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142: PCP or Not to PCP - That's the Question

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142: PCP or Not to PCP - That's the Question

Jun 13, 2023

You may be asked to provide one at every doctor's appointment, but the role of a Primary Care Provider (PCP) can often seem blurred. But should you have one? The Who Cares guys are joined by Dr. Matt Chabot, a seasoned internal medicine physician, to demystify the importance and benefits of having a PCP. Hear about the guys' own experiences and the potential impact a PCP can make on your health.

Episode Transcript

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.



Scot: Every once in a while, I'm asked this question and I'm not sure how to answer it. And the question is . . . Well, I know how to answer it because the answer is no. But the question is, "Who's your primary care provider?"

Mitch: Oh, sure.

Scot: Yeah. I know I'm supposed to have one, and when I'm asked the question, I'm like, "Well, I don't have one." And then I feel like really bad that I don't because I should care about my health and I should have one.

Troy, do you have a primary care provider?

Troy: I do, Scot. I'm surprised you don't list me as your primary care provider, because it seems like I get a lot of text messages from you, so you might as well just list me. Why not?

Scot: All right. Well, that's great.

Troy: I do have a primary care provider.

Scot: Mitch, do you have one?

Mitch: I do. I got one a couple of years ago, and it was good.

Scot: Man. All right. I guess I'm the odd one out. So there was a 2015 study that said 28% of men don't have a personal doctor or a healthcare provider. I guess I'm in that 28%.

Troy: There you go. Yeah, you're one of the three.

Scot: If you're among ethnic minorities, it's even higher. Forty-seven percent of Hispanic men don't have a PCP.

Mitch: Wow.

Scot: And this is kind of shocking. We normally don't talk about women because it's a men's health podcast, but women are doing a little bit better, but 17% of them don't have one. So, anyway, I don't know.

The question is, is a primary care provider really that important? And why don't guys have one and what can we do about it? I guess we're talking about what can we do about Scot today on the show.

Troy: This is all for you, Scot.

Dr. Chabot: New title, "How to Fix Scot."

Scot: Yes, "How to Fix Scot." This is "Who Cares About Men's Health" with information, inspiration, and a different interpretation of men's health. I'm Scot Singspiel. I'm primary-care-provider-less and I bring the BS. The MD to my BS is Dr. Troy Madsen.

Troy: Hey, Scot. Don't say your primary-care-provider-less. Like I said, I'm here for you, man. I've got your back.

Scot: Appreciate that. Always with his unique perspective and a guy that now very much cares about his health, he's a, "I care about my health convert," it's Producer Mitch.

Mitch: Wow. Yeah. And one of the first steps was getting a PCP, actually. So, sure, I'm excited to talk about this.

Scot: And our expert today, Dr. Matt Chabot. He is a board-certified physician in pediatrics and internal medicine. So he sees men of all ages. How are you doing, Dr. Chabot?

Dr. Chabot: Men and boys, yes. No, I'm doing well. I'm a little worried that your primary care provider is in the emergency department. That seems to speak to a high level of illness that you're experiencing.

Scot: Yeah, you should be, but that's not the case in my instance. The question is, Dr. Chabot, do you have a PCP, a primary care provider?

Dr. Chabot: I do. I would be ashamed if I didn't. No, I think there's this saying that's, "If you are being your own doctor, you probably have a fool for a doctor." You're probably not partial at that point.

Scot: Back to this conversation about men and having a primary care provider . . . or Mitch referred to it as a personal care provider. Is there a reason you call it a personal care provider, Mitch?

Mitch: No. That must have been a typo. Sorry.

Scot: All right. I just . . .

Dr. Chabot: I honestly love that typo.

Troy: It's really nice.

Dr. Chabot. I think that that's a good PR campaign for primary care in general. Just call it personal care. It sounds better.

Troy: I like it.

Scot: So what percentage of your patients, and I know you don't probably have stats on this, do you think would call you their primary care provider? Meaning you have a relationship with them. You've seen them more than a couple of times.

Dr. Chabot: I would say at this point, the vast majority. And I do have stats on this. The university really does monitor this closely. And I'm at 90% of the people that I see I am listed as their primary care person.

