A Case That Highlights the Importance of Having a Primary Care Physician

This was a man in his 70s.

He regularly visited a university hospital every two months for blood tests and medication for hypertension, under the care of the nephrology department.

At the end of May, he began to feel unwell. He developed insomnia and loss of appetite.

His wife took him to a psychiatric clinic, where he was prescribed herbal medicine for autonomic nervous system imbalance.

However, his symptoms did not improve, so he and his family came to our clinic.

After listening carefully to his wife’s concerns, I ordered blood tests.

The results revealed a dangerously low sodium level (severe hyponatremia), which was causing his insomnia and loss of appetite.

We diagnosed the condition and immediately began treatment.

This case highlights several important issues.

1. His “regular doctor” was not truly functioning as his primary care physician.

He was essentially visiting the university hospital only to receive medication and routine blood tests.

When he became ill, it was not easy for him to travel to the university hospital, obtain an appointment, or receive immediate care.

As a result, his family had to search for a medical facility on their own.

2. The family assumed it was a psychiatric problem.

They decided for themselves that the symptoms must be psychological and searched for a psychiatrist.

The psychiatrist prescribed medication aimed at relieving the symptoms.

However, when the treatment did not work, there was no clear follow-up plan or guidance such as, “If you do not improve, please come back so we can investigate further.”

As a result, the patient and his family were once again left to search for another medical provider on their own.

3. Many medical facilities only address the immediate problem.

If there is no physician taking responsibility as a true primary care doctor, treatment often ends with simply prescribing medication.

There may be no one continuously following the patient’s condition, reassessing the diagnosis, and ensuring that the underlying cause is identified.

Unfortunately, this style of healthcare has become common.

But I do not believe it should be considered normal.

In areas with many medical facilities, patients may eventually find another doctor.

However, in rural regions where physicians are scarce—or even in large cities where many doctors focus only on narrow specialties—the outcome can depend greatly on whether a patient happens to find a physician who is willing to look broadly at the whole person and take responsibility for their care.

My Conclusion

For patients whose conditions are stable, it is often better to transition from a university hospital to a clinic close to home.

That clinic can become their true primary care provider.

Then, whenever something changes, they know exactly where to go.

Routine blood tests can be performed locally, and if abnormalities are found, the primary care physician can refer the patient back to a university hospital when specialized treatment is needed.

This approach is much easier for patients and their families.

A comprehensive primary care physician looks at the whole picture.

We ask:

• Is this a serious physical illness?
• Is it a mental health condition?
• Is it an acute medical problem?
• Could multiple factors be interacting?

Unless Japan develops a stronger primary care system, I believe more elderly people will struggle.

As more older adults visit multiple hospitals and receive medications from different specialists, healthcare costs will inevitably continue to rise.

Older patients often have several medical conditions at the same time.

These conditions interact with one another.

In addition, serious illnesses in elderly patients often present with symptoms that do not match what is written in textbooks.

For diagnosis and treatment to be successful, it is extremely valuable to have a physician who knows the patient well—their usual appearance, personality, way of speaking, and overall condition when they are healthy.

When that same physician sees the patient during an illness, the differences become immediately apparent.

Communication is smoother, decisions can be made more quickly, and appropriate treatment can begin without delay.

That is the value of a true primary care physician.