Author: Dr. Deborah Jones

Six reasons you need a primary care doctor in this age of specialization
As we age, most of us develop health issues. Along the way we may visit a specialist to handle each of these issues: for example, a cardiologist to treat hypertension and a gastroenterologist to treat acid reflux. However, it has become increasingly clear that in today’s era of specialization, you need a primary care doctor more than ever to coordinate your care, give you treatment appropriate for your age and gender, and prevent future health problems for the fullest quality of life.

You may be surprised at how much of your treatment a primary care doctor can provide. Primary care doctors know your whole story, while specialists may not be in communication with each other or understand the range of your health care needs. Medicine has become increasingly specialized, and specialists can provide much needed targeted treatments for specific ailments or organ dysfunctions. But fragmented, uncoordinated care is the handmaiden of specialization.

What is a primary care doctor?

This term is generally restricted to internists (who have completed a 3 year residency in internal medicine, and treat adults) and family physicians (who have completed a 3 year residency and treat patients of all ages). Geriatricians are internists or family physicians with additional training in caring for the elderly, often in primary care. Within the healthcare system, these types of physicians are often called “PMDs”, for primary medical doctor or “PCP” for primary care provider.

The word ‘primary’ care may imply simple or elementary medicine, but primary care is a highly complex practice. PMDs are prepared to diagnose and treat all common diseases, and many, if not most, of the less common ones too. Additionally, they are uniquely qualified to provide comprehensive and holistic care to patients with multiple simultaneous diseases. PMDs also try to prevent future health problems-– they don’t just treat what you have. PMDs keep up to date on the frequently changing recommendations on preventive medicine (e.g., vaccines, mammograms, colonoscopies). In all of their functions, PMDs strive to give care tailored specifically to each patient.

Why do you need a primary care doctor?

Above all, primary care is good for your health and will help you live longer. Multiple studies have demonstrated this. Here are six important reasons you need a primary care doctor now more than ever:
1. A PMD can coordinate and oversee your care. The more complex and varied your health conditions are, the more important a PMD becomes. A PMD will give you guidance on how to integrate varied, complex, and sometimes contradictory recommendations that you may receive from multiple specialists.
2. A PMD can save you from unnecessary or harmful treatments by taking the time to understand you as a person and know your history. The PMD has a 30,000-foot view of all your health problems. The PMD considers your age, gender and other factors to ask “is this really the right treatment for you?”
3. A PMD can ensure that your medications are not hurting you. Some medications can be dangerous in older patients. A PMD might replace or stop medications that may do you more harm than good and detect drug interactions. It has been estimated that 265,000 adults (age 65 and older) each year go to the emergency room or are hospitalized because of an adverse drug effect. A PMD also can almost always shorten your medication list if it is too long for you; so, the PMD can end up saving you money.
4. A PMD can offer a second opinion on whether a treatment recommended by another doctor is likely to be beneficial. For example, many treatments have been proven effective only in patients under 65 years old, and older patients may not derive the same benefit from them.
5. A PMD works to prevent possible problems by offering vaccinations, screening tests and discussing lifestyle changes like weight loss, exercise and quitting smoking.
6. A PMD can help you realize you’re developing health problems you hadn’t noticed yet. Problems with vision, strength and fall risk, urinary incontinence, depression or anxiety, and memory can sneak up on you over time without detection—even by doctors who don’t ask. These are things that you may not report, but PMDs are trained to look for.
Click on the link to read the follow-up post: How can you know if your primary care doctor meets your needs?

