Healthcare doesn't suck, we're just doing it f*cking wrong.

Here's how to start doing it better - literally today.

Tiffany Ryder

Oct 02, 2024

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I hate flying.

Not like… ‘It makes me uncomfortable to sit in a middle seat’ kind of hate. More like, ‘TSA wrongfully assaulted me in the New Orleans airport and I will do absolutely anything to avoid flying’ kind of hate.

So, there just aren’t enough fancy cocktails or muscular, bronzed bodies lying in the California sun compelling enough to get me to book a flight there.

But of course, you know what is compelling?

Healthcare Reform.

Which is how I ended up across the country in San Diego talking to HR leaders at Benefits At Work 2024 discussing one of the few experiences on this earth worse than being fondled by TSA… the Emergency Room visit.

ER visits used to be an anomaly in the US, and still are in many countries.

But something’s changed here.

So, what is it?

Well… even if I take off my tin foil hat (which I’ll definitely be putting back on), a look at the data on the accessibility, utilization and quality of primary care has more to do with whether or not patients end up in the ER than just about anything else we can measure.

As someone who has worked in a variety of hospitals in both Europe and the US, this fact also resonates with my personal and professional experiences as well. Over time I’ve become absolutely convinced that…

Foregoing quality primary care is THE biggest mistake patients make in managing their health, and it’s also one of the BEST tools in our toolbox as a society and as individuals to prevent unnecessary ER visits & the associated harms & costs that come with those visits.

Given that over 100 million Americans don’t have a relationship with a primary care clinic, odds are that at some point you've ended up at urgent care or the ER simply because you weren’t an “established patient” at a primary care office.

I hear this one a lot. And I get it -

Sometimes people need timely non-emergency care and you just don’t know where to go to find it.

On every single ER shift, I see kids who ARE. NOT. DYING.

No broken bones, no trouble breathing, just run-of-the-mill mild stuff… pink eye, rash, cough for 2 weeks… things like that. And before you get pissed at these parents because, after all, what kind of inconsiderate monster would risk their kid getting some sort of weird infectious disease in the ER waiting room all while having their employer spend 3k on a visit for something that’s really, ‘not that serious’?

Let me share a little story.

ME:

5-min into my exam of a 6 year old I’ve had to chase around the room

“So Peyton actually looks really good considering you guys are here and her chart says she’s been coughing and sick for the past 2 weeks. What actually brought you in on a Tuesday night, because I’m happy you’re here but thankfully, I’m not seeing anything that’s concerning to me?”

THEM:

“Well, we’ve been trying to get her into see her pediatrician but they still won’t see kids who have a cough, fever, sore throat… and honestly, we were just starting to get worried because it’s just taking her a really long time to get better and the school won’t take her back without a note. We didn’t want to bother you but we didn’t know what else to do”

This is the point where I usually stop listening and start focusing on controlling my face because I’m absolutely livid - I naively believe that doctors have a duty to care for SICK PEOPLE, but I digress…

I tell this story to point out the very real fact that over-utilization of the ER is a systems issue with many contributing factors and is NOT simply a problem of ‘inconsiderate, entitled sick patients’ or ‘paranoid, anxious parents’ who should already know how to just ‘do better.’

Because the reality is:

The skill of communicating effectively with your clinical team and being able to navigate the system in order to get “the right care, in the right place, at the right time,” is just not an easy one.

And in the moments where primary care is unaccessible or confusing, for one reason or another, urgent care or the ER seems to provide a totally reasonable alternative, even though insiders know and the data are clear, that for non-emergencies - it’s not even close to good enough

Consider this.

More than 250,000 Americans die or are permanently disabled due to medical error every single year and 1 in 10 adults have medical debt - the ER contributes heavily to BOTH of those problems and the solution is hiding in plain sight.

Let's talk through the reasons why I think you should perhaps reconsider this narrative: ‘specialists offer better care’ and reconsider the way you might be thinking about primary care.

Specialty care (including the ER) is a harmful surrogate for primary care

And most patients don’t realize how much it’s costing them.

Reason #1: Specialty care is less likely to be as effective.

