Do I Need a Primary Care Physician?

If you want to stay healthy, building the right care team is key. We all know how important it is to keep an eye on our health, especially  as we age. Reminders to get periodic screenings like mammograms and colonoscopies are all over print, television and radio ads every day and many of us see a specialist or two such as a dermatologist or cardiologist  on a regular basis.  But is getting periodic screenings and seeing our specialists enough? Or should we have a Primary Care Physician in place as well? What does a Primary Care Physician do and how often should I see one? In episode 7 of the Sage Aging podcast we answered all these questions and more. Here is what we discussed:

  • What is a primary care physician?
  • Are all primary care providers the same as it relates to who they serve – families vs seniors?
  •   Why is having a primary care provider important and Can it improve general health?
  •  What does a primary care provider NOT do?
  • In what settings can you find primary care providers – sole practitioner, medical groups, hospitals?
  • Is telehealth a good option for a primary visit? 
  • When is the best time to establish a relationship with a provider?
  •  How often should I see my primary?
  • Can primary care providers manage chronic conditions or is it just a general health relationship?
  • Do primary providers assist in coordinating care with specialists?
  •  How are caregivers/family members involved in care plans for older adults?
  • When choosing a provider, what questions should I ask?
  • What should I bring to my office visit?
  •   As a family member/caregiver of a patient, what are some best practices to be an effective advocate for your loved one?

Links & Resources

Read the full transcript here

Closed Captioning

Liz Craven 0:01
This episode of Sage Aging is brought to you by Polk ElderCare Guide, your source for senior care and living options in Polk County, Florida. Visit us online at polkeldercare.com. Did you know that an adult with primary care physicians are 19% less likely to experience premature death than those who only see specialists. If you ever wondered if you really need a primary care doctor, then this is the podcast episode for you.

Hi, I’m Liz Craven, and like so many others, I’ve faced the overwhelming task of being a caregiver for people that I hold dear. I understand how tough the day to day of a caregiver can be, and how hard it is to come by good information. Here’s one thing I know for sure, education is key. Equipped with the right tools, and good information caregivers will experience less stress and find better balance in day to day life. For the past two decades, I’ve built my career on connecting older adults and those who care for them to the education and resources they need to navigate the aging journey. This show is dedicated to the same welcome to the Sage Aging podcast. Hit subscribe now, and let’s get started.

Hello, and welcome to episode seven of the Sage Aging podcast. I’m your host, Liz Craven. If you want to stay healthy building the right care team is key. We all know how important it is to keep an eye on our health, especially as we age. Reminders to get periodic screenings, like mammograms and colonoscopies are all over the television and radio ads every day. And many of us see a specialist or two such as a dermatologist or cardiologist on a regular basis, but is getting periodic screenings and seeing our specialists enough, or should we have a primary care physician in place as well? What does a primary care physician do? And how often should we see one? We will answer these questions and more in this episode of Sage Aging? My guest today is Dr. Ambika Soni of Soni Family Medical practice with offices in Polk, Osceola and Orange counties in Central Florida. A graduate of University of Illinois at Chicago College of Medicine, Dr. Soni founded the Soni Family Practice with a mission to care for patients like family, and believes that building relationship with patients and their families is key. For more information about Dr. Soni or how you can reach her, go check the show notes. We’ll have a link there for you so you can link directly to her and her information. You’ll also be able to find show notes at SageAging.us in our blog there. Welcome to the show, Dr. Soni and thank you so much for joining me today.

Dr. Soni 3:31
Thank you so much for having me today. This is wonderful. I’m very excited to join in with you with this wonderful talk.

Liz Craven 3:38
So I don’t know if you’ve heard our podcast before, but I like to start with a little bit of fun before we get into our topics. So I’ve got a few questions that I’d like to ask you for a lightning round. Is that okay with you?

Dr. Soni 3:52
Of course that sounds like fun.

Liz Craven 3:55
Okay, first question is books or movies.

Dr. Soni 4:01
Movies

Liz Craven 4:03
Do you have a favorite?

Dr. Soni 4:05
Um, I’m into romantic and Pixar movies because I can enjoy those with my kids as well.

