Primary, Secondary, Tertiary, and Quaternary Care

A doctor at one level of medical care.
A doctor in one level of medical care. Joe Raedle/Getty Images

Medical professionals talk about levels of care as related to complex cases treated and the skills of the providers. Levels of care include primary, secondary, tertiary and quaternary care. Since we patients sometimes hear these words, their definitions can help us better understand exactly what those professionals are referring to.

What is Primary Care?

Most of us are very familiar with primary care.

That is our first - and most generalized - stop for symptoms that are new to us or concerns that we've contracted a cold, flu or other bacterial or viral disease. We may also seek out primary care for a broken bone, a sore muscle, a skin rash or any other acute medical problem we think we've developed. In addition, primary care should be our coordinating care, although that doesn't always happen the way it should.

Primary care providers (PCPs) may be doctors, nurse practitioners or physician assistants.

There are some primary care "specialties" like OB-GYNs, geriatricians and pediatricians, too. Learn more about primary care, its focus and who provides primary care services.

What is Secondary Care?

If you have ever seen a specialist after being referred by a primary care provider, then you have been referred for secondary care. Secondary care simply means you will be taken care of by someone who has more specific expertise in whatever problem you are having.

Specialists focus either on a specific body system or on a specific disease or condition. For example, cardiologists focus on the heart and its pumping system. Endocrinologists focus on our hormone systems and some specialize in diseases like diabetes or thyroid disease. Oncologists work on cancers.

Secondary care is where most of us end up when we have a medical condition to deal with that can't be handled by primary care. Sometimes, problems with specialty care develop because we have been referred to the wrong kind of specialist. We can also experience problems when we are seeing more than one specialist, each treating a different condition, and our care is not being fully coordinated. The specialists need to work with your primary care health team.

What is Tertiary Care?

Once a patient is hospitalized and needs a higher level of specialty care within the hospital, he or she may be referred to tertiary care. Tertiary care requires highly specialized equipment and expertise such as coronary artery bypass surgery, renal or hemodialysis, some plastic surgeries or neurosurgeries, severe burn treatments or any other very complex treatments or procedures. A small local hospital may not be able to provide these services and you may need to be transferred to a medical center that provides these highly specialized tertiary level services.

What is Quaternary Care?

Quaternary care is considered to be an extension of tertiary care - even more specialized and highly unusual. Because it is so specialized, not every hospital or medical center even offers quaternary care.

The types of care that might be considered to be quaternary would be experimental medicine and procedures, and highly uncommon, specialized surgeries.

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