Specialists are highly trained to execute well in their niche, but that does NOT mean that their skills provide the best solution for your particular medical concern or that they are an expert on YOU as an individual (and I say this as someone who practices IN a specialty)

Medicine has become increasingly siloed with patients being treated by multiple clinicians in many different specialties with no one taking time to reflect on the full picture which means - things are missed.
Clinicians must take on increasingly larger numbers of patients. There are associated increases in documentation, and only a minimal exchange of information between members of the medical team which means - things are missed.

It’s exactly how you would go about creating a perfect environment for catastrophe.

Omissions and miscommunication regarding your medical history or medications can be harmful on a spectrum from ineffective to deadly - and to add to that risk you must also consider time to access care, which brings us to....

Reason #2: Specialty care is more likely to be delayed.

Delays are common in medicine, and they often compound medical problems - from an 8-hour stay in the ER to a 3-month wait to see Endocrinology - patients without primary care wait more.

Pre-diabetes becomes diabetes, because you didn’t know you were at risk.
Bladder infection becomes a kidney infection or even sepsis, because you couldn’t get treatment in time.
Fatigue becomes stroke while waiting to see Endocrinology, because it was actually your heart causing your symptoms, not your hormones.

But it’s not just the lack of oversight with increased risk of medical mistakes or the risk of harms from delayed care, unnecessary use of specialty care is also… incredibly expensive.

Reason #3: Specialty care is pricey.

Although this is intuitive, it’s worse than you might think.

A review of 2023 data shows that the average cost of a visit to a traditional primary care office runs about $170, while a trip to the orthopedist is $446 and an ER visit dials in at an average of $2450 (14x more expensive).

High costs are easier to justify when you need the level of care offered, but when it’s simply a stop-gap for primary care, is it worth the elevated risk or the elevated cost?

It’s also worth noting that, for non-emergency problems suited for a primary care office,

Specialty guidelines will favor over-testing and over-treatment because they are designed specifically for more severe or specialized cases that couldn’t be treated in primary care.

Read that one again.

Harms compound quickly, but thankfully solutions are squarely within your power to implement.

The easiest way to protect yourself and your family is by finding an amazing primary care clinic.

And by the way, this isn’t nearly as difficult as people think -

Here’s how.

Tip #1: Understand all of your options.

It used to be that everyone simply went to the Family Medicine Doc or Pediatrician in their town - and if that didn’t work, 'TOUGH!' - but in 2024, the landscape is different.

As a result of changes in billing, some clinics have cut out insurance billing altogether in order to better serve their community. This model is known as ‘Direct Primary Care’ (DPC) and it’s similar to what you might think of as ‘concierge medicine,’ but without the hefty price tag.

It’s basically a subscription for care (like Netflix) where unlimited visits to your doctor cost less than most cell phone plans and because they keep the total number of patients they see smaller, you can almost always get same-day appointments. In my experience, most DPC practices arrange for patients to get labs and imaging at cost or close to it, and (if your state allows it) many offer 'in-house' dispensing of generic medications (also at cost).

Side note - I actually discovered DPC when I quit my job and went back to graduate school & because I couldn't afford the 10k deductible on my ACA plan. The local DPC doc cost me $70 a month for unlimited use and had a 4.9 out of 5 star Google rating, so I tried it. I loved it and have been getting great care ever since.

To check out these types of practices near you, Google ‘direct primary care near me’

Tip #2: Make it pleasant.

It’s harder to do things you expect will be aggravating, so take some time to set yourself up for success by defining what would make using primary care more enjoyable for YOU personally.

Are telemedicine services important to you?
Can you get a same-day appointment when needed?
Is the person answering the phone pleasant and friendly?
Do Google reviews suggest most patients are happy?

Doing this research takes a little work upfront, but it carries enormous value.

Tip #3: Use this script.

Most of us weren’t taught how to navigate the healthcare system, but this particular step is easy. After you’ve done your research and are ready for the next step, you just pick up the phone and say these magic words to whoever answers the call.

“Hi, I’d like to make an appointment to establish care. Can you please talk me through the process?”

Ta daaaaa! It’s literally that simple.

And while obviously this won’t fix everything right away and of course finding the best fit takes some trial and error, once you do, it pays in dividends.

So until next week,

Tiffany