Dr. Who? Dr. What?

In October, I received a form letter from my primary care physician, announcing that she was leaving her internal medicine practice to become a concierge doctor.

I was not happy to hear this news, as E has been my doctor for well over a decade, and I trust, like, and admire her. E is a good 20-25 years younger than I am, so I had been hoping that she would see me out the door. (Her husband is my dentist, and my hope is that he ain't going anywhere. I've been getting my dental care at his practice for nearly 50 years. E's father was my dentist for decades, and I was delighted when E joined the practice.) 

The form letter from E stated that all of her patient's would be assigned a new doctor by mid-November, and we were not to contact her office. Don't email us, we'll email you.  

When I saw the note, I gulped and did three things: 

• I wrote E a very nice snail mail note telling her that I was grateful for her care over the years, and, while I was disappointed in the news that she was leaving, I wished her well.
• I got in touch with K and M, two friends from different spheres of my life who are also patients of E. All three of us are long-standing members of the E Fan Club. All three of us were upset by the news.
• I wrote an unwanted email to E (or E's practice) saying that, before assignments were made, patients should be asked for their preferences. Mine would have been a woman doctor, one affiliated with Mass General,where I have been a mostly healthy part of the family for nearly 50 years, and one who was relatively convenient to get to. MGH is the hospital where my husband spent the last week of his life. I know my way around there. Brigham & Women's is part of the Partners healthcare system that MGH is a member of. I did not want to get shunted off to The Brigham, even though it is a fine hospital. Whenever I visit someone there, I get lost.

No response to either the note (wasn't expecting one), nor the email (kinda/sorta was).

Pairwise, K, M and I had several convos about the sitch. (As an aside, K is a retired primary care physician, M a retired nurse. They know things.)

On a lovely mid-October day, I was on the train, tootling out to the 'burbs to have lunch with a friend. I was checking my email and saw a notice from Partners. I had my assignment. In suburban Waltham. 

I immediately texted K and M, and spent the rest of my train ride on the phone with one or the other of them.

K had also been exiled to Waltham. M, through a convoluted set of circumstances - and a lot of persistence on her part - had been okayed to see O, a resident in E's practice.

The notification said that the Waltham facility was accessible by public transportation.

Their definition of accessible is not quite the same as mine. 

I plotted a trip, and for me to get from home to the new doctor in Waltham via public transpo would take 1.5 to 2.1 hours each way. It would involve multiple changes train-bus-bus, and, depending on the route, would require a .4 to 2.0 mile walk up a hill. (The detail on the hill climb wasn't included in the route info, but, as it turns out, I used to work in that area and know all about the hill.) 

Not that I would ever be taking public transpo out to the wilds of Waltham - Uber all the way, baby - but, seriously folks, to expect a carless elder who lives a 10 minute walk from E's practice - which is still a practice - to trek out to Waltham seems pretty daffy to me.

When I got home from my lunch, I shot a response off, saying that I thought it was pretty outrageous to assign a carless city-girl elder to the boondocks. I also asked to be assigned to O, the resident physician that M had arranged to see. The curt auto-response was pretty much of the sorry/not sorry variety. It included a number to call if I wanted something different.

So I called and spoke with a very nice young woman who told me that there were no MGH-affiliated PCP's anywhere in the city of Boston taking new patients. She laid out my options, which were mostly in locations farther away than Waltham, but the coup de grâce was that I could get assigned - guaranteed, they're taking new patients - to Amazon One Medical. NO THANKS! Make that NO FUCKING THANKS.

While I was speaking with the very nice young woman, I saw that another message had come in from E's office, this time not an auto-response, but a personal note from E's practice manager. She apologized for the process having upset me, and told me that if I were willing to see a resident - who would only be around for a couple of years - she would assign me to O. 

Yes, seeing a resident 10 minutes from my house was infinitely preferable to schlepping out to Waltham. Over the course of time, I've seen a number of residents and nurse practitioners and physicians assistants. Happy to see any and all. Sure, for continuity of care it's nice to have your very own personal Marcus Welby, but that's not the wave of the present, let alone the future.

Meanwhile, K wasn't able to line up with O, but was assigned to another resident which she, as a physician herself, thinks is just fine.

So all good.

But it's no secret that there's a shortage of primary care doctors, and Mass General Brigham has been hit especially hard. 

So they've now launched:

...an AI app that questions patients, reviews medical records, and produces a list of potential diagnoses.

Called “Care Connect,” the platform was launched on Sept. 9 for the 15,000 MGB patients without a primary care doctor. A chatbot that is available 24/7 interviews the patient, then sets up a telehealth appointment with a physician in as little as half an hour. MGB is among the first health care systems nationally to roll out the app. (Source: The Boston Globe)

Look, medicine is one area where I think AI shows some real promise. I've read that it's proving to be better at identifying breast cancer than mammograms are. And I'm sure that eventually AI will be very good at looking at tests and symptoms and making a diagnosis, which should be especially helpful in rare and complex cases. There's too much stuff to know out there, and doctors really aren't able with keeping up with it all. So bring on AI. (Not to mention that half of us are using AI search to get preliminary diagnoses for ourselves, our friends, and our families. Asking Dr. Google - and making sure that the sources are legit and not some ChatGPT iodiocy spewing bot - helps us figure out what to ask the doctor when we see them.)  

But I'm not fully sold on sticking an AI intermediary (and AI-driven devices) between patient and physician. 

It will, of course, happen sooner rather than later. And there may be plenty of places - refilling a prescription, the common cold - where Dr. AI will perform plenty well enough. But there's something to be said for the doctor in the white coat actually looking you in the eye when they're delivering good, bad, or just sort of meh news.

Maybe MGH needs to start treating its primary care doctors better so they won't be running out the door. It's a demanding job to begin with, and the paperwork, the midnight emails, the Dr. Googling don't make it any easier. But I can certainly see a point where having a personal PCP will only be for those who can afford concierge medicine, while the rest of us "see" a robot, or a doctor in Timbuktu via telehealth, or a rotating carousel of residents and nurses, or whoever it is that's on duty that day in the healthstop or Amazon's fakeroo doctor's offices. 

Me, I'm just happy to be seeing Dr. O for my annual come January.  So what if it's the first, last, and only time I'll see her? Crisis averted, at least for now. No more worrying about Dr. Who and Dr. What. 

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Image Source: SciTech Daily