Last week was my long-awaited follow-up appointment with my primary care physician (PCP). I walked out of the appointment, filled with gratitude for my doctor and the trusting relationship we are developing after only our second visit.
I consider myself one of the lucky ones to have a primary care physician. Lucky when my last primary care physician left Providence Westside Family Practice, I asked to be referred to a physician and got one. Lucky plus a dose of intentional self-advocacy.
She is my 4th PCP in my 12 years living in Olympia. I must wait longer than I wish for appointments, but she is worth it. I can email her (on MyChart) if I need a refill or an issue to discuss. Her lack of in-person availability is a sign that she is over-assigned patients, not by her choice I can assure you. This is disadvantageous for patients and physicians. Herein lies one major source of PCP burnout: overwhelm. Under this pressure, PCPs do not have the time to care for their patients the way they know to be safe and thorough.
In the days of private practice, I saved 2 slots in the schedule for urgent needs. If those slots were full and it was important to see the patient, I would stay late and do so. This avoided a trip to the Emergency Department or urgent care where patients saw someone they didn’t know and who didn’t know them. That was when doctors controlled the size of their practice and their schedules. When follow-up appointments were too far out, it was time to stop taking new patients for a while. That is not how things are done now.
If you can’t see your doctor, at least be seen by a fill-in professional at their facility. This is important for continuity. If I need an urgent appointment, I go to the Providence Westside Family Practice Clinic or Urgent Care, where my doctor will see the chart notes and tests from the visit.
Follow-up appointment availability is important for other reasons. It allows for quick check-ins. These check-ins help catch problems early, thus avoiding crises, potential hospitalization, and worse. These appointments are efficient and economical. But don’t count on getting them as often as is optimal in 2024.
Continuity and follow-ups are not only important for the patient’s ease and comfort, but they also lead to better and more efficient care. Know your doctor and your doctor knows you: your preferences and values, style and personality (stoic, dramatic, under or overstated for instance). When you have developed a trusting relationship over time, you do not have to start over at every visit. “How are you doing since your husband died? Or how are things with your daughter away at college?” not only shows care but may have important health-related consequences your doctor wants to hear about. Referrals and tests can be ordered specifically tailored to you. It is expensive and time-consuming to over-refer and test.
Back to my recent appointment.
First, there was a billing and insurance-related ‘bullet’ to dodge. I was booked into an annual visit with no co-pay. When I told the front desk clerk that I expected this to be a follow-up visit she deferred me to the medical assistant (MA) and doctor to decide. It was clear to the MA when she heard my agenda that this was not a routine annual checkup. The clerk was able to change the appointment type to a follow-up.
Is this kind of clerical glitch navigable for most patients? Not likely. This would be both confusing and off-putting. Navigating this nuance requires a rudimentary understanding of medical billing codes and how they are reimbursed. Self-advocacy for the right appointment would not be obvious to most.
My second interaction was with the medical assistant (MA). She called my name and introduced herself to me as my doctor’s MA. This small, reassuring, and personal act meant a lot and I thanked her immediately for doing so, to her surprise. She said it is important to make her patients feel comfortable when seeing the doctor, which can be stressful.
Such an introduction, sadly, is not reliably occurring. I’ve had many a medical assistant usher me to a room as if I was her next number and had to ask both her/his name and title to know who was talking at me. A simple act of kindness and introduction goes a long way in little to no extra time to build comfort, trust, ease, and a feeling of being cared for. Are administrators and instructors myopically looking at the bottom line and skimping on training?
I went prepared with a list of concerns. See my prior column May 2, 2023, for guidance on how to do this with a worksheet you can download.
The doctor came in and we immediately ‘negotiated’ who would start. She said, “Go ahead” as she could tell I had a list. It was immediately obvious she had read my chart before walking into the exam room. Yippee! That, too, has not been typical in my experience. This was confidence and trust-building.
That is after she introduced her AI chart note assistant to me, sitting on the counter, the size of a cell phone! Knowing how burdensome charting chores have become with electronic medical record systems, I was delighted to see it. She shared that it does not perform perfectly in that she still needs to edit her notes, but it has been a big help. Clerical burdens are a major cause of burnout for primary care physicians and professionals. Kudos to Providence for providing this tool to relieve some administrative burden hopefully avoiding another PCP's premature retirement.
I wanted to fill her in on my medical care and issues since we first met. She could ‘see’ all my visits at UW Medical Center in the electronic record. Not only was she grateful for the details, but she affirmed my perception that the specialty care I was seeking in Seattle has not been responsive in our community. She shared with me that she is now referring patients to Seattle for some specialty care. This affirmation felt reassuring and supportive. It is no small feat to travel to Seattle and navigate the ‘I-5 nightmare,’ but I need expert guidance and treatment for conditions that were not being addressed locally.
Sadly, not everyone in our community who needs care can access it at such a distance. Specialty care in Thurston County has had its share of corporatization with its profit-driven motives and physicians ‘losing their way’. Some Olympia area specialty groups need to do better for the community. Many are good doctors working in bad systems. Specialty clinic staff and doctors, email me about the challenges and I’ll write about them.
My next issue was a request to change a medication dose based on the geriatric research I’d done. My doctor had the humility to say she was not aware of that but based on my reasons for the change, agreed to guide me in doing this gradually. She was neither offended nor defensive. I was impressed and grateful. She suggested a follow-up blood test in two months. I asked for a visit after that test, to which she agreed, though it took an act of scheduling magic to accomplish. In this third office visit, we will be able to check in on the labs related to the dosage change and I can update her on the specialty care I will have received. We will continue to build a relationship and continuity, benefiting both of us and the bottom line.
My final step was to take care of the visit’s co-pay with the hopes of dodging a (typically confusing) bill later. If I find medical bills and insurance EOBs confusing, what about the rest of us?
At a time when the state of primary care is under attack from attrition, retirements, newly trained professionals choosing other career paths, and many more, I hope that my story illustrates why these first-line physicians (as well as primary care nurse practitioners and physician assistants) are so important. This crisis is finally gaining the attention of leaders in medicine, education, government, and healthcare systems. The demise of primary care is expensive, inefficient, and eroding the quality of health and healthcare.
It is with your primary care physician/professional that your health care, comfort, trust, reliability, relationship, faith, and prevention begin and end.
With our current shortage, getting a PCP if you lose yours poses a serious challenge. Still, make the effort. Wait for the appointment. See my column on choosing a PCP (4/18/23 column link).
I hope that by sharing my story of the gratitude and peace of mind that accompanies knowing you are being cared for by a physician who has your back is motivating and hopeful.
Debra L. Glasser, M.D., is a retired internal medicine physician in Olympia. Got a question for her? Write drdebra@theJOLTnews.com
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KellyOReilly
Dr. Debra, thank you for another article on navigating the "healthcare" system. Finding a PCP who accepts new patients was so difficult that I settled for an appointment with a NP just to get my foot in the door. My first appointment is in mid October which was the first available when I called at the end of May. Just finding a practice that would answer the phone was not easy. Apparently, some are transitioning to text messages these days and that will put off seniors who won't text message. Good grief! I'll tell you, I felt like I hit the lottery just to get an appointment to see someone. I was told the first appointment would be a "meet and greet" but I'll take what I can get and go from there. Thanks for the tip about billing--I'll keep my eyes wide open on that score. I'm sharing this so folks know how very difficult it is to get healthcare of any kind, even for those of us blessed to have insurance in addition to medicare.
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