— I was lucky to get the care I needed during a recent emergency. Everyone else deserves the same.
by Fred Pelzman, MD, Contributing Writer, MedPage Today
Fred Pelzman is an associate professor of medicine at Weill Cornell, and has been a practicing internist for nearly 30 years. He is medical director of Weill Cornell Internal Medicine Associates.
Some of you (I hope at least a few of you) noticed that I’ve been away from this column for a few weeks. Unfortunately, it was because I became a patient.
I woke up at 4 a.m. a couple of weeks ago with excruciating lower back pain. I tried to push through it — tried getting dressed for work — but eventually it became really quite unbearable.
By the time I decided to head over to the emergency room, I started to realize what people mean when they say they have “10 out of 10” pain. This was something I couldn’t ignore. My eyes were swimming; I was diaphoretic, tachycardic, pale, and retching from the pain.
At first I thought I had a kidney stone, since I’ve had these in the past, but with my kidney stones, I always tried to move around to find a comfortable position. In this case, however, no position was comfortable and every movement made things worse. A very tolerant NYC cab driver took me across town — tolerant because I was writhing all over the back seat of his cab, at times with my feet up on the ceiling — and he generously offered me a plastic bag to barf in.
After a couple of hours in the emergency department, and after finally getting my pain controlled enough to let me hold still for a CT scan, we concluded that it was not a kidney stone, and no significant pathology was noted. Unfortunately, however, no cause for my pain was detected. The emergency room team decided it was something musculoskeletal, and sent me home with pain medicines.
The care they provided for me was outstanding and timely, and they paid attention to someone who was clearly in extremis. And I didn’t even have to flash my MD identification. But left without a clear diagnosis, I realized that I couldn’t continue on pain meds and function normally. So, I reached out to some colleagues who were terrific about getting me in and getting me evaluated, ultimately leading to a diagnosis and a treatment plan, all of which took place over a couple of unhappy, opiate-fogged days.
Looking back on this period of time, I realize now how precious and privileged it is to be able to get this kind of care — the right care at the right time. If I didn’t have insurance, if I didn’t know the right people, and if they weren’t ready and able to squeeze me in and expedite my care, I might still be suffering.
Many of our patients face these uphill battles; it’s a crime that we’ve allowed our healthcare system to become something that doesn’t get our patients the care they need right when they need it.
After coming out from the pandemic, we’ve seen a flight of physicians across every specialty away from healthcare. They’re moving into different ventures and walking away from primary care and even specialty medicine. The shortage of physicians is bad, and it seems as if it’s only going to get worse.
We’ve all spent enormous amounts of time apologizing to our patients, after we place a referral to a dermatologist, gastroenterologist, surgeon, or cardiologist, and then they send us a portal message saying, “No one can see me for 2 [or 4 or 6 or 8] months or more. Isn’t there something you can do?”
As I’ve talked about before, a lot of this comes from the primary care doctors being overwhelmed and having to refer out things that they ordinarily might manage on their own. Another problem is that subspecialists are often managing chronic patients who should be turned back over to their primary care providers for ongoing care of stable and less complex issues.
But I worry that in the developing political and social environment, these things are only going to get worse: the doctor shortages, the access to care, and the disparities in care between the well-insured, the insured, the barely insured, and those at the margins doing without. How are we going to make America healthy again without healthcare?
Now is the time to invest in primary care, by leveling the playing field, by increasing the access our patients need, and by building up centers of care in underserved areas such as low-income neighborhoods and rural communities. We can build smarter systems to help us take better care of people, make sure they get everything they need, keep their health maintenance updated and chronic medical problems controlled, and never have anything or anyone fall through the cracks.
There were lots of people there to catch me when I needed it, and everyone deserves that. I call it 10/10 healthcare.