Scot: Wow. I'm starting to feel more and more like the outside guy here. All right. So, Mitch, let's talk briefly about our experience with our personal care provider, our primary care provider, our primary care physician, whatever you want to call it, that doctor you have a relationship or that healthcare provider you have a relationship with. It could be a physician assistant, couldn't it? Or not, Dr. Chabot? What's your take on that?

Dr. Chabot: Oh, definitely. So APCs, which are advanced practice clinicians, encompass PAs or physicians' associates, they're often called too, and nurse practitioners. They very much fill that primary care role for a lot of folks. So you can go with either.

The training is different in that to be an MD or DO, it's more years, and a PA is less years. But they bring a very different and valuable perspective. We work with them a lot in the clinic where I am and they're great.

Scot: So, Mitch, tell us about your experience in finding a primary care provider and what that's brought to your life.

Mitch: Yeah, I'd say when I first got insurance again, so early 30s, I was like, "All right. I'm going to start caring about my health. I'm a producer on this show. I should probably go do something about it." And so I signed up for just a physical at some random clinic that was on the list of my insurance or whatever.

And when I showed up, I had a very nice chat with the administrative assistant who was checking me in and everything like that. And in the back of my head, I'm like, "I should probably get a PCP because that's a question that I can never answer on a form." I had never had one before.

And so I just spoke up and I said, "Hey, I'm new to all this. What do I need to do to get a PCP?" And she was so sweet and so kind, and she's like, "It can be hard to find a good one. It's going to be hard to find people taking new patients, etc. But here's the guy who's been treating my kids since they were teenagers," and gave me a name and a number, and I've been going with him since.

It's been nice to be able to fill that out. And it's been kind of nice when I go to these specialists, and it's a sleep specialist where it takes months to get in, to be able to transfer the care over to a central person.

Now, I only see him maybe once or twice a year, but he's kind of the guy who makes sure that all of my care is being . . . He's the single point person for all the stuff that I'm having done.

Scot: So you got lucky. You just kind of right off the bat found one and you're good to go. All right. I do want to dive into the benefits, what benefits you feel that having a PCP brings. But Troy, tell us about your PCP.

Troy: Yeah, I think my story is kind of similar to Mitch's. I found my PCP years ago, and it was again after . . . We'd talked before about how I had had some high cholesterol readings and got concerned about that. So I set up an appointment with a PCP and I found someone online who . . . I didn't know him, but I thought, "Well, he seems like a good guy." And he was about my same age too, so I thought . . .

Scot: What did you base that on, the picture or his name?

Troy: Yeah. He looked like a nice guy. He works for The U.

Dr. Chabot: A kind smile.

Troy: Yeah, he has kind eyes. So I went and saw him and liked him, and he is a great guy. I have continued to go see him every year since then.

And kind of like Mitch, I see him once a year, and he has been someone I've been able to go to with issues that have come up. And as we've talked about stuff on the podcast that's come up, I've been able to go to him and say, "Hey, we talked about migraines. I think I might have migraines." He said, "Yeah, I agree. You have migraines. Here's some medication." So it's been great for that.

We talked about the colonoscopy. He gave me the referral last year and got that set up for me. So he, again, has been the point person in coordinating my care and someone I see . . . it's pretty much a yearly basis.

Scot: So I'd say about 20 years ago I had to go in for the annual physical or whatever, and I did. I kind of fell in with this doc that I liked, and he was there for two or three years, and then he ended up retiring, right? So I've had a different journey and I think this is why I don't have one. So he ended up retiring.

I think mine is more circumstance. Mitch got lucky. Maybe I just got unlucky.

So then I get another one for a couple of years, and then I change jobs. And when you change jobs, oftentimes you change insurance, right? So now I've got to go to a different clinic. Then I had another for a couple of years and that one moved.

I do go to University of Utah Health, so there are residents there. So one of them was a resident, and after the residency, that individual moved. So I just kind of got to the point where, "Why do I keep trying? They just keep leaving me."

Mitch: Oh, no.

Dr. Chabot: "I've been hurt before."

