Primarily careless

occupations_doctorI should Probably thank Rachel for the inspiration for this post (Lord knows I’ve been short on it lately, exhibited by my sparse blogging as of late). And, depending on the response I get from you folks, perhaps I should thank her for inspiring me to do something that will be good for my health long-term.

But anyway. here’s the confession: I don’t have a so-called “primary care” doctor.

In fact, I’ve only had one PCP in my entire life. He was young and naive when I started seeing him. I was one of his first-ever patients, and my propensity to pee without discretion (as babies often do) was a quick lesson to him in why he should leave the expensive silk ties at home. He was a smart guy though, which is evidenced by the fact that, six or seven years later, he postulated diabetes when – even today – many pediatricians would dismiss the symptoms as “nothing to worry about”. But Dr. Goldman was a pediatrician, and by the time I reached college age, that waiting room filled with wooden blocks and colored beads on a twisty wire just didn’t appeal to me anymore. So I told my mom that I didn’t want to go back. She understood.

In college, they had the Health Center. I’m not quite sure what they did there, but it sufficed for my medical needs while I was on campus. During semester breaks, I figured I could see my father’s doctor if the need arose. It never did.

Of course, I still had my regular endocrinologist (I had also graduated from a pediatric one to an adult one) to take care of my diabetes.

When I got my first job and had to sign up for a health plan, I was in for a bit of a shock. I’d always been under my father’s plan and didn’t worry about it, but now I had to select from a bunch of plans, all with varying premiums, payments, and rules. Somehow I ended up on an HMO and needed to designate a primary-care doctor. Somewhat arbitrarily, I again chose my  father’s PCP but had never seen him. It’s a good thing too, I suppose, because a few years later he was arrested for doing certain inappropriate things to certain patients that no one should ever do to anyone – and I’ll leave it at that.

That job — and that insurance plan — didn’t last long. I’ve never been on a plan that requires PCPs or referrals since then. And I’ve never had someone, other than an endocrinologist who tended to a very specific, focused need, since,

Sure, I’ve seen doctors. Sometimes they were at the “instant care” clinics where you don’t need an appointment or a prior relationship with the doctor (these are not Urgent-Care centers, they are more like a medical McDonald’s, where you come in, wait in line, and eventually get some mediocre service from a doctor who can’t seem to rely on repeat business).

Once, when I was particularly ambitious about resuming a healthy lifestyle, I made an appointment with a real so-called “family doctor”, just to have him examine me (beyond my pancreas) and make sure I was OK – and to hopefully build a relationship for future needs, but he repeatedly questioned why I was even there. Another time I made an appointment with a local practice because of a killer ear infection — all I remember is that the doctor’s first name was Brandon, he used the term “like” a lot, and I’m pretty sure he was born during Beverly Hills 90210’s heyday. Being in my late 30s, putting my well-being in the hands of Dr. Doogie just didn’t sit too well with me. I got my antibiotic, but I haven’t been there since.

Still, every time I see a specialist (whether diabetes-related, like an ophthalmologist; or non-D related, like a dermatologist) there’s a line on the form asking who my “primary doctor” is. Either I put my endo’s name there or I leave it blank. It always leaves me feeling a bit guilty — like I’m neglecting a part of my health.

When one has Type 1 diabetes, it most certainly is responsible for 99% of the ailments that person faces, but every so often, “real-people-sickness” rears its ugly head. Then what?

I’m happy with my endocrinologist. I’m happy being part of the ninety-nine percent. But should I have someone to handle the other one percent?

Should I get annual (or semi-annual, or once-a-decade, or whatever) physicals? I’m pretty sure my blood-work will all come out fine, but that I’ll only last two or three minutes on a treadmill. So what?

What would you do? What DO you do? What should I do?

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Posted on August 27, 2013, in Personal. Bookmark the permalink. 10 Comments.

