Silos, the Grocery Store, and a Case for Primary Care

One recent trend in medicine which bothers me is the rise of single problem telemedicine websites. You may have seen these types of ads: “Are you bothered by X?” where X is the medical problem of your choice – a headache, sexual dysfunction, hair loss, etc. “Go to our website — ____.com — to connect with an online provider to treat you today!” Don’t let these ads fool you! They are trying to silo and isolate your care which is the opposite of what I define as quality medical care. As a physician, I feel that my duty is to see you as a whole person, not as a collection of isolated problems. This philosophy is called “cura personalis” which also happens to be the motto of my medical school.

In an effort to silo care, these sites lead you to believe that having one telemedicine visit with a random online provider is adequate to treat your problem. Yes, perhaps it is adequate but it is not the best type of care for you. Try this analogy. You don’t go to a broccoli store, a chicken store, and a rice store to get the ingredients you need for dinner. You probably primarily go to a grocery store that has all of the groceries you need in one place. You become familiar with the grocery store so you feel comfortable shopping there. 

If you don’t know where something is, the employees can point you in the right direction or they know where to go to find the answer. Seeing a primary care doctor is like going to your familiar local grocery store – you can receive all of your care in one comfortable place from a doctor who is never out-of-stock of the essential health “groceries” you need.

Another point of contention I have with these single problem telemedicine websites is that I rarely find that a medical problem occurs in a silo without involvement from your other organ systems. Our body is a complicated, highly interconnected package. Your heart does not beat without input from your nervous and hormonal systems (among others!). A primary care physician, unlike a random online provider, will dive into the problems that are affecting you to try to figure out the root cause. Yes, I can treat your headache, but I am also interested in investigating WHY you have a headache to begin with. After several follow up visits, I have found the root cause of a patient’s headache to be depression, sleep apnea, estrogen-induced headaches, among other seemingly unrelated medical problems.

Quality primary care is care that is provided by a doctor who knows you, knows what’s going on in your life, and has a vast array of medical knowledge to pull from. Borrowing from a few grocery store slogans: Your neighborhood primary care doctor’s office – where medical care is a pleasure!