Scot: Yes, I have been. I think somebody else moved to another clinic within the system, but that clinic was too far away. So I've adopted more of this clinic view. I guess I figure if my health records are within the system and I kind of go to the same clinic, that's good enough.

I also think things for my annual checkup, maybe just a physician assistant can do that, so usually I just schedule it with a physician assistant as opposed to an MD.

Dr. Chabot: Scot, can I jump in on the physician assistant?

Scot: Yeah, absolutely.

Dr. Chabot: Which is just to say, the more current term is actually . . . They're still called PAs, but they go by physician associate because they are pretty independent.

I think that is sometimes something that people are considering this is a lesser provider somehow, which I think we should push back against that narrative a little bit. Yeah, they're different. They're different in the scope of things that they can do. A really good PA can get you to the place you need to be, even if they don't do all of that stuff themselves.

So their benefits are usually access, right? I heard how you got bounced around a lot and nobody could see you for a while. The American healthcare system has been plagued by that because we just don't have enough doctors because it takes us forever to train every doctor because we're trying to teach them how to be scientists as well as doctors. And so the pushback to that was PAs. Anyway, as that's evolved over decades, they've become more and more just providers in their own right.

So, anyway, to anybody listening to this, I would say don't feel like you're getting the short end of the stick if you're seeing a PA. I myself see a PA for my primary care person, my personal care person. So, yeah, I just wanted to make sure that was out.

Scot: I think that's a great point. And I wasn't by any stretch of the imagination saying that a physician associate was lesser than. I just figure if I'm going in and it's for a physical and we're just going to kind of do those routine things, I'm not a complicated case, like you said, like an internal medicine doctor would do.

Dr. Chabot: I agree. Yeah.

Scot: And I think that's another good point, because what I'm hearing here is if part of having a relationship with a primary care provider is about access, the person that coordinates the care, it sounds like a physician associate, that's what they excel at maybe.

Dr. Chabot: Yeah, for sure.

Scot: So that's a great person to have. All right. Cool.

Dr. Chabot, how about your primary care provider? How did you fall into that relationship and how long have you guys been going out?

Mitch: Oh, my.

Dr. Chabot: It's weirder because it's a woman. So, yeah, thanks for that. But no, it's great. So I've been seeing my primary care provider . . . Like you mentioned, I kind of have a sense of my own health status in that I'm not that complicated. I don't need that much. Admittedly, I go to the physical once a year and a lot of my motivation for doing that is the insurance perk. They'll give you some money with my insurance to say, "Yeah, you got your flu shot and your physical." And I think, "Oh, that's enough for me to go."

But I've been seeing my primary care person for like five years or so, and they're great. I think they fulfill the sort of . . . The reason I like this person, I knew them because I work in the system, and I think they can speak to my level of medical jargon, right? I think that's always a tough thing. If you're not medical, you don't want somebody who's talking over your head. But at the same time, if you are medical, you want someone who just cuts right to the chase.

Scot: Yeah. So we've kind of briefly mentioned some of the things maybe your primary care physician might do for you. Helping to coordinate care is one. But is a PCP really that important? Am I in a bad situation that I don't have one? And are Mitch and Troy in just such a better situation because they do?

Dr. Chabot: We're all very worried about you, yes. And it's tragic.

Troy: I was going to echo that too, because Matt, like you said, I think a lot of what you're doing is just kind of the yearly thing. We do get an insurance discount at The U. And I will admit that's been an incentive for me. I like, though, having that relationship, but sometimes I have wondered too, "Is this necessary for the average person." So it's a good question, I think, Scot.

Dr. Chabot: Of course, you're talking to a biased audience, right? It's like you ask a car mechanic, "Do we need car mechanics?" And they'll be like, "Yeah." But I would say I, as a primary care person myself, know and accept that healthy people in their 20s and 30s probably are not dragging themselves to the clinic every year just because. And that's okay, right?

But there is a fair amount of things, especially when you get over 40, that even the healthy person who feels great should be looking at. And the things I'm going for here are mostly metabolic health, right? I haven't seen the recent stats, but the majority of Americans at this point are at an unhealthy weight. And the amount of blood pressure, blood sugar, cholesterol problems that we find in people who feel like they're just doing fine is enormous. So if we're not looking, we'll never know.

