Best course of action when you have no Primary Care Physician?
December 8, 2015 1:25 PM Subscribe
I need to know where to begin -- I fear I may have a serious health concern but have no PCP/GP as I've only recently started taking responsibility for my health.
Bluntly put, I have concerns that I have symptoms of Hodgkin's Disease (full body itching, swelling in supraclavicular nodes) and need to know where to start because I do not have a Primary Care Physician/regular doctor. I feel this is a valid concern because the same type of cancer was responsible for the death of my father at 46, and his mother at 36.
I am currently under the care of an obstetrician as I am about 28 weeks pregnant with my first child. I intend to ask him for advice on where to start tomorrow, but I'd like to know the right questions to ask -- you know, the type that don't make you sound like you're off your nut.
I do not have a regular physician because 1) I've had a fear of doctors since my father's death and 2) my ex-husband acted as though it was a waste of time, money, etc. to seek preventative medical care. Prior to getting pregnant, I began making some (albeit minor) strides towards medical normalcy (got my first pap smear and gyno exam in over 10 years), and I've attended every prenatal appointment I've been scheduled.
Bluntly put, I have concerns that I have symptoms of Hodgkin's Disease (full body itching, swelling in supraclavicular nodes) and need to know where to start because I do not have a Primary Care Physician/regular doctor. I feel this is a valid concern because the same type of cancer was responsible for the death of my father at 46, and his mother at 36.
I am currently under the care of an obstetrician as I am about 28 weeks pregnant with my first child. I intend to ask him for advice on where to start tomorrow, but I'd like to know the right questions to ask -- you know, the type that don't make you sound like you're off your nut.
I do not have a regular physician because 1) I've had a fear of doctors since my father's death and 2) my ex-husband acted as though it was a waste of time, money, etc. to seek preventative medical care. Prior to getting pregnant, I began making some (albeit minor) strides towards medical normalcy (got my first pap smear and gyno exam in over 10 years), and I've attended every prenatal appointment I've been scheduled.
Congratulations on the pregnancy and the steps forward in your own health care. This is a concern that your OB can totally start the process for assessing, and it may actually be pregnancy related in whole/part (pregnancy can cause weird symptoms!), so don't feel you are 'asking the wrong person'. Simply put, call and ask for an appointment, outline your concerns and your family history. You may be sent for labwork or referred to someone else. Your health is a primary concern to your OB! Don't feel bad for wanting this investigated; your health is important for your sake and the babies.
Going forward, asking your OB for a referral for primary care for you +/- your child is a very responsible thing to do! Other sources of finding a good doc may be asking your local health unit, asking other new mom's or accessing 'referral lines' through your government/insurance. Good Luck with the pregnancy!
posted by Northbysomewhatcrazy at 1:37 PM on December 8, 2015 [2 favorites]
Going forward, asking your OB for a referral for primary care for you +/- your child is a very responsible thing to do! Other sources of finding a good doc may be asking your local health unit, asking other new mom's or accessing 'referral lines' through your government/insurance. Good Luck with the pregnancy!
posted by Northbysomewhatcrazy at 1:37 PM on December 8, 2015 [2 favorites]
One really good thing to do is to write down the points you want to mention, so when you're speaking with your doctor you don't forget anything.
-- your current symptoms
-- the relevant medical history re: your dad and grandma
-- anything else
-- your specific ask: "I don't have a PCP right now. Can you refer me to someone? If he/she can't see me quickly, do you have a second and third recommendation?"
Lastly, if you are going in to see this OB you may want to consider bringing a close friend with you. That person can take notes, and/or you can give them a list of your questions and they can prompt you if you forget to mention something. (I am the friend of someone who is seriously ill, and this is my function at the many, many appointments I attend with her.)
And you can use this same technique going forward, when you see the new GP.
posted by BlahLaLa at 1:37 PM on December 8, 2015 [8 favorites]
-- your current symptoms
-- the relevant medical history re: your dad and grandma
-- anything else
-- your specific ask: "I don't have a PCP right now. Can you refer me to someone? If he/she can't see me quickly, do you have a second and third recommendation?"