[N.B. This post was originally published on June 17, 2019.}

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January 16, 2023
Five tips for talking to the people you love about their health
Many of us want to help our parents or other people we love as they age. But, we have no idea how to help. For sure, engaging them in conversation is already a big help. If you want to talk to your loved ones about their health, here are five tips for beginning the conversation:
1. Don’t assume that because your loved ones haven’t shared their health concerns with you that they don’t have any. They may not want to waste your time or cause you any worry. And, if your loved one is uncomfortable, or possibly ashamed, sharing private information even with family members, a more successful approach may begin with gentle expressions of support rather than pressure to accept help.
2. Express your support to help them maintain a high quality of life and get everything they need from their doctors. You could ask them what they have heard about health buddies, or a health care proxy. Let them know that sharing their concerns with you or a health care buddy they trust can help ensure they get the care they need. If you sense reticence, consider asking an open-ended question, such as, ‘How can I help you make sure you are getting the care you need from your doctor?”, or “What would be the most important thing for me to know about your health?” This might be more helpful than, “Is there anything I should know about your health.” or “Is your doctor taking good care of you?”
3. If they are living at home independently, remember that they may be scared to voice their concerns for fear of losing that independence.
4. If they are worried about spending money on themselves, keep in mind that they might not be addressing a health condition because of the cost. But the cost of the service may be far less than the risks of not getting treatment. Let them know that there are often free and low-cost resources for people with low incomes.
5. Finally, explain to them that it’s generally helpful to have a buddy with you at the doctor’s office to hear what the doctor is recommending, take notes, and make sure all important issues are raised, like medication side effects.
Remember, everyone’s different. Some of us feel our age and some of us feel like we’re still in college. Some of us like to talk about our health and some of us keep our conditions to ourselves. Some of us assume that we should have health problems in older age and don’t take the time to go to the doctor and some seek treatment whenever they have a new symptom.

(N.B. This post was originally published on January 2, 2017.)

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January 10, 2023
Four questions to ask yourself about your primary care doctor
I’ve explained the many reasons it’s important to have a good primary care doctor (PMD). Once you have one the next question is, how can you know if your PMD meets your needs?

Most of us trust our doctors and believe they meet our needs. And, without medical expertise, it’s hard to judge whether a doctor is good beyond the doctor’s bedside manners. Do you like the doctor, and feel comfortable with the doctor? Of course, these things matter. Research confirms that patient health improves with better doctor communication skills. A doctor’s reputation, training, and certification are also important to review. The office location, and how smoothly the office functions are important factors.. However, there are other questions you should ask yourself about whether your primary care doctor meets your needs that are more subtle.

Here are four questions to ask yourself:
1. Does your PMD listen to you, know you, and share important decisions with you? Does your PMD practice ‘the art of medicine’? A good PMD will ask you questions about your view of your health, and health priorities before giving recommendations on important testing or treatments. For example, continuing routine mammogram screenings after the age of 75 is something for women to discuss with their doctors; the U.S. Preventive Services Task Force does not recommend it. But, the right decision is whatever is best for you. This discussion can also be important if you are considering a new drug or surgery. Age, kidney disease, diabetes, heart disease and gender may reduce (or increase) the effectiveness of some treatments, and you should know these factors before making a decision.
1. Is your PMD comfortable discussing all of your medical problems? A good PMD will address any and all medical problems you raise, and doesn’t constantly refer you to specialists for every symptom.
1. Is your PMD prepared to ‘be the quarterback for’ or ‘orchestrate’ the care from all your other doctors? All PMDs do want to coordinate care with your other doctors, but realistically may not have the time or resources to do this effectively. At the very least, does your PMD attempt to know what the other doctors are recommending for you?
1. Do you have a PMD who tries to prevent new problems and not just treat existing ones? A good PMD will keep a ‘health maintenance’ list on you, or some similar file, that records your needs for screening tests, vaccines, and other preventive medicine items.
You may be surprised to learn that some PMD behaviors may not reflect whether your PMD is meeting your needs:
- A good PMD may often have a staff member relay his or her response to your phone calls. PMDs have to balance how to spend their time, and may decide that some of their responses can be safely and effectively delivered to you through their staff. This doesn’t mean they haven’t thought or care about you!
- A good PMD might sometimes be rushed, and unable to discuss multiple concerns at every visit. A good doctor will always at a minimum identify and address your most urgent needs, acknowledge the others, and make a plan for additional visits.
If you haven’t really thought about these questions, you’re not alone. It’s easier to assume your doctor is meeting your needs than to find another doctor. You might want to consider asking a family member or close friend to help you to answer these questions. If some of your answers are no, consider starting here at this Just Care link to find a new internist or family physician who better meets your needs.

