Remember when you were a kid and you had an imaginary friend? Like Bonnie, or Dave. Our parents twigged to it quickly and played along, offering Bonnie a snack or reminding Dave to buckle his seat belt. The trouble is when the chips were down there was a reckoning. Our imaginary friends hung us out to dry.
Turns out that as grown-ups, we still have imaginary friends. They are our primary care health providers, our “family doctors.” We cling to the myth that we have a provider that will be there for us, that we will be able to see when we need him or her, if not on the same day, then within two or three days at most. What are the chances?
A lot of effort is put into public health education, to advise us about when we should seek care and at what level. Which symptoms mean “wait and see.” Which should be addressed sooner rather than later. When to go to the ER as opposed to waiting for an office appointment. Broken leg? ER. Persistent cough and cold? Office. At what temperature does a fever demand more attention than an aspirin or two?
The internet is full of advice. Urgent care or walk-in clinics are an alternative when a primary provider can’t fit you in, but as one website says: “They don’t know you or your health history like your primary care does.” The reason to have a “family doctor” is to have someone who knows your medical past, whether you give an accurate medical history of a problem, whether you have a short fuse or a long one, medically speaking, and what medications you’re on.
A physician you’ve seen for years will sometimes be willing to guide you through initial treatment of a seemingly minor problem without a visit. Anyone else will want you to come in. In their defense, this is the responsible way to go about health care if you have no prior relationship with the provider.
The trouble starts when you try to reach your provider by phone. That’s rarely possible. One estimate is that a primary care practice must carry an annual census of over 2,000 patients to be financially viable. That does not leave much time for taking or returning phone calls. It’s hard to reach a live human at all. Often, it’s a voice message that promises to get back to you “by the end of the next business day.”
If you can connect, you discover that your provider doesn’t have anything available that day. Nor in the next few days. “She’s booking pretty far out…” How far is far out? Three weeks. “Would you like me to call around to the clinics and see if someone can see you?” Well, not really.
Any licensed provider should be able to render appropriate care, but we are not prepared for “any licensed provider.” We want to see “our” doctor, but he or she has become an imaginary friend. When we access health care we are still queried as to who our “regular” doctor is, even though we see little of them. An annual physical can still be scheduled with the provider of your choice if you call far enough ahead, but anything in between, not so much.
Patients loved their family doc, but the doctors themselves? They devoted mind, body and soul to their practices, available day and night, running back and forth between the office and the ER in the day and crawling out of bed to see a patient admitted to the hospital at night. They missed birthdays, anniversaries and graduations. Their marriages and children paid a price.
If the “family doctor” ideal was hard on providers, the “imaginary friend” provider is detrimental for the patients. Are these the only two options? One emerging model is the “concierge” plan where patients sign up with a physician for an annual fee and get to see that particular physician as needed. Insurance might still be needed for major illness, lab tests and diagnostic imaging; the jury is not in on the ultimate workability of this model.
Should we abandon the pretense of having a regular provider? We could enroll in a hospital-based system with one-stop shopping. Call a single number, relate the problem and a triage nurse would arrange for you to be seen at the appropriate level of care within a reasonable time. You might not know who you would see, but at least you would see someone.
Relying on an imaginary friend for health care does not work. Health care delivery has become extremely frustrating for patient and provider alike. It’s time for a new model that recaptures the human element and puts the “care” back in health care.
Jill Goldthwait worked for 25 years as a registered nurse at Mount Desert Island Hospital. She has served as a Bar Harbor town councilor and as an independent state senator from Hancock County.
Jill Goldthwait worked for 25 years as a registered nurse at Mount Desert Island Hospital. She has served as a Bar Harbor town councilor and as an independent state senator from Hancock County.
