Melanie Cole (Host): Primary Care Providers, PCPs at MIT Health include doctors and nurse practitioners who specialize in internal medicine, family practice or adolescent medicine. And these PCPs handle most of your healthcare needs. The PCP you decide on will be your personal clinician, the one you’ll visit for the most routine non-urgent care and with whom you’ll discuss your most challenging health concerns and questions. For new patients, choosing a PCP can be a daunting challenge. How do you know which of our many capable providers best suit you? Welcome to Conversations with MIT Health. I'm Melanie Cole. My guest today is Dr. Patrick Egan. He’s a family practitioner providing primary and urgent care for adults as well as teenagers at MIT Health. Welcome to the show, Dr. Egan. I’d like to start by asking you what do you think are the most important qualities to look for when searching for a primary care provider? What questions do you like to recommend that the listeners ask their potential doctor? 

Dr. Patrick Egan (Guest):  I think a lot of what people have to figure out is how do they sit with their provider in a personality sense, I think, even more importantly than at a physiology sense. Most of the interactions that one has with one’s primary care provider are going to be around health and staying healthy as opposed to taking care of some sort of abnormality or problem. A lot of the problems that we run across, even for those visits, are not a huge deal in the sense that we’re not trying to reclaim some sort of youth. We’re trying to help people figure out how do they manage through their days. Finding someone that has both a personality that works with you as well as a medical philosophy that seems to work with you is going to be really helpful. Some providers are much more interventional and feel better about providing more information for the patients, and some providers tend to do less. I tend to be someone who does a lot less. I'm not very much into labs and tests and all that. If I can avoid it, I can avoid it, then we’ll do whatever we’ve got to do. But when patients make the connection with somebody, a lot of what is going to happen is how do you just feel about that person, how do you feel in your gut, and is this someone that you can tell important and sometimes uncomfortable stuff to that person to figure out how to make whatever situations better or that you can do that in a way that helps you stay healthy. Because the majority of folks that we take care at MIT arepretty healthy folks, and we want to really keep them that way. 

Melanie:  Do you have some specific questions that you can give to help guide that person to getting? Because we obviously can't ask a provider personal questions about themselves, and using that gut, that instinct, as to whether or not you get along on that level, what questions should you ask that provider that can help you in that decision? 

Dr. Egan:  I guess one of the first ones, you need to figure how to -- it’s not even a specific question necessarily but it’s rather a sense for how the provider runs the visit or how does the provider allow the patient to run the visit. A lot of times, that’s going to be a big issue for folks to try to figure out. Many people feel like they’ve got their list of stuff and they really want to make sure they address it, and that’s great. Other people feel better or more comfortable allowing the provider to be the guide through their visit. And you can even ask that directly to the provider, how does he or she try to do that. At the same time, one can ask quite directly to the providers as well, how do you manage complicated problems, how comfortable are you communicating with patients, with other doctors, how easy is it for me to get a hold of you, how easy is it for me to share my information both online as well as through paper copies or however else you can do it. What I find when I’m working with patients is there’s a ton of information, and managing the information is often tricky.People want to know what they need to know, but there’s so much that comes at you that it’s very, very hard sometimes to sort out what’s important and what’s not. Having a comfortable relationship with that provider who can help you sort through those questions is going to be a really big help. One way to get at that as a patient is looking at a prospective primary care provider or practitioneris to ask directly how does that provider manage information—because it can be very overwhelming—what are the tricks the provider’s figured out over time, how does the provider help [either] her patients managing that kind of information. It’s not a check the box kind of question, but I think the response will be very illuminating for the patient. 

Melanie:  Now, I’d like to ask you a little about yourself, Dr. Egan. Explain your approach to healthcare. 

Dr. Egan:  My approach to healthcare is I see myself very much as a teacher and a support person much more than a practicing physiologist. As I mentioned earlier, the majority of the topics that I discuss with my patients are not necessarily about the terrible diseases that we can all imagine. But rather, they are about how to stay healthy or how to get through some sort of incidental condition that’s come up—how do you manage a really bad cold, for instance. I tend to do a lot of teaching with my patients. I find that that is the easiest way for more to communicate with them about how can they take care of the problem. To a great extent, there’s a real limit on what providers can offer to patients when they’ve got a whole variety of what are typically self-limited issues. The patients themselves are going to end up taking care of whatever the condition is, if it’s a bad cold or even managing something like asthma. The better that they understand what’s going on, the better those patients are going to be able to care for themselves. My role in this is not to go home with them and tell them every minute what to do but rather to show them. And I constantly use images like Google Images or I’ll find something on the web to show them as a resource to help explain what I’m trying to tell them about in terms of caring for whatever is going on. The basic idea is the more that they know about whatever their condition is, the better off they’re going to be able to take care of it, minimize its impact, essentially make it not a problem but just something that happens form time to time that they don't have to worry about it. 

