It’s quite common for a new WholeHealth Chicago patient filling out our forms to answer the “How can we help?” inquiry with “I’m seeing too many doctors and they don’t communicate with each other” or “I want all my health care in one place with one doctor who knows me.” Having worked as part of a small group for more 20 years, it’s hard for me to grasp how bloated and unwieldy health care became when I wasn’t looking.
I get a sense of its true bloatedness when I review the stack of medical records our new patient brings in. Looking at the numerous referrals to specialists, repetitive tests and x rays, and surgical procedures of dubious worth I think, “She’s right. There’s no one in charge.”
Yes, she has a theoretical primary care physician (PCP) selected from an insurance “Provider Directory,” but with her insurance constantly changing she’s lucky if she gets in a single visit before she (or her PCP) moves to another medical group. Add to this the fact that in the huge medical groups–the ones that own hospitals and medical offices with physicians as employees– referrals to specialists are encouraged. Specialists perform surgeries, and surgeries are the cash cow of health care. Simple stuff gets referred out.
Although this patient’s PCP could perform her Pap smear in five minutes flat, instead she’s sent to a gynecologist. She’ll be sent to a dermatologist for a patch of eczema (the biopsy will be an extra charge), a gastroenterologist for constipation (the colonoscopy an extra charge), and a rheumatologist for aches and pains (more blood tests than she has blood, all at extra charge).
Most likely none of these physicians, neither the PCP nor the specialists, actually know each other, couldn’t place a name with a face on a bet and never talk on the phone or communicate by e-mail. At one time, it was hoped that electronic medical records (EMRs) would solve these communication problems, but EMRs have been a major disappointment for one simple reason: no two EMR systems are able to share information. Unless your PCP and dermatologist are both employees of say, Northwestern, your PCP will probably never know what happened at the dermatologist’s office.
And when it comes to two competing healthcare giants, like Rush and Northwestern, there’s probably a better line of communication between Israel and the PLO.
If you’re basically healthy and take care of yourself, you really don’t need a medical team—one visit every couple of years is plenty. Obviously your care becomes more complex if chronic conditions develop, and in this case communication between and among physicians is of utmost importance, if only to save you superfluous doctoring. With a little effort, it’s possible to locate a primary care doctor (who actually gets to know you and your problems) to act as a health care system ombudsman and a mouthpiece when you’re dealing with specialists.
Here at WholeHealth Chicago, and like the docs over at Northwestern or Rush, we do have online access to your medical records. But unlike France, for example, where every doctor and hospital uses the same software and your complete chart is available to any physician, we (again like Northwestern) have access only to information generated by our own office. On the very positive side, your records are available to me 24/7 and we use email a lot, not only to send messages between practitioners, but also to answer questions from you.
Because WholeHealth Chicago is a small group, our physicians and practitioners see each other in hallways, in the lunchroom, and during weekly case conferences. We share information constantly. We also use “curbside consults.” If, for example, you’re in my office and I’m stymied by something that needs a chiropractic opinion, I can walk about 30 feet, tap on Dr. Rubin’s or Dr. Maurer’s door, and say, “Excuse me, when you finish with your patient I need to ask you something.” This is extremely handy and while it’s routine for us, by their very size and spread of offices, curbside consults are completely unknown at a Northwestern or a Rush.
If you do need a specialist, we’re not obligated to limit you to one system. There’s no one to tell us, “Use any specialist, so long as she’s from Rush (or Northwestern or Advocate).” Did you know doctors can actually be fired for sending patients to rival hospital systems? Our own WholeHealth Chicago specialist list is the result of years of professional interaction and mutual respect. Physicians on our list know we’re an integrative practice, respect our work, and are intrigued rather than threatened by our use of herbs or homeopathic remedies. Best of all, after your visit with one of our specialists we receive a faxed summary, usually within 24 hours.
What about hospitals? Our group is so oriented toward wellness and prevention that we regard hospitalization as our professional failure (not yours). I think maybe two or three patients a year actually end up in a hospital, usually with appendicitis or an elective surgical procedure like a joint replacement. Again, we’re not tied into any single hospital system. We simply give you our recommendation for which hospital is best for your needs, and in fact we’ve sent patients as far as Mayo Clinic and M.D. Anderson.
Locating a small-group PCP
Let me offer a few suggestions for finding a small-group primary care physician who won’t forget your name, won’t send you to a specialist every time you cough, and will accept the responsibility of being in charge of your care.
- Locate a small group (three to five physicians) of family practitioners or internists whose ages range from on the young-ish side to those of seasoned clinicians. The young ones can tap the experience of the grey-haired ones and the olders can rely on the kids for their energy and fresh approaches.
- Try to find a group that’s not owned by one of the large health care systems. Doctors in these systems are supervised employees. They must play by the company rules and can be fired for “low productivity,” which means they can get canned for spending too much time with you.
- If you’re a woman and there’s a gynecologist in the group, that’s a plus. One less office to visit for gynecological concerns.
- A group that has good ancillary care (nurse practitioner, chiropractor, nutritionist) is also a plus.
- It’s a good sign if the group schedules new patients for an initial hour visit and most follow up visits for 30 minutes.
- To me, of least importance is hospital affiliation. You’ll probably never need to go into the hospital and most PCPs don’t make hospital visits any more (everyone uses “hospitalists”).
In general, if you become ill, need a physician, and can’t get in to see your PCP, start getting comfortable with the physician-supervised urgent care centers. You’ll get fast service covered by insurance and your PCP will get the details of your visit within a few hours. Avoid emergency rooms for anything other than true emergencies. Otherwise, you’ll waste hours of your time, may be treated rudely, could find yourself having thousands of dollars worth of unnecessary tests, and your PCP will rarely get a copy of what you endured.
Lastly (and this is very important), on your search for a medical team find an office where you yourself are a bona fide member–where your insights are listened to, your suggestions are considered, and where no one rolls their eyes when you have a question about something you read on the internet.
David Edelberg, MD