Psychiatrists I know. Primary care physicians... not so much. Help?

April 11, 2012 12:54 PM

Stupid question filter... I honestly do not know what to expect or do with a primary care physician.

Here's the thing. I'm seeing psychiatrist through the local university's mental health clinic for my bipolar, but they say I need to obtain a primary care physician (also through their system) because they move their patients out to primary care once they're stable. That's cool with me because I've been stable for a while so I'm not expecting to be at the mental health clinic for long. It's unusual in my experience because I've never had a medical doctor handle my bipolar, but what can I do? And, I've never had a primary care doctor and I dunno what to do with one, or what they'll do with me.

See, the last time I had any kind of steady insurance was through my first husband's Navy insurance, and that was mostly clinic visits. I've never gone in for regular check ups and have never seen any doctor more than three times in a row. Usually, I only see a doctor if I'm sick and or in a lot of pain (and I have to very sick or in a lot of pain). However, now I need to see a doctor that's not a psychiatrist at least once a month or once every two or three months? That's a brand new experience for me.

I'm 45 now (female). I've been diagnosed over the years with the following: fibromyalgia, arthritis, asthma, GERD, high cholesterol, IBS, migraines, degenerative disc disease, and the aforementioned bipolar. To top it off, I just had blood work which suggests there might be something amiss with my thyroid (joy!). I'm only taking medication for the bipolar and a rescue inhaler for the asthma. I understand that if something is amiss with the thyroid, I'll need to take something for that... lovely.

Anyway, my question is, when I have an appointment with a primary care physician, do I give them this list of diagnoses? Or would that overwhelm them. Do I just tell them I need a primary care physician for my bipolar meds (and possible thyroid meds)? Should I just make an appointment not say anything about previous diagnoses and just let them ask all the questions? Also, since I haven't seen a regular doctor in forever, and all of these diagnoses have been made over the years by different doctors all over the country, will a doctor just take them at face value, or they going to put me through all kinds of x-rays and blood tests (again... *sigh*)? Some guidance would be appreciated. Honestly, the anxiety of not knowing what to expect has kept me from actually contacting an office and that's jeopardizing my psychiatric care at this time.

posted by patheral to Health & Fitness (10 answers total)

The first time you ever see any doctor, they always give you the checklist of "have you ever been diagnosed with...." diseases, so you'd have to tell them anyway. This is the kind of thing they need to know.

Talk to them when you get in about what your primary reason for the appointment is, but knowing that list of diagnoses is something that can only help them get to know you in general.
posted by EmpressCallipygos at 12:58 PM on April 11, 2012

Anyway, my question is, when I have an appointment with a primary care physician, do I give them this list of diagnoses?

They'll have you fill out a bunch of paperwork in the waiting room when you have your first appointment. This is where you put your diagnoses and your medications. Do not wait for them to ask.

Also, since I haven't seen a regular doctor in forever, and all of these diagnoses have been made over the years by different doctors all over the country, will a doctor just take them at face value, or they going to put me through all kinds of x-rays and blood tests (again... *sigh*)?

If you have current complaints they might want x-rays or blood tests. You might proactively get some of your records together from the other doctors. When you make your appointment with the PCP, ask the receptionist for their fax number. When you call your old doctors, give their records department the new doctor's fax number. You shouldn't need to do anything else.

I would definitely recommend an internist over a generic family doctor.
posted by desjardins at 1:00 PM on April 11, 2012

They'll work through your entire medical history with you. Volunteer this information as appropriate, if their questions don't hit all the points. They'll take diagnoses at face value for the most part, but it helps a lot if you have medication on hand relevant to these diagnoses. It's their job, not yours, to look out for your health, so really, give yourself a break.
posted by MangyCarface at 1:00 PM on April 11, 2012

Anyway, my question is, when I have an appointment with a primary care physician, do I give them this list of diagnoses?

You should disclose any medical conditions you have, as treating certain ones without knowing you have other ones could lead to complications (e.g. a medication that treats X but ends up exacerbating Y because the doctor knew about X but not Y.) You don't want to be put on a diet that helps your cholesterol but worsens your GERD, for instance.

More likely than not, they'll want to give you a full physical as well as run whatever tests they need to based on the severity/testability of your conditions.
posted by griphus at 1:00 PM on April 11, 2012

I would think that they'd want medical records from previous doctors, clinics, and hospitals where you've been cared for to send them copies of your medical records. Possibly (probably?) they would arrange this for you if you gave them a list.
posted by XMLicious at 1:00 PM on April 11, 2012

They'll work through your entire medical history with you. Volunteer this information as appropriate, if their questions don't hit all the points.

Given your complicated medical history, it might be helpful to write down notes - or even a complete medical history - in advance and at your own pace.
posted by Mr.Know-it-some at 1:13 PM on April 11, 2012

Best answer: In the past, when I was moving fairly frequently and so changing doctors a lot, I have typed up a summary sheet of my previous medical history (with dates, etc.) to give to the doctor on the first visit. Generally I brought three copies (one for me to reference, one for the chart, one the doctor can hold in hand). The computer systems are not always super user-friendly when the doctor's trying to look at a lot of information at once, and getting records can take time.

I might do something like:

Current conditions:
Bi-polar -- medication A 2x/day; diagnosed January 2011
Asthma -- inhaler as needed; diagnosed summer 1992
Thyroid? -- bloodwork pending
Arthritis -- OTC Advil as needed; diagnosed November 2009

Past diagnoses:
fibromyalgia -- believe this diagnosis incorrect
GERD
high cholesterol -- cholesterol now under control; no medication or treatment since 2008
IBS
migraines -- no longer get migraines; took medication B from 2002-2005
degenerative disc disease

You get the idea. It can also help you organize your memory, give you something to refer to, and help you figure out what you would like treated. A primary care doctor can help you get this big list under control and work out a treatment plan with you so you can feel like you're managing your health, not that you've got disparate random stuff going on that gets treated when acute and ignored otherwise.
posted by Eyebrows McGee at 1:14 PM on April 11, 2012 [3 favorites]

With your very long list of diagnoses, you need a regular physician. And McGee has an excellent suggestion, one I would have made myself if I had gotten here first.
posted by yclipse at 5:57 PM on April 11, 2012

Response by poster: Thanks y'all. I'll have to sit down and remember when and where I was diagnosed with what. There's no way I'll be able to get my medical records from all the doctors I've seen over the years because I don't remember them all. However, I can probably cobble together a list of at least when I was diagnosed... probably. :)

Thanks for the suggestion.
posted by patheral at 6:48 PM on April 11, 2012

patheral, when you were diagnosed is less important than what you've been treated with and how well it's working. So don't sweat exact dates.

Glad you're getting in to a primary care! You definitely need one. Not only will they deal with all the diagnoses you have (and believe me, they see people with a list 2-3 times as long as yours every day), they will also oversee your preventative healthcare such as mammograms, colonoscopies, and immunizations. They will not try to address everything at the initial appointment, they will just get the ball rolling. Most of your diagnoses are the type that are made clinically (based on your history and physical), so in terms of testing you probably will just get the usual screening blood work, cholesterol panel, and thyroid studies.
posted by treehorn+bunny at 12:08 AM on April 12, 2012