I have been living in the Maryland suburbs of the DC metro area for 3 whole years now under my own insurance plan without a primary care physician. In college, I did my best to schedule doctors’ appointments over breaks and holidays when I would be home in Pittsburgh. This was especially necessary because it’s very difficult to see an out of area doctor on University of Pittsburgh Medical Center Insurance, which I and the majority of Pittsburgh residents had at the time.
When I was diagnosed with Crohn’s Disease in the beginning of 2008, my gastroenterologist told me I would need to start seeing a doctor near school to manage my disease. I worked with my insurance company to ensure I could see an out of area provider. They may have even picked the doctor. When I returned to school to start my new semester, I met with my new gastroenterologist. He was an older man and more than a bit out of touch. He lectured me on the effects of stress and how it can exacerbate the symptoms of Crohn’s Disease. “Do you have anything causing stress in your life right now?” he asked. “Um, it’s the first week of classes and I just broke up with my boyfriend,” He continued his lecture, telling me it was important to eliminate all stress from my life. So naturally then I should drop out of school and never date again. Come to think of it, work and families create stress too. Perhaps I should just sit in an empty room by myself all day. Needless to say, I was not a fan of Dr. DC Gastroenterology from the start.
Despite my disdain for my new doctor, I continued to see him. I was a busy college student with out of area insurance. I had classes, extracurriculars, and parties to worry about. Switching doctors is stressful too! I was able to get appointments when I needed them, and get the medicine I needed to manage my disease… until I didn’t.
By the time I graduated in December 2008, my symptoms had worsened to a point where a drastic medical intervention was necessary. I set up meetings with my doctor, only to be seen by a new fellow or physician’s assistant unfamiliar with my case for 15 minutes, occasionally followed by 5 minutes with my doctor himself. The doctor never seemed to remember the details of my case that while either, and seemed less and less “with it.” (Did I mention he was probably in his seventies?) I was scheduled to start my first job in February and decided that it would be a good time to find a new gastroenterologist once I started my new insurance plan. Meanwhile, the current doctor’s office prescribed me a low dose of steroids, prednisone, to help my symptoms. It wasn’t enough and they quickly bumped my dosage up. It still wasn’t enough. My dad came down to help take care of me and we visited the doctor’s office. They bumped my steroids up again. (Did I mention they have horrible side effects, all of which I was experiencing) They said if I didn’t respond, I would need to be hospitalized and that I would most likely need surgery to remove part of my colon.
Needless to say, my dad and I were pretty scared. We had already been researching other doctors in the area (bless my parents for trusting me when I said I didn’t like the one I had) and following this terrible appointment we walked down the block to a different practice that we had been eyeing. My dad was on hold with the insurance company requesting authorization to get a second opinion. He looked at the receptionist with fear in his eyes and asked if there were any gastroenterologists that could see me. The sooner the better.
I was seen two days later. Unfortunately I got sicker before I got better, and I did need to be hospitalized and ended up moving back home to Pittsburghto recover. But I did make it back to the DC area, and it helped knowing that a good concerned and cooperative specialist was there ready to help me manage my disease. He had even called to check up on me while I was gone and spoke with my gastroenterologist in Pittsburgh to stay up to date on my treatment.
When I moved back to the area three years ago I enrolled in an HMO insurance plan that didn’t require referrals to see specialists. Aside from my gastroenterologist’s practice, I have been to four other specialists to deal with things like asthma and high blood pressure. I visited the emergency room once for a high fever at night on the weekend that appeared to go up instead of down with Tylenol (I was being extra cautious since I take immunosuppressant medication) and I made one trip to urgent care for a strep test. Lately, coordinating my care between all of the specialists has been a real chore. I photocopy pages of lab results before visiting doctors, I consult multiple doctors before starting new medications, and I have a lot of questions. Most of my doctors are willing to answer them to the best of their ability, but by now, we all agree: I need a PCP to help me with this.
I wish this was the solution to my problem. Instead, it is yet another stressor in my life. Most PCPs in this area are NOT accepting new patients. In fact, when you hear of one that is, you almost have to wonder what’s wrong with them. I’m not looking for someone to give me a strep test; (although I may need him or her to do that for me at some point) I need a partner in managing my health. I deserve a doctor’s office where the staff is efficient in courteous in scheduling appointments whether in advance or on the same day if I am ill, who accepts my health insurance plan, and doesn’t play games when billing. I deserve a doctor who is knowledgeable, listens and addresses my concerns in a pleasant if not supportive manner. I deserve a doctor who is part of an on-call network should I be ill after 5pm or over the weekend. I deserve a doctor who will visit me at the hospital of my choice should I be admitted.
It seems like I’m asking for a lot. And I know not every doctor can do everything well, they are human. But it shouldn’t be treated the same way as a self-declared princess holding out for a tall dark and handsome doctor or a lawyer making $200K+/year who is funny, charming, good with kids, and has the same religious/political/ideological beliefs as she does. After all, I’m not asking for exclusivity here! But my health is too important to settle for a frog.