  1. In Australia I annoyingly have to get a repeat referral from a GP every 12 months to see my endocrinologist who sees me every 3-4 months and tends to remember who I am…so bureaucracy and living in a small town kind of forced me to establish a regular relationship with a doctor. I tend to have a posse of people who help with my health though – an acupuncturist, Chinese Medicine herbalist, osteopath. My GP gets that holistic is my approach and tends to support that. It means when I need something from him like my driver’s license medical form signed like last week, he understands where I’m at and can ask the right questions, but then he also does not have waste time with the inane, repetitive stuff that I’d have to endure if I was seeing someone new and had to explain my story.

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  2. Scott, I’m right there with you. I have a primary doctor, but I hardly ever see her. We started off great, but she wanted to see me every three months, just like my endo. Why, I wondered, other than to bill me? So I had to be honest with her: I told her I couldn’t justify coming every three months. To her credit, she said she understood, but still wanted me to get a physical every year. I cancelled my last appointment for a physical.

    It’s true, we need an “I’m sick” doctor sometimes. I probably need to go see her a little more often than I do, or at least more often than when I need an antibiotic.

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  3. Wow. I have to say, I never thought a blog about getting away from a bad-for-me PCP would be a conversation starter.

    I feel like there is value in having a family doctor, because even though I have a team of people who I see regularly, my PCP is looking out for other things (or at least this one is) and since he also see my husband, I think he actually can give us better care because he knows what we deal with for the other person.

    “Medical McDonalds” is a great term by the way!

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  4. I don’t have an endo, but my pcp is an internal medicine specialist. So I see him every 3-4 months and he reviews/adjusts my diabetes stuff along with exams for regular-people-sick stuff. One stop shopping!

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  5. Hmmm…funnny thing.

    I have a primary care doctor and see him once or twice a year, but I have never seen an endo. Even after 29 years with Type 1.

    Similar situation…diagnosed at age 14 by the family’s doctor in a small northern Wisconsin town. Doubt there was such a thing an a kid endo anywhere within 200 miltes.

    Went to college and didn’t see another doctor for seven years when I finally got a job with insurance. I found a doctor who is great and understands diabetes. Helped with the switch from regular/NPH to Humalog/Lantus years ago. Keeps up the reminders to get my eyes checked yearly and HbA1c tests every few months. I am not looking forward to the day he retires.

    Maybe the answer is to find what works for you.

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  6. I’ve had some really bad PCPs before. (One actually asked WHY I could possibly need an endocrinologist referral.) But – I have an HMO-lite, so I need to name a PCP in order to even get my insurance paperwork started. Mine have mostly just been referral writers. (Or since I also get killer ear infections – someone to get me anti-biotics.)

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  7. I would suggest that your primary care doctor should be an internal medicine doctor with a good knowledge of heart disease. As people with diabetes, our biggest risk beyond keeling over from a low BG is heart and vascular issues. I don’t usually see my internist other than once a year for a physical, but as I age with long term diabetes, it’s a good thing to be checked out once a year by a knowledgeable doctor. He also keeps track of immunizations and things like colonoscopies. (You get to have that fun thing when you turn 50.)

    When I was younger, I didn’t have an internist and got by with my endo and OB/gyn. When my previous endo stopped seeing patients twelve years ago, I was required to get an internist/primary care doctor for an endo referral. It was a good decision for me and I feel fortunate that I’m healthy enough that I don’t see him very often. But he is there if the need arises and that’s a good thing.

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  8. For some reason, I’ve been “lucky” enough to always have an insurance plan that requires a PCP. I don’t always have to go see him to get referrals, but I have to list him every freaking place I go. It is kind of nice having the over-arching care of my PCP – I get flu shots there every year, go in at least 3-4 times per year for sinus infections brought on by allergies, etc. They know me there. The nurses are nice and call me by name, especially now that my daughter also goes there (they are Internal Medicine AND Pediatrics – score!) And I’m all about preventive care – getting a physical once per year isn’t the worst thing ever 🙂

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