s dive right in - these are the absolute bare minimums and necessary characteristics of a primary care doctor if you want to navigate this complex healthcare system safely.

1. Great Communicator

Your doctor must understand you and that will only happen after many, many appointments with him/her and many conversations. For that to happen they must know which questions to ask, how to answer effectively, and how to explain things on your level. Communication can’t happen in the traditional 7-10 minute primary care appointments or every 4.5 months.

2. Bluntly Honest

Your doctor can’t afford to sugar coat things or do things for your health just to ensure 5-start Google reviews. The best primary care doctors know when to say no and they’ll say no a lot. That’s because mainstream medicine creates a lot of harm when we intervene, so knowing when not to intervene is the doctor’s greatest skill.

3. Passionate About Clinical Medicine

Clinical medicine is an art and it evolves rapidly. The best primary care doctors have podcasts, books, and blogs they consume to learn more, improve their skills, and fuel their passion.

4. Extremely Resourceful

A great primary care doctor knows where to look up the right information, has a Rolodex of great specialists to refer patients to, and understands nuanced clinical interventions like biofeedback, pelvic floor therapy, and where to look for the right experts.

5. Strong Patient Advocate

Advocating for your patient means empowering them with the right skills and stepping in when necessary to help the patient move forward. Inevitably, we’ll have some health setback and how your primary care doctor approaches that will either demoralize or empower you.

The First Person You Text

Modern healthcare includes modern technology. While total body MRIs have proven to be more problematic than helpful, texting has been one of my best tech tools of modern medicine. After an appointment with my patient we often only scratch the surface. The real teasing comes from ongoing texting, emails, phone calls, and voice messages.

Getting to Know Your Doctor - Them Getting to Know You

You know you’ve gotten to know your primary care doctor when you can anticipate what they are going to say and how they are going to react. Usually that’s a good thing and as long as your doctor is not dismissive or condescending, you should feel supported by their words.

Getting to know your doctor takes time. Just like a great friendship you might even need a few tiffs to really ‘get’ each other. The courtship is that first UTI or cold you catch and you’ll really test each other’s commitment when that one serious health event happens.

Mainstream vs. Modern Primary Care

When I worked at Kaiser Permanente I got a $250K salary to see about 24 patients per day and handle their primary care needs. Whatever couldn’t get done in that appointment would get scheduled 3 months later for follow-up. Frustrating, I know.

In my current virtual primary care practice in California, I charge my primary care patients $150/month (often called a Direct Primary Care practice) and I see 6 people per day, max. The rest of the time I’m communicating on text and exchanging voice messages back and forth.

At Kaiser, I would find out a few weeks later after my patient ended up in the ER for something and they’d already have a post-discharge appointment with another random doctor before I would see them for follow-up.

In my private practice I’m right there when they patient is checking into the ER and many times I can talk to the ER doctor directly because I know my patient - I know them very well.

I wouldn’t say one model is better than the other but in one model I am the actual primary doctor of a someone I know very well and in another I am the assigned PCP on file of a KP member. I prefer the former.

The Thing About Health Coaching

One of the most important things I do as a primary care doctor is to help my patients understand their health, make and stick to healthy decisions, and make sense of all the information that’s out there. This is health coaching.

Actual health coaching is a bit more involved and a bit more proactive and while not necessary for everyone, some people really benefit from having closer follow up until they find their own rhythm.