What’s the difference between primary care and specialist care? Perhaps a little example will help. Mine.
I had just spent a rough night with stomach flu at my motel at Lewisburg, W.Va., and didn’t feel like breakfast before a scheduled 9 a.m. interview at the Rainelle Medical Clinic. When I paid my bill, I should have known something was wrong. I had to look closely to see so I could sign my name.
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Outside, the countryside looked foggy. When I got into my car and started out, a startling truth came over me: There was no fog. It was my eyes. My vision had suddenly dimmed. I could not see road signs, and could not make out much in the distance.
I inched along on the winding highway, driving as carefully as I ever have. I took out my contact lenses with my free hand, thinking that they had somehow fogged over. Not so. Was this what it is like when you start going blind?
It was the longest 45-minute drive I’ve ever had, but I knew one thing: What better place to be going than a primary-care clinic? Then I thought: What would they know about my condition? Won’t I need to see an eye specialist or some other kind of specialist right away?
At the clinic, April Vestal, coordinator of the clinic’s Kellogg Foundation medical scholars, and nurse practitioner Jill Cochran suggested I eat a cracker. Nurse Jocelyn Emerson took my blood pressure. It was fine. They didn’t seem worried. Another nurse had me read the eye chart. I could only see the top line.
They ushered me into the doctor’s office. Phillip Jarvis, a thin, white-bearded man with a wise look, knew I wasn’t the typical patient from the mountains when I began talking about the possible need to see an ophthamologist.
“I don’t run a shuttle referral service here,” he said.
That shut me up. After he examined me, he told me he had never seen anything like this in his years of practice, but common sense told him it was probably related to my apparent virus.
“I think it will get better as the day goes along,” he said. “If it doesn’t, then we can talk about seeing a specialist.”
He was right. Gradually, the vision came back. At the end of the day, I went in to interview Jarvis for my story on primary care and also report to him on my condition.
“Did you notice that the first thing popped into your mind was the need to see a specialist?” he asked. That, he said, is what is wrong with the U.S. medical system, that everyone wants to pursue the highest cost option at the beginning.
He wasn’t sure what went wrong, but said if I really wanted to know, I could contact my eye doctor when I got home. I did. His nurse came on the line and said it sounded like an ocular migraine induced by a virus, but it was impossible to know since it had gone away.
“If it happens again,” she said, “come in and see us.” At $75 an office visit, of course.