Liz Craven 4:13
Perfect. I love that. I enjoy Pixar movies too, but my kids are all grown. My husband and I still go and see them and typically are the only adults in the theater without kids.

Dr. Soni 4:26
So funny I love it. Okay.

Liz Craven 4:29
Second question, what is your favorite food?

Dr. Soni 4:33
It’s a great question. I love all food. But if I had to pick I would probably say Italian. I love pizzas and pastas. So those are my go to foods.

Liz Craven 4:45
Yeah, me too. Okay, the next question jeans and T shirts or are you a fashionista?

Dr. Soni 4:53
Jeans and T shirts all the way. I’m all about comfort

Liz Craven 5:00
A girl after my own heart for sure. Okay, and the last question, what is your biggest pet peeve?

Dr. Soni 5:11
Hmm, that’s a tough one. Um, I would say for myself, it would be being late. I don’t know why my husband that is always like, Why do you always have to be the first one everywhere. And with my practice, too, I hate being late I am my biggest pet peeve is just running late. I love to be on time. I don’t know if it’s a good thing or a bad thing. But…

Liz Craven 5:33
I think it’s a combination of both. And I think you and I were meant to be friends because that’s my biggest pet peeve too. And my husband says the same thing. Well, that was fun. Thank you. I love doing that because it really sets the tone for the audience and lets them hear a little bit about who we are. And I think that it’s just really important for them to know who’s speaking To them more than just the topic itself. So thanks for playing along. So let’s get on to our topic, primary care provider, that can be something so confusing to people as almost anything within the medical realm is. What do those things really mean? And what should I do with them? Do I really need that? So let’s start with primary care 101. Tell us what that really means.

Dr. Soni 6:29
So a primary care provider is somebody that has either an internal medicine or family medicine or a pediatric. And what it is, is someone that’s managing your entire body from your head down to your toes, so you go to them for any condition that you may have. They also help manage your preventive care, so all of your screening tests how to prevent chronic disease, and when we do have a chronic disease, they’re the person that’s going to help manage your chronic disease to help decrease the risk of complication. But basically, all in all, they’re your go to person for your health needs.

Liz Craven 7:05
is the role of a primary care provider to arrange care for chronic conditions as well. In other words, do you kind of plan out the care in its entirety, and then specialists work together with you or do people do those things separately?

Dr. Soni 7:23
It’s best to do it together with your primary care provider. So for example, if somebody has heart disease, and they go straight to the cardiologist, which is wonderful, they can help manage your cardiac conditions. But also with heart disease, there’s other complications that can happen as well, such as having, you know, like a vascular disease or having diabetes or high blood pressure that can also relate to the high heart disease that your senior cardiologists for. So the goal of the primary care provider is to help manage the entire person, not just one part of the body, that’s managed by the specialists, the primary care providers work very closely with their specialists because that’s the way to manage them in the best potential way. Primary cares can do quite a bit for the patient and help manage them. But there’s certain parts where we have to have the specialists come in to manage our patients better to prevent a complication. So say if somebody has heart disease, and they need a stent placed, or they need some type of surgical treatments that are needed to help improve their chronic conditions or prevent a further complication. That’s when we work side by side with the specialist. And when you have your primary care doctor, when you come back to the primary care doctor, we explain things a little bit better, more one on one, the specialists are very busy. So they tell the patients quite a bit of information. And once the patients leave the room, they’re like what just what did they say and they may get confused or not understand everything fully. So primary care providers help aid in that as well. So when the patients come back to my practice, after seeing a cardiologist, I go through through everything, and I asked him all the questions. So I understand you learned a lot that visit. But what questions do you have for me? And how can we continue our goal to prevent any further complications?

Liz Craven 9:11
So it would make sense then that using a primary care physician would be good for your health overall?

Dr. Soni 9:18
Yes, definitely. Most definitely. Yes.

Liz Craven 9:22
I saw a statistic that was so interesting to me, it said 19% less likely that you’ll experience a premature death if you use a primary care physician than those who just use specialists.

