Exhibit A: Five year old child goes to the ER with a swollen ear. Yes, swollen. As in, inflated a full inch away from where his ear SHOULD be located on his head. After sitting and waiting for over an hour (or two or three, time seems to stop inside these clinics), one quick review and the technician says, "Yep. It's an ear infection. I'll get you some antibiotics and you can schedule a follow up in three weeks." Fortunately, Momma won't take no for an answer in this situation (she KNOWS ear infections and this is something else). After a second opinion, the child is taken for a CAT scan to "check for an infection in the brain." Really?? We've gone from "Take two aspirin and call me in the morning" to "Your child may have a serious issue .... with .... his .... brain!?!?!?" The child ends up being admitted into the hospital and being pumped with high-octane antiobiotics for three days before being released.
Exhibit B: Army wife is seeing her primary care physician and is asked the standard "depression" questions. Some variation of: Have you felt sad or hopeless in the past two weeks? Have you lost interest in activities you once enjoyed? Have you cried uncontrollably during the past two weeks, etc. etc. Her husband has been deployed for over six months, she's tired, she's down, and ALL of these questions apply to her state of mind at this time. She bravely answers "yes" to all of the questions ... to which the technician says, "Okie-Dokie. I'll go see if your PCM is ready for you." Nothing else was ever mentioned at all! She said later, "I'm glad I wasn't suicidal when I got there ... because THAT certainly wouldn't have helped."
Exhibit C: Exhibit C is my own story of EVERY TIME I VISIT OUR CLINIC. I am not sure what ailment I would need to impress somebody there, but they always seem to treat me like I am some kind of nutcase who just needs a pat on the back to make it all better. To be clear, I am not sick often (really. hardly ever.) and the times that I am sick, I really wait until there is an obvious issue that over-the-counter medications are not resolving for me. I am not a frequent visitor and I am a courteous patient. I arrive on time, answer all the questions succintly, and try to be an overall pleasant person during these visits. So why is it that I am treated like I have a mental condition instead of a physical one? Many of the PCMs I've seen are condescending, arrogant, or just plain uninterested. This is not what I want for the person who is supposed to be responsible for my health and well-being.
Let me caveat this by saying that every specialized department I've ever used is completely the opposite. The EENT clinics that my son has seen (on numerous posts, with two surgeries in two different places) are highly professional and take the time to make sure you understand the ailment and treatment options. Both prenatal, labor-and-delivery, and mother/baby units that I encountered (with the birth of both boys) were fabulous! These providers were helpful, friendly, and (gasp!) interested! Is this so much to ask of primary care providers?
I've decided that these PCMs have several things going against them ... one, the sheer volume of people they must see each day. I think most are over-worked, probably underpaid, and deal with a lot of people every single minute of every single day. Two, there are lots of crazies out there who will blame the doctor, the nurse, the technician (and anyone else around) for the slightest inconvenience ... and you might have the appointment right after them! Three, because they do see so many people, developing one-on-one relationships are difficult. The PCM will not necessarily know you, your kids, your job, or your history. This must make it more challenging to always prescribe the best care.
If you're new to the military, please don't let me discourage you. I know there are dedicated professionals out there who are not jaded by the sheer volume of people they must see each day. And if you are new, here are some things I've learned (and am working on) to ensure my own well-being ...
- Arrive on time. On-time in military clinics means at least 15 minutes prior to your appointment time. They will write down your arrival time and nothing says "I'm here to waste your time" like a late arrival time.
- Write your ailments down, adding as much detail as possible. It's less likely that anyone can make you feel uneducated when you come armed with facts. Specific symptoms, remedies tried, dates, times, and notes on what helped/didn't help all help you keep yourself straight and prove that you are taking this appointment seriously.
- Write your questions down and ask them. If they make you feel rushed, tell them the number of questions you have and don't let anyone sweep you out the door. Say, "I have four questions for you before I go" and make sure you get answers.
- Follow your instincts. If something doesn't sound right (like "Oh, it's just an ear infection") and you know it, stand firm and request a second opinion. Be polite, but don't back down. Sometimes, big things can be missed and you should be prepared to demand appropriate care.
- Keep a good attitude. This one may sound odd after reading my earlier complaining, but I do think this one can go a long way. People are generally more friendly and helpful to those who present themselves as generally pleasant and competent. I will always give the benefit of the doubt to the provider and know that I did what I could to make the meeting positive and productive.