Lastly, if you are going in to see this OB you may want to consider bringing a close friend with you. That person can take notes, and/or you can give them a list of your questions and they can prompt you if you forget to mention something. (I am the friend of someone who is seriously ill, and this is my function at the many, many appointments I attend with her.)
And you can use this same technique going forward, when you see the new GP.
posted by BlahLaLa at 1:37 PM on December 8, 2015 [8 favorites]
Definitely bring this up to your OB immediately. While you have Hodgkins in your family medical history there are serious pregnancy complications that also manifest with whole body itching. Good luck to you.
posted by peanut_mcgillicuty at 1:38 PM on December 8, 2015 [4 favorites]
posted by peanut_mcgillicuty at 1:38 PM on December 8, 2015 [4 favorites]
Definitely ask your OB who they may recommend and tell them your symptoms. In fact they may be able to recommend someone that they communicate with regularly which will help coordinate care. Your OB may also be able to order some initial tests.
You'll need a GP or PCP as an initial visit. They can run basic tests and recommend you to specialists (and for some insurance plans you may need a formal referral to a specialist.)
If you can't get a referral or suggestion from your OB - which you probably can, then check through your insurance's website. Call around if they book out a while, get in as soon as you can. Sometimes they can offer same-day appointments if you call in the morning, some doctors have wait list they can put you on in case someone cancels. I wouldn't go to to someone if you can't get in within the next week or two.
Write down your symptoms, family history, and concerns for your appointment so you can clearly and calmly explain your problems. At this point, panicking won't change the outcome, just get into the appointments as soon as possible. Also suggest a therapist. I have chronic illnesses that still aren't all sorted and a therapist has been amazing in helping me organize the steps and keep calm during all of it.
A good thing to learn is you can talk or ask about your health problems with whatever medical professional you're seeing. They can help you by letting you know what to do, even if they aren't' the person to do it. You are their patient and they're there to care for you, including directing you to the right doctor.
"OB, I'm having worries about X due to Y. Do you have a recommendation for a PCP? Is there anything we should do now? Do you have an idea what they may be?"
posted by Crystalinne at 1:40 PM on December 8, 2015
You'll need a GP or PCP as an initial visit. They can run basic tests and recommend you to specialists (and for some insurance plans you may need a formal referral to a specialist.)
If you can't get a referral or suggestion from your OB - which you probably can, then check through your insurance's website. Call around if they book out a while, get in as soon as you can. Sometimes they can offer same-day appointments if you call in the morning, some doctors have wait list they can put you on in case someone cancels. I wouldn't go to to someone if you can't get in within the next week or two.
Write down your symptoms, family history, and concerns for your appointment so you can clearly and calmly explain your problems. At this point, panicking won't change the outcome, just get into the appointments as soon as possible. Also suggest a therapist. I have chronic illnesses that still aren't all sorted and a therapist has been amazing in helping me organize the steps and keep calm during all of it.
A good thing to learn is you can talk or ask about your health problems with whatever medical professional you're seeing. They can help you by letting you know what to do, even if they aren't' the person to do it. You are their patient and they're there to care for you, including directing you to the right doctor.
"OB, I'm having worries about X due to Y. Do you have a recommendation for a PCP? Is there anything we should do now? Do you have an idea what they may be?"
posted by Crystalinne at 1:40 PM on December 8, 2015
Yes, tell the OB "Look, I don't have a PCP right now, but I'm concerned I have Hodgkin's symptoms and it runs in my family. What do I do next?" I would be *shocked* if your OB hasn't dealt with this kind of thing before. People go without PCPs all the time, for various reasons (and, honestly, there's very little evidence that well visits result in improved health for adults). I bet pregnancy is a very common reason for returning to the medical fold!
Although this is scary business, this is what doctors are FOR, and telling your current healthcare provider about your symptoms and family history is excellent patient behavior.