And the reason healthcare in this country has had some not-great results is probably because we ignored those things for the 10 years when we could have done something about it. And then people come in when they're finally having heart attacks, and then you get to be Troy's problem.

Troy: Yeah, exactly. I'm curious, too, because a lot of that yearly visit is the physical exam, like someone's being examined, you're listening to their lungs, their heart, palpating their abdomen. What value do you find in that for the average person?

Dr. Chabot: So you've got to promise not to tell anybody that I said this, but not much.

Troy: Yeah, that's why I wondered.

Dr. Chabot: This is terrible, because I teach a physical exam course in med school. But admittedly, what is the utility of listening to somebody's lungs who's just totally healthy? Not much.

But where I actually take these physical exams more so is a conversation. It's like a coaching session. It's, "Let's talk about anything else that came up in your family this year because . . . Oh, man, your brother was diagnosed with cancer? That actually means something for you in terms of you now need different cancer screening tests," and stuff like that. So I find the conversation aspect way more valuable than the dance of the Western Shaman where I use my stethoscope on various parts of your body.

Troy: It's so refreshing to hear you say that.

Scot: I want to jump in and hopefully I can defend the practice. So the listening to the lungs part, that's what we're talking about right now, or listening to the heart of a healthy person. Are you saying generally, if somebody appears healthy, you're not uncovering stuff there? But it's that metabolic stuff, it's the cholesterol test, the blood sugar test, that's where the real value is?

Dr. Chabot: Yes, those things. And don't get me wrong, I still do all that stuff, but I accept that I don't change people's lives often with the physical exam in a healthy person. But I do change their lives often with the blood tests that we get at that same visit. So, yeah, that's something that you've got to be in person for. You can't just read it online. You need someone to actually look at your chemistry to know what's going on.

Scot: And the conversation, that's the value too, getting a little bit of your health history and.

Dr. Chabot: Yeah, and that's a lot of what I do in these because so many people have metabolic problems, right? Because weight is such a prominent thing and it results in so many issues downstream, that's a lot of what I talk about. That's the public health crisis that is engulfing us, right?

So I get a lot of people who come in for, "I'm here for my insurance dollars. Oh, yeah, my back hurts and my knees hurt." And I'll say, "Let's make a plan to make you 10 pounds lighter and I'll bet you your knees won't hurt." So it's that sort of conversation often.

Scot: So I was asking myself this question about what is the benefit of a primary care provider? And I've heard that just even having a relationship with a provider can help improve somebody's health. And I'm like, "Is that really true?"

So I did a quick little research scan and there was a study published by the "Journal of the . . ." JAMA. What is that? "Journal of the American Medical Association"?

Dr. Chabot: Yep.

Scot: So it was a 49,000-person survey. Actually, it was more than that. Forty-nine thousand had primary care providers, 21,000 did not, and they found that the populations with providers were significantly more likely to fill prescription medications, have more routine preventative visits, and more likely to get screenings.

It's just that relationship. And maybe some of it is the insurance, right? So then you go see them, you have that conversation about, "Yeah, I do have a family history of cancer," and then you get those screenings, as opposed to somebody who did not have a PCP might not have ever gone down that path, right? So just even having one as a healthy person, according to this evidence, can make a big difference. I think that's pretty powerful.

In addition to early detection and prevention of diseases, finding those things in the test, you hear sometimes, "It's a single point of contact for health questions," which I sometimes think is BS, because how am I going to get a hold of this doctor outside of my appointment? I mean, is that part of a primary care provider? Is that true? Could I get a hold of you if you were my guy?

Dr. Chabot: Well, that's an interesting question. So depending on the system that you're in, there are different ways to do that. So in the university system, for example, we have this patient portal where you can send your doctor a message, and that is a great place to start, to say, "Is this a big enough deal that I even need to see somebody?"

And what we're dealing with in the university is we made this system and now everybody can talk to us, and boy, do they talk to us. We don't necessarily have time for . . . because we're also supposed to be seeing people in clinic.

