This Issue

Primary care

Honesty at heart of good medical partnership

Your primary care provider — the CEO of your health care

Q & A

A closer look

To check a particular doctor’s background, contact the Massachusetts Board of Registration in Medicine at (800) 377-0550 or visit

The profile will give:

• Date of licensure in Massachusetts

• Education and training (residency)

• Medical specialties

• Board certification(s)

• Professional information

Address and telephone number
Insurance plans accepted
Hospital affiliations
Availability of translation services

• Awards, research and publications

• Malpractice claims paid, hospital discipline and criminal convictions in the past 10 years

• Disciplinary actions of the Massachusetts Board of Registration in Medicine in the past 10 years

A closer look

Types of primary care providers

Personal health journal

The right choice

Types of primary care providers

  • Internist — treats adults of all ages

  • Pediatrician — treats children from birth to age 18

  • Family practitioner — treats the entire family regardless of age

  • Geriatrician — treats elderly people with complex and multiple diseases

  • Gynecologist — treats females usually of child-bearing age

  • Nurse practitioner and physician assistant — provide primary care under the supervision of a doctor

Personal health journal

A personal health journal — a handy tool for both you and your doctor — is simply a collection of information about your health that you gather and manage. The journal should include not only the names and numbers of your doctors, but lifestyle goals as well. Your health information should be accurate, detailed and current.

A health journal should include:

  • Illnesses and injuries
  • Hospitalizations
  • Surgeries
  • Diagnostic tests, such as X-rays and scans
  • Screening tests
  • Treatments and procedures
  • Allergies
  • Immunizations
  • Medicines, including exact name and dosage
  • Over-the-counter vitamins and supplements
  • Family history of diseases

Be sure to include dates. For instance, if you are hospitalized, make note of the date admitted and the date of discharge. Be specific. If you have had abdominal surgery, specify the type. You do not need to include minor illnesses, such as coughs and colds. Take your journal to your doctor’s appointments.

For more information on developing a family health history

Oral, Head and Neck Cancer
Awareness Week is May 8 – 14.

Photo by Vannessa Carrington/Mass. Eye and Ear

Get screened for head and neck
cancer. It’s free, quick and painless.

Boston Medical Center
Moakley Building Lobby
830 Harrison Avenue
Date: April 2
Time: 8 a.m. - noon

Tufts Medical Center
860 Washington Street
Date: May 12
Time: 2:30 – 4:30 p.m.
Mass Eye and Ear
243 Charles Street
Date: May 13
Time: TBA
Dedham Family Dental
Dr. Helaine Smith
30 Milton Street, Dedham
Date: May 11
Time: 9 a.m. – 1 p.m.

Mass General Hospital
Voice Center

One Bowdoin Square,
11th Floor
Date: May 13
Time: 9 a.m. – 1 p.m.
Remember to call ahead to confirm
time and date
of screenings.

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The right choice

Finding the right primary care physician for you is not always easy and it shouldn’t be taken lightly. It is one of the most important relationships you will ever have. This is the person who will monitor and direct all your care. You need to be sure. There are many factors to consider.

Honesty at heart of good medical partnership

Dr. Julien J. Dedier, an internist at Boston Medical Center, says that teamwork and trust are essential for a successful doctor/patient relationship. (Photo courtesy of Boston Medical Center)
Dr. Julien Dedier, a doctor of internal medicine at Boston Medical Center, readily admits that much has changed in medicine over the years, especially among primary care physicians (PCPs).

And that’s a good thing, according to Dedier.

While PCPs are still busy diagnosing and treating a litany of illnesses, gone are the days when paternalism ruled the medical approach. Health care is now more of a partnership.

“I’m part of a team,” he said. “They have to know that I am working on their behalf. My job is to know my patient and my patient’s overall health well enough to establish trust and confidence.”

For Dedier, that means being aware of more than just his patients’ height, weight and blood pressure levels. “I need to know the total picture,” he explained.

PCPs like Dedier are in high demand these days. According to the 2008 National Ambulatory Medical Care Survey, more than 60 percent of the 956 million physician office visits that year were for primary care.

That’s not unusual. Primary care — considered the portal of entry to the health care system — encompasses the greatest number of patients and provides the widest array of services. People flock to their doctors for colds, aches and pains, immunizations, screening tests and medication. Coughs that don’t abate, rashes that persevere, even broken bones all wind up in a doctor’s office or clinic.

