is this how it's supposed to work?

October 23, 2012 1:25 PM

Am I wrong about how primary care vs. specialists works or is my doctor's offfice badly managed?

Three times now I've called my doctor's office with minor problems (some of which may become major if not treated) and they can never see me promptly. This time it's boils on my elbow that are looking angrier by the day. My doctor can't see me until Nov. 5 and the receptionist tells me that's OK because I need a dermatologist anyways. She's not really qualified to tell me that over the phone and I've been succesfully treated for this in the past (several years ago) without seeing a specialist.

Plus, it's more expensive for me to see a specialist. What if I had Aetna's HMO plan instead of Open Access (that lets me see specialists without a referral)? Would my only options then be wait until Nov. 5 and risk blood poisoning or go to the ER (for 20 times the cost of a primary care visit)?

posted by Jahaza to health & fitness (22 answers total)

This is generally how Primary Care works in the US, yes. Do you have access to an urgent care center? That's where I would go under my PPO insurance if I needed to be seen, well, urgently and I didn't know what sort of specialist I needed. If I did I would go directly to the specialist because I have a PPO and can.
posted by brainmouse at 1:28 PM on October 23, 2012 [1 favorite]

Your HMO would require a visit to the Primary Care Doctor before you could see a specialist, but an RNP (high level nurse - registered nurse practitioner) can give that referral or prescription.

Urgent care is how I would go here - they have everything you need, don't count as a specialist, and will see you quickly.
posted by bensherman at 1:31 PM on October 23, 2012

I would pay out the nose (and do!) for an insurance plan that lets me see specialists without a referral for exactly this reason. If your primary care doctor's office sucks, everything sucks if you need to get a referral from them for further care.
posted by griphus at 1:31 PM on October 23, 2012

Is there another primary care physician you could find in your network that would take you sooner? It's unusual, but there are offices that are extremely service-oriented and will take new patients on short notice when they have an urgent problem. (Case-in-point: I was 5 minutes late to my doctor's office when I had Lymes disease -- not yet diagnosed -- and had bad looking skin rashes all over. The waiting room was empty, but they wouldn't take me. Said I should go to the ER if I was really worried, or I could make an appointment for the following week. Called the doctor my mom went to and they fit me in that day.)
posted by DoubleLune at 1:31 PM on October 23, 2012 [1 favorite]

You could certainly look for a different primary care provider. Mine is quite well-respected in the area, but I just called today because I am feeling a bit sick and he was able to fit me in tomorrow. He actually could have fit me in today, but it didn't work with my schedule.
posted by Rock Steady at 1:32 PM on October 23, 2012 [1 favorite]

I would call the office back and say, "This is really uncomfortable and the situation is not getting better, is there any way you can work me in today?" If not, head to urgent care.

Also, find a new PCP, because that shit is not cool.
posted by Ruthless Bunny at 1:34 PM on October 23, 2012 [4 favorites]

I think that's bullshit - primary care doctors should reserve some time each day for sick visits. It's ridiculous to have to go to urgent care for something so easily treatable by a pcp; waits at urgent care can rival those at ERs. I agree that you should look for a new doctor.
posted by imalaowai at 1:39 PM on October 23, 2012 [1 favorite]

Your HMO would require a visit to the Primary Care Doctor before you could see a specialist, but an RNP (high level nurse - registered nurse practitioner) can give that referral or prescription.

Right... I actually usually see the PA in my doctor's practice, but they still didn't have anything until next week, even when I said it was urgent.

I can see a specialist ($35) more cheaply than a visit to urgent care ($100) so I'll probably scare up a specialist appointment. The $20 difference isn't worth debating with my primary care doctor's receptionist.

Sounds like I should look for a new primary care doctor.
posted by Jahaza at 1:39 PM on October 23, 2012 [2 favorites]

Agreeing with others that you shouldn't stay with a doctor who can't see you when you need medical attention. I'd just add that if you otherwise like the doctor, you could write a note explaining the problem. If it's a case of a good doctor and a bad receptionist - that is, someone who's miscategorizing the seriousness of the case - the doctor will want to know about the problem and appreciate the information. If not, then you can be extra sure that you need to find a new doctor.
posted by Mr.Know-it-some at 1:41 PM on October 23, 2012 [2 favorites]

Well run primary care practices reserve appointment slots every day for sick calls. I'd find a new primary care doc.
posted by COD at 1:49 PM on October 23, 2012 [1 favorite]

A couple points:

1. If you had an HMO then you would have to wait for 11/5, see your primary doc, then have them refer you to a specialist. Open Access is a PPO plan so you can go straight to a specialist if you want to. So really you are better off on a PPO if you even need to see specialists.