So you might encounter, and it kind of makes sense, of, "Yeah, sorry, I can't just answer this necessarily on email. This is enough that we need an appointment." And that kind of bums people out. But that depends a lot on the insurance system that you're in and the clinic that you're in.

There are these clinics that have a completely different model where they're like, "Oh, we don't make money based on how many patients we see. We just charge a monthly fee or a small monthly fee, and then we just take care of you as much as you need, and you can call us or text us or whatever."

And then there are the other places which will very much say, "I've got to see you face-to-face any time I literally say two words to you."

I think the trend is moving away from the "I have to see you face-to-face any time you want any information" because doctors realize that that's not efficient. Patients certainly have realized forever that it's hard to get an appointment. So it'll be an interesting space to see where that goes.

Scot: Hey, Mitch, I want to ask you, what do you get out of having a personal care provider?

Mitch: So the couple of benefits I experience . . . And I am glad to hear that the Western Medicine Shaman dance is not actually . . . Because I'm always confused, like, "What are you checking for?"

But at the same time, every year that I sit with that guy, it's always when he is about to leave I'm like, "Okay one quick question." I have one thing that's on my mind that I'd like to know and I have an opportunity to talk with the doctor about that, to have them even just put my mind at ease about something, right?

So I find that a real benefit to be able to know that at least once a year, a couple of visits additionally if I need them, I have a guy that I can talk to about these ideas and I can bounce ideas off of him and he can give me some advice.

Dr. Chabot: Yeah. I love that.

Scot: Do you find your patients do that? Is that pretty common, or is Mitch kind of the outlier in that respect?

Dr. Chabot: I mean, the doorknob comment, I'm on my way out the door, that's super common. But what I clued into on what you were saying, Mitch, is even if it's just sort of a nagging concern, like, "I'm not sure how worried about this I should be," I get a lot of those.

And often people will apologize and say, "Oh, I'm sorry this didn't turn out to be a big deal." And I'm like, "No, I'm here selling reassurance on some stuff." That's a valuable use of a primary care person that you weren't perseverating on this for months and/or you didn't just show up in the emergency department randomly because you were so worried, right?

There are easier ways to deal with a lot of these things, and I think that's a prime example of how primary care docs make care more efficient for patients and also for systems and public health and stuff.

Mitch: As for the making it efficient thing, I've shared on this podcast a lot over the last couple of years, I've been going to a lot of specialists and figuring out a lot of really nagging issues and getting them fixed. I've needed some specialist care and my PCP is someone who I can say, "Hey, I'm having trouble sleeping. It's been chronic and I need to find a sleep specialist." He's the one that helps direct me to a good person or a good center or a good clinic to reach out to. It's not me searching on my own.

And especially over the last year and a half, two years, with everything from mental health to hormones to everything, he has been indispensable in cutting out all that BS of trying to find the right doctor, and do they take your insurance. He knows and can at least give me some guidance.

Dr. Chabot: Right. It's a lot better than a Google search.

Troy: Yeah. And I can say, too, I think from my experience . . . And I kind of mentioned these already, but as I've asked myself, "What's the real value in this?" three very tangible things.

First of all was just having someone to go to. We talked about migraines and it was like, "Well, I don't want to self-diagnose here, but I sure feel like I might have migraines after we talked to our migraine specialist. I've been dealing with this for years and just trying to self-treat." So I don't think I would have really pursued that if I didn't already have that relationship with a PCP. I think having that made it really easy to go see him and talk to him and get treatment.

The cholesterol screening, I think that piece every year has been very good, because my cholesterol was high and then I've made changes, but I've continued to make changes over time just based on those numbers. It reinforces kind of where I am now and what I'm doing and keeps me on that track.

And then I never would have gotten a colonoscopy last year if I didn't have a PCP. If I didn't have that relationship already, I would have thought, "Well, I'm over 45. That's the recommendation now. But I'm not over 50. And it used to be over 50, so I'm not going to worry about it."

Scot: Play that five-year cushion.

Dr. Chabot: Refer to the other guideline, yeah.

Troy: Yeah, I like the older guideline better, so I'm going to stick with the older science. I trust those guys more. So if it hadn't been for the PCP and having that relationship, I would not have gotten a colonoscopy.

