BLOG: The Roles of Primary Care

A great primary care doctor knows how to flex into multiple roles for a patient.

We typically wear one of three hats.
1. Diagnostician
2. Care Strategist
3. Coach

1. 𝗧𝗵𝗲 𝗗𝗶𝗮𝗴𝗻𝗼𝘀𝘁𝗶𝗰𝗶𝗮𝗻
The role here is to help patients identify and understand risks to their health, including the magnitude, character, and timeline of each.

Sometimes, a patient comes with symptoms that require investigation - something as simple as a funny feeling or a sprained ankle to more complex issues like sexual dysfunction or mental health. Other times, they feel perfectly fine, but comprehensive testing reveals hidden "icebergs" beneath the surface.

Clinical acumen is of course crucial - some of my favorite moments in medical training were learning from the crew of Master Clinicians at UCSF, piecing together complex diagnostic puzzles a la Dr. House.

But we also have to recognize that new symptoms and potential diagnoses can be quite overwhelming for patients. Together with our patients, we “hold” the anxiety of this uncertainty, while providing a strong, reliable foundation of knowledge and support.

2. 𝗧𝗵𝗲 𝗖𝗮𝗿𝗲 𝗦𝘁𝗿𝗮𝘁𝗲𝗴𝗶𝘀𝘁
Once we've assessed the magnitude and character of each health risk, we shift into creating actionable plans. Historically, doctors played this strategic role primarily for patients with complex medical conditions. However, the landscape has evolved. With our expanding understanding of exercise, nutrition, sleep, and pharmacology, 𝘄𝗲 𝗻𝗼𝘄 𝗿𝗲𝗰𝗼𝗴𝗻𝗶𝘇𝗲 𝘁𝗵𝗮𝘁 𝘀𝘁𝗿𝗮𝘁𝗲𝗴𝗶𝗰 𝗰𝗮𝗿𝗲 𝗽𝗹𝗮𝗻𝗻𝗶𝗻𝗴 𝗶𝘀 𝗲𝗾𝘂𝗮𝗹𝗹𝘆 𝗰𝗿𝘂𝗰𝗶𝗮𝗹 𝗶𝗻 𝗱𝗶𝘀𝗲𝗮𝘀𝗲 𝗽𝗿𝗲𝘃𝗲𝗻𝘁𝗶𝗼𝗻 𝗮𝘀 𝗶𝘁 𝗶𝘀 𝗶𝗻 𝗱𝗶𝘀𝗲𝗮𝘀𝗲 𝗺𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁.

The care strategist role unfolds in three phases:

a. We engage in a careful prioritization exercise. This involves weighing each risk or symptom against both its potential clinical impact and the patient's personal values and goals.
b. We evaluate the full spectrum of treatment options. While our primary aim is improving patient health, the sustainability and practicality of our plans are equally important. In my practice, I deliberately structure plans to balance "quick wins" (immediate actions that help patients feel better) with longer-term ROI investments in their health.
c. We collaborate with patients to align on a concrete action plan.

Excellent communication and humility are key here. Success in the care strategist role hinges on our ability to transparently share our medical frameworks and clearly articulate the reasoning behind our concerns. Only by maintaining an understanding lens that welcomes disagreement can we create the potential for meaningful progress.

3. 𝗧𝗵𝗲 𝗖𝗼𝗮𝗰𝗵
This is arguably the most challenging role of the primary care doctor. Anyone who's ever had an exceptional coach knows how rare they are. It's a skillset that requires deeply understanding someone, mastering the art and science of behavior change, and executing with a long-term vision. You have to build trust and carefully balance tough love with acceptance and grace.

While clinical acumen drives much of Diagnostics and Care Strategy, this role is more about understanding humans and our emotional dynamics - especially as AI will progressively support the former two roles.

In my practice, as a physician and personal trainer, the Coach role is a fundamental force in driving patient outcomes. It's about execution in the last-mile of impact and knowing how to use your tools (the relationship, diagnostics + wearable data, and behavioral psychology) to help our patients connect the dots.

When we get this right, we transform the healthcare experience from a series of transactions into a cohesive journey of sustainable change. That's where the magic happens.