Dr. Soni 9:37
So primary cares we like when we order bloodwork, we can pick up kidney problems, we can pick up all sorts of potential complications that could be arising and help reverse some of those complications that could happen. So if we, you know, if we change our diet, and we exercise and we avoid things that can be damaging certain organs, that’s how we can help prevent issues and we can also pick up cancers earlier, we can pick up things that potentially A person may not be feeling and they didn’t know was something that was you know, stirring up in their body unless they were senior primary care where we were able to order certain bloodwork do certain testings to potentially find something earlier and prevent cancer or a chronic condition.

Liz Craven 10:16
That makes a lot of sense. So you’ve said a lot about what primary care does. What does a primary care provider NOT do?

Dr. Soni 10:26
That’s a great question. So primary care providers don’t do surgeries, such as like a gallbladder removal. Don’t do colonoscopies back you know, maybe 20 years ago, we used to do some sigmoidoscopys, but we don’t do colonoscopies, we don’t do surgeries. And that’s basically what we don’t do. We do quite a bit for the patients in our clinics.

Liz Craven 10:49
You can care for patients of any age. Is that right?

Dr. Soni 10:53
That is correct. That’s a great question. So I’m a family medicine doctor. So I see everything from newborns day of life, one all the way Up to 110. So family physicians we see all ages. That’s why we’re called family doctors because we see, you know, the grandkids, the kids, the grandparents, and even the great grandparents, as opposed to internal medicine that are just adults 18 and above, and then pediatrics are less than 18. And we’re all considered primary care.

Liz Craven 11:22
That was going to be my next question. That’s very interesting to me, because a lot of people that I get feedback from through our website and also through phone calls. They’re curious about that. Well, I see an internist. Is that sufficient to be called my primary care physician or when I go to see my GYN annually for a checkup? Is that considered primary care?

Dr. Soni 11:50
So an internist? Yes. Because an internist can do quite a bit. They’re just they are considered primary care and they do check a lot. organs and all, you know the head to toe body. a gynecologist is considered primary care as well, but it’s limited to more so of women’s health have you know pelvic exams, breast exams, they do order labs and some of them can do full spectrum, but majority of ob gyn do more so of women’s health, pertaining to, you know, pap smears and breast exams.

Liz Craven 12:25
That makes complete sense. So in what settings can you find primary care providers? Obviously, in an organization like yours, you have your private offices, are there other venues that someone might find a primary care physician?

Dr. Soni 12:42
Yes. So multi specialty groups have primary care as as well as hospital affiliated groups also have primary cares as well. Solo practices also have primary cares. So there are those are the multiple settings that we see them in the outpatient settings. multi specialty solo and hospital affiliated positions.

Liz Craven 13:05
So with everything that’s going on right now, have you begun to use in your practice telehealth?

Dr. Soni 13:12
Excellent question. Yes. So we have been doing quite a bit of telehealth to keep our patients safe at home but still managing their chronic conditions. It’s been wonderful. I’ve never used telehealth prior to COVID-19 of what’s going on currently. But yes, it’s been wonderful. Our patients appreciate it because they’re because they’re kept safe at home, still able to see me I’m still able to examine them over the phone, you know, they show me their swelling in their legs or they have an abscess somewhere I’m able to look at it or a rash and it’s been wonderful. I don’t think that long term it’s the best but definitely for short term, managing acute cases and still managing chronic conditions. It’s been working out very well and our patients love it and definitely appreciate it quite a bit.

Liz Craven 14:00
I’ve been curious about this, does that give you an additional view into their home setting? Because especially with older adults, we know that the home environment is very important to their health. Does the telehealth give you the opportunity to see a little beyond what they’re telling you when they come to the office in person?

Dr. Soni 14:21
Yes, that’s a great question. So I’ve been I’ve been seeing more and more of that with my patients just seeing where they live kind of how their you know, their home is environment is it safe I’ve seen patients you know, with bars in their house and just, you know, them showing me their their animals and food are over the counter meds that they’re using that they forgot to bring in something vitamins and natural herbs, supplements and quite a bit of things. So it’s been a great insight for me to experience my patients home and another part of their environment. So it’s been wonderful to see that

Liz Craven 14:54
Technology has certainly changed things in every aspect of life, hasn’t it?

