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I’m Healthy. What do I do now?

December 22, 2013

You can uncover your eyes.  I’m not going to write about Obamacare.  The Affordable Care Act has been discussed on the health blogs exhaustively and comprehensively.  And then discussed again.  Whether you like it or not, it’s here.  The next problem is:  now that I have my insurance, what do I do with it?

If health insurance were like car insurance or home-owners insurance, you would get coverage and forget about it.  It’s there if you need it.  Since health insurance is not really insurance at all and is more like a method of payment, now that you have it you can use it right away.  You don’t need to wait for an accident or a flood.  You can make a flurry of appointments with all kinds of folks with that magic plan number.  Except for the deductibles (watch out, those can be substantial) the cost of it all is spirited away and you never hear about it.  But remember, the cost is still there.  The ACA does almost nothing to reduce cost.  It’s just that now the amount of skin you have in the game is substantially reduced.

So what to do?  If you are healthy, I would recommend an initial visit with a primary care provider.  Not to find out if you really are healthy.  Not to get a whole battery of tests to “make sure”.  In fact, you may want to refuse all the recommended screening tests at first.  The reason to see a PCP is to establish  A RELATIONSHIP.  The absolute best way to get a doctor to take good care of you is to make sure they know you.  Talk about your wife and kids, your golf game, your deepest fears, whatever.  This doctor (it could be a nurse practitioner as well) will ask you a bunch of questions about your health and the health of your ancestors and behaviors that affect your health.  Answer as truthfully as you can because when the @#$%^% hits the fan, the more your doctor knows and understands you, the more they can help you.  You don’t need to see this person every year or every other year.  Annual physicals have not been shown to improve health.  Just make sure someone knows you.

How to find that primary care provider?  This one is tricky.  You could just go to whoever’s closest or whoever is listed first in the phone book.  But because you are looking to establish A RELATIONSHIP you would like to try to find someone with whom you “click”.   Someone who has the same goals for you that you do, or is at least willing to adjust their goals to yours.  Or who has the same sense of humor.  Or who hates avocado.  Whatever.  The single best way to do this is to ask someone who is a lot like you where they go.  If everyone you know hates their doctor, start with someone of the same ethnic background or gender, if that matters to you.  This is not racist.  It is absolutely true that a doctor who is more like you is more likely to be someone who will be responsive to your needs.

If you haven’t seen a doctor for a long time, the doctor might give you a long list of screening tests that you need to get.  You don’t need to get them.  The list is based on standard of care and best practices by large physician groups and panels of experts.  Each test may or may not be appropriate for you.  Remember that if you are healthy and have no family history, screening tests are often more likely to find something wrong that isn’t really wrong and scare the boogers out of you for no reason.  Also remember that, unfortunately, PCP pay is increasingly tied to their “compliance” with these tests.  So your doctor kinda has to suggest them.  Discuss. Make a good decision for you.  Here is where THE RELATIONSHIP becomes more obviously important.

A final word.  Your PCP likely doesn’t have much time.  If you have a specific concern, or if you didn’t get everything covered you want to get covered, make a follow-up appointment specifically for that.  Or ask your doctor if they respond to email, as many increasingly do.  Again, most doctors don’t get paid for anything they do that is not booked as and “appointment” so don’t get bent out of shape if they need you to come in.  It’s a really bad system.  Welcome!

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