We’re the overseers of our healthcare

As my cough was going into its third week, it was time to tell my doctor. A nurse replied to my MyChart message. I could try Flonase. If I didn’t get better, I should go to an urgent care center.

I was surprised and, frankly, piqued. My doctor didn’t have time for me? 

She wasn’t singling me out for neglect, I’ve learned. Healthcare delivery changed when I wasn’t noticing. It had been a long time since I’d needed immediate medical care. I see my doctor every six months, scheduling the next appointment before leaving the office.

You may have already found that it can take weeks or longer to get an appointment with your doctor. There is a shortage of primary care physicians — internists, family medicine MDs, and pediatricians. Many PCPs retired during COVID or left the profession because of burnout. Medical schools don’t enroll as many primary care trainees as needed. Students are choosing more lucrative, prestigious specialties. 

Primary care physicians don’t typically leave time slots open so that sick patients can be squeezed in. Their main role nowadays is to monitor and treat ongoing health issues. Problems that are not life-threatening but need quick treatment — for instance, an infection, an allergic reaction, a sprain, a cut, a rash — are referred to urgent care centers. Their trade association reports that the number of such centers is growing seven percent each year because of the PCP shortage.

The PR spin says that urgent care has benefits. A patient can be seen promptly without an appointment at a location that’s likely close to home. Urgent care holds down costs. Equipment is less specialized and less expensive. The majority of providers are nurse practitioners and physician assistants who are paid less than MDs. (But while urgent care is cheaper for providers, it can be more costly for patients. My insurance charged a $65 copay for a visit to Physicians Immediate Care. A PCP appointment costs me $0.) 

I was diagnosed with acute bronchitis and prescribed three medicines that seem to be working, so I’ll not criticize the urgent care center. But I don’t prefer the current system to being able to see a familiar, trusted doctor. It doesn’t sync with how medical associations describe primary care physicians — as “the first point of contact” and “provider of diagnosis and treatment of both acute and chronic conditions.” Your PCP is supposed to know your complete health picture and, if you need to be referred out, coordinate communication with all your providers. I may tell my doctor about my urgent care treatment, but I don’t know whether it will be noted in my records. 

Another episode reinforced the perception of how uncoordinated healthcare delivery is today. The osteopath to whom my PCP referred me for an arthritic right knee thought that mild arthritis, which an x-ray showed, did not explain the degree of my pain and stiffness. She sent me to a physical therapist, who asked what changed around the time the knee problems intensified. Not until several weeks into PT did I think of an answer: I’d started to take rosuvastatin to lower my cholesterol. Research confirmed that statins can cause muscle, joint, and tendon pain. My doctor took me off rosuvastatin as a test when I told her via MyChart that I suspected it harmed my knee, which has since improved.

“You had to figure it out?,” an incredulous friend asked. “Isn’t that what doctors are for?”

I should have read about the possible side effects of rosuvastatin. Maybe the osteopath should have checked my medication list. Maybe my PCP should have asked me to let her know how I was doing on rosuvastatin. I’m still wondering when my knee trouble would have been diagnosed if I hadn’t made the statin connection.

Both episodes have diminished my faith in our healthcare system. I don’t doubt providers’ competence, but they are pressed for time and overburdened. Who is overseeing my healthcare? It has to be me.

At my next regular appointment with my PCP in July, I’m prepared to argue for a cholesterol-lowering alternative to another statin. Research has shown bergamot tablets to be effective. I like my doctor and respect her opinion, but it’s ultimately up to me.