Primary care physicians (PCPs) hold the key to better health for you and your family. These physicians are on the front lines of health care and they get to know you, your family and medical history. It’s important to have a PCP that you like and have a good relationship with to get the best care possible.
Your PCP is like the quarterback on a football team calling the plays, or in this case, making the plans to address your health concerns and guiding your plan of care. Primary care can handle 85 percent of the problems that patients have, and can coordinate care needed for other problems as well.
It’s so important to get good primary care that many health care systems, including Johns Hopkins Medicine, are creating a new approach to primary care called “medical homes.”
Vice President of Population Health and Advancement at Howard County General Hospital, Elizabeth Edsall Kromm, Ph.D., offers some important insights on the benefits of primary care.
Broad Knowledge and Skills
While PCPs are not specialists, they have a special skill set, which allows them to be adept at spotting a broad, underlying condition responsible for a range of symptoms. Depression or a chronic inflammatory disorder, for example, can manifest in any number of ways: stomach discomfort, joint pain or problems with multiple organs.
There is a growing emphasis today on preventive medicine and maintaining overall wellness to ward off problems before they occur, if possible. Helping preserve and protect your health helps you save money on health care costs and also reduces costs for the health system overall.
For example, cardiovascular disease, diabetes and other chronic conditions are preventable. The effect of healthy habits on a person’s life can be enormous. Recent preliminary evidence shows a 5 percent reduction in weight in an overweight person can reduce their risk of diabetes by 65 percent.
Your Primary Care Team
To help ensure care is delivered most effectively and efficiently, health care systems are creating the “patient-centered medical home.” In short, the medical home transforms a primary care clinic or other facility into a home base, where most of what a person needs for better health is located and available.
Though the primary care physician remains at the center of providing care, emphasis on a team is paramount. These teams typically include nurse practitioners, physician assistants, health coaches, community health workers and more.
Technology Makes It More Personal
Electronic medical records are another component of the medical home that seamlessly weave together detailed notes from every care provider who sees the person, lab and imaging results, and the like. This way the primary care team can get reports on which patients are facing gaps in their care.
If you’re healthy and feeling good you’re probably wondering why you would need a primary care physician. According to William Saway, M.D., an internal medicine physician on staff at HCGH, “Even if you’re totally healthy, a primary care physician plays a very important role in keeping you healthy.”
Several benefits for having a primary care physician include:
Gaining a Medical Home
“Your primary care physician’s office is your medical home—they know you and your medical history to treat you best when you are feeling sick,” says Dr. Saway. They also ask you about your family’s medical history and use that information for preventative care and to determine any screening or testing you may need. “Patients who are otherwise healthy may have a family history of a condition that they in turn are susceptible to and they need to be monitored,” notes Dr. Saway. An emergency room visit can often be avoided by establishing a relationship with a primary care physician. Some local primary care practices also have extended hours or operate urgent care centers.
While you may feel perfectly fine, Dr. Saway warns, “You can have high blood pressure, diabetes and/or high cholesterol, which are silent killers. Pain brings you to the doctor and bleeding brings you to an emergency room but these conditions don’t give you a clue that you need to see the doctor. An annual visit to your doctor for screenings can provide insight before a condition can become serious.”
Access to an Educational Resource
A physician’s job is also to educate. For example, it is important to understand the consequences of high blood pressure or cholesterol or untreated diabetes. Your physician is your resource. Use your wellness visit to ask questions and get answers. If the need arises for you to seek the care of specialists, your physician can recommend specialists specific to your needs. Furthermore, they can provide collaboration between specialists and guide you to the appropriate resources. Specialists and patients should keep the primary care physician informed so care can be effectively managed.
Electronic Tracking of Your Health Care
Most physicians offer an electronic medical record that tracks test and screening results and generates reminders when you are due for a follow-up appointment, exam or test. This tool can be extremely helpful for managing a chronic illness. Your physician’s online website portal can provide education and an option for you to communicate with your doctor.
Internal medicine and family practice physicians serve as primary care physicians. Internal medicine physicians provide health care to adults and are skilled in preventing, diagnosing, treating and managing adult diseases as well as encouraging disease prevention and screening and promoting well-being. Family practice physicians provide ongoing, comprehensive health care for patients of all ages and genders. They also emphasize disease prevention and screening.
