The value of having your own doctor

Stefan Popielcyzk and his wife, Alexandra
Stefan Popielcyzk and his wife, Alexandra, appreciate that their primary care physician, Ryan Dadasovich, MD, takes the time to listen to their concerns.

Your nagging earache just won’t go away. Your teenage daughter needs a physical before starting high school. Your 75-year-old father-in-law keeps forgetting where he puts things.

Life can get complicated, especially these days, so when a medical problem pops up, you need to deal with it quickly and without too much stress. The best option – and there are several in the digital world – is to contact your doctor. That is, if you have a doctor.

Long before there were medical websites, telehealth apps and urgent care centers, most everyone, young and old, had a personal or family doctor, who sometimes cared for families over several generations. They would see patients in their offices or even make house calls. Those old-school doctors were trained to diagnose and treat a wide range of health problems, and if necessary, refer patients to a specialist for further care. But that’s so 20th century!

Today they’re called primary care physicians or primary care providers (PCPs) and are typically trained in internal medicine, family medicine or pediatrics. They include not only traditional doctors of medicine (MD) but also osteopaths (DO), physician assistants (PA) and advanced practice nurse practitioners (APRN). Alongside specialists such as orthopedists, cardiologists, oncologists and neurologists, PCPs remain important members of the healthcare community, even if not as many people have their own PCP as compared to 50 years ago.

Even in the internet age, though, there are many good reasons for having a PCP, from birth to end of life. “One of the main benefits is having a doctor you’ve built a relationship with, who will always be there for you,” said Nasreen Kathrada, MD, a physician with Northeast Medical Group and Greenwich Hospital, both part of Yale New Haven Health. “That one time when you aren’t feeling well, it’s helpful to have a doctor who knows your health history and can attend to you in a timely manner. That relationship has shown to lead to more accurate diagnoses and treatments.”

A PCP can be the first healthcare professional you contact when an immediate medical issue arises. Consider that persistent earache. It’s easy to do an online search, make a self-diagnosis and schedule an appointment with an ear, nose and throat (ENT) specialist. “But sometimes the online search can be incorrect,” said Beth Moore, MD, who recently returned after a 10-year hiatus from primary care. “That time might be better spent seeing your primary doctor first, even if it’s a disorder that requires a specialist.”

Besides dealing with one-time problems, seeing your doctor regularly is the key to long-term preventive health, said Dr. Moore, a physician with Northeast Medical Group and Greenwich Hospital. “My belief is that the relationship between a primary care provider and patient is a valuable and necessary part of guiding you through the healthcare system your entire life.”

Primary care physician, Ryan Dadasovich, MD
As a primary care physician, Ryan Dadasovich, MD, can refer patients to specialists for preventive care or to treat specific conditions, if the need arises.

In mid-September, Stefan Popielcyzk, 73, had his annual wellness visit with his PCP, Ryan Dadasovich, MD, a physician with Northeast Medical Group and Greenwich Hospital. Like many local private-practice physicians, Dr. Dadasovich has reopened his office after the coronavirus shutdown in March. Both wearing masks, they talked about Popielcyzk’s overall good health, the exception being type 2 diabetes, which he has controlled with medication since being diagnosed in 1999. As they chatted, Dr. Dadasovich checked his blood pressure, heart rate and other vital signs, and later gave him a flu shot.

“He’s an amazing doctor,” Popielcyzk said. “Whenever I ask him a question, he always listens, doesn’t rush and explains things before making a decision. I follow his directions when he talks. We need doctors like that,” he said, lovingly noting that his “wonderful, beautiful wife, my angel,” is a patient, too.

Nasreen Kathrada, MD
Nasreen Kathrada, MD, enjoys interacting with patients and getting to know them on a personal level.

A wellness visit is different from a physical exam, Dr. Kathrada explained. A wellness visit is a Medicare term defined as a visit to a PCP by someone 65 or older once every 12 months to develop or update a personalized plan to help prevent disease and disability, based on current health and risk factors. “Besides preventive health issues, a wellness visit also includes a cognitive test for signs of Alzheimer’s disease and dementia,” she said.

“A physical exam is more comprehensive. It involves examining joints, the abdomen, eyes and ears, generally looking for any abnormal signs,” said Dr. Dadasovich. A PCP will recommend having a physical annually or less often, depending on your age, gender, and personal and family medical history, he added. It includes a series of blood tests, screenings and vaccinations, again depending on age and gender. A PCP may also refer you to a dermatologist, eye doctor, dentist and other specialists for preventive exams or to treat specific conditions.

Ira Cutler views Dr. Moore as the captain of a team of specialists he sees, including an endocrinologist for type 2 diabetes, a neurologist for Parkinson’s disease and a cardiologist for coronary-related issues. By accessing Cutler’s electronic medical records, “she can tell what’s going on with my other physicians,” the 74-year-old Norwalk resident said. “She can communicate with them and make sure everything’s in sync.”

This is actually Cutler’s second go-round with Dr. Moore as his PCP, dating back nearly two decades, before she took time off to help raise her children. Coincidentally, about the same time Dr. Moore resumed her medical career, Cutler went online to find a new PCP. “And there she was, all of a sudden back in the world,” he recalled. “I immediately signed back up with her.” When he saw her in September for his annual wellness visit, they picked right up on their previous relationship. “It was like we didn’t miss a beat,” he said.

Beth Moore, MD
Beth Moore, MD, believes having a comfortable and trusting relationship with a primary care physician is key to good health.

Cutler is among numerous former patients who have returned to Dr. Moore, she said. While that’s a compliment to her, it also illustrates the importance of having a comfortable, trusting relationship with a PCP. “A patient will have faith in the word of an already trusted doctor,” Dr. Moore said.

Some studies have shown that states with a higher ratio of PCPs have better health outcomes and lower rates of mortality, and patients who regularly see a PCP have lower health costs than those without one. Nonetheless, there is an impending shortage of PCPs nationwide by 2032, the Association of American Medical Colleges estimates.

“It’s a pay issue,” Dr. Dadasovich said, alluding to the unfortunate situation confronting today’s medical school students. “Many are coming out with astronomical student-loan debt,” he said, so they decide to become specialists, who earn considerably more than PCPs. “It can be a no-brainer.”

So why did these three physicians opt for primary care? “Internal medicine suited my personality,” said Dr. Dadasovich, who had considered gastroenterology and anesthesiology after completing his residency in 2010. “I’m very comfortable with my decision.”

Dr. Kathrada, who opened her practice about a year ago, chose internal medicine partly because her schedule is less demanding than that of most specialists, allowing more time with her two young children. But that wasn’t her only consideration. “Primary care is where I felt most comfortable during my residency,” she said. “That was the reason I went into medicine. I love interacting with my patients and getting to know them on a personal level.”

Dr. Moore’s path to primary care was more serendipitous. She left a career in sales 30 years ago to go to medical school after reading an inspiring magazine article, then had an influential mentor “who sent me into primary care,” she said. “He taught me how to understand that fundamental health problems we deal with as PCPs are actually saving people’s lives. Hopefully,” she mused, “there will always be someone who gets the fire lit under their bottom, just as I did, to really want to help patients.”