PCPs have their hands full. They diagnose everything from high blood pressure to diabetes to cardiovascular diseases and make referrals to other providers. In a sense, PCPs are CEOs, having the overall responsibility of managing their patients’ total care.

But the biggest job, at least according to Dedier, is to listen and pay attention.

The PCP needs to know, for instance, why a person shuns flu shots or refuses to take medication for an illness when he or she feels fine. “I have to understand where my patient is coming from and take each concern seriously,” he said.

Dedier demands one thing in return from his patients. “Honesty,” he said. “I want patients to feel comfortable telling me what they have or haven’t done. My role is to help them improve their health.”

But he has to know the truth. “If I prescribe a medicine and a patient swears up and down that they have taken it when they have not, it causes a problem,” he explained. The patient’s response could cause him to alter the dose or try another medication when either move is not necessary or worse, could be harmful.

Though PCPs are essential to the health care system they are in diminishing supply. The 2011 Physician Workforce Study by the Massachusetts Medical Society determined that the shortage of family practitioners and internists in the Commonwealth is severe and critical. The waiting times for an appointment range from 36 to 48 days.

And it’s only expected to get worse. Medical students are not choosing primary care as their area of clinical interest, as noted in a recent study published in the Archives of Internal Medicine. Furthermore, the health care reform bill enacted by President Barack Obama expands coverage to millions of uninsured Americans, making the PCP central to meeting the increased demand and the law’s success.

An important function of the PCP is screening. And that is not always as straight forward as it would seem. Screening guidelines can fluctuate and PCPs — and patients — have to keep pace. The U.S. Preventive Services Task Force (USPSTF) is a group of PCPs charged with examining research and making recommendations of the types and frequency of screening tests to be followed by PCPs.

The group’s decisions are not taken lightly and can determine those tests for which insurance plans will pay. Some of their decisions are controversial and cause uproar and confusion.

The USPSTF recently released a new draft recommending against prostate-specific antigen (PSA), the blood test used to screen for prostate cancer, stating that there is “moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” The task force thus discourages the use of PSA screening even for men of high risk, which include African Americans and those with a family history of the disease.

The group’s position is that many prostate cancers are slow growing and ultimately not fatal, and that the aggressiveness of the cancer cannot always be accurately predicted. Consequently, the medical treatment prescribed is often excessive. Also, false-positive results can lead to unnecessary — and often harmful — medical care.

Dr. David Wang, a urologist at Boston Medical Center, said that he adheres to the standards of the American Urological Association (AUA) and respectfully disagrees with the USPSTF recommendation. “The PSA is not a perfect test,” he acknowledged. “But it’s the best we have. We don’t want to turn the clock back 25 years when the majority of men were diagnosed after the cancer had spread.”

Wang said that he recognizes that over-treatment of prostate cancer exists. “But to deny the test to African American men or men with a family history is a disservice,” he said. “Some men want to know and the decision for PSA testing should be a decision made by the patient after discussion with his doctor.” The AUA further affirms that “when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging or risk assessment and monitoring of prostate cancer patients.” As for Wang, he will continue to discuss the test with his patients.

The task force is recommending changes in the guidelines for Pap smears as well, which screen for cervical cancer. It is advocating testing every three years between the ages of 21 and 65 in women who have had sex and have a cervix. Prior recommendations called for screening within three years of vaginal intercourse and repeat tests every one to two years.

For Dedier, keeping an open mind should always be the rule rather than the exception. Take alternative medicine, for example. The 2007 National Center for Health Statistics found that almost 40 percent of adults and 12 percent of children used some form of complementary or alternative medicine, such as acupuncture or herbs.

Dedier said that he is not opposed to different forms of medicine. “I just need to make sure that the patient is not being harmed,” he explained. If a patient prefers garlic over medication to bring down cholesterol, it might be worth a try, according to Dedier, but he is quick to point out that if the cholesterol is not down in three months’ time it’s best to have another discussion.

Sensitive topics that a patient prefers not discussing are not overlooked. Like obesity.

He starts with the BMI, a measure of healthy weight based on height. “I present it in medical terms,” he said. “Your BMI is one that doctors would consider obese and it’s a cause of mortality and morbidity.”

That starts the conversation on the health impact of weight and measures to take to reduce it.

More than most, Dedier says he is keenly aware that while he is examining a patient, he too is being carefully examined as well.

He welcomes the scrutiny. “They have to figure out if I’m the right one,” he said.