Unknown Speaker 14:59
It definitely has.

Liz Craven 15:02
So how often should someone see a primary care physician?

Dr. Soni 15:08
Routinely, I would say one to two times a year if somebody has no medical conditions at all, but we do a wellness or a physical exam every year. That’s a once a year visit and then the second time I usually recommend just, you know, coming in for a checkup. But if somebody has a chronic medical condition such as diabetes, heart disease, high blood pressure, asthma, COPD, kidney disease, they should be seen every three months. There are medications that goes through the liver or the kidneys that need to be checked to make sure that there’s no damage that’s been done to certain organs and to make sure that things are well controlled. So three to six months is what I say if somebody is uncontrolled every three months, if they are well controlled with their chronic diseases, every six months should be okay but at least every three months for chronic conditions

Liz Craven 15:59
And primary care visits are typically covered under insurance plans without a copay for at least one visit a year. Isn’t that right?

Dr. Soni 16:08
That is correct. All wellness exams are considered without a copay. So it’s wonderful. You come in, you see your doctor, you get a full body checkup, you get your labs orders. And it’s a no copay. And that’s what I tell my patients definitely take full effect of that and come in and see us there’s no charge at all. And the wellness exams are so important, because that’s when we sit down and we really talk about all of our screening tests such as mammograms, bone scans, colonoscopies, lab work, are they up to date on their vaccines, such as flu vaccines, when are they due for their pneumonia or the shingles shots? So those are the most important time to come in to help your health conditions and find out what truly is going wrong or what is going right. And that’s the time to ask your physician all your important questions as well.

Liz Craven 16:59
So for certain demographics, especially for older adults who are needing assistance, it’s really important to involve the family in their medical care and their medical decisions. How do you do that creatively without stealing their independence, if you will, you know, a lot of a lot of older adults are a little resistant to family necessarily coming in with them. How do you handle that as a physician to make sure that your patients are getting the best out of your care?

Dr. Soni 17:31
That’s a great question. So when I establish care with my patients, I really try to get to know them. That’s number one. That’s you want to create a relationship between yourself and the patient. So they have this comfort and understanding to confide in you as somebody to express their concerns and how they want to increase all of their health conditions and make sure they’re managed well, but there also comes times when once I’ve known the patient and established that care with them. I can see if there’s any problems such as dementia, or they’re having a hard time remembering or doing things. And when I start to see that, I definitely ask them if they come into the room by themselves. So who’s out here with you? And before I even ask him that when we’re building our relationship, I do ask Who do you live with, who you know, who is someone that you can find. And so I already have that baseline understanding with my patients. So when I have a concern that there possibly is dementia or things like that, that’s when I would definitely want to, you know, have the family more involved in the care. But most of my patients when they do come in, I’ve met their children or their grandchildren or their nieces or nephews or whoever is bringing them to the office visits. I do like to have that full round of family interventions with the patients to begin with as well because I feel that’s a great way of knowing the patient a little bit better. And with our practice, since we’re a family medicine, we tend to see the rest of the family as well such as their children. Their grandchildren. And so it gives me a better understanding of the family dynamics and of the conditions as well, because a lot of these things could be genetic as well and what things possibly could be running in the families. So having a good family conversations and establishing that care between the family and the patient is key. I think it’s key and I do tend to have the family involved when necessary, and the patients do understand and appreciate that.

Liz Craven 19:28
And so what suggestions would you have for family members, especially caregivers, a lot of caregivers are listening to this podcast, and trying to navigate this whole journey with the person that they love that they’re caring for, what are some ways that they can approach being intimately involved in the healthcare without causing friction in the relationship?

