Primary Care

October 22, 2008

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


  • 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.


11 Responses to “Primary Care”

  1. Nity Says:

    I went to a bad Primary Care dr for 2 years. I so regret not changing sooner. I love my new Primary Care Dr. I’m glad that even though he didn’t have the greatest apt, he did fulfill the main criteria. That definitely needs to count for something!

  2. bellaandherfella Says:

    Too funny, I am watching Seinfeld and they were just discussing the same thing: there are docs who graduated at the bottom of their class, too. Seems maybe you found one. At least he fulfilled your necessities. Good luck with your next IVF!


  3. Cara Says:

    Wow. What a long experience to be left with such a “satisfied – but not impressed” feel. Sorry.

    I, too, am glad that he doesn’t have the power to impregnate you.

    Good luck!


  4. Nancy Says:

    Weird. I don’t know if I’d even be able to finish the appointment with him – I’d maybe of just walked the hell out!

    I thankfully have an insurance plan I do not need referrals from, but I did luck out when I found my PCP 12 years ago. At the time, it was just the doctor’s office literally next door to the condo I lived in. When I moved 15 miles away, I found a new doc but I still find myself going back to him. I rarely see him, as I usually only see the PCP when I’m sick and my doc is always booked. I usually see one of his partners of the NP or whatever.

    I’m kind of babbling about my doctor. I guess my point is that I hope you are able to find someone like him for yourself. At least you can check off one doctor who’ll be ~off~ your list!


  5. Erin Says:

    Here from ICLW. I hate my PCP too. They seem to know nothing especially about m/c and infertility.

    They say that primary care is dying because all of the decent med students want to be specialists to make more money. It seems like we might all be stuck with not so great PCPs.

  6. Michelle Says:

    I hate my Primary Care DR but I am staying with her right now because of the referrals and don’t want to go through the hassle of changing right now.

  7. Sassy Says:

    That is so worrying. I’ve been through a lot of mediocre doctors and it always worries me how many people do have to go to them for important treatment and advice.

  8. eggorchicken Says:

    I’ve also often wondered about the doctors that finished ‘last’. As my uncle always used to say – pass mark is usually 50%, that means people can get qualified whilst not knowing HALF of their work! lol.

    All the best with your next IVF (oh, and I do mean In Vitro Fertilization 😉 )


  9. michellep Says:

    Haha, I love how he confirmed the IVF acronym. You must have wanted to walk out right then and there. And yeah, I’d say needles jabbed into reproductive organs under general anesthesia is worth mentioning, too.

  10. Caba Says:

    What a pain! I agree though, I feel like my PCP really didn’t matter that much when dealing with IF. You PCP gives you a flu shot, your RE takes care of the important stuff. Maybe later when you have less going on in your life, you can take your time and look for another doc. Or keep trying the one not accepting patients, because eventually (maybe?) they will be again.


  11. birdsandsquirrels Says:

    I just went through a similar search for a PCP. I did wind up with a female doctor reasonably close to our house, but she’s not very nice. That’s one of my criteria – nice. I searched all over for pictures of potential PCP’s in my new town because I (probably falsely) thought that if the doctor had a kind look about them, I would be happier with them. Unfortunately, my new PCP had a kind looking smile, but has actually turned out to be rather cold and unhelpful. And her office is yucky and the nurses and receptionist are stupid. I want to find a new one, but right now, it’s too much of a hassle.

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