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"So, what do you do for a living?"

How often has each of us heard this at a dinner party, a birthday party, or some other event with a bunch of people we have never met, and felt a little hesitation as we started to think about how to answer?

"I'm a physician, a primary care general internal medicine doctor."

A Variety of Complaints

Sometimes, this is met with downright admiration for us. "Thank God for you primary care doctors; we need more of you." "Why aren't there more of you?" "You should get paid as much as those specialists."

Sometimes, they respond with a polite smile, and then nod and turn away. But more often than not, I find we all get led down an often long and contorted series of paths, involving a rehash of the trials and tribulations of our current mess of a healthcare system.

Sometimes, it's a long litany of complaints about their primary care doctor. "I tried this practice -- it was total chaos. I could never reach them on the phone; no one ever called me about my results; no one could diagnose me or figure out what was wrong with me; no one spent any time with me or listened to me; the doctor spent all their time in the exam room typing into the computer and looking like they were about to start swearing."

Sometimes, they complain about their inability to find a doctor at all. "No one takes my insurance; there's a 6-to-12-month wait list to get in to see the doctor; my former primary care doctor went concierge; everyone the insurance company told me was in-network isn't taking new patients."

What's the Best Way to Respond?

Sometimes, it behooves us to kindly and gently respond to each of these issues, to help try and make some sense of this terribly messy system we've allowed to be built up around us.

"Well, your primary care doctor probably gets 100 of these patient portal messages every day, so they may not be able to respond immediately to your question about whether you need to get the old COVID-19 booster today or wait until the one for the next variant comes out."

Or "I know that the subspecialist you see never answers your calls, but it's not your primary care doctor's job to explain their test results or refill the medicines they prescribed for you, or explain why the surgery they did still left you in pain."

Or "I know it must be frustrating after you do blood tests, and you walk away with a lot of complicated instructions, and you're not really sure what to do, but trust me -- your doctor is probably trying really hard."

Consider the Reality

In fact, that doctor is probably coming in early, leaving late, packing patients into an already overbooked schedule, working through their lunch hour, and answering portal messages, emails, and sending lab results messages through their dinner hour and on toward their "pajama time," when they should be spending it with their families or caring for themselves.

Yes, it would make a lot more sense if the doctor had a lot more people helping them: more people answering the phones, more people helping them make the electronic medical record work for them instead of against them, more nurses, technicians, physician's assistants, social workers, and community health workers -- but somehow, that doesn't work into the economics of the business plans of either a small private practice or a large academic medical center.

And you're right -- it's probably unfair that your doctor went concierge. No, I can't explain why, even though you pay them thousands of dollars a year extra, when you called and asked to be seen that day, they said you should probably go to the emergency room.

I understand it can be frustrating, when you come out of their office after telling them what's the matter with you and what's been bothering you, that you now have seven different referrals to seven other doctors. But to be honest, no one's giving your primary care doctor the time and the resources to be able to really help figure out all those things on their own in a 20-minute (at best) office visit.

Just recently, at an evening fundraiser with a large group of people I didn't know, after telling folks that I was a primary care general internist, I found myself in the middle of a long tirade against all the ills of the healthcare system, from bureaucracy and regulatory rules, the demands of the electronic medical record, the billing requirements and volume issues we face, the lack of support, the challenges of dealing with insurance companies and trying to get our patients the medications and procedures that we think they need. I felt myself growing red in the face, and had to stop, slow down, and tell myself that these folks probably didn't want to hear all of this, me standing on a soapbox.

The Dream Scenario

Wouldn't it be great, sometime in the future, if every time we introduced ourselves at one of these events, the person across from us replied with one or more of the following:

• "That's amazing, I love my primary care doctor. They're pretty near perfect. Not only that, someone always answers the phone at their office, a live human being, every time. They help me get in to see my doctor when I want to see them, and if they're not available, then they arrange for me to see someone else who can help me take care of this issue."
• "Everyone at the office makes sure that everything I need gets taken care of, that all my information in the system is accurate, that I'm enrolled in the patient portal, and that I know how to use it."
• "I get to spend time with my doctor and the nurse, and other members of the healthcare team, all of whom I feel are totally devoted to making sure I get the best care, the right care at the right time."
• "I have plenty of opportunity to get all of my questions answered, in a way I can totally understand."
• "My test results are communicated to me in a timely fashion, by someone who can take the time to really explain what they mean, and what I need to do next to take my healthcare to the best place."
• "When I start on a new medication, someone calls me to make sure there were no issues with insurance or the pharmacy, goes over how to take it, checks on efficacy and side effects, and helps me make a plan for my health."
• "When my doctor wants me to see a subspecialist for something that they've tried to manage and need some help with, then there's almost always someone available in an appropriate timeframe to help figure out this conundrum."
• "My medications are covered with co-pays I can handle; my bills from the insurance company are not confusing: everything is covered that I need; and I have all the support I need to make sure I get all my preventative care done and manage my acute and chronic medical conditions."
• "So, yeah, I think it's wonderful that you're a primary care doctor. Everyone appreciates you and what you do for us all."

I'm just saying.

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