Dr. Soni 19:54
That’s a great question. So first off with the caregivers and anyone that’s helping take care of the family members, they have to be on the HIPAA. So the patient has to give consent before we’re able to talk to them. But a lot of times if family members have concerns, say if I’m doing a routine urine analysis where my patient has to leave the room for a minute and go give a urine sample, that’s a lot of times when the caretakers and the family members expressed our concerns to me, or they’ll catch me in the hallway before I go in the room or, or they’ll call and say, Hey, I need to talk to Dr. Soni to talk to her about what’s going on. Because sometimes it gets to these sticky situations where they don’t want the patient to feel bad if they’re concerned about possibly dementia, or if there’s some other things that are going on. So confiding in the physician with the caretakers is really important. So expressing what you see that is going on. Are they forgetful, you know, is there problems with urination or leaking of urine or any concerns that are going on it’s really important to express that to the physician taking care of the patient. Because sometimes we as physicians don’t know what’s going on until somebody tells us or until we’ve asked those significant questions. But communication is the biggest key to help manage any chronic conditions and you have to have a good foundation between the patient and the physician.

Liz Craven 21:18
That’s really great information. Thank you. So when choosing a provider, what are some key questions that we should be asking?

Dr. Soni 21:28
So when choosing a provider, what I recommend is a lot of people do some research and exploring physicians, but key things is when you meet the physician for the first time, see the connection that you’re having. See if this is something that you as a patient feel comfortable expressing some of your concerns that you may have. So having that strong connection is the best as I really really think because that helps all of us. It’s it’s a circle, it’s a full circle. We need everybody on the same page. So if you feel that connection, and you also want to ask them, are they comfortable managing Junior conditions? If somebody has, if they’re complicated, they have many conditions. You want to express your concerns at the first visit to say, Are you comfortable managing these things? And what would you do if you’re not comfortable? Would you be willing to send me to a specialist to help manage my conditions? And then just making sure that comfort is number one, and just making sure that you feel confident that the physician can manage your conditions accurately and appropriately?

Liz Craven 22:33
I agree with you wholeheartedly. That’s so important. I’ve been a caregiver myself and obviously been to see the doctor myself. And I think that communication and trust are the two key factors for me as it relates to building a relationship with a care provider. So when somebody comes to an office visit with you, what would it be best for them to bring along with them.

Dr. Soni 22:58
So I encourage our patients To bring in their all their medications, including over the counter medications or any herbal supplements that they’re taking. if they have any medical records such as their last set of bloodwork, their last mammogram, their last colonoscopy, or bone scan as well. And if they have any records from their last doctor, their previous doctor, their primary care, or any specialist reports, that makes our lives a lot easier. So we can read through everything and get to know the person medically as you know, a whole person. So it’s it makes it a lot easier because sometimes obtaining records from old doctors can be a little challenging or things get lost or patient forgot where they had their mammogram. So I advise you even when you have things done, always keep copies for yourself. And these days, electronic resources are excellent. There’s a lot of patient portals out there where you can still print information out even if you’ve left the practice. So if you have access to a patient portal printout, your last set of bloodwork and any routine screening tests and your last note would be wonderful if you can bring that in. And also bring a list of questions if you have because I know sometimes the first visit can be quite nerve wracking just meeting a new physician hoping things will go well, but also writing things down. So you’re well prepared to ask any questions that you have that day as well.

Liz Craven 24:17
And when someone is visiting with you, can you give caregivers and family members who might come along some best practices as to how they can be the most effective advocate for their loved one?

Dr. Soni 24:30
Um, I mean, what I usually recommend is just communicate with me if there’s any problems with anything just communicate with me as long as they’re on HIPAA. The HIPAA is a form that patients fill out who they feel comfortable talking about medical advice is okay if it’s our daughter, their son, you know, a daughter in law son in law. And as long as that signed in the chart, we can communicate at any time they can always call our practice, but that’s what I usually say just communicate with me. I think I sound like a broken record. I just can munication is definitely the biggest key for health and wellness of our patients.

Liz Craven 25:05
Well, not a broken record at all, because that’s a message that is so important. And we really need to get that across. So I think the more times we say it, the better off everybody will be. Well, we’ve talked a lot about primary care and what it is and how families can be involved, when’s the best time for someone to establish a relationship with a primary care provider?