If your access to care is limited because of cost or insurance, Chase Brexton Health Care offers solutions as a Federally Qualified Health Center that serves underserved populations in the community as well as insured patients. “Our health care team is focused on helping patients stay healthy and providing care for urgent and chronic diseases. I enjoy working with my patients and their families to provide them with a comprehensive, team-oriented approach,” says Sarah Connor, D.O., a family medicine physician on staff at HCGH.
Specialized Program Changes to Meet Evolving Needs: Acute Care for Elders (ACE)
Geriatrician Anirudh Sridharan, M.D. with geriatrc nurse practitioner Francie Black, CRNP.
Caring for the ever-growing elderly population is a challenge faced by health care systems across the country. Responding to the need for improved hospital-based geriatric care, Howard County General Hospital launched the Acute Care for Elders (ACE) Program in November 2011, providing the community’s aging population with the specialized care needed to help minimize complications from hospitalization.
A national effort, the ACE model is designed to help elderly patients avoid inactivity that can lead to physical and cognitive decline during a long-term hospital stay. Patients admitted to HCGH’s ACE Program, must be at least 70 years of age, admitted through the Emergency Department from home and be considered at risk for functional decline.
Anirudh Sridharan, M.D., a geriatrician who specializes in hospital-based care and medical director of the ACE Program, explains that the program has benefited elderly patients by giving them the attention necessary to make their hospitalizations safer. “Howard County, like the rest of the country, is facing a shift in demographics. The fastest growing part of our population is people over the age of 65,” says Dr. Sridharan. “Treating an elderly patient is different than treating a younger patient; they are more likely to get confused in the hospital and more likely to suffer side effects from medications. It is vital that these vulnerable patients be given specialized attention that addresses these challenges.”
Since the program was launched, Francie Black, CRNP, a nurse practitioner with HCGH’s ACE Program, says the nursing staff is more keenly aware of the need to prevent deconditioning of elders in the hospital with a focus on getting patients up and out of bed. “Elders are mobilized as soon as day one, but definitely by day two of their admission to the hospital,” explains Francie. “The nurses and care technicians automatically add getting out of bed as a daily goal. There is a greater incentive for patients to walk in the hallways, and the solariums on the unit give our patients a destination as well as more daylight. We want our patients to function here as they do at home.”
Francie Black helps a patient stay mobile during a hospital stay, one of the goals of the ACE Program.
Coordination of care between the patient and their primary care physician, hospital doctors, nurses, nutritionists, case managers, pharmacists
and the patient’s family is an integral component of the ACE Program. Through a multidisciplinary approach to care, HCGH’s ACE team ensures that admitted patients remain mobile, well-nourished and have ample opportunities to exercise their bodies and minds.
“The ACE Program has heightened awareness of the need to collaborate with caregivers in the hospital, with the family, and the community to safely discharge an elder from the hospital, keep them from coming back to the hospital, and to improve their quality of life,” adds Francie.
If you are like me, your eyes glaze over when Medicare is mentioned in the news. I know I should learn more about it. I’m still pretty far away from using it myself, but planning for my future should include more than projecting my income and savings, it should include projecting my future expenses, shouldn’t it? Besides, my parents use Medicare, and it would be a good idea to understand what the heck Part A, Part B and Part D have to do with medical costs and reimbursement. (And what exactly is a Single Payer Health Care Plan as opposed to Medicare Advantage?)
A quick search turns up the alarming statistics that the typical senior household has $66,900 in savings, and the average man needs $124,000 to cover health care during retirement. (The average woman needs $152,000- not because we’re weaker, but because of that whole life expectancy thing.) Those are startling statistics!
Recently, my out-of-state aunt fell and broke her hip and had to be transferred to a facility that could provide the skilled care needed to get her back on her feet, but, because she stayed only 2 and one-half days in the hospital, Medicare could not cover the cost of that two week nursing home stay. Unfortunately, the family learned about the rule the hard way.
After all, being wise is an essential part of being well!
Mary Catherine Cochran works as a Senior Communications Project Manager at Howard County General Hospital: Johns Hopkins Medicine where, among other things, she manages and writes for the Well & Wise blog.
Heart disease is the leading cause of death in men and women in the United States, according to the Centers for Disease and Prevention (CDC). Unfortunately, you may not realize that you are at risk of having a heart attack until it’s too late.
