One year later, I’m still my own PCP. Here’s why.
About a year ago I wrote about the tricky balancing act of being an informed consumer of one’s health and self-treatment. The responses to the article were overwhelming; some agreed with me, many shared that they had engaged in similar practices over their career, and even more quoted Osler’s famous aphorism that the doctor who has himself as a patient has a fool for a doctor. Largely at the prompting of the comments (and my wonderful wife), I finally set out to make an appointment with a PCP to “get established.”
Not wanting to schedule myself with a colleague, I started my search for my new PCP with my insurance directory. Sifting through a combination of outdated listings of doctors no longer accepting new patients and those whose contact information was no longer up to date, I ended up finding one accepting new patients in-network about a 20 minute drive from home. I was able to get a new patient appointment about six weeks out – not great, but not horrible compared to the other options, where I would be waiting a few months.
I arrived for the appointment dutifully 30 minutes prior to my scheduled time, according to the instructions sent beforehand. The check-in process was smooth enough, and thankfully having filled out my information online ahead of time, there was no additional paperwork I needed to do as I sat down. I waited about 45 minutes – again, not great, but not horrible. After being called back to the small exam room, I was faced with the first challenge of the encounter: deciding whether to reveal my medical background, and when.
This has always been a tricky point for me. Reveal too early, and the doctor may underexplain or overestimate how much you understand about what’s being said, or gloss over details of treatment that they assume you already understand. The conversation runs the risk of becoming a chat between colleagues about your disembodied body, an abstract third party as an object of study that happens to remain in the room with two intellects. Underdisclose, and you risk being talked down to or brushed off – and then having to go back and explain why you didn’t lead with the fact that you had a medical background in the first place.
The truth of the matter is that most of the time, it will come out whether you like it or not – in the smallest moments, perhaps when you slip up and mention the time your grandmother had aFib with RVR when she was hospitalized prior to her death, or when you slip into using other doctor “code words” like presented, episode, or titrate. I’ve found that despite my best efforts, something will inevitably give me away. I decided to start by saying, "I’m a physician, but I’m here today as a patient" – hoping this would get us off on the right foot.
To my new PCP’s credit, they handled the disclosure well, and treated me like a patient rather than a colleague. Some appropriate (in my estimation) bloodwork was ordered, and I was sent on my way, with instructions to follow up in a year or sooner if anything came up. I had thought that morning about whether or not I needed to be fasting, but it turns out that I need not have wondered – in order to get labs done, I’d need to schedule a separate appointment. When I asked for a printed copy of labs I could take somewhere on my own, the staff looked confused but acquiesced – as if it were the strangest thing in the world to not stay within the system for this. Explaining that I had to go to certain labs for insurance purposes did not help matters.
The major challenges came after the appointment. I quickly learned the reason that most people went to the system’s lab – there was no way to get records to this physician that came from outside their health system. There was no external-facing fax number, email, or option to upload documents to the patient portal. While I had the results in hand, I had no ability to give them back to the doctor who had ordered them. Facing the unenviable task of manually typing out a portal message with the results (a service which incurred an additional charge), I instead decided to take matters into my own hands and interpret my own labs.
Recognizing that my cholesterol was higher than optimal, I ended up seeking out a nutritionist who helped me lower my numbers quite nicely. I did at one point drop off a paper copy of my labs at my PCP’s office, having no other way to communicate with them easily. It might as well not have mattered; I never heard back about my results. I suppose I could have called to schedule a follow-up appointment to discuss a nutritionist referral, but my enthusiasm for a follow-up cooled significantly after getting charged a facility fee of about $100 for my visit — a charge my insurance didn’t cover. I quietly wondered how many of my patients in a less fortunate financial situation made the same calculus.
In fairness to my PCP, I get it. Friction is necessary to a certain extent to prevent PCPs like me from being overwhelmed, even though I know it’s frustrating for patients. Routine visits with healthy patients feel just that: routine. But the time you spend for even just a “routine” preventative exam sets the tone for an entire year’s worth of interaction, and the follow-up and next steps you give a patient could be the difference between them coming back better (or worse, if you aren’t providing specific guidance and they do their own research). I was fortunate in that I knew what to do with my next steps and sought it out; a less savvy patient might not understand there was a problem at all, or find bad information about what to do next. If nothing else, the experience exposed a stark truth to me that isn’t always apparent day-to-day for us docs: Most of the things that determine a patient’s health and wellness happen between office visits with them.
In a certain sense, I am still my own PCP. I’m an MD. I’m never going to stop trying to be curious and proactive about my own health, and looking for ways to improve it. I’m going to see my own lab results before my doctor does, and I’m going to try to figure out what’s going on and how to fix it. I’m going to be frustrated with the medical system at times, and look for creative ways to problem solve. But in this sense, I’m not so different from any highly engaged patient. There was value in the PCP visit I made for myself, but not for the reason you might think – it taught me that I’m not that different from the patients I serve, and it taught me more about how I should expect patients to behave based on rational drivers like convenience, education level, and access to care on a personal level.
In a world where access to frictionless services and information are widespread, the experience of getting my own doctor was, to put it kindly, underwhelming. I haven’t canceled my follow-up appointment for next year, but I don’t expect much out of it after my first one, either. I’ve settled on it being wise to have a “second opinion,” on an annual basis, even if I have to supplement what to do in between. I still consider myself to be my own PCP – perhaps not literally, but somewhat spiritually, in that what I do every day impacts my health, not just what I do once a year.
Are you your own PCP? Share how you care for yourself in the comments.
Dr. Brennan Kruszewski is an internal medicine physician in Hudson, Ohio. He is passionate about transforming primary care. He enjoys spending time outdoors, especially biking the trails of Northeast Ohio. He is active on social media, and blogs at his personal website. Dr. Kruszewski was a 2024-2025 Doximity Op-Med Fellow and is a 2025-2026 Doximity Op-Med Fellow. Opinions expressed here are his own and not the opinions of his employer.
Image by ChatGPT