So I can say those three things are very tangible things that I can comfortably say if I didn't have a PCP in place, I would not have pursued that.

Scot: I have a question for both of you. Mitch kind of triggered this. Mitch, you say every year you go in, if you've got maybe something that you're like, "I don't know if this is a big enough deal to worry about, but I'm going to ask because here's my annual visit. I know I'm going in," do you write those things down throughout the year somewhere? Do you keep a record of that?

Mitch: No, just in the back of my head playing over and over all day long.

Dr. Chabot: It's unhealthy.

Mitch: Yeah, thanks.

Scot: How about you, Troy? I mean, if you have issues, do you write them down?

Troy: I do. I do write them down. Because I have my PCP appointment scheduled for usually a couple of months in advance, I'll just kind of jot down things I want to talk to them about and stuff that's maybe been on my mind. Stuff that's not urgent, I don't need to contact him right now, but I usually try and get a list together.

Scot: For me, the benefit when I had a PCP for two or three years . . . I mean, I just liked the guy. I don't know what it was. I liked the guy and I liked that relationship. I mean, as silly as this sounds, when I was in the waiting room and he walked in, it was nice to see that familiar face and it was nice to have a doctor go, "Hey, how are you doing? How's everything going?" That was just kind of nice. I mean, that sounds kind of cheesy, but it was.

And I also knew that I was going to visit him every year. For me, I'm kind of a people pleaser, so that every-year visit, there was some accountability.

So if he made a recommendation the year before and he was like, "Hey, you know what, Scot? You probably shouldn't be out in the sun without sunscreen so much. You've got a great looking tan, but it's probably not the healthiest thing. Maybe you should consider wearing some sunscreen or some longer sleeves," then I would think about that. I'd go back in the house and put on a longer sleeve shirt, and I'm like, "Yeah, he's got a point."

Or, "Hey, Scot. You know what? You're probably about 10 pounds overweight. Maybe if you could work on that. "And I wanted to do a good job. So he was an inspiration kind of in a way. I don't know if anybody else can relate to that.

Dr. Chabot: The secret corollary I can give to you is doctors appreciate that too in the, "Oh, man. Yeah, this is Scot. I know him." That feels different in my visit, where it's like we're old friends. We've talked since way back when, right? That is a selling point for providers, and they like that just as much as patients like that.

Scot: It just comes back to relationships, right? Relationships in our world are so important. And I don't want to say you wouldn't get as good of care if you didn't have a relationship, but sometimes that changes the dynamic between people, right? You're more likely to maybe say something when you might not have, or think about something a millisecond longer than you might not regularly have, or go, "You know what? This isn't the same Scot that I remember from a couple of years ago. Is everything okay?"

Dr. Chabot: Right. Yeah, I've had a couple patients describe this sort of unsettling image of me as the angel on their shoulder telling them not to eat a donut or something. And they're like, "What would Dr. Chabot say? I know he's going to yell at me," or something. I'm like, "I like to think I don't yell at people." But I am their accountability drill sergeant or something.

Scot: Yeah. We've kind of established that a relationship with a primary care provider or a personal care provider is a good thing, but then we look at some of the barriers that might keep men away. And there are a couple of studies that could lead this part of the conversation. I would like Dr. Madsen and Dr. Chabot to jump in, or Mitch too if this resonates with you. And if you're listening, maybe one of these will resonate with you.

So one of them is the process of getting that PCP is kind of unwelcoming and unaccommodating, and you spoke to that. It's hard to get time off of work. If you don't have insurance, that's difficult. So I think that resonates with us, and the way a lot of organizations overcome that is, "Hey, we'll give you a discount on your insurance." So it makes the effort a little bit more worthwhile.

Another thing that was mentioned, and I'm curious to see if you feel this is true, is that men don't like to help-seek, especially if they think the concern is not significant. And I think we kind of touched on that, right? Some guys even apologize, "Oh, I'm sorry that wasn't a big deal." But that shouldn't be a deterrent, right?

Dr. Chabot: Right.

