Dear Primary Care Provider…

Published on by Marilyn

Dear Primary Care Provider: 
I’ve wanted to write this letter for a long time, but never took the time. But after a morning coffee conversation with my 23-year-old daughter, I knew that I owed it to her and to the rest of the United States to write what I’ve seen, write what I know.

Because we’re frustrated. And it’s not your fault, but you are the face of medicine today. So I have a few things I want to say, and I’d like you to communicate these to your colleagues in specialty practices, to your staff, to your former professors, and to your administrators. Thank you ahead of time for listening.

  1. We don’t understand your language. You speak Doctor, and we speak The People. The dialects are completely different. We are smart and successful– but we don’t know what the heck you are saying. So train yourselves to speak with the people, not AT the people.
  2. We are so intimidated by you. Really. You frighten us. You come from a culture that is so rigid and inflexible – that would be the culture of western biomedicine – and we don’t know this culture. And your staff can be the worst. Pick your receptionists, medical assistants, and nurses carefully. Because they can make people feel so stupid and small.
  3. Our bodies sometimes scare us. Look, you study the body for a living. For most of us, high school biology was a long time ago.
  4. When we express something that feels important to us, we often feel dismissed. It’s a horrible feeling to have our vulnerability met by nonchalance. We need you to see the person behind the words; to hear the story beyond the symptoms.
  5. On that same note, I think you expect us to know more about our bodies than we do. We don’t. That’s why we come to you.
  6. Please ask us to repeat back what you have told us. That gives both of us an opportunity to clarify misunderstandings.
  7. We know you aren’t our friends, but we do talk about you at parties. We rave about you if you are good, and we tell people to steer clear if you aren’t. We are your best advertisments. All we ask is that in return you treat us with dignity and respect, and sometimes we feel like it’s missing.
  8. A little empathy goes a long way. And I think in the long run, you will realize that our visits will be shorter if you can express that empathy. I suggest you read The Empathy Exams and The Spirit Catches You and You Fall Down. 
  9. Culture matters. We view illness and health through a cultural lens. If you don’t get that, then you will fail as a true physician.
  10. After we leave you, we fight with our insurance providers. Because the fact is, the Affordable Care Act did not fix a broken system. It merely provided a bandaid. So two weeks after we see you, we usually get a bill. And that’s why we don’t keep follow up appointments. Because insurance is a multi billion dollar industry, and we can both agree that it runs healthcare.

We appreciate you and the work you have put into your education and our appointments. But we need you to know these things so that you don’t lose us.

Sincerely,

A patient, a nurse, and a mom.

PS – please teach your staff how to take blood pressures properly….just sayin’….

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10 thoughts on “Dear Primary Care Provider…”

  1. You know…I’m wondering if this is an East Coast Doctor thing? I don’t have any experience with doctors on the east coast. But I have loads of experience here in the midwest…and even more now taking my mother-in-law to countless appointments both with her primary care doctor and with many specialists. I have not experienced doctors the way you have. The ones we’ve seen (even in the last two months) have been generally patient and kind-hearted. They seem to take the time to connect, even with the elderly who struggle to understand the quick speech of the medical world. We do have the problem of long waits in doctor’s offices but I think that’s because the doctors are really taking the time with previous patients. I’m just wondering if this is a regional issue here in the US and not a nation-wide problem.

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  3. Thanks for a great post, Marilyn. Every point seems right on the mark, but your comments about physicians needing to select their staff carefully really caught my attention. I’ve known too many excellent doctors who, good as they were, just weren’t worth putting up with their staffs. I’ve often wondered if some of the very character traits that make for an exceptional PCP mitigate against sound hiring and managerial skills.

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    1. That is really true – have never thought about that. I would love to make medical office etiquette mandatory. It should be the LLBean model – Customer is King!

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  5. Marilyn, I appreciate this blog. In all my 84 years of visiting health providers I can honestly say that for the most part, my experiences have been good and in some cases excellent. However, now that I am a medically vulnerable Senior I will admit that our medical care system is leaving a lot to be desired. Medical office managers usually schedule a patient every ten to fifteen minutes. That of course leaves little time for one on one with the physician. The receptionist, the scheduler, the nurses, the lab, the technicians, the PA, the rent, the taxes, the malpractice insurance, and on and on, have to paid. Patients are essential as they are the paying customer. As customers we do have the right too speak up. Most of us are too intimidated to do that. We have a doctor friend who recently told us that one of his patients fired him. He said the patient had an unusually long wait period and when he finally got to him the patient shouted, “Your are fired! I am firing you!” The patient left. Perhaps patients have been too patient too long and it’s time to muster the courage to speak up. Sorry this is so long.

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  6. Well said! I would like to add to the list. Take our time as valuable just as much as you want us to value yours by paying your extraordinary amounts of money for your time spent with us. Please don’t over book and make us wait and ungodly amount of time when my time away from my work, family and personal life is just as valuable as yours. Then, because you are over booked you come in and out as if we were part of an assembly line.

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