How often do we ask patients when they come into the ER if they've seen their PMD for the issue? How often do we discharge pts. with the instruction to "follow up with your PMD?"
See I was hanging out with some friends at a different watering hole than my usual spot. Got talking with some people and naturally once people found out that I was a nurse, out came the usual "1001 questions to ask a stranger if you find out they are a nurse"
"Why does it burn when I pee?"
"See, I've had this boil on my butt for the past 6 months and..."
"is KY jelly the same as regular jelly? My boyfriend said it wouldn't make a difference and now..."
Ok. Ok. I was kidding about the quoted questions!
But they DID ask me a bunch of pointed questions. I could answer most of the "general stuff" (why is chronic high BP bad for you etc.) but dutifully told 'em that I couldn't give any medical advice for their respective issues and that they should follow up with their primary care physician.
The minute I said 'primary care physician', the subject changed abruptly. From that one discussion with about 14-18 patrons, I found:
1. A good minority didn't have a primary care physician. Granted these were mostly under the age of 30.
2. A VERY common complaint was the wait times to "get an appointment".
3. Complaint #2 was worse if the doctor being sought was a specialist.
4. A variant of complaint #2 was "My current doctor is an idiot/I am unhappy with services provided" and they are currently looking for a new PMD.
So the next day, I did a bit of digging around. I called a bunch of doctor's offices to see if they were accepting new patients.
4/8 were not accepting new patients at this time.
Of the 4 who were accepting new patients, 2 of them were a good distance away, and one of the closer docs didn't take my insurance.
I admit the results surprised me.
What are all these pts. supposed to do when they don't have a PMD and can't get in/see one in a reasonable amount of time?
Don't get me wrong - I totally understand that the ER's role is NOT primary care. I get that.
I'm not even bringing in complications such as "no insurance" etc (I had a buddy who ended up waiting almost 50 days before buddy could see a specialist and get an MRI done for debilitating migraines/headaches.) And we're not discussing people who don't have a doc because they didn't think they'd need one (for whatever reason - over sight, ill informed etc.)
Is access to primary care that desperate in our country?
The other reason I ask the question is because I follow medical bloggers online - and a bunch of the blogging docs are warning that with the way Govt./CMS is regulating practice and with falling compensation rates/insurance company hassles - primary care is no longer an attractive field for many med school graduates (here's an article from 2008).
So am I over-reacting to the whole thing or is there a legit issue here?
