I recently took care of a patient in the hospital. She had worked as a medical writer, naturally, we hit it off trading information about blogging and information marketing.
She had been living with type 2 diabetes for over 10 years. She informed me that recently her blood sugars were out of control. Her last A1c was over 10%.
Over the last year, she had gained a lot of weight. Her legs were swollen and she felt short of breath especially when walking. She said she had shared her health concerns with the nurse practitioner at her primary care physician’s office. She even asked whether she should start insulin because of her high blood sugars.
At one point she had asked the nurse practitioner if she could be referred to an endocrinologist. To her dismay, the nurse practitioner advised that she continue taking metformin and that her weight gain was because she was fat!
Unfortunately, by the time my patient was admitted to the hospital, her A1c was well over 12%. She was also diagnosed with advanced heart failure. I was sorry for her experience. That’s because I am passionate about empowering people to THRIVE with Type 2 diabetes.
I wrote a post several years ago on five tips on how to pick a healthcare provider. At the time, the article was geared toward choosing a physician as your primary care provider.
The American healthcare system continues to become more complex. Perhaps you’ve been in a similar situation as my patient.
With the physician shortage predicted to be between 46,000-121,000 by 2032, mid-level providers definitely help fill this gap.
So when should you be seen by a physician (MD or DO) rather than a mid-level provider such as a nurse practitioner or a physician assistant?
Here are some suggestions when you may need to see a physician as your primary healthcare provider:
You have a complex medical history
If you have three or more medical conditions such as type 2 diabetes, high cholesterol, and high blood pressure, heart disease etc, it’s a good idea to start out by seeing a physician as your primary care provider. You’ll need to be monitored more frequently monitoring. And if you are on multiple medications there may need to be frequent adjustments to the dosing.
If you need complex laboratory or other diagnostic tests
You may need to undergo advanced laboratory tests to help come up with a treatment plan. This is another situation where being seen by a primary care provider may be optimal. If you are seeing a functional medicine physician, you may need advanced functional medicine laboratory tests such as advanced lipid profiles, inflammatory markers, adrenal, thyroid, detoxification panels or epigenetic testing to name a few. If laboratory tests are not interpreted correctly this could affect how well you do.
You’re simply not feeling better
Sounds like common sense right? You should be feeling better, not worse. If you are not feeling better then you need to do something different. So just as my patient suggested she probably needed to be seen by her primary care physician. And if she still was not getting her blood sugars under control, or she was experiencing weight gain that could not be explained. It may mean asking to be referred to another provider such as a specialist. (more on that in a future blog post:)
If you begin to experience new symptoms
Similar to not feeling better, it is also a good idea to be seen by your primary care physician when you begin to experience any new symptoms. The earlier new symptoms are identified, the less the risk of potential complications. Perhaps if my patient had tests when her legs started swelling and she started gaining weight, her heart failure might have been found at an earlier stage when it may have been possible to control it with medications and lifestyle changes.
Request to be seen by your primary care provider at least twice yearly
Many people living with a chronic illness see their healthcare providers about every 3 months. That’s about four times a year (barring any complications). If your primary care physician has a midlevel provider, it’s a reasonable request to ask to be seen by your primary care provider every other visit. That way, your primary care physician can stay in the loop and possibly help identify any potential complications.
If you are not getting your questions answered
If you feel like your health concerns are not being addressed by a midlevel provider, you should request to see your primary care provider.
I personally love it when patients and clients ask questions. To me, it means that they are engaged in their healthcare.
Some providers may feel answering questions takes too much time. They may even feel that you are questioning their competence. Let your healthcare provider know if you feel that you are not getting your questions answered. If you have a midlevel provider ask to be seen by your primary care provider. And if your primary care provider is not able to provide answers to your questions, request to be seen by a specialist if necessary.
Sometimes you may have to invest time, effort and money in finding some answers for yourself. And that may include joining an online coaching group, attending a live seminar, searching reputable internet sites.
Remember the saying your health is your wealth? You need to treat your health as you would the most expensive stock in your financial portfolio -because it is priceless.
You can be assertive without coming off as aggressive or abrasive. Trust that your healthcare providers are on your side. At the same time, be willing to be persistent.
Do not settle for less than the best outcome. Be willing to dig deeper to find the root cause of your illness. This may mean being willing to invest in working with a functional medicine consultant.
If you would like to schedule a free 25-minute discovery session to explore working with me as your functional medicine consultant, send a request to email@example.com.
To your health and wellbeing,