SyndicationSep/29/2008
Primary care physician
A primary care physician, or PCP, is aphysician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medicalconditions, not limited by cause, organ system, or diagnosis. A PCP generallydoes not specialize in any medical specialty, such as neurology, cardiology, orpulmonology, nor perform surgery. The term "PCP"is most commonly used in the United States where it can be used to refer to twodifferent types of health care providers. The acronym may be used to refer toeither a primary care physician, who must hold a medical degree, or a primarycare provider, who may be either a nurse practitioner or physician assistant,or an alternative medicine practitioner with no formal medical training. Aprimary care physician can be described by medical training, skill and scope ofpractice, role in the health care system, and the usual setting in which careis delivered. Primary care physicians are declining in numbers in many developedcountries.
All physicians first complete medical school (MD,MBBS, or DO). To become primary care physicians, medical school graduates thenundertake postgraduate training in primary care programs, such as familypractice, general practice, pediatrics or internal medicine. Some HMOs considergynecologists as PCPs for the care of women, and have allowed certainsubspecialists to assume PCP responsibilities for selected patient types, suchas allergists caring for people with asthma and nephrologists acting as PCPsfor patients on kidney dialysis.
Scope of practice
A set of skills and scope of practice may define aprimary care physician, generally including basic diagnosis and non-surgicaltreatment of common illnesses and medical conditions. Diagnostic techniquesinclude interviewing the patient to collect information on the presentsymptoms, prior medical history and other health details, followed by aphysical examination. Many PCPs are trained in basic medical testing, such asinterpreting results of blood or other patient samples, electrocardiograms, orx-rays. More complex and time-intensive diagnostic procedures are usuallyobtained by referral to specialists, due to either special training with atechnology, or increased experience and patient volume that renders a riskyprocedure safer for the patient. After collecting data, the PCP arrives at adifferential diagnosis and, with the participation of the patient, formulates aplan including (if appropriate) components of further testing, specialistreferral, medication, therapy, diet or life-style changes, patient education,and follow up results of treatment. Primary care physicians also counsel andeducate patients on safe health behaviors, self-care skills and treatmentoptions, and provide screening tests and immunizations.
Role in the health care system
A primary care physician is usually the firstmedical practitioner contacted by a patient, due to factors such as ease ofcommunication, accessible location, familiarity, and increasingly issues ofcost and managed care requirements. In some countries, for example Norway,residents are registered as patients of a (local) doctor, and must contact thatdoctor for referral to any other. Also many health maintenance organizationsposition PCPs as "gatekeepers", who regulate access to more costlyprocedures or specialists. Ideally, the primary care physician acts on behalfof the patient to collaborate with referral specialists, coordinate the caregiven by varied organizations such as hospitals or rehabilitation clinics, actas a comprehensive repository for the patients records, and provide long-termmanagement of chronic conditions. Continuous care is particularly important forpatients with medical conditions that encompass multiple organ systems andrequire prolonged treatment and monitoring, such as diabetes and hypertension.
Health care setting
PCPs provide the majority of services at theprimary level of care, an entry point to a system that includes secondary care(by community hospitals) and tertiary care (by medical centres and teachinghospitals), also referred to an ambulatory care setting versus inpatient care.Many primary care physicians follow their patients in a variety of health caresettings, such as offices, hospitals, critical care units, long-termfacilities, and at home. A primary care physician may supervise a non-physicianhealth professional (which may be a primary care provider), such as a nursepractitioner or physician assistant.
Studies of the quality of care provided byprimary care physicians
Studies that compare the knowledge base and qualityof care provided by generalists versus specialists usually find that thespecialists are more knowledgeable and provide better care. However, thesestudies examine the quality of care in the domain of the specialists. Inaddition, these studies need to account for clustering of patients andphysicians.
Studies of the quality of preventive health carefind the opposite results - primary care physicians perform best. An analysisof elderly patients found that patients seeing generalists, as compared topatients seeing specialists, were more likely to receive influenza vaccination.In health promotion counseling, a studies of self-reported behavior found thatgeneralists were more likely than internal medicine specialists to counselpatients and to screen for breast cancer.
Exceptions may be diseases that are so common thatprimary care physicians develop their own expertise. A study of patients withacute low back pain found the primary care physicians provided equivalentquality of care, but at lower costs than orthopedic specialists.
Factors associated with quality of care by primarycare physicians include:
The more experience the primary care physician haswith a specific disease.
Physician group affiliation with networks ofmultiple groups.