A cardiologist can take care of your heart. A nutritionist can help with your diet. A mental health provider can support your emotional well-being.
But who is looking at everything together?
For Dr. Benston Johnson, that question gets to the heart of primary care.
After more than 20 years practicing in clinics, hospitals and urgent care settings, Dr. Johnson has seen what can happen when patients move through healthcare without someone connecting the pieces. Today, as a physician with First Stop Health, he sees virtual primary care as an opportunity to build something different: an ongoing relationship that evolves with the patient and helps guide what comes next.
We sat down with Dr. Johnson to talk about why that relationship matters, what fragmented care looks like in practice and why sometimes good primary care means knowing when not to treat.
“The key is to actually have a relationship that is ongoing.”
" When you establish a relationship with a primary care physician, you're establishing a relationship with a medical professional who is invested in your plan of care and your overall health. "
A healthcare plan can change over time because patients change. Their health status changes. Their access to care can change.
Over time, we can make adjustments to that plan. We're not only treating chronic illnesses like diabetes or high blood pressure. We're also looking ahead at the potential complications from those illnesses and what we can do to help prevent them.
The key is having an ongoing relationship where the patient and physician understand each other and can figure out the best plan forward.
Primary care doesn't happen in isolation. Dr. Johnson works alongside physicians and nurse practitioners as well as mental health providers, nutrition professionals, health coaches, nurses, medical assistants and referral specialists.
That means the next step can depend on what the patient actually needs.
A nutrition professional might help with dietary changes. A health coach might support exercise or sleep habits. Nurses and medical assistants can follow up when lab results raise additional questions.
When specialty care is needed, the referral team can help patients find appropriate options and navigate the transition.
And the relationship doesn't necessarily end when the referral is made.
“We get the notes back. We follow up with the patient,” Dr. Johnson explains.
The specialist's recommendations become another piece of the patient's larger care plan.
“It’s not only that we refer the patient out, but we also keep track of what’s going on with the patient.”
Dr. Johnson: A fragmented healthcare system is essentially poorly coordinated care between various medical providers, specialists and settings.
Think about all the different places a patient might receive care: an emergency room, hospital, urgent care, primary care clinic or specialist's office.
It becomes very difficult for one patient to go through that system smoothly when those pieces aren't coordinated.
For example, imagine a patient comes to primary care with chest pain and is referred to a cardiologist. During the workup, we also discover diabetes or a thyroid problem.
The cardiologist is focused on the heart. Who's taking care of everything else?
Without effective primary care, those other issues can go unaddressed.
That's how patients can end up moving back and forth through emergency rooms and hospitals with problems that haven't been managed consistently.
Someone needs to understand how the different pieces fit together.
Primary care can help identify the problem, coordinate with the appropriate provider and then bring that information back into the patient's overall plan.
Dr. Johnson sees that continuity as particularly important because a patient's needs rarely fit neatly within one specialty.
“We try to see how the actual bits and pieces of everything else fit into the healthcare plan.”
For Dr. Johnson, virtual care is about removing some of the friction that can prevent the relationship from developing in the first place.
During his years practicing in person, Dr. Johnson regularly heard the same reasons patients couldn't make it into the office: they couldn't get time off work, find coverage, arrange childcare or solve transportation issues.
Virtual care can remove some of those barriers. Appointments can happen around the patient's schedule, including around work, rather than requiring someone to give up half a day just to receive routine care.
For workers in industries like construction or oil fields, Dr. Johnson says that distinction can be especially important. Finding someone to cover a specialized role while an employee goes to the doctor isn't always simple.
“By the time everything's all said and done, half the day is gone,” he says of a traditional office visit. “That's just not feasible in the long term for a lot of people.”
Not necessarily. One of Dr. Johnson's patient stories illustrates why continuity and follow-up matter just as much as identifying an abnormal result.
Bryan was in his late 30s when he came to Dr. Johnson after going more than 20 years without seeing a physician. Testing revealed prediabetes, slightly elevated cholesterol and a high blood pressure reading.
It would have been easy to look at that blood pressure number and immediately treat it. Instead, Dr. Johnson wanted more information.
READ: 20 years without a Doctor | Bryan's Primary Care Journey
Dr. Johnson: I would disagree with them. Primary care is foundational to the health and healthcare plan we establish for a patient.
Our healthcare system is fragmented. We need a good primary care base to help patients get the care they need.
There's also the practical side for employers.
When employees can't easily access routine care, a doctor's appointment can mean arranging coverage, taking significant time away from work or delaying care altogether. Virtual-first primary care can reduce some of those barriers while helping employees establish an ongoing healthcare relationship.
Healthcare often happens one encounter at a time.
A lab result. A specialist visit. A prescription. An urgent care appointment.
Dr. Johnson's perspective asks a different question:
Who's making sure all of those moments add up to a plan?
Primary care can provide that continuity. It can catch a risk early and follow it over time. Connect a patient with another provider and make sure the handoff happens. Recognize when treatment is needed and, just as importantly, when it isn't.
And as the patient's health and circumstances change, the plan can change with them. That's what makes the relationship itself so important.
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