Scot: Yeah. And men don't like going into a visit and saying, "So why are you here today?" and not having an answer. "Well, the reason I'm here is because I kind of have this thing." We want to be able to say, "I have pain here." But that's totally okay too, right? Having that conversation through that conversation, sometimes you uncover what the problem is.

Some men don't have an understanding about the benefits of general health. They think healthcare is just for acute emergencies. What do you think about that, Dr. Chabot, and you, Dr. Madsen, actually?

Dr. Chabot: I would agree with that as sort of a broad stereotype. I know there are definitely exceptions to that. But yeah, I think that's part of the male ethos, is, "Come in if there's something bleeding."

I see all kinds, right? It's a broad range of people that worry too much or people that worry not enough. And I think all those folks are welcome, right? If you're too worried about stuff, the primary care person is there to bring you back to the middle. And if you're not worried enough, then the primary care person can also find some stuff that you really should be worried about.

Troy: Yeah, I was going to say also along those lines, the more time I spend in emergency medicine taking care of emergencies, the more I believe in preventive care. There's so much that can be done on the front end to prevent the stuff on the back end.

And on the back end, a lot of times we're putting a Band-Aid on something, figuratively, whether it's treating a diabetic emergency or getting someone to the cath lab to treat a heart attack. It's probably going to help, but quite honestly, if you can get stuff taken care of on the preventive side through the primary care provider, that's where the real value is in healthcare, in my opinion.

Scot: Some other reasons guys don't seek out healthcare according to these studies, they think they're doing good enough. I think Mitch fell into that for a while.

Mitch: Yeah. "I'm doing fine."

Scot: Right. "It's probably nothing to complain about. I don't want to be a whiner. I've been kind of suffering with this mildly annoying thing for a while." Or things.

This thought that women are the ones that are supposed to be worried about wellness and men aren't. It's not a concern of ours.

So those are some of the barriers. I guess the thing about barriers is if there's a reason you're not going in, maybe you should change your mind, because primary care can provide some pretty good benefits.

Are there any other barriers that speak to any of you gentlemen? I mean, you all go, so I guess not. But if the financial incentive wasn't there, what would you do, Troy?

Troy: The biggest thing that probably spoke to me from that list was that idea that it's tough just to go in when there's really not a reason to go in. It's just like, "Hey, I'm here. Do you have any issues?" "No, I don't. Everything is good." "Okay, cool. Good to see you." Do the physical exam.

So that is hard to do without some financial incentive. I will be completely honest. So that's probably the biggest barrier for me.

There have been a couple of years I've asked myself, "Do I really need to see the PCP this year? Oh, yeah, there's that insurance discount. Absolutely, I'll go see him." If I didn't have that, I can honestly say I don't know that I would go see him.

Scot: Okay. And then there's this thought that maybe a question doesn't get asked. Because you do have this appointment, well, maybe I'll do a little inventory and see what's going on. I think we all could identify a couple things that may or may not be an issue, right?

Troy: Well, that being said, every year that I've said that to myself, then as the appointment has come up, I've thought, "Oh, I really should ask about this. This family history I have has been on my mind. I should bring this up." And there's always been something I've asked eventually.

Scot: Sure. Mitch, how about you, if you didn't have the incentive? Or when you didn't have insurance, was that your major barrier or were there other barriers that you had?

Mitch: Oh, my major barrier was not having insurance. Even the idea of going to a general health doctor for a checkup, just an annual physical, I was terrified about how much it would cost and blah, blah, blah. So no, as soon as I got insurance, I went and got one.

Scot: Gotcha. Dr. Chabot, you mentioned the financial incentive. That's gone. What's your barrier?

Dr. Chabot: Time. Yeah, for sure. Like we've mentioned here, I've got enough stuff to do that there's got to be a tangible benefit. And I think that's why I'm happy we're having this conversation, is just sort of reinforcing for people that those benefits are out there. They're real. And not just in terms of like, "Oh, I didn't die and have a heart attack," but just living better.

So I think that's where I'm at with these. Maybe this isn't a mission-critical sort of issue, but we're able to solve something that somebody's been struggling through for a while.

