Providing Health Care as a Family Physician

Family physicians in small towns have a difficult job. You are often the go to person for everything health care related. Even if you cannot help the patient, you are the first one sought out for advice. Our practice in Williston provides so many different functions.
On the patient level, I provide my patients personal health care used in diagnosing and treating illness. My focus is on the patient rather than the disease requiring me to understand patient's goals for health and balancing my treatment plan's intensity with quality of life issues. I try at all times to focus my treatment decisions with the goals of the patient. From a healthcare stewardship perspective, I only order those tests that will enhance my ability to make a diagnosis or treat the patient more effectively. Trust and understanding allows for the development of a continuous healing relationship. All of this is done within the context of the family and the community.
On the health care system level, I serve as the initial point of entry for my patient's evaluation of medical issues. After the triage is performed, I attempt to match my patient's needs with the available resources without trying to over- or undertreat my patient. Coordinating health care services as required allows me to place my patient appropriately in the hands of a specialist when I believe it is required after careful history, physical examination and appropriate testing suggests I cannot care for my patient within the scope of my training and experience. This is my contribution to health care stewardship as it relates to healthcare resource utilization.
On the population level, I direct my patients to appropriate levels of care beyond primary care for secondary and tertiary services such as cardiac catheterization for unstable angina or chemotherapy for cancer. Providing immunizations for my patients helps to stop the spread of communicable disease and assists the public health functions required of all family physicians.
It is not always easy to follow healthcare stewardship principles and practices. Sometimes you just have to say "no" to the request for the MRI of the back with a minor strain or "no" to the prescribing of the antibiotic for a viral illness. I believe patients for the most part respect your judgment as long as you can justify your decisions based on the evidence. Your patients do not need an entire course on anatomy or pathology but a little detail can go along way in helping patients becomes stewards as well.
I had a great day in the office today. Many of the patients received the medical care they needed, not necessarily the medical care they wanted.
Dr. Dale