Brian Sick, M.D.


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Brian Sick, M.D., Medical Director, Primary Care Center, University of Minnesota, discusses why cancer survivors need a primary care physician.

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Brian Sick, M.D.

  1. 1. Why do I Need a Primary Care Physician? Brian Sick, MD Internal Medicine/Pediatrics Medical Director, Primary Care Center University of Minnesota
  2. 2. I have gotten excellent care from my oncologist. Why do I need a primary care physician?
  3. 3. Objectives• 1. Convince you of the need for a cancer survivor to have a primary care physician.• 2. Show you how to make that as smooth a process as possible.
  4. 4. Why do I need a primary care physician?• Access to care• Whole person care• Preventative care
  5. 5. Whole Person Care• Oncologists – excellent cancer care – narrow focus• Primary Care Physicians – excellent primary care – broad focus
  6. 6. More patients have access to primary care than oncology• In 2010: – 219,441 primary care physicians (family med, internal med, med/peds) – 12,743 heme/onc• Or, – 2,901 people per family med – 2,834 people per internal med – 24, 253 people per heme/onc 2012 Physician Specialty Data Book. Center for Workforce Studies. AAMC. November 2012.
  7. 7. Most common reasons for visit 1. Preventative physical examination 2. Hypertension 3. Preoperative evaluation 4. Diabetes 5. Low back pain 6. Depression 7. Abdominal pain 8. High cholesterol 9. Cough 10. Chest painPrimary Care Center, University of Minnesota. September 2008.
  8. 8. Annual Preventative Check-Up• Time to look at the whole person health• Get to know the patient in more depth• Directed physical exam• Review meds• Necessary blood work (there is no global cancer blood test)• Update preventative health screening• Update cancer survivor follow-up
  9. 9. Non-cancer preventative health• Abdominal aortic aneurysm screening• Alcohol abuse screening• Chlamydia screening• Depression screening• Domestic violence screening• Immunizations – flu, pneumococcal, shingles, hepatitis• Osteoporosis screening
  10. 10. Oncology and Primary Care Comparison of health maintenance in breast cancer survivors. Neither PCP PCP only Oncology Both PCP or oncology only and oncologyMammogram 30.3 60.7 80.3 86.7Influenza 28.1 62.6 59.1 70.1Lipid 20.4 42.1 34.5 54.9Cervical exam 3.2 24.7 12.3 38.8Colon exam 1.4 12.6 10.8 21.2Bone density 1.4 7.0 8.9 9.9 Earle, C, et al. Quality of non-breast cancer health maintenance among elderly breast cancer survivors. J Clin Oncol 21(8):1447-1451. April 15, 2003.
  11. 11. Choosing a primary care physician• Make a list of characteristics you would like in a doctor• Ask friends for referrals• Look at logistics: – ease of getting to clinic, hours (including after hours), location of lab/imaging, etc.
  12. 12. Yelp.comBased 100% on individualreviewsHealthcare is a minorcategory of reviews.Only displays the reviewsof trusted reviewers
  13. 13. Annual FeeAngie’s List Based 100% on reviews Healthcare is minor part of the reviewsWrong
  14. 14. HealthGradesprivately owned; data from claims, state records,medical boards, telephone surveys, patient ratings ? $12.95 for a more detailed report
  15. 15. Minnesota HealthScores( directlysubmitted by clinics.Cost, quality andpatient experiencedata on clinics,medical groups andhospitals.
  16. 16. Transitioning Care
  17. 17. Patient Example• 50yr old shows up with hypertension• Remembers he had some sort of brain cancer as a 19yr old• Knows he has a VP shunt and had radiation but does not remember the details• Family history of high blood pressure and cholesterol
  18. 18. How to help the transition• Partnership – oncology and primary care• Patient – owner of their own health• Plan – survivorship plan
  19. 19. PartnershipBreast cancer survivor rating of primary care physician survivorship care• General care 78%• Psychosocial support 73%• Health promotion 73%• Knowledge about cancer follow-up 50%• Late effects of cancer therapy 59%• Symptoms from cancer or therapy 41% Mao, J, et al. Delivery of Survivorship Care by Primary Care Physicians: The Perspective of Breast Cancer Patients. J Clin Oncol 27(6): 933-8. Feb 20, 2009.
  20. 20. Partnership28% felt their primary care physician and oncologist communicated well
  21. 21. How to help the transition• Partnership – oncology and primary care• Patient – owner of their own health• Plan – survivorship plan
  22. 22. Patient• Healthy living• Know own disease• Medication list – bring meds or updated list• Portable health care record
  23. 23. Healthy Living• Balanced diet• Regular physical activity – Relationship between exercise and survival – Obesity adversely affects prognosis – 30min five days a week• No tobacco use Irwin , M. Physical activity interventions for cancer survivors. British J Sports Med 43:32-8. Oct 23, 2008.
  24. 24. Patient• Healthy living• Know own disease• Medication list – bring meds or list• Portable health care record
  25. 25. Portable Medical Record• Needs to be concise yet complete• Used in transitions of care – Home to ER/hospital – Specialist to generalist – Doctor to doctor• Easily accessible – ideally web based• Updated regularly
  26. 26. Portable Cancer RecordCancer diagnosis Treatments Accessed March 28, 2009.
  27. 27. How to help the transition• Partnership – oncology and primary care• Patient – owner of their own health• Plan – survivorship plan
  28. 28. Survivorship Plan• Survivorship Guidelines – – Patients and physicians need to know about this resource
  29. 29. Preventative Care Child to Adult Transition
  30. 30. Start the transition early
  31. 31. Transition PlanEstablish goodmedical habits
  32. 32. Transition for AdultsCancer diagnosis Treatments Accessed March 28, 2009.
  33. 33. Where does it all break down• Lack of education• Lack of insurance• Lack of a plan “I’ll have someone come in and prep you for the bill.”
  34. 34. Patient Example• 50yr old with brainstem glioma at 19yr• Radiation and VP shunt• Family history of high blood pressure and cholesterol• Seen in Long Term Follow-Up Clinic for survivors of childhood/adolescent cancer – Identified risks: pituitary, skin cancers in field of radiation, mild memory deficits, headaches
  35. 35. Patient Example• Transition document clued me into increased risks – MRI of brain done, pituitary hormones checked, detailed skin exam yearly• Age-related preventative screening – Colonoscopy, PSA/DRE, lipids, glucose, skin exam• I manage his hypertension, hyperlipidemia, vaccines, acute visits• Periodic visits with LTF clinic
  36. 36. What is a “cancer survivor”?
  37. 37. Definition National Cancer Institute: “In cancer, a person is considered to be a survivor from the time of diagnosis until the end of life.”National Cancer Institute. Accessed March 28, 2009.
  38. 38. So, patients and providers need to plan for survivorship• Establish care with a primary care physician• Plan for the transition
  39. 39. Questions?