Where Did My Doctor Go?
When I was a little girl, I was fortunate – what I have now come to understand as privileged – to have access to doctors of different kinds for whatever I needed. It was easy to get in to my primary physician, whether for an annual physical or when something came up, like a throat infection or a mystery allergic reaction. Maybe because my maternal grandfather was a pharmacist, I inherited a high level of trust and respect for medical practitioners of all types. This regard continued throughout my adult years; however, as life unfolded and I entered the world of software consulting, changing providers became routine due to frequent job transitions.
When selecting a set of new in-network providers, it became my habit to conduct an interview process. Taking charge of my health, I developed a habit of conversing with potential providers, ensuring they were comfortable with alternative treatments like acupuncture and chiropractic care (early on, those treatments were rarely covered by insurance). My self-advocacy and collaboration with doctors proved effective for most of my life, but over the last 10-20 years I began to notice that I did not always see the same provider each time I went to the doctor’s office, which thwarted the ongoing partnership that I wanted. In addition, it began to feel less and less like the doctor managed the practice; on more than one occasion I had the appointment scheduler try to tell me what my provider did and did not treat, typically giving me different information than was later shared by my physician.
More recently, it is often difficult to get an appointment with my provider when I am ill. In some cases, we can do a teleconference call, but most of the time a physical exam is needed for diagnosis and treatment – and, depending on staffing, it might be challenging to get in the same day. So instead, if I have acute symptoms, I am likely to opt for urgent care or, in more severe cases, the emergency room. There, I must count on the on-duty provider I see to listen to me and review any notes in whatever electronic medical record is accessible. Add to all this that I have seen more providers retiring, changing the type of practice they do, or having turnover for one reason or another. This means that I have lost the ongoing relationship with a regular provider. My success at self-advocacy depends on the goodwill/energy/focus of whoever I’m seeing at the moment.
With the gradual changes in the healthcare industry, it seems like a gargantuan issue to solve. The focus of the US healthcare industry has often revolved around diagnoses, treatments, and outcomes on a case-by-case basis. It is tempting to want to return to a time when healthcare operated more in a way that suited me. However, I know that’s not the answer; we need to be looking forward. As the system is increasingly embracing whole-person care, value-based care, and with more focus on consumer-centricity, I am encouraged to believe that we are on the march to addressing these issues. However, many in the system with a better personal solution may not realize the gaps being faced by many of us who are still trying to coordinate our own care. My hope is that as we embrace new technology and new business models, the type of relationship-based, accessible, and equitable coordinated care that most of us crave becomes a reality for all.