Going forward do you want a primary care doctor? Ask your OB for a recommendation, and/or if you're in the US and you have health insurance, go to your health insurer's website and use their online doctor-finding tool to find a primary care doctor who is accepting new patients. I know you feel weird about this because you've avoided the doctor out of fear and you probably have some shame about it, but people do this all the time (the avoiding and the selecting a new doctor parts). I'm a middle-class, professional, masters-degree holding woman, I have basically no scary family health history and I had good insurance but I still didn't have a primary care doctor for like eight years, mostly because I hate/am anxious about making phone calls. I was over thirty when I got my first pap smear. You are not alone in your lack of PCP!
posted by mskyle at 1:41 PM on December 8, 2015 [2 favorites]
Although this is scary business, this is what doctors are FOR, and telling your current healthcare provider about your symptoms and family history is excellent patient behavior.
Going forward do you want a primary care doctor? Ask your OB for a recommendation, and/or if you're in the US and you have health insurance, go to your health insurer's website and use their online doctor-finding tool to find a primary care doctor who is accepting new patients. I know you feel weird about this because you've avoided the doctor out of fear and you probably have some shame about it, but people do this all the time (the avoiding and the selecting a new doctor parts). I'm a middle-class, professional, masters-degree holding woman, I have basically no scary family health history and I had good insurance but I still didn't have a primary care doctor for like eight years, mostly because I hate/am anxious about making phone calls. I was over thirty when I got my first pap smear. You are not alone in your lack of PCP!
posted by mskyle at 1:41 PM on December 8, 2015 [2 favorites]
I have actually often had an OB-GYN as my PCP through my insurance, although I don't right now. So, depending on the doctor, she may be used to seeing patients as a primary care contact in addition to for pregnancy-related issues. In any case, she should be able to point you in the right direction of where to go next. Whether you will need a referral will depend completely on your insurance -- typically, if you have an HMO you'll need to get a referral, but if you have a PPO, you do not.
posted by rainbowbrite at 2:05 PM on December 8, 2015 [1 favorite]
posted by rainbowbrite at 2:05 PM on December 8, 2015 [1 favorite]
Congratulations on taking charge of something that a lot more people have issues with than you might think. (It's easy to think you're off your nut about things people don't talk about because nobody's talking about them.) I've been where you are and it's scary but getting it order is the best way to fix it AND feel better.
I guarantee that asking your OB for a PCP/GP recommendation because you don't have one will even rank as one of the 100 weirdest things your OB has been asked this month ; it probably won't even register as weird at all.
posted by MCMikeNamara at 2:09 PM on December 8, 2015
I guarantee that asking your OB for a PCP/GP recommendation because you don't have one will even rank as one of the 100 weirdest things your OB has been asked this month ; it probably won't even register as weird at all.
posted by MCMikeNamara at 2:09 PM on December 8, 2015
Our OB said at the beginning of the pregnancy: "During the pregnancy, I am your source of primary care, even if the issue seems to be unrelated to the pregnancy. It might be related, and there may be different treatment approaches. Plus, other doctors are often scared of treating pregnant women and will probably send you back to me anyway."
So just ask your OB. Don't worry about who should treat this; he will either do so or refer you as necessary.
After the birth, you can ask for a referral to a primary care physician. You don't have to do anything at that point, but you can sign up and then will have a point of entry to the medical system if you need one in the future.
posted by Mr.Know-it-some at 2:16 PM on December 8, 2015 [2 favorites]
So just ask your OB. Don't worry about who should treat this; he will either do so or refer you as necessary.
After the birth, you can ask for a referral to a primary care physician. You don't have to do anything at that point, but you can sign up and then will have a point of entry to the medical system if you need one in the future.
posted by Mr.Know-it-some at 2:16 PM on December 8, 2015 [2 favorites]
Convey the following snippet to your OB I have concerns that I have symptoms of Hodgkin's Disease (full body itching, swelling in supraclavicular nodes) and ...the same type of cancer was responsible for the death of my father at 46, and his mother at 36. and make sure he also checks for any pregnancy related complications that can cause the same problems.
Pregnancy causes all kinds of wonky issues. It is not at all uncommon for pregnant women to itch. Some women have a hard time keeping up with the need for food an drink that is required to fuel a growing fetus. This can lead to chronic low grade dehydration and that can cause dry skin which can cause itching. The body will strip you of resources to give to the baby. Your needs come second in this game.
