Wednesday, April 26, 2006

"Primary care physician" = "doctor/patient relationship"?

I don't think so.

We’re changing insurance companies again. Therefore, we’re all changing doctors again. Once again we will blindly pick a name off a page and hope that he speaks English without too much of an accent. This never used to bother me very much. I was a healthy adult with little need to actually see a doctor, so who cared if it was a different one every time? Five doctors in six years didn’t have much effect on my life.

But my life is different now. Now I have Jonathan, and potential pregnancies, and hopefully more children. Now I want a real “primary care physician”. Someone who can keep all the records on all the members of my family in one place. Someone who in ten years will recognize me when I bring my fourth child for her shots or because of an ear infection. Someone with whom I can have a relationship.

Every health-care article I read talks about how important the “doctor-patient relationship” is. Doesn’t that sound like a nice idea? Only I’m not sure that in today’s world, it will ever really happen.

This new insurance provider will be my fifth since I started college. Every job change has meant an insurance change. Sky-high insurance costs often force employers into an insurance change. And every insurance change has meant a doctor change. In a system like this, there is no chance to build a relationship.

And it isn’t only the fault of insurance. The longest “relationship” I’ve ever had with a doctor (in fact, the only time in my adult life that I’ve seen a doctor more than once) was with Dr. O. during my pregnancy. Something like 15 visits over nine months. I was happy with him, comfortable with him, trusted him with the delivery of my child. Only when it actually came down to it, someone else delivered my child, and the hospital wouldn’t even call him.

Before Jonathan was born, I interviewed a lot of pediatricians. I found one I liked and set everything up so that he would automatically be Munchkin’s pediatrician from birth. Only he was on vacation when Jonathan was born, so we were assigned another pediatrician. She was nice enough, but I had no idea who she was or what her theories were or if she would do a good job with Jonathan’s circumcision (she didn’t.)

Jonathan is one year old now, and the new doctor under the new insurance next month will be his fifth doctor. How can good healthcare happen under these circumstances? If a given doctor sees me or my child only once or twice before passing our files off to someone else, what are the chances of actually catching something abnormal before it becomes a real problem? I doubt they are very good.

It is a frustrating situation, and it seems doubtful that it will get fixed any time soon. Universal healthcare doesn’t seem to be the answer from its track record in Europe and Canada. HMOs seem to force doctors into doing things in ways they may not like, but most of us can’t afford to be in a PPO program. And no matter the program, the doctors are seeing too many patients in too little time and with too little background information…because after all, any given patient might be me or my son with our history of bouncing from doctor to doctor to doctor.

I heard recently of a pediatrician who still does house calls. I wonder if he’s taking new patients? I wonder if Gabe would mind moving?


Elena said...

Tell me about it. We've finally found a pediatrician we really love... and we're finally on insurance that he takes! Mahesh Vyas in Yorba Linda. Small practice, he takes a lot of time with each patient, gives thoughtful answers to all your questions... And though he does have an accent, its the sort of accent that makes someone more interesting to listen to, not the sort that makes him hard to understand.

But all that's probably moot, since it's all up to the HMO. =( Boo.

Jess said...

you know, you might try Dr. A. even if he doesn't share all your health-care philosophies, because he IS good at the patient-doctor relationship part.