[This post was originally published on June 4, 2015.]
September 19, 2022
How to prepare for your doctor’s visit
Whether you’re in good health or poor health, in a separate post I explained why it’s important to have a good primary care doctor. And, I’ve provided four questions to help you know whether your primary care doctor is meeting your needs. Here, I want to help you prepare for your doctor’s visit, so that you make the most of it.
1. Confirm that your doctor accepts your insurance. If you have traditional Medicare, ask if the doctor accepts assignment, which means that the doctor accepts Medicare’s rate as payment in full. If you have a private insurer such as Aetna or Cigna, to save money, make sure the doctor is in-network. Always find out how much more you may have to pay out-of-pocket.
2. Ask a family member or person you trust to join you. No matter what your age, it’s always good to have a health care buddy, a second pair of ears to listen to the doctor’s advice and, ideally, to take notes. You may also want your buddy to ask questions. The doctor’s visit can be stressful. You can decide to have your buddy be present for some or all of the visit – you are in charge!
3. Make sure you bring a list of your medications with you, both prescription drugs and over the counter. And, ask your doctor whether you should be taking all these drugs. It may be that you don’t need to be on a drug or that one drug you’re taking interacts poorly with another one. As you collect the bottles, think of any concerns, side effects or questions you have about your treatments.
4. Make a list of all the questions you have for your doctor and other information you want to share, including any symptoms and concerns you have about your health. [Editor’s note: If you go alone to the visit, be sure to bring a pen and paper to take notes and repeat the doctor’s advice in order to confirm that you understand it.]
5. If it’s your first appointment, you want to be sure to let your doctor know about any chronic conditions and any other health problems you have, as well as diseases that run in your family. If possible bring past medical records, test results, and your immunization records. You can ask the last doctor you saw to provide this information to your doctor, or you can sign a release form to have your new doctor’s office request your prior records. If you are already an established patient of the doctor, be ready to provide your doctor with any major family health updates—for example, if your brother has been recently diagnosed with high blood pressure, or a parent was diagnosed with cancer.
6. Check with the office if you are expected to come on an empty stomach to your appointment. There are only a few tests that need to be done in the “fasting state” (meaning, no food or drinks other than water for 12 hours). If you are expected to be fasting, tell the office if you are taking medications that require food, or if you think this will be difficult for you for any reason. Remember that most routine tests are not affected by drinking water, but being dehydrated could lead to slightly abnormal results.
7. If your doctor is suggesting a test or treatment, to avoid overtreatment, be sure to understand why you need it. What are your options? How will it help? Are there side effects?
8. Be sure that when you leave the office you understand your diagnosis and what you need to do, as well as when and how to contact the doctor and when to make another appointment. If you need a new prescription, make sure you know when to take it and what to do if you experience any side effects.
[Editor’s note: This post was originally published on June 29, 2016.]

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November 15, 2021
Ten tips for checking your blood pressure at home
Doctors are increasingly recommending that patients check their blood pressure at home to diagnose high blood pressure (hypertension) and make treatment decisions. Seeing the pattern of your blood pressure at home allows a doctor to make a more informed decision about treatment than a single test at the doctor’s office.

To ensure appropriate treatment, it’s important that you take appropriate steps when you monitor your blood pressure. Mistakes in your technique at home could misdirect the doctor to prescribe you too much, too little, or the wrong type of medication.

If you’ve been advised to monitor your blood pressure at home, follow these ten tips to ensure your data is accurate:

At your doctor’s visit:
1. Learn your numbers. Ask your doctor what your target blood pressure is. Targets can differ by as much as 20 points, depending on age and medical condition. Ask your doctor how often to check, and what results require an urgent call to the office, or a visit to the emergency room.
2. Bring your machine to the doctor at least once. The office can check your machine against office measurements. Make sure that your cuff size is correct: a cuff that’s too small will overestimate your pressure and a cuff too large will underestimate it.
3. Relax. It’s common for your blood pressure at the office to be higher than your results at home. This is called “white coat hypertension,” and is probably a result of the mild anxiety you may feel at the doctor’s office. That’s why doctors often recommend patients check their blood pressure at home. Doctors sometimes recommend further testing with another method, if available, for patients with white coat hypertension; this method is called ambulatory blood pressure monitoring.
At home:
1. Plan in advance. No smoking, caffeine or exertion 30 minutes before. Empty your bladder. Rest for 5-10 minutes before you start.
2. Know the correct body position.
  - Sit upright with your back supported and your feet on the floor. Don’t cross your legs or rest them on an ottoman.
  - Rest your arm at the level of your heart (for example, on pillows, books, or on a table). If your arm is too low—for example, lying in your lap–your results could overestimate your pressure.
3. Consistently measure either the right or left arm.
4. Stay still and quiet while the machine runs.
5. Repeat the cycle once.
6. If you get a high number, don’t panic. Expect some normal variations between days. Remember things like emotion, stress, exertion, or pain temporarily raise blood pressure, and this is not necessarily the same as poorly controlled blood pressure. Your blood pressure will typically be a little higher in the morning than the evening. Use your doctor’s guidelines to know what your action plan should be for high numbers.
7. Check your blood pressure regularly, if your doctor has recommended home monitoring. Checking it only when you are feeling bad can be misleading. But, do not become overly obsessed with checking if your blood pressure is alright. Two to three times a week is usually sufficient, unless your doctor recommends otherwise. Light headedness may indicate your blood pressure is too low, so do check in that instance. Low blood pressure is a frequent problem for older patients leading to falls or other problems, so it is important to note when this happens. Record your numbers in a log with the date and time, and bring the log to your next doctor’s appointment.
This post was originally published on May 15, 2015