If your OB is any good, ruling out cancer for your peace of mind while pregnant by sending you for appropriate testing (instead of poo-poohing your concerns) should not at all seem unreasonable, given the family history. He may or may not need to refer you to another physician to request tests. If testing does turn up a positive diagnosis of cancer, that becomes a whole other ball game. But I would personally ask if he can just order the testing himself as part of my OB care.
posted by Michele in California at 2:18 PM on December 8, 2015
Pregnancy causes all kinds of wonky issues. It is not at all uncommon for pregnant women to itch. Some women have a hard time keeping up with the need for food an drink that is required to fuel a growing fetus. This can lead to chronic low grade dehydration and that can cause dry skin which can cause itching. The body will strip you of resources to give to the baby. Your needs come second in this game.
If your OB is any good, ruling out cancer for your peace of mind while pregnant by sending you for appropriate testing (instead of poo-poohing your concerns) should not at all seem unreasonable, given the family history. He may or may not need to refer you to another physician to request tests. If testing does turn up a positive diagnosis of cancer, that becomes a whole other ball game. But I would personally ask if he can just order the testing himself as part of my OB care.
posted by Michele in California at 2:18 PM on December 8, 2015
OBs are very used to acting as women's PCP, especially during pregnancy. Your job as a patient is not to know what specifically to ask, it's to explain how you're feeling/what your symptoms are and why you're worried, and sometimes, depending on the doctor, to advocate harder than is comfortable for a follow up if they are dismissive. If the OB tries to say it's no big deal but you are worried, you will do nothing wrong and not be a nut at all if you reply with something like "I know it may be unlikely that it's [whatever], but for my own peace of mind I'd really like to follow up on this. Are you the right person to test for this further or can you refer me to someone who can help with that?"
posted by brainmouse at 2:29 PM on December 8, 2015
posted by brainmouse at 2:29 PM on December 8, 2015
I am a male who, for a short period of time, had my wife's OB/GYN listed as my PCP. She was terrific. We moved or she would still be listed as far as I am concerned.
Hesitate not.
posted by AugustWest at 2:35 PM on December 8, 2015 [2 favorites]
Hesitate not.
posted by AugustWest at 2:35 PM on December 8, 2015 [2 favorites]
Response by poster: Thank you all so much for your responses. I feel much better prepared to discuss this with him tomorrow morning.
posted by nohaybanda at 5:07 PM on December 8, 2015 [1 favorite]
posted by nohaybanda at 5:07 PM on December 8, 2015 [1 favorite]
You've got some great advice here already. I'll just add that it's much more common than you think for people to react to situations like this with fear and avoidance of medicine and its practitioners. I grew up in hospitals because of a medical condition, and as soon as I turned 18 and had control over my medical care, how did I react? I stopped going to any doctors, dentists, pharmacies, anything that made me feel that I was in charge of my body. No more awkward and uncomfortable examinations, medical students, invasive tests, you name it.
Later, in grad school, I'd learn to view this as a valid, frequently-seen manifestation.
Eventually my body caught up with me and an emergency brought me back to medical care. This time around I saw a counselor, though, and got much better at managing my own health care. That's something I hope you do, too.
posted by late afternoon dreaming hotel at 5:28 PM on December 8, 2015
Later, in grad school, I'd learn to view this as a valid, frequently-seen manifestation.
Eventually my body caught up with me and an emergency brought me back to medical care. This time around I saw a counselor, though, and got much better at managing my own health care. That's something I hope you do, too.
posted by late afternoon dreaming hotel at 5:28 PM on December 8, 2015
I'm sure you'll do fine! I'm not sure if it provides any reassurance, but a complete blood count is routinely done as part of your prenatal labs (would have been done on you sometime in recent weeks) and typically would show abnormalities if you had Hodgkin's. Definitely still investigate this, of course, but don't panic yet. These symptoms could also be related to pregnancy, so it's definitely for the best to start by discussing them with your OB.
posted by treehorn+bunny at 8:34 PM on December 8, 2015
posted by treehorn+bunny at 8:34 PM on December 8, 2015
This thread is closed to new comments.
You don't sound "off your nut" at all.
posted by JimN2TAW at 1:31 PM on December 8, 2015 [5 favorites]