How to get Health Care in a system that stinks
People don’t like going to the doctor. And they’re right: too often, it means navigating a phone tree, being on hold, filling out multiple forms, taking time off work, waiting in the waiting room for longer than is reasonable, being rushed through intake by an assistant who’s stressed, waiting again in a cold exam room, getting asked the same set of questions you just answered, being interrupted 15 seconds into your story, and rushing out without a total understanding of what to do next. And then receiving an impenetrable bill. If you’re already not feeling well, all this is even worse. If you’re feeling fine, it’s a tough sell to go through all this for the possibility of some future benefit.
Even I, a healthcare provider, hate it. Recently, I went to see my PCP for an ongoing hip issue, and she didn’t even examine me or tell me what she was thinking– she just ordered xrays and sent me out the door. I left feeling like she hadn’t helped me at all and neither she nor I had a good idea what was going on.
Health insurance is knotty, barbed wire running through a lot of this. When we think of health insurance, we often expect everything we need to be covered. But when you think of car insurance, or homeowner’s insurance, that’s not what happens– you are in charge of the routine maintenance and repairs, and if something terrible happens, you don’t lose your shirt. But health insurance is different, and these days, it’s a tangled web of incentives and expectations and information (or lack thereof). And it’s expensive, since it’s doing way more than protect against catastrophic loss. And by and large, it doesn’t serve us (patients or professionals) very well.
Everyone agrees: this is terrible.
There has to be a better way. But while the Medicare wonks and the HMO execs are hashing out plans and tinkering with their payment structures, what about you and me? How to we get help with our health?
A sizable number of people are seeking primary care outside of the system that the health insurance industry creates and runs. Some join “concierge” or direct-access practices, where they pay a flat fee to an individual practitioner to cover all their routine needs. Some pay out-of-pocket to see naturopathic or functional medicine practitioners instead of allopathic (“Western”) providers. Some don’t get regular primary care at all, and use drop-in retail and urgent care clinics for day-to-day things. In these cases, people may either forgo insurance (which leaves them vulnerable if they have a significant illness or accident), or they purchase a high-deductible “catastrophic” plan to protect that would kick in if they had an unexpected major expense or hospitalization.
What can YOU do?
For some folks, especially those who are generally well and need mostly health coaching, lifestyle intervention, and management of minor things like UTIs and ear infections, this might work just fine. If you are sticking with a “regular” practice and insurance, though, what can you do?
First, know that an MD isn’t your only option. I of course believe nurse practitioners are often better at listening and integrating whole-life factors into care. You could also see a DO (osteopathic doc, who may practice in any specialty) or a PA (physician assistant). You might be able to see a naturopath (ND) under your insurance– but labs or meds may or may not be covered. This isn’t to say that all of these folks will be good or that all MDs are bad, but in general, the professional training and philosophies are just a bit different in ways that many people find refreshing.
Manage your appointment. Try to get the first appointment of the day (or possibly the first after lunch as a backup plan). You’ll wait less and the people you see will be less fatigued and flustered. But also just plan to be there for a while, and bring a book. If you end up waiting, consider it found time for reading. If you get out on time, it’s found time to take yourself on a coffee date.
Make a (short, realistic) list of what you want to talk about when you’re there and bring it with you. This should be one or two high-priority issues, and know you might not get to more than that in a single visit (but you might, you never know!). Be clear right away about what those things are. If you have specific questions, write those down too, and note the answers. Look at your list when the appointment’s drawing to a close and if they haven’t been answered, ask them again.
If you want, bring someone with you. Then you have company, and another set of ears, and someone else to speak up if you need to get your voice heard. You should always be allowed to have an advocate. If you get pushback on this, you should start looking elsewhere for care.
If your doc (or other provider) suggests tests or treatments and you agree with the plan, follow through. Get the test. Take the med. It’s hard to get a benefit from a plan you don’t follow, so you may wind up disillusioned when you’ve left some benefit on the table.
Think of this kind of health care visit really as an illness detection and/or management plan. Remember that– most docs aren’t really prepared to work on creating optimal wellness. (Often because they lack time and training, not desire).
So yes, get health care when you need it. And you probably will. Clinics and hospitals are there for you when you are hurt or sick. But know that true health might come from outside the medical system. Take responsibility for learning and practicing health. Eat real food, move your body often, and sleep. Read, take classes, experiment with different practices. Try yoga or meditation. Research and experiment with dietary patterns. Take in lots of information (but remember that things that sound crazy are probably crazy, and anyone can post health advice on instagram). Practice radical honesty with yourself. Do you know that you should exercise more, go to be earlier, drink less, or eat more vegetables? You can do these things, and a doctor doesn’t need to be (and probably won’t be) the one to help you. Own your health, and you may find that you can use the medical system the way it works best– to manage specific, acute kinds of illnesses and injuries.
