Understanding whether you should see a physician and which one you should see based upon your condition and health insurance plan, while having a limited knowledge of health care and the system is a complicated task. Health care has become so big and so specialized, advances in treatment happen so rapidly, that it is difficult for a physician to keep up with the changes, let alone a patient. Add to this the burden of determining what your health plan might or might not cover and how you need to route through the system or schedule your visits so that you are not left holding the bill can be a daunting task. This can be further complicated by the fact that most patients do not understand what to expect or what is appropriate treatment or an appropriate outcome for their condition.
As an example, I have two sons with asthma. It took a Physician’s Assistant watching them play sports who said to my wife, an RN, “you know I think your boys have asthma”, to get us to look at the coughing differently. Whether denial or oversight, she was right. Following the diagnosis, we spent 5 months getting their condition under control. During this time we had multiple physician visits, self referred to a specialist, there were disagreements between the pediatrician and the specialist on how aggressively to treat, the use of oral steroids because they got very sick, weeks of nights awake with a nebulizer and even an ER visit, which just upset my wife to no end. All of this happened, and we knew the health care system and had some clinical expertise! In the end, through persistence we were able to get answers and appropriate, excellent health care. Today both have well controlled asthma.
For others we know, it has been a similar story, but not necessarily a similar outcome. Many of our friends children have asthma and it surprises me how many appear to be experiencing excessive coughing and high usage of their short acting medications. Per the treatment guidelines their asthma is more severe than that for which they are being treated. Often times, my wife, a pediatric nurse will speak with the parents and provide them with questions to ask their physician as well as tell them to track the coughing and inhaler usage and report that to their doctor as well. Because the parents do not understand what the evidence based guidelines are or the possible outcome of successful asthma treatment, they have no idea that things could be better. Unfortunately, most are not lucky enough to have a healthcare advocate as part of their family.
This is one reason why having a care coordinator or health advocate can be so important. Having a nurse or other health professional that can be called upon when dealing with questions and situations which go beyond the patient’s knowledge of health care can lead to better outcomes. Sure it would be great to be able to call your physician, ask them the questions and be comfortable that they have the knowledge on the latest treatments and time to deal with the issue. But unfortunately given the current system, primary care physicians do not have the time. Will they have more time under health reform? I’m not really sure. To get more time with your doctor, they need more reimbursement. This may be possible, but the other problem is that there are a limited number of primary care physicians and the projected shortfall, particularly when the uninsured are placed into the health care system, as is proposed under health reform, is projected to make this problem even worse.
So for now at least, the best answer is to have your own personal nurse or other health professional who can serve as your care coordinator/health advocate. Check with your insurance company or your companies HR department to see if these services are provided. They can be helpful whether you have a chronic condition or are just trying to change your behavior and become healthier.
If your company is interested in providing these types of services, contact U.S. Preventive Medicine.
Thanks to Ashley L. Reynolds, MSN & Certified Health and Fitness Specialist from the American College of Sports Medicine; U.S. Preventive Medicine’s Senior Vice President of Health and Member Services for his assistance with this post.