Dr. Soni 25:30
I would say now, and I can’t stress that enough. If somebody does not have a primary care provider, you don’t want to wait till you’re sick or you have an urgent visit to be looking scrambling to find a primary care physician. Even if you have no medical conditions. I really urge everybody please get a primary care provider right away because they’re your gateway. They’re your go to person that’s going to be your best best bet for your wellness and your health. So if you do not have one, I really urge everybody, please look for primary care doctor close to you somebody that you can get to easily and establish that care. So it’ll be the best thing that you can do for your health.

Liz Craven 26:09
Thank you. And one last question as it relates to that, having to do with insurance. Is choosing a primary care physician dependent on the insurance that you carry or do most primary care providers accept a pretty wide variety of policies.

Dr. Soni 26:26
It’s all area dependent as well. But insurance companies do dictate who you can and cannot see. So unless you have a PPO means that you can travel outside and see anybody that you like, if you have an HMO, you have to stick to positions that are in the list of affiliated physicians with that insurance company. So it does go through insurance company. So always ask your insurance company for a list of the local primary care doctors or if a friend is seeing your primary care provider that you’re interested in seeing You can go to their website, and you can see if they take your insurance. And if they do, go ahead and establish care right away.

Liz Craven 27:07
Dr. Soni, thank you so much for joining us today, the information that you’ve provided has been wonderful. And I know I know a lot more about primary care than I did before. I think that it’s important that we get as much information out to people as possible about the tools that are available to help keep us all healthy, and especially as we age to stay as healthy as possible. Thank you so much for joining us today. And I hope you’ll come back and visit with us again sometime.

Dr. Soni 27:38
Thank you so much for having me. This was a wonderful, wonderful lecture and a wonderful talk I I really truly hope everyone’s learned something well and if you have questions, please talk to your primary care doctor.

Liz Craven 27:50
And for our listeners, we’ll be linking all of Dr. Soni’s information so that you can get in touch with her directly and her website in our show notes. Again, you can Find those at Sage aging.us. Thanks for joining us, and we’ll see you next time.

Thanks for listening. If you found value in today’s conversation, I’d really appreciate it if you would click Subscribe now and share the Sage Aging podcast with a friend. If you have topic ideas you’d like to share, we’d love to hear from you. Drop us a line at Sageaging.us

Liz Craven

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As I’ve been preparing to launch this podcast I’ve enjoyed revisiting stages of my own life and reflecting on how this topic became such a passion for me. While I’ve built my career on helping older adults and their families connect to needed education and resources, my connection to the aging and care process goes much deeper.

Some of my earliest childhood memories are of my own multi-generational family living together in one home. I was 4 or 5 when my grandmother moved into our home to help care for my sisters and I while our parents worked. Soon after, her father and grandfather moved in as well. We had 5 generations living under one roof! That was a beautifully chaotic adventure and knowing what I know now, I have so much respect for what my parents and grandmother did.

Fast forward to age 24. Newly married and pregnant with our first child, I spent several months with my in-laws to help care for my husband’s grandmother who had Alzheimer’s. Fast forward again to about 2009 – Wes and I have two teenagers about to head to college and his mother is diagnosed with cancer. Several years later, my mother is diagnosed with cancer. Several years after that Wes’ stepdad is diagnosed with Alzheimer’s disease and his father is suffering from severe dementia. You can see where this is going right? For the better part of the last 10 years we have been the caregivers. We see it as an honor and privilege to have been able to do that for our parents.

The key to navigating our later years is being proactive about gathering information before we get there and staying engaged once we do. To be sage is to be wise. There is wisdom in taking the time to ask questions, seek solutions and know your options before the need arises.

Each week we will discuss relevant topics of aging with experts who can help us to understand and be better prepared for aging. We’ll also introduce you to some Sage Agers who are totally owning their journeys through life. No topic will be off limits and we will deliver open and honest conversation meant to educate and empower our listeners. Each episode will also be available in video and blog formats.

Whether you are proactively seeking to broaden your own knowledge, a caregiver for a loved one or a professional working in the aging care industry, this podcast is for you. We hope you will join us as we explore and celebrate Sage Aging.