By Russell Herring, DNP, FNP-BC, CSCS
My wife hates healthcare. She hates the dentist. She hates primary care. She seriously hates medical specialists. A ranch-girl, raised with a father whose end-of-life plan is a one-way trip into a random gully somewhere, she hates going to the doctor. This doesn’t mean she is without valid complaint about her personal health, nor that her issues with the healthcare system are not also valid. It has occasionally created a heated, though brief, conversation between husband and wife.
Go see the doctor.
“No, I hate going to the doctor.”
Then quit complaining about it.
I’m older than I used to be, but in many ways no wiser. We’ll have this same conversation for a year, and I’ll stick my foot in my mouth over and over and over again.
“This is the problem (indicates problem…). I know what is wrong and what needs to be done, which means this kind of specialist can fix it, but I have to go see another doctor before I can see that doctor for a referral. Then they’re going to want to do all of their own things which I don’t want and didn’t ask to have done, before I can get a referral to the specialist I wanted to see in the first place. Then, they won’t be able to see me for a year, so I’m just going to live with it.”
I’m uncertain how many untreated, chronic conditions she may have at this point.
My wife is perfectly illustrative of frustrations commonly expressed by patients I see. I’ll see people who haven’t seen a doctor, of any kind, in decades. Others, who have been seen at walk-in, exclusively, for similar time-frames. Like a car running out of gas, everything in a human body may appear normal, outwardly and on the exterior, while the entire machine is about to run out of gas. Patients who’ve been treated exclusively by walk-in or in immediate care, without the long-term guidance of a primary care provider can have troublesome, complicated medical histories and medication lists, which read like the assembly instructions for an aircraft carrier, though written in a foreign language and translated by somebody who doesn’t speak that language. Once or twice each month, I’ll see a patient who has been referred to primary care because the diversity, severity, and complexity of conditions exposed during a walk-in visit are well beyond the scope of immediate care to piece back together.
Urgent care, immediate care, and walk-in care, exist to solve a problem. One concern. In 5 minutes or less. Problems or concerns which cannot be resolved quickly aren’t well suited for an immediate care setting.
I’ll accept that the system of healthcare in the United States could be better, without turning this into a political piece. I’ll see patients who recently obtained health insurance, after many years without, and I’ll set about repairing the miscellany of chronic, severe conditions which should have been addressed during Clinton’s presidency. I’ll see a patient who should have been on a blood pressure medication 15 years ago, but now has to be seen by cardiology, nephrology, optometry, and possibly others. I’ll see a patient who may have spent $1,000 on blood pressure medications over the course of a decade or more, who now has to be seen by multiple specialists because their perpetually high blood pressure has resulted in permanent damage to invaluable body parts.
Primary care exists to manage and control these sorts of problems while they remain minor, and to keep them minor. I take pride in the long-term, strategic choices and results I obtain with my primary care patients. I rejoice when I’m able to piece together a long-term treatment plan which enhances not only another human’s life expectancy, but to improve the quality of those years as well. These are not the kind of answers typically found in walk-in care.
Primary care exists to treat problems and to triage problems at the lowest level. Certainly, there are many problems which we cannot resolve within the spectrum of primary care, but we exist as masters of preventative care for a reason. Primary care serves as the football coach, whose responsibility is not necessarily to run, throw, or kick a ball but to guide the player through the game and advise them on when to do each. Our goal is to PREVENT your cardiovascular disease with diet, exercise, and lifestyle modification, or medication as necessary, BEFORE you have to be treated by an interventional cardiologist. My hope is that my patients never have to see a specialist, but my expectation is that I know when specialists need to be included in the treatment plan.
Everyone should have a person who is “their doctor”. Whether your doctor is a physician, a physician’s assistant, nurse practitioner or something else, everyone should have a primary care provider who cares about your long-term health and who is helping you to make the decisions which will provide you with the best chances of long-lived health and wellness. Everyone should have a regular doctor who hassles you about your blood pressure, who keeps an eye on your blood sugar, weight and general health. Everyone should have a trusting relationship with a healthcare generalist, with someone who knows you and your family.
The reality of many specialists is that there are simply too many people, and not enough hours in the day. Your primary care provider conducts many of the initial diagnostics and entry-level treatments for a wealth of conditions. A diversity of the initial steps required to see a specialist are managed by your primary care doctor so that your specialist can see you faster. Among the things patients may not know or realize, is that many specialists will not see patients without a referral and they may also require that certain tests, treatments or procedures be completed before accepting you as a patient. This means that a specialized practitioner can hone in on next-level diagnostics and therapeutics more quickly. Ultimately, this means that specialists can see more patients, meaning that they can actually see and treat the people who need them the most, sooner.
It is frustrating for patients when they are required to have a referral prior to seeing a specialist but this hurdle exists to ensure the specialists are available to treat specialized conditions. If the cardiothoracic surgeon is busy diagnosing your acid reflux, instead of conducting open-heart surgery, then valuable time is lost to those patients who need specialist care.
America has become a land of chronic disease. We’ve become a land of diseases and conditions which take decades to manifest. Primary care is not only the model to rectify this trend but the best means available to treat the chronically ill.
The conversation revolves, in my home, as it does at work.
“I’m healthy. I’m fine. I don’t get sick.”
The logical flaws inherent in the statement, “I don’t need vaccinations, because I don’t get sick” are challenging for me to articulate. Perhaps this thought process speaks to the difficulties, hurdles and fallacies of the American healthcare model, which values acute phase, “sick care” over preventative care and wellness. The goal should be, and is – within primary care, to keep you from getting sick in the first place, to prevent, rather than intervene. Americans spend the majority of our lifetime healthcare dollars, total per person, within the last couple years of life. We don’t spend these dollars to improve the quality of our lives, over the duration, but to extend them at the very end, once we’re already ill. Preserving a state of sickness at the end of life certainly seems like a terrible way to spend our golden years.
Patients tell me that getting old hurts. That old age is not for the faint of heart. They tell me they wish they’d had all of this free time when they were in their 20s and 30s, when they were young, vibrant and full of energy. They tell me that it would be a lot more palatable to work for a living when they didn’t feel like doing so many other things instead.
I’ve been given the opportunity to practice this line of thought at home. I’ve practiced and rehearsed with my wife, family and friends; perhaps I can help you, too?
About Russell Herring, DNP, FNP-BC, CSCS
Russell R. Herring, DNP, joined the Great Falls Clinic in 2018 and is among the newer healthcare providers and prescribers in the State of Montana. He works alongside Dr. David Engbrecht and Dr. Carey Welsh in Family Medicine at the Great Falls Clinic Northwest location. Russell specializes in diagnostic, preventive, and therapeutic healthcare and treatment plans for acute and chronic illness, and in education and guidance of patients regarding disease prevention and health promotion. He is currently accepting new patients at the Northwest Clinic, 1600 Division Road, Great Falls. For more information or to schedule an appointment, please call 406-268-1600.