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August 19, 2019
Six ways to help speed your recovery after surgery
Healing after surgery always takes time. But, there are things you can do or not do to help speed your recovery after surgery. And, yes the most basic five are ones that will not comes as a surprise. Keep in mind that it’s always best to have a buddy at the hospital with you before, during and after surgery if at all possible. For more on that and how to prepare for your hospital stay, click here.
1. Don’t smoke. Smoking is not only bad for your lungs, it’s bad for your entire body. Smoking hurts your vascular system, which can slow down the speed at which your wounds heal and can lead to infection. If you smoke, keep in mind that Medicare covers smoking cessation programs. To learn more about Medicare coverage to help with smoking cessation as well as for other preventive services, click here.
2. Eat well. A poor diet can slow down recovery. If you are malnourished, you will likely have a weaker immune system and your body will be less prepared to recover from surgery. Malnutrition is considered a risk factor for illness and mortality after surgery. Medicare sometimes covers nutrition counseling.
3. Keep your weight down to a healthy level. People who are overweight are less fit for surgery, often because they have heart disease, high blood pressure and breathing issues as well. Obesity can slow down the wound healing process. Medicare covers obesity counseling programs.
4. Take care of your health condition. If you have a chronic condition, such as diabetes or hypertension, make sure you are getting good treatment to manage your condition. A managed chronic condition will help you recover faster from surgery. For example, good blood sugar control speeds up healing and reduces the risk of infection.
5. Make sure you understand and follow directions for your care after surgery. You should receive a written discharge plan before you leave the hospital. And follow these steps before leaving the hospital.
6. Make sure you understand what medications you should be taking (or not taking) after your surgery. For example, your surgeon or primary care provider may recommend changes to your usual blood thinner (such as aspirin) or diabetes medication after surgery.
Here are two other things you might want to know:
1. Some evidence suggests that chewing sugarless gum after surgery can help your digestive system to get back to normal, especially if you have a bowel surgery. There is no apparent downside.
2. Very little evidence supports the notion that carbohydrate supplements prior to surgery speeds the recovery process.
This post was originally published on September 17, 2015.

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March 4, 2019
How to soothe a sore throat
It is that time of year when many of us find ourselves with a sore throat. And, most of us are looking for some way to ease the symptoms, if not cure the sore throat altogether, ideally, without antibiotics. Here’s how to soothe a sore throat.

Britain’s National Health Service recommends taking ibuprofen, along with lots of cool or warm drinks and cool soft foods, and avoiding hot drinks. Tylenol can also help ease the pain. Even if your sore throat makes it difficult to drink, it is really important to keep up your fluid intake! Your throat pain will get worse if you let yourself, and the lining of your throat, get dry.

The National Health Service further recommends homemade gargling with a mouthwash of salty water and sucking on lozenges and hard candy. Lozenges containing menthol may be helpful. Honey is also good. Put some in your tea! The honey helps to soothe the throat as you swallow. You will want to avoid acidic food and drinks, and spicy dishes; they may be irritating. Also, you should not smoke.

Harvard Health recommends getting plenty of rest, drinking a lot of water, and using a cool mist vaporizer.

When do you need antibiotics for a sore throat? Cochrane, an independent network of researches that uses high-quality information to help you make health decisions, advises that antibiotics are of limited use in treating sore throats. They have unpleasant adverse side effects such as diarrhea and rashes.

Cochrane further reports that some Chinese herbal medicines appear to be effective in curing a sore throat. But, it cannot recommend any specific medicines because no trials of these medicines were designed well enough to provide compelling evidence.

Do not waste your time or money on probiotics or special xylitol-based chewing gum for your sore throat. They are not effective, according to a new report in the Canadian Medical Association Journal.

