Primary Care

As part of the sequence of necessary events leading up to IVF #2, I just went to see a new primary care physician. With my new insurance, I had to establish a PCP as well as obtain a referral for infertility treatment and for the hysteroscopy that Dr. Full Steam Ahead is recommending.

My main criteria in choosing a new PCP:

• not too far from my house
• will sign off on referrals

Preferences:

• female
• knowledgeable about infertility
• competent

I received separate glowing recommendations from my acupuncturist and from a lady who does pottery with me for a female physician in my town. With two recommendations for this woman, and zero recommendations for anyone else, she seemed like an obvious choice. However, she wasn’t accepting new patients. Neither were any of the other female physicians in the entire town. It’s not a big town, but there are several female physicians from whom to choose (or in my case, from whom I could not choose).

Finally I found a male physician in town who was accepting new patients, who would make an appointment in less than two weeks, and who was on my insurance list of PCPs. Good enough.

With REs, I’ve always gone to the kind of doctors who were in the top of their class at their prestigious medical schools. It turns out that if you do the math, even the most prestigious med school has people at the bottom of the class. Apparently that’s where Dr. Primary must have been. To be fair, I don’t know why someone at the top of his class would work in a small practice in a small town, affiliated with a small non-research hospital. The fact that Dr. Full Steam Ahead is a superstar located within 20 minutes (albeit at a large practice affiliated with two larger research hosptials) is very lucky.

Anyway, here are some highlights from my visit with Dr. Primary:

• I waited over one hour before being seen — for a morning appointment
• I did not fill out any paperwork. Even as a child I cannot recall a doctor where I never filled out any paperwork. I even have to fill out paperwork when I get a massage — at the airport. I answered a couple of questions for Dr. Primary’s receptionist, and a few for the nurse and doctor. Dr. Primary conducted the most cursory family history and review of systems I have ever encountered, even compared to places like urgent care and university health clinics.
• In his questioning about my surgical history, I mentioned IVF. Comment #1: “Oh, in vitro fertilization?” Do the letters IVF stand for anything else? I don’t think so, but I guess it’s good for him to double-check. Comment #2: “It’s not really a surgery. It’s more of a procedure. It’s not that invasive.” My response: I was under general anesthesia, so it seemed worth mentioning. Also, it’s actually kind of invasive. If someone were poking holes in his reproductive organs, he might reconsider.
• He was full of weird assumptions. When I mentioned needing a hysteroscopy because of M/C #2, he asked, “So did you lose the baby around 12 weeks?” No, actually, not even close. Why would he guess that?
• At the checkout desk to obtain my referral paperwork and hand over my co-pay, I saw referral paperwork for a different patient to a gynecology and infertility office, with the patient’s name in full view. I don’t know whether she was being referred for gynecology or for infertility, but it made me think that my name will be next to be broadcast for all of my neighbors.
• After the meeting with the doctor, the nurse came back to administer my flu shot (while I was there, might as well…). She asked me how I liked the doctor — a very loaded question. I said he was nice. “Oh, isn’t he? I just love him. I’m not allowed to go to him because the staff can’t be seen in this practice, but if that rule weren’t there, I would definitely see him. Of course, it might be a little strange for your boss to be your doctor, I don’t know. There’s a gal who works here who says, ‘I don’t want my boss to see my hoo-hah!’ (laughs hysterically) She is a hoot. I told her, ‘The doctor doesn’t usually look at your hoo-hah, you see a different doctor for that.’ But I guess she has a point.” Me: “Mmm-hmm.”

In this era of paperwork paranoia and HIPAA hysteria, it’s quaint to see a small-town practice that isn’t a stickler for documentation nor privacy. Slightly bothersome, but mostly quaint.

In the end, Dr. Primary fulfilled both of my main criteria: referrals for infertility and the hysteroscopy, walking distance from my house. He fulfilled none of my preferences, but those were much less important. It’s just a funny counterpoint when the other doctors I seek out have to be the absolute best or I feel like it’s pointless, to encounter a pleasant but decidely mediocre doctor. Thankfully, my chances of reproductive success have nothing to do with him.