Primary Care Saved My Life

My father was a surgeon in Illinois. When he died in 2009, several people came up to me at his funeral and said, “Your father saved my life.” That was nice to hear, but at the same time I couldn’t help but think, Of course you saved peoples’ lives, Dad—they were at Death’s door and you did something dramatic that kept them alive. Well, I want to make the case that one doesn’t have to be a surgeon or oncologist or other specialist to save lives. In fact, I would argue that generalist physicians may save more lives than specialists by recognizing a range of problems earlier, encouraging more preventive care, making educated referrals and, when done well, serving as the case manager when an accurate diagnosis necessitates gathering data from a number of specialists. I am a case in point. For almost all of my life here in Minneapolis (45 years) I have chosen “Group Health” (now HealthPartners) as my healthcare provider network. They encouraged me to choose a primary care provider (PCP) and stick with that person. The idea was that my PCP would get to know me and my healthcare needs. With that knowledge he/she could provide more continuity of care than the ala carte system for choosing providers. I followed their advice and have had several PCPs over that time period. For the past 20 years or more I have had the same PCP. Previously, I was seeing a nurse practitioner, but sadly she died too young. All this to say that I am not

By Carol C. White, MA, MPH fickle about who I trust with my general care needs. When I reached 50 that NP reminded me that it was time for my first colonoscopy. I dutifully signed up and had the procedure done at the network hospital. It wasn’t very pleasant, but the results were good. When I turned 60 with a new PCP, I must admit that I didn’t schedule that second colonoscopy. For the next five years my PCP badgered me about getting it done. When that wasn’t working, he began to prescribe the FIT test, a noninvasive fecal DNA test that requires the patient to collect a stool sample and send it in. Ick! By the time I reached 67 I finally did the FIT test and sent it in. Shortly after, I received a letter saying that my test was positive, and I should schedule a colonoscopy ASAP. Frightened, I scheduled one for right after Christmas. I was relieved to discover that in the 17 years since my last test, the pain control methods had improved greatly. Conscious, but VERY mellow, I and the gastroenterologist watched the screen while he visited my colon. Suddenly, he said “Look here, I see a cancer,” and pointed to a small alien attached to the outside of my upper colon. Thanks to the new pain meds, my first thought was, “that’s interesting.” My non-drugged husband was not so sanguine. Six weeks later, after blood tests had been done and shown a low-level cancer, I had colon surgery. The surgeon took lots of lymph nodes along with the alien to see if it had spread. No lymph node involvement and no need for radiation or chemo. Six weeks later I was back to my old self and five years later I feel great—skiing, backpacking and traveling. I have had several colonoscopies in that time, and I checked my own blood work via “My Chart” once a year, along with my oncologist. We agreed that nothing was changing. After three years of follow-up with the oncologist, I asked him if I could go back to being monitored by my PCP. He said it was OK by him if it was OK with my PCP. And, at any time, if I had any symptoms or wanted to see him, I only needed to call and schedule an appointment. Now I have colonoscopies every three years and blood work every year. I am 74 years old. Cancer in remission is not the only thing I need to pay attention to. My PCP worries about my glucose level, whether I have had my mammograms, whether I am exercising enough, and he hears about my latest travel adventure (the one where I got taken down off the too steep mountain hike by horseback in the Andes). God forbid, should he die before I do, I plan to go to his funeral and tell his child or wife, “Your father/husband saved my life!”

Carol C. White, MA, MPH, is a retired public health professional. Her last 20 years of work were spent with small public health/primary care hybrid organizations serving a range of underserved communities with special cultural needs. Through these experiences, along with experiences as a patient, she developed a strong interest in using quality improvement methodologies, systems analysis, consumer advocacy and multi-disciplinary approaches to refresh and reorient American health care for better and more affordable healthcare outcomes.