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December 19, 2017
September: Healthy Aging Month
Did you know that September is Healthy Aging Month? Here are a few reminders on healthy aging for adults of any age.
1. Stay connected to friends and family. Social bonds are important for physical and mental health. In fact, frequent social interactions have been shown to promote longer life.
2. Get moving! Be physically active on a regular basis. Work in at least 150 minutes of moderately vigorous activity each week. “Moderately vigorous” can be brisk walking (at a pace of 4 miles per hour), heavy cleaning, gardening, light bicycling, or doubles tennis. Remember that any amount is better than none at all!
3. Get enough rest. Aim for at least 7 to 7.5 hours of sleep. Sleep promotes energy, alertness as well as physical and mental well-being.
4. Have an annual appointment with your primary care doctor, even if you are feeling great, find out what health screenings you are due for Know your cholesterol, body mass index, blood pressure, glucose, and A1C. Medicare considers an annual wellness visit so important for older adults that it covers the full cost. Here are some tips to prepare for your doctor’s visit.
5. Get up to date on your siblings’ and parents’ medical history. Many of us are able to report major family history regarding major diseases like cancer, stroke and heart attacks. These are important to know about, including the age at which they were diagnosed. Also make sure you are informed on family history of other conditions, such as allergies, asthma, auto-immune diseases, arthritis, osteoporosis, fractures, bleeding or clotting disorders, liver or kidney problems, migraines, dementia, skin conditions, cholesterol, diabetes or pre-diabetes, mental health, and gastrointestinal problems. This webtool from the U.S. Surgeon General may help. Share this information with your doctor and your family.
6. Watch your diet, for reasons beyond weight. Many conditions, such as blood pressure, diabetes, cholesterol, headaches, sleeping problems, mood, irritable bowel are substantially prevented, ameliorated and sometimes cured with dietary changes. Not sure what or how to change? Find a good nutritionist through your physician! Medicare covers nutrition counseling. A few basic points: Get 4.5 cups of vegetables per day. Limit sugar intake. Eat lots of whole grains (What is a whole grain?) Avoid trans-fats entirely (“partially hydrogenated vegetable oils”).
7. Here are some other great tips for healthy aging.
September 20, 2016
Six tips for helping your loved one change unhealthy behaviors
About half of illness and premature death in the U.S. stems from unhealthy behavior that many of us wish we could change–habits such as smoking, being a couch potato, playing too many video games, skipping medication doses, or eating too much sugar.

If you are worried about the unhealthy behavior of someone close to you, you have probably wondered how you could help to change it, if you haven’t already tried. The next time you talk to that person, consider these concepts borrowed from a counseling technique used by professionals called “Motivational Interviewing*.”
1. Ask permission first: “Are you willing to talk about” the behavior?
2. Inquire about and then accept how the person thinks about the behavior. “What do you think about it?” “Are you ready to act and try to change it?” If no, that’s OK–accept the answer. Accepting the person’s resistance to change, rather than pushing against it, can be a way to open the door for future conversations.
3. Ask, “What do you like about” this behavior? You may be surprised what you learn. You can follow that up with, “What do you not like about it?” Helping the person talk out loud abut the good and bad parts of this behavior can be useful to the person.
4. Listen to yourself: Are you talking too much? If you find yourself pushing, persuading, arguing or explaining you may be headed down the nagging track. Your role here is to get your loved one to talk and feel understood.
5. Try using open-ended questions starting with words like “what” or “how,” rather than yes/no questions. Ask for the person’s ideas about change and get the person to talk in positive terms. Here are some possible questions to ask:
  - What are your motivations to stop or change?
  - What might life be like if you changed this behavior?
  - What are some of your ideas to try to stop or change?
6. Extend an offer of partnership, hope and support. In addition to affirming positive statements or plans, you might consider making a plan with the person to check back at a later time, or ask how you can help.
Remember that even baby steps are helpful when trying to work on behavior change. You may need to have multiple conversations, sometimes over weeks or months or years to support the individual. But have confidence in knowing that getting someone you love to even talk or think about giving up smoking, or getting out to exercise, is a step in the right direction. You are in it with the person for the long haul and let the person know that!

* Miller WR and Rollnick S. (2012). Motivational Interviewing: Helping People Change, 3rd Ed. New York: Guilford Press.
March 24, 2015