Health decisions are a multi-stage process. It’s not simply about picking a drug or booking an appointment. You may have to interpret test results, you may have to consider lifestyle changes, and you may well have to live with some degree of uncertainty.
You need to work out which of the symptoms are of concern. A good GP will help you with that. These benefits in terms of day-to-day decision-making are huge. Primary care allows you to make decisions on a day-to-day basis.
A place to start when things change.
A new symptom doesn’t in itself point to one particular cause. Headaches, fatigue, indigestion, and sleep disturbance all have a multitude of possible aetiologies. The PCP will want to know when the symptoms are occurring.
They ask about the severity and other symptoms. Take a full medical history and current medication list, and then they’ll know what to do. That’s how they work.
Making sense of the test results.
Medical reports will contain some very odd-sounding terms. A result outside the lab’s reference range doesn’t in itself mean you have a disease. A result within the range doesn’t in itself mean you don’t have a problem.
They’ll look at the history and the examination findings and take into account any other relevant information. The GP will decide whether or not to do repeat testing and what the next steps are.
Patients can always come to us and ask us which of the findings are the most important. They should also ask us when they can expect an update.
Turning advice into practical habits.
Health advice is very difficult to put into practice in real life. You may well want to get more active, improve your sleep, change your diet, stop smoking, etc whilst juggling work, family and finances.
A GP visit will break down a broad aim into achievable steps. The clinician will discuss what is realistic in terms of change and will take account of any existing health problems.
A follow-up will be arranged if appropriate, and they will also be able to explain what has worked. They can do that in advance rather than feel they have to go in and follow a perfect plan right from the outset.
Reviewing the drugs and the potential side effects.
People may well be on prescriptions from various clinicians as well as OTC products, vitamins and supplements. It’s vital to have an accurate list so that the clinicians can check for potential duplication of medication or potential interactions and treatments that they’ll need to go through.
Each of those specialists will have their own piece of the jigsaw. The patient is frequently left in the dark as to how the various pieces of advice and treatment fit together.
Primary care is the place where you look at the reports, review the meds, and pick out the issues that are still there.
Patients must always let each clinician know about the relevant diagnosis and the treatments. They must make sure that the key records have been passed on.
Adapting care to the various life stages.
Health priorities will vary over time. Children will have their age-appropriate checks and vaccines. Adults will have their screening in line with their personal risk and in line with the current guidelines.
Older people will benefit from a medication review, a discussion around their fall risk, and support with a number of the conditions they’re managing.
The clinician will help the patient to work out what the appropriate preventative steps are for them in the context of their age, their history and their own individual circumstances.
Recommendations will of course vary. They will be shaped by your family history, any existing conditions, whether or not you’re pregnant, and your own individual preferences.
You should always ask why a test vaccine is recommended. You should ask what it can and can’t do and whether there are indeed any alternatives.
Building confidence to ask the questions.
Some patients will, of course, just avoid raising the issue for fear of being judged. They’ll think the symptom is too insignificant. A respectful ongoing relationship is a huge advantage in terms of being able to talk.
You can talk about all sorts of things in the consultation (stress, sleep, substance use, sexual health, etc.), and all of those things can have an impact on adherence to treatment.
Knowing when primary care is not enough.
Primary care will be the guide for a huge number of our day-to-day health decisions. It does have its limitations, of course. Some conditions will require specialist assessment and investigation and may in fact need to be treated in hospital.
A clinician will refer if the symptoms are ongoing. The test results may require further investigation and the condition may be outside the remit of primary care. The patient can of course ask why the referral is being made and what information they should take with them.
They should also be made aware of what support is available should their symptoms get worse in the meantime. Sudden chest pain, severe breathlessness, signs of stroke, or major bleeding would all be reasons to call the emergency services.