While there is very little you can do to change your family medical history, you can make lifestyle changes to lower your risk. First, learn about the behaviors that increase the risk of heart disease, and then start taking preventive steps.
Behaviors that Increase Heart Disease Risk
Eat a heart-healthy diet
Add these following foods to your diet. They are considered to be the main ingredients of a heart-healthy diet.
Vegetables – greens (spinach, collard greens and kale), broccoli, cabbage and carrots
Fruits – apples, bananas, oranges, pears, grapes and prunes
Whole grains – plain oatmeal, brown rice and whole-grain bread or tortillas
Fat-free or low-fat dairy foods – milk, cheese or yogurt
Protein-rich foods – fish high in omega-3 fatty acids, lean meats, poultry, eggs, nuts, seeds, soy products and legumes (lentils and some bean types)
Oils, butters, nuts and seeds – canola, corn, olive, safflower, sesame, sunflower and soybean oils; nut and seed butters; walnuts, almonds and pine nuts; and sesame, sunflower, pumpkin and flax seeds
Aim for a healthy weight
Body mass index (BMI), a measure of weight relative to height, is commonly used for determining weight category (underweight, healthy weight, overweight and obese). Adults are typically considered to be at a healthy weight when their BMI ranges from 18.5 to 24.9.
Use Johns Hopkins Medicine’s BMI calculator to help determine your BMI.
Improve your emotional and physical health by learning to manage stress and practice stress-reducing activities, including:
Seeing a mental health care provider
Joining a stress management program
Being physically active
Practicing relaxation therapy
Speaking with friends, family and community or religious support systems
Increase physical activity
Routine physical activity can lower bad (LDL) cholesterol and increase good (HDL) cholesterol levels, control high blood pressure and help with losing excess weight.
The National Heart, Lung and Blood Institute recommends the following:
Moderate-intensity aerobic exercise – at least 2 hours and 30 minutes per week
Vigorous aerobic exercise – 1 hour and 15 minutes per week
Before starting a new exercise program, you should first ask your doctor how much and what physical activities are safe for you.
Speak with your doctor about programs and products that can help you quit smoking, and try to avoid secondhand smoke. If you are having trouble with quitting on your own, consider joining a support group.
Visit your doctor
According to David Jackson, M.D., a cardiologist on staff at HCGH, one of the critical steps to keeping your heart healthy is seeing your doctor for a routine physical exam. Your doctor checks your blood pressure, cholesterol and blood sugar – the big three indicators for heart attack and stroke.
“If your numbers start to become abnormal, you may not feel different or experience symptoms, so it’s important to have them checked periodically and more frequently as you age,” says Dr. Jackson. “Having a primary care physician monitoring your care to identify trends in your numbers is important.”
Man and Woman Sleeping [Credit: Monkey Business Images] / [Dreamstime.com]
Most of us love the extra hour we gain when daylight savings time ends in the fall. However, feeling better rested may not result from simply sleeping in an extra hour. Rather, aligning your waking time more with daylight – a physical cue that makes all the difference – is the more likely explanation.
Your biological internal clock, known as circadian rhythm, responds to light and darkness. When your activity does not correspond with sunlight cues, it throws off your circadian rhythm, causing your sleep to be disturbed. The extra hour helps with resetting your body’s exposure to sunlight.
Getting a good night’s sleep is important. If you are wondering how important, consider the risks associated with poor sleep and the benefits of good-quality sleep.
Risks from Poor Sleep
High blood pressure
Benefits from Good-quality Sleep
Experiencing improved memory and concentration
Feeling less moody and grouchy
While seven to nine hours is optimal for most adults, you can achieve big improvements in your sleep quality by practicing consistency, which is going to bed and waking up at the same time every day.
If you are not currently doing this, try testing it. Make a point of going to bed and waking up at the same time for a couple of weeks. I did this several years ago. For two weeks, I went to bed at 11 p.m. every night and woke up every morning at 7 a.m. After five days, I felt like the last time I had slept so well was in middle school.
However, if you think you are getting enough good-quality sleep, but are still very tired, that is a signal for getting evaluated. Start by contacting your primary care provider who may be able to treat your sleep condition or recommend someone who can. The good news is that common sleep disorders can be treated.
Rachel Salas, M.D. is the assistant medical director for the Johns Hopkins Center for Sleep at Howard County General Hospital.