2. Are you 100% positive that a trip to Urgent Care is $100? Urgent Care is different than an ER visit and pretty much every single insurance plan I've seen in the last 5 years qualifies Urgent Care as a normal doctor's visit. This is their niche, you get more immediate care for non-life threatening maladies without paying for or clogging up the ER.

3. Yes, you should probably find a new doctor anyway as every doc I've ever been to keeps times open every day to see people with more immediate concerns, if yours can't manage that then they might not be the best doc for you.
posted by magnetsphere at 1:49 PM on October 23, 2012

Are you 100% positive that a trip to Urgent Care is $100? Urgent Care is different than an ER visit and pretty much every single insurance plan I've seen in the last 5 years qualifies Urgent Care as a normal doctor's visit. This is their niche, you get more immediate care for non-life threatening maladies without paying for or clogging up the ER.

Sadly yes. I've had this insurance plan for a number of years and within the last couple of years they added an extra "urgent care" category that we didn't have before. Urgent care used to be a specialist visit, but they broke it out into its own category with a higher co-pay.
posted by Jahaza at 1:55 PM on October 23, 2012

Oh, and I've set an appointment with a specialist for tomorrow.
posted by Jahaza at 1:55 PM on October 23, 2012

Glad to hear it. And be sure to write a letter to your current doctor's practice advising him/her of your reasons for changing doctors. Feedback is super-important.
posted by Ruthless Bunny at 2:11 PM on October 23, 2012

This is common but not acceptable! I've been able to get plenty of same-day and next-day appointments for urgent medical situations. Unfortunately a lot of great doctors have horrible receptionists/schedulers. I had a hell of a time trying to get an appointment with my new gynecologist. My dad knows her and had to to call her and get the appointment directly. If there is any way you can get in touch with the doctor directly (email maybe, or call and leave a message for her) maybe s/he can push the appointment through.
posted by radioamy at 2:21 PM on October 23, 2012

I've changed PCP's 3 times in the last 7 years for various reasons. All of my docs have been able to see me, if not same day then at least the following day for anything that could fairly be labled "acute". Now for physicals or other routine "checkup" type appointments I've often had to wait 2 weeks, but if I had a doctor who regularly couldn't see me within 48 hours I would change doctors, ditto for over referring to specialists.
posted by dadici at 2:21 PM on October 23, 2012 [1 favorite]

The real problem is the scheduler thinks she has some diagnostic skills and she doesn't. It's not her job to determine if you need a specialist.

Yes, change doctors. You may do better with a larger practice instead of a solo practitioner. If there are 5 or 6 doctors in practice they can usually handle overflow more efficiently.
posted by 26.2 at 2:49 PM on October 23, 2012

I had this problem with my old PCP, and I think part of the reason was that I was in a smaller town. I waited over three months once with intense chronic pain because the only specialist in town was booked solid. And the whole time my PCP just told me to take some Advil.

Once I moved to the Big City, I have yet to wait more than a day for something major and only a week for things like regular checkups. Heck, recently I had a wicked sinus infection (something I've had before) over a holiday weekend and while my doctor couldn't schedule me until Tuesday, he did apparently check his messages on Saturday and call in antibiotics and decongestants for me the same day.
posted by teleri025 at 2:50 PM on October 23, 2012

I've experienced an initial receptionist brush off before. Unless you tell them "this looks really bad / is developing and is a thing that looks serious" they will file you into a non-urgent slot. If you impress upon them that you are sick, now, and need to see a doc, they will either get you a sooner appointment or schedule a call back from your doc or a physicians assistant or RN who can assess the urgency.

You have to squeaky wheel / advocate sometimes. This sounds like one of those times.
posted by zippy at 7:20 PM on October 23, 2012

Put another way - if you call with something you present as minor, well, it's minor so not urgent. If it becomes less minor, then you call and tell them that rather than wait for it to become an ER visit.

But be sure not to say something is minor if you think it is major.
posted by zippy at 7:24 PM on October 23, 2012

Something to keep in mind: lots of primary care doctors in the US will give you a referral without actually seeing you. When I need to see a specialist, I call my doctor's office and give the receptionist some information about the specialist I want to see (address, name, fax #, etc.). Then they put together the referral and fax it over to the specialist's office. I've seen a number of specialists this way.

My guess is that my doctor isn't the only one who does this. Because so many insurance companies insist on referrals, I think many doctors offices just provide them to their patients.
posted by Ragged Richard at 8:17 PM on October 23, 2012 [1 favorite]

They've gotten better! Probably because they're now convinced I have issues that need to be taken care of promptly. :-/
posted by Jahaza at 7:18 AM on May 14