I have three adult daughters, all college graduates. All are in long-term relationships with men, children, dogs, and careers. I am “Dad” and will always be Dad. I additionally happen to be a physician who cares for adult patients. If they are ill or have a medical problem, their first phone call is to my cell phone. If it’s not a phone call, it’s a text message. I do not bring this up to give the impression that I am complaining about it. They are my children; I love them and always will. Anything I can do to comfort or help them is always fine with me.
I have stressed to them that they need to find a family physician or internist to handle their medical care which is compassionate, available, caring, accessible, and will advocate on their behalf. The older two are financially secure enough to find a concierge physician, and I have encouraged that. My younger adult daughter lives about one hour south of my home and practice. She has a primary care physician under contract and on her Blue Cross Blue Shield PPO panel. That internist is an employee of the large medical health system that recently purchased my local community hospital. They have been purchasing doctors’ practices and putting in place hospital-employed physicians with the speed and rapidity that a wildfire spreads in the dry California brush propelled by the Santa Anna winds.
My daughter called me this morning at 6:15 a.m. with a