Quick access to primary care reduces suffering. Make sure your doctor’s office provides it. | Expert Opinion
Access to primary care is challenging these days, and it is worth the effort to find a practice that can be your health-care home base.
A good friend shared a story with me that highlights the fallout of poor access to primary care on short notice. Generally healthy and in her mid-50s, she developed severe, sharp lower back pain shooting into her right leg.
When she called her primary care office, she received an all-too-common reply: No appointments were available that day. So she went to an urgent care clinic for blood work and x-rays, and she was prescribed oral steroids and anti-inflammatories.
But her pain intensified over the next 24 hours. She called her primary care office again, and this time was instructed to go to the emergency room. After eight hours, and another set of blood tests and x-rays, she was still suffering, with only minimal improvement.
» READ MORE: How a primary care physician can help you navigate the health-care system.
The following day, she made herself an appointment at an orthopedics practice. There, she was diagnosed with sciatica, given a muscle relaxant and a small supply of opioid painkillers to use sparingly. The orthopedic specialists also offered her a follow-up appointment to assess her progress and provided a contact number for questions. Finally, one week later, she began to improve, with her pain lessening.
All told, she endured three fragmented visits for medical care, hours of wait time, excessive testing, and days of suffering with pain and worry. A same- or next-day appointment with her primary care doctor, followed by a quick check-in by phone or messaging in an online patient portal, would most likely have achieved the same outcome without the hefty emotional and financial price tag.
Access to primary care is challenging these days, and it is worth the effort to find a practice that can be your health-care home base. Your primary care practice can provide preventive care, help manage your chronic health conditions, coordinate referrals to specialists (medical or surgical), and recommend resources like social services, nutrition counseling, and mental health care.
The ER is always the best place to go if you are experiencing certain acute symptoms, like chest pain, shortness of breath, sudden weakness or slurred speech. But when other urgent, non-life threatening problems arise, the primary care office should be your first touchpoint for three important reasons:
It helps to be seen and evaluated where you are known. The essence of primary care is continuity. It is where you are cared for when ill or just trying to stay well. Primary care teams get to know patients over time — your medical history, communication style, care preferences, and fears stemming from past trauma. All of this is invaluable when evaluating new symptoms.
Your primary care office has access to your medical records. Your medical record keeps track of previous illnesses, test results, chronic conditions, current medications, and preventive care. It is a vital resource that helps your doctor know what you have been through, and where you may be vulnerable to help ensure accurate diagnosis and safe treatment.
You should have the opportunity to follow up if things change or are not improving as expected. A visit to urgent care or the ER is often an isolated encounter. The assessment may involve more testing than you typically receive at your primary care office, since this is the one chance the clinician there has to evaluate you. Unlike in primary care, they do not typically offer you a follow-up visit to see how you are doing, since they are busy handling serious and life-threatening conditions. So if you go back to an urgent care clinic or ER, your evaluation will often begin from scratch, as if you were not previously evaluated. This is disconnected, inefficient, and expensive.
We can do better in primary care to improve access on short notice. At my practice, every clinician keeps some appointment slots blocked for same-day care only. Other offices may offer walk-in visits without an appointment, designate a certain clinician as the “provider of the day” for urgent needs, or offer on-demand virtual care. Even when you can’t see your own physician, the provider you see will have access to your medical record, current prescriptions, and other information that will help them give you the best care.
There is no “one size fits all” approach to getting into a primary care provider on short notice — just be aware of which option your practice offers, and that you are comfortable with it.
Urgent care clinics and emergency rooms provide excellent care, especially when your needs are appropriate for them. For most non-emergent problems, though, primary care is your best first stop. If you have trouble accessing primary care on short notice, give that feedback to the practice. Fewer doctors are working in primary care, which requires creative solutions — and your ideas matter.
Jeffrey Millstein is an internist and regional medical director for Penn Primary and Specialty Care.