Redefining the Gatekeeper

Your primary care doctor is keeping that gate open - not closed - as your primary advocate.

Do you ever wonder, why bother checking in with my primary care doctor when I know I just need to see the specialist?

How many people choose an insurance plan based on whether they have direct access to a specialist of their choice?
The “gatekeeper” role of the primary care doctor seems to generate such a restrictive feeling that for most it has become a rallying cry for health care reform.
And today, between the choices of EPOs, PPOs, and affordable private pay models, one can sprint to their cardiologist within a heartbeat.

From a random isolated heart flutter, to the fleeting feeling of “indigestion” (or is it really chest pain?), seeing the cardiologist and undergoing a battery of tests is now the definitive means of saying “yes, I have great insurance!”

But does that also translate to great care?
What would happen if the specialist subsumes the role of the primary care physician, and makes decisions that quickly become autonomous and impart authority. This prevailing sentiment can quickly take hold of the patient, making it harder for anyone else to weigh in and consider alternative options.  

But why would that be a problem? The patient got in with the “best cardiologist in town,” and received a thorough evaluation with recommendations for a cardiac catheterization and possible balloon/stent intervention.  

Well, if it turns out the patient had an unbeknownst lesion within the large intestine, a routine screening test for occult bleeding may have been able to help in this diagnosis. This would have needed resolution prior to any consideration for aspirin. And without aspirin, there would be no option for the planned intervention.
The situation would be fraught with further complication if a stent was deployed and then bleeding developed. Now the aspirin would be stopped and there would be high risk for stent occlusion.

In redefining the role of gatekeeper, the primary care physician performs the necessary systems checks so that any planned interventions by a specialist can proceed without issue.

The cardiologist may ask about prior bleeding, but it’s your primary care doctor who gives even greater perspective to the clinical picture. And whether it’s ensuring that all screening tests have been done, or whether other foreseeable procedures will not impact the feasibility of the one planned, it is the invaluable role of the primary care physician to make sure that when the gate is opened it stays opened. 

Seeing a cardiologist is very exciting in today’s era as interventions have now replaced the surgeries of yesterday, and have set new roads for the future.
But the potential for potholes remains! Your primary care physician paves your road for a smooth journey.