I had to go to my PCP (primary care physician) a few weeks ago to get a medication renewed and this issue came to mind again. It bugs me so I want to spit-ball my dream solution.
Problem
When you go to the doctor for routine care/checkups, it’s a logistical pain in the ass. I’ll use my appointment as an example:
- I had to make an appt for the PCP. So I take a few hours off work to go to that. She wants me to have some bloodwork drawn to make sure the medication isn’t destroying my kidneys. She also reminds me it’s time for my pelvic/pap exam, mammogram, and colonoscopy.
- I can get the bloodwork done on a walk-in basis, but have to go to the neighborhood Labcorp. Not a problem except for finding the additional time to do that.
- I have to make an appt with her office again, or with a gynegologist for the pelvic.
- I have to make an appt with the radiology company for the mammogram.
- I have to make an appt with a gastroenterologist for the colonoscopy. After helping my husband with the logistics of his, I know that will actually be TWO appointments. They want to see me for a medical history first, and then schedule the procedure.
So that’s a lot of time off work doing all that crap, and it’s not like I don’t have a lot going on. I’m not saying I don’t care about my health. I just think it should be easier. Everything is set up for the benefit of the practitioner, instead of the patient. So after we figure out the insurance problems/national health care issue, we should then redesign the practice/logistics part of medicine to be more patient-focused. Here is what I’d like to see:
You make ONE appointment with your PCP. The doctor does whatever examination he needs to and then you immediately do the other things he wants you to do. Bloodwork? Phlebotomist walks into your exam room and gets the job done. Gynecology? Simply disrobe, doctor comes back and gets the job done. Mammogram or any other xrays? Walk one door over to the radiologist, wait no more than 5 minutes and get that done. Colonoscopy? Walk one more door over to the outpatient surgery, and again wait no more than 5 minutes. You don’t have to see the gastro first, because your PCP has already forwarded your history to him. Also, since your PCP knew you were due for a colonoscopy, he sent you the prep kit in advance. Viola! You’ve just gotten a LOT of work done in around 4 hours. See you next year!
Sure… that works fine until the phlebotomist discovers you’re a “hard stick”, the gyn exam turns up something that needs to be looked at harder, the mammogram turns up a suspicious spot - biopsy on site or asked for second opinion? - and your other x-ray was delayed due to the arrival of an emergency case.
I get that it’s all a pain in the ass, but you can go only so far with efficient scheduling in medicine. I agree it could be better, but I doubt it will be as perfect and seamless as you portray here.
You’re essentially asking for just in time scheduling, where not only do radiologists have the capacity to see everyone who needs a mammogram but also there are enough spare radiologists standing by to ensure people whose doctors just decided they need one can get one within five minutes. I can imagine such a system existing. I can also imagine it costing five times as much as the current system.
Its annoying, but this strikes me as pretty low down on the list of things that are horribly wrong with the United States health care system. And in the primary care physician world, it strikes me that its a part of the system where market forces can actually lead to better outcomes: your primary care physician and their web of referrals sounds like a mess. My doctor’s office has a small room where a representative from the laboratory company has a presence. So I got all that done as part of my physical appointment. Maybe you just need a better PCP.
I definitely need a better PCP. I was muttering about this to myself the other day, and also thinking about my reumatologist and remembered that my reumy has an in-office phlebotomist and also Xray/radiologist. So he’s set up for one-stop-shopping, if you will. I need to find a PCP who works similarly.
Granted that if they do find something wrong in any of the routine diagnostics, then you’re by necessity off to appointment hell with specialists for more in depth work.
I also have this dream that they should combine various treatments to calm the patient with their diagnostics that stress you out. Like how chiropractors often have on site massage therapists. Wouldn’t it be nice to get a foot massage while you’re in the dentists chair? Or have a shoulder massage while you’re seeing the podiatrist? Hell, just getting a massage while you’re in the waiting room, if the doctor’s running late. That would make me a more patient… patient!