So, early this morning at the Volunteer Rescue Squad, after only one early-morning interruption, I had an interesting discussion with my upcoming-shift Crew Chief (CC) who works full time in the same Emergency Room (ER) that we take our patients. And spawned the though for this post.
The discussion went something like this: CC has a young child. CC is very familiar with how ER works, it’s her job. CC or child has a cold/not feeling well. CC calls her Primary Care Physician (PCP) or Pediatrician as appropriate. Staff answering PCP’s phone offers an appointment weeks to months from current date. As an alternative, PCP’s phone staff recommends going to the ER. CC politely tells staff that she will be bringing her child and her illness to the office post-haste, find an appointment or she will discuss this with the ER medical board for abuse of ER resources.
I’ve had the same problem, so has my wife, and I’m sure that a butt-load (something less than a metric shit-ton) have had the same thing happen – PCP has no time today, this week, and probably next, go to the ER.
Which then overloads the ER with BS cases that should have been handled by the PCP IF THE PCP WASN’T ALREADY OVERBOOKED. Why is the PCP overbooked? Not their choice. Most Docs and NPs want to spend time with their patient, not pumping info into a computer. And same Docs/NPs are forced by their medical group/Medicare/Medicaid to see as many patients as possible. And Doc/NP has to comply, as the “negotiated rates” are so stinking low, that the Doc/NP must replace quality of visit with quantity of visit to make ends meet, and to meet organizational metrics (boo, hiss, metrics).
The one medical person most intimately familiar with you is now unable to take the time to treat their patient when they most need the care. And if you aren’t persistent with PCP’s office staff, you’re off to the ER, or if you’re lucky, an intermediary-level “Doc-in-a-Box” like what Walmart and others are doing. Urgent Care or some-such. The folks who know diddly-squat about your history other than what they glimpse in their (hopefully available) electronic medical records.
Is this planned, or an unintended consequence of our medical insurance and government health care system? Is there a fix short of overturning the apple cart? I do read occasionally, like on Maggie’s Farm of Docs who operate on a no-insurance basis. Cash or credit, no insurance. And another story about “Uber for Doctors“, where the doc can to a phone consult at any time, or if necessary, do a house call. All for a fixed fee, no insurance involved. Tie this into a catastrophic insurance policy instead of the “Health Insurance” that we are forced to buy into, and you have a workable alternative. If you don’t want to pay cash, you are stuck with an insurance plan to defray costs, which might be better for those more prone to illness/disease/injury. But for those who rarely see a doc, don’t want to see a doc, don’t want to call an ambulance, tie up critical ER resources or join the rest of the neighborhood at the Urgent Care facility, it’s a reasonable alternative. I like and would use if our little tail-end-of-nowhere offered such.
A little back-story: My grandfather was a well-known and trusted General Physician in the large city where he was born and lived. He kept office hours, did in-home visits, did general surgery, accepted payment in cash, chickens, bread, car service, etc. Saved my life when I was diagnosed shortly after birth with Pyloric Stenosis. Didn’t have electronic medical records, paper only, which my Mom helped file, visited his patients at the city’s Very Famous Medical College pre- and post-op. But didn’t spend all day shuffling from exam room to exam room seeing a mess of patients, to the point that he could not take care of the ill or injured patients who he knew needed his care.