Do All Guidelines and Medical “Studies” Relate to Direct Primary Care?

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I am a believer that many of the medical studies done (if they are not fabricated), as well as the recommendations by government organizations, may not relate to Direct Primary Care.

Let me first say that we definitely need guidelines and recommendations. Many of us use Up-to-Date or similar references. DPC, however, changes the equation because cost is often removed.

For example, we were told that screening for hypothyroidism or low D is not recommended, but the reasoning is mostly due to the price of the test. But a TSH or D level is less than $10 for the patient now in DPC. Does that change things? I think it does. Yes, the issue of false positives comes into play, and you still have to reason out what tests are worth getting, even if it is affordable. But that is what makes us doctors.

Here is something I found to prove this:

U.S. Preventive Services Task Force (USPSTF)

Cost-Effectiveness Concerns: While screening for certain high-risk groups, such as pregnant women or those over 70, has shown to be cost-effective, the cost-effectiveness of routine screening in the general population, particularly in younger asymptomatic individuals, is not definitively established and remains a topic of discussion.

The key term is COST-EFFECTIVE. This is like a governor on a car restricting speed. It hovers over and affects everything they recommend.

If researchers looked into Direct Primary Care, however, they would have to start over with most screening recommendations because almost ALL of it is cost-effective!!

And the first thing I would tell them is that yearly Complete Physical Exams are a good thing!! I know what the recommendations are now:

Although many doctors still recommend people get an annual checkup, growing research suggests that these visits have not had a significant impact on patients’ long-term health.

I call bullsh%t.

This conclusion and recommendation are about clearing the schedule in the industrialized model. But DPC is free-range medicine. We have time to see our patients. Doing the annual exam is extremely important, in my opinion, to do those extra and affordable blood tests as well as doing skin checks and finding murmurs, etc. We also check in with the patient for psycho-social issues. I found more major problems that were fixed by doing the complete physical than anything else I did as a doctor. And patients loved it, which is critical to slow the churn in DPC.

In summary, I think we have entered a whole new world with Direct Primary Care as far as research and guidelines are concerned. It’s time to think differently.

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About Douglas Farrago, MD

Dr. Farrago is a retired family physician based in Forest, Virginia. Since 2021, he has run DPCnews.com, a leading resource for the Direct Primary Care (DPC) movement. He is the author of three best-selling books on Direct Primary Care: The Official Guide to Starting Your Own Direct Primary Care Practice The Direct Primary Care Doctor’s Daily Motivational Journal Slowing the Churn in Direct Primary Care (While Also Keeping Your Sanity) In 2016, Dr. Farrago conceived the idea for the Direct Primary Care Alliance and co-founded the organization alongside other pioneering DPC physicians. He is widely recognized as a leading expert in the DPC model and frequently lectures to medical students, residents, and practicing physicians on how to successfully start and run their own DPC practices.Dr. Farrago sold his Direct Primary Care practice in October 2020 but continues to receive care there as a patient.