Scot: I mean, Troy and Mitch, they're in pretty good shape. They've got their primary care providers. But for a person like me who's struggled, I've kind of adopted this "I just go to the same clinic" sort of philosophy. Would it be a good idea for me to at least try to find somebody that I continually go back to? And if they leave after a couple of years, fine. But try to find somebody else I continually go back to.

Dr. Chabot: So I think it's always great to have a person who is your person. But the strategy of sticking to the same clinic, a lot of clinics have good systems around that, right? So I would say either way is fine. It kind of depends on your own personal preference also and what your level of need is.

So if somebody is on three or four or more medications and has a bunch of chronic healthcare issues, you're probably going to want to talk to the same person every time. But if you're otherwise healthy and probably just need to get pointed in the right direction once a year, probably better to just go with maximum availability, and that might be a different person.

So where I work at the university, if you have a primary care provider listed on your chart, they will try for appointments with that person first, and then they're welcome to go anywhere else. It doesn't limit you to have a designated primary care person. It just points people towards that person. And all the information that comes in about you goes to that same point person.

I think the only really bad option is to stick your head in the sand and never see a doctor, right? That has been shown time and again to not do well. Then once you develop health issues, you can't usually make them go away. You can really just sort of make them better and stave off disaster.

So getting into a physical once a year, regardless of exactly who it's with, is good and that's what you want. And what would be even better is if it's with the same person every time. But you can't always make that happen in the real world, so there you go.

Scot: All right. So let's wrap this up. Any takeaways? So my three guys that already have primary care . . . Mitch, did you get a takeaway from this or were you like, "No, duh, Scot. Get on board with this"?

Mitch: No, I recognize how lucky I am to have one. And I think that if you are in a situation where you're on the fence about, "Oh, do I really need one or not" . . . For me, someone who for the longest time did not interact with healthcare or their own health for the longest time in my life, my PCP is someone who I really appreciate having for a lot of reasons.

Scot: And I think access. Because you said you had some more complicated things, that access is super important for you, is kind of what I've taken.

Troy, how about you? Takeaways?

Troy: I will say my takeaway is that even though the initial incentive for me to see a primary care provider and sometimes the continuing incentive has been that financial incentive the insurance plan provides, even without that, I've found enough value in it that if I don't have that, I'll continue to see a primary care provider every year. Again, because of that access and because of the very tangible benefits I've seen in the past because of that relationship.

Scot: How about you, Dr. Chabot?

Dr. Chabot: Well, this just gives me warm, fuzzy feelings. Thank you, everyone.

Mitch: Aw.

Dr. Chabot: Oftentimes, I feel like primary care goes a little under-recognized perhaps about the benefits of it for average people, right? So I think me working in primary care, I've always felt really solidly that most, if not all, people should have a primary care doctor. And I'm just excited that we got to have this conversation mostly.

Scot: Yeah. Cool. I think my takeaway is a couple. One, this notion that guys think, "Oh, I'm doing well enough," or, "I'm healthy," I think it's good to have somebody that you go see every year that can check you on that, right? Because there are times I've thought that, and then as I'm getting ready to go for my annual physical, I'm like, "You're kind of not." It's like a reality check, so I think that's a good thing.

And I think just telling yourself, "I'm going to make this a yearly commitment, even though I don't think that I need to go, even though I don't think I have anything wrong," because quite frankly, as you approach that appointment, it forces you to start thinking about those things.

When you start thinking about them, you start taking that inventory and you might be able to find something that can improve your health or prevent health problems down the road.

So I think that's my big takeaway, is just to have that. Even though you tell yourself you don't want to go or you don't think you have to go, go because I think most of the time, you're going to find that you're going to get some benefit out of it.

Dr. Chabot: It's a privilege, not a chore.

Scot: It is a privilege, not a chore. Thank you very much for listening. So if you're listening and you don't have a primary care provider, your assignment is just to go find somebody and make that yearly commitment. It can make a huge difference in your health. The research shows that. People with primary care physicians, even healthy people, benefit.

If you have something you want to share, if you have an experience you want to talk about, if you have something you look for in a primary care provider, whatever, you can email the show,

Dr. Chabot, thank you for being on the program. Thanks for caring about men's health.

Dr. Chabot: It was my pleasure. Thank you for having me.


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