Melanie:  How do you interact with your patients? How easy is it to communicate with you? Can they reach you at different times or only when they’ve got their appointment? How do they communicate with you? 

Dr. Egan:  Needless, there are lots and lots of ways of communicating. MIT Health has, as part of its electronic medical record, a module that’s known as Follow My Health, and that allows patients to send emails directly to me through the medical record. There are also ways of getting to me. If people prefer to use regular email, that’s okay. If people prefer to call and talk on the phone, that’s okay. However, the Follow My Health module has a benefit of everything is both available when we’re interacting. That is, I can look at the chart, and the patients are able to look at their own charts as well, or at least parts of it, and all of that communication is documented simply. Basically, the messages that we send back and forth are recorded as notes in the chart. The other mechanisms are for many people a whole lot more comfortable. Lots and lots of folks of my generation and older are not very comfortable with new-fangled communication modalities and prefer to talk on the phone because a lot of what we want to communicate is often lost when it’s strictly words on a page rather than the intonations that come with talking on the phone. Or if people need to, we’ll set up and appointment and have them come in, because sometimes even those communications need to have that visual piece to it as well. We really need to talk face to face to sort some of these out. So there’s a whole variety of ways that I work with my patients to make sure that all information flowing around is what they need when they need it. 

Melanie:  In just the last few minutes, what are some of your favorite things about working at MIT Health , and what would you like prospective patients to know about you? Any languages that you speak or philosophies on healthcare? 

Dr. Egan:  The opportunity that I’ve had in the last years since I arrived at MIT Health has been phenomenal. I've enjoyed taking care of the folks that I've met as my patients. Many of them have absolutely fascinating stories to tell, and I’m constantly getting myself in trouble with the schedule because I want to talk to them about their lives. Knowing about their lives makes any of the medical decision making that I have a whole lot easier in the sense that the context for how they make medical decisions is going to have a whole lot of an impact on the decision itself. I try very hard to understand what folks are doing because that is really helpful in terms of understanding how we can manage a particular problem. I’m constantly amazed by more than that. I'm constantly amazed by how the work that folks do is both very interesting to me as strictly an observer. I wish I were a scientist, but I'm not. But it also gives real insight into many of the things that they hold to be important. And sort of understanding how that affects them and what they hold to be important makes a lot of our decision making easier. The things that I project back to them, I think, are that philosophically, I tend to be a minimalist as physicians go. I do fewer tests and I order fewer lab tests and I try to minimize the number of medicines that I prescribe. I try to make sure I don't underdo any of that stuff. But as a standard, I'm much less of an active measure of all of these body parts. The other things that are worth noting is I speak Spanish. I spoke in medical Spanish for a long time, and I’m getting better and better in my conversational Spanish. But I'm quite comfortable working with Spanish-speaking patients. I can do an entire visit that way. In several previous jobs, that was essentially part of the requirement. We had to be able to do it in order to work there. I’m a family doctor, which is different from many of the other physicians that are here, and that, as I've mentioned, requires one to think about patients in a larger context. Families, communities, their work life, all of those other outside forces that have such impact on their health, that’s how I approach most of the care that I deliver, which is patients are not operating in a vacuum. There’s a lot of other stuff going around, and it’s part of my job to understand what those factors are in everybody’s life and help, among other things, take advantage of them, typically, but know if there’s anything else like students who are stressed by their finals, that’s a big deal. I’m good at managing in that context. I’m quite comfortable talking about patients where one scenario, this is the decision we would make but in a different scenario, a very different decision would be sort of the best thing for them.  

Melanie: Thank you so much. It’s great information. You sound like a very nice man. For more information on Dr. Patrick Egan, Listeners can visit Health.mit.edu for more information and to get connected to one of our providers. That concludes this episode of Conversations with MIT Health. Please remember to subscribe, rate and review this podcast and all the other MIT Health podcasts. . I'm Melanie Cole. Thanks so much for joining us today.