Primary Doc: We Don't Like Gatekeeping, Either

In 2003 I almost died - simply because I did not have a referral.

I was in the process of moving back to my home town, when I began having a flare up of Crohn's disease: diarrhea, cramping, pain, blood in my stool, and a constant, gnawing fever. I knew exactly what the problem was, and exactly what medicine I needed, but I could only obtain the medicine from a gastroenterologist. Lucky for me, the very same gastro who diagnosed me as a kid and treated me for many years was willing to work me in. Unlucky for me: I didn't have a referral - and my insurance company wouldn't pay for any of it.

That meant I had to see a primary care physician first: I had to find a PCP that was accepting new patients, and wait for a "new patient" visit to open up. Weeks and weeks went by, and every day I grew sicker and weaker, until finally I was allowed to spend thirty minutes in a PCP's waiting room, 5 minutes in her exam room, and sent away with a referral to see my gastro. Two months after my symptoms started, I finally got the medicine I needed - but I was debilitated, wasted, and damn close to dead.

The referral process has always struck me as one of stupidest and most obvious inefficiencies in our health care system. Even in the best of health, I still need to see a gastro at least once a year; because referrals are only good for six months, that means I have to see my PCP first. For someone with a chronic, incurable illness, this makes no sense: the process costs me an extra twenty bucks, but it costs my insurer additional hundreds.

And, of course, primary care physicians don't much like it either. So argues Chris Rangel: "the importance and utilization of primary care has been marginalized even by patients who increasingly see it as a bureaucratic burden." And primary care is probably the most important, essential, and efficient part of our health care system. As Dr. Rangel puts it, "primary care works!"

I have a great PCP today, and I see him regularly for matters unrelated to Crohn's. Patients like me should see PCPs - but because PCPs can give excellent care, and not because they're reduced to gatekeeping for the insurance companies.

Photo credit: storem