Importance of Primary Care | YMyHealth

An interview with Dr. Jeremy Neuman of Ally Primary Care in Atlanta, Georgia

Our YMyHealth Contributor, Carly Flumer was in her late 20s when she got diagnosed with thyroid cancer in Maryland after having not a single symptom. While across the country a fellow millennial, age 34, who ran his family farm in Texas was diagnosed with colorectal cancer—something he had never heard of before—after experiencing what he thought were hemorrhoids. As the story goes, he ignored it because he had no family history of colorectal cancer and thought his rectal bleeding was simply a sign of hemorrhoids. By the time, he went for a colonoscopy, he had large precancerous polyp in his sigmoid colon.

These are just two of the stories our YMyHealth Contributors, a cancer survivor and another, a gastroenterologist has shared with us, but both lead to a common place: primary care.

For that is where Flumer was diagnosed when she was just there for annual checkup and that is where here fellow millennial, the farmer in Texas, could have learned about colorectal cancer in his 20s and its signs and symptoms had he attended annual primary care checkups—a place that many other millennials who are experts in the healthcare field have told us is the first opportunity for health education and awareness that so many in their 20s, 30s, and 40s have missed.

So, we asked a fellow millennial who has dedicated his career to primary care, Jeremy Neuman, MD, to share with us from one millennial to another, why you should make establishing a relationship with a primary care doctor and consistently visiting them a top priority for your life.

Q: What made you choose primary care as your path in medicine, and what continues to be the "wow factor" of the field?

"Primary care is beautiful. It doesn't close doors—it opens them," says Dr. Neuman. "Primary care can mean diagnosis, can mean relationships. I get to have the fun. I get to not just look at one organ or one system. I get to look at the whole person."

Dr. Neuman explains that he gets to hear people's stories and know them, which he finds especially rewarding as he watches them grow and prosper over time. "I get to be the diagnostician. I get to have the fun medical puzzles myself. For us in our generation, growing up watching House, MD, with all the medical puzzles, I get to have that fun. I get to be the one when people come in saying, 'I can't get out of bed, I'm so tired,' or 'I'm having this terrible pain.' I get to be the one who uses my head to think and try to figure stuff out."

Q: Can you tell us about Ally Primary Care and the direct primary care model?

Dr. Neuman explains that direct primary care is an emerging model about 10 years old, with roots in concierge medicine going back even further. In this model, patients pay their doctor directly. After working in large hospital-based outpatient clinics with short appointment times and limited human contact, Dr. Neuman felt the need for change.

"I created Ally Primary Care with the intention to develop relationships with folks over long periods of time to give them a lot more time and to really be like that old-timey doctor that maybe the generations ahead of us remember—where they could actually call somebody and get a human being who would come to the house, would know you, know your context, know what's going on, and could really look at you as a person instead of as a bothersome roadblock to them getting to their next client."

Q: How do you define primary care and its scope?

"If you have a problem, you come to me. That's primary care," Dr. Neuman states simply. "And that problem could be something going on now, or it could just be, 'Hey, how do I make sure that I'm around and healthy 10, 20 years from now?'"

He explains that primary care is the first step in figuring out what's going on, though not necessarily the last step. "It is not a field defined necessarily by depth, but a field defined by breadth. I'm trying to know a little bit about a lot of things so that even if I'm not exactly sure about what's going on with something that's rare or complex, I know who would know that. It's my job to be that catch-all, to be that person, that face, that guide for when people have anything going on that can help them know what to do, can be their ally to kind of figure out what's going on."

Q: What are some misconceptions about primary care among millennials?

One major misconception, according to Dr. Neuman, is the belief that feeling well means there's nothing to gain from seeing primary care. "I think there are certainly some truth to that. There's some truth to low intervention and if you're doing well, continuing to do what you're doing. But I don't think that's the full truth."

He emphasizes that one of his biggest roles, especially with relatively healthy patients in their age demographic, is to look for things that wouldn't show symptoms: "Look for blood pressure, cholesterol, sugar, things that can put a lot of strain on the heart, but by the time that the human who's in that vessel knows it, by the time we get symptoms or some complication, it is very late in the game."

Q: Can you share some examples of how primary care has made a difference in catching issues early?

Dr. Neuman shares that such cases occur weekly, though he emphasizes these stories should be taken in context. He recalls a recent case of a 38-year-old with headaches that turned out to be an aneurysm about to rupture, and a 30-year-old whose early mammogram, prompted by family history, revealed stage three breast cancer.

However, he cautions, "I want most people to know that that's not the usual, and if you come to the doctor with a headache, please do not assume that you are going to have a brain cancer or aneurysm. But at the same time, this is why it's great to have somebody in your corner who knows you, who can help you sort through these things."

Q: What qualities should people look for when choosing a primary care physician?

Dr. Neuman likens the doctor-patient relationship to "best friends on a bus"—not everyone will be the right fit for everyone else. However, he outlines three key qualities that define a good doctor:

Someone who knows their stuff
Someone who can communicate their knowledge in an understandable, actionable way
Someone who has the time to both express and share what they need to share

"They could be the smartest and most sympathetic physician in the world, and if they have five minutes with you, that might not be a very effective provider," he notes. "They could be the most empathetic, have the best bedside manner and have all the time in the world, but if they don't know medicine, they don't know you, then they might be getting things wrong or might not be thinking of everything."

Q: What's your final message about the importance of primary care?

Dr. Neuman encourages people to explore direct primary care: "Check out direct primary care. I'm biased. I have a direct primary care clinic, but it is a model that I fully ascribe to because it allows us to have so much more time." He notes that the number of direct primary care clinics has grown from less than 200 in 2016 to more than 3,000 today.

"If you want to find a primary care doctor who has time, who has a business structure that doesn't incentivize you getting out of their clinic, but a business structure that incentivizes you staying healthy and happy, Google 'direct primary care near me.'"

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The Value of Primary Care: A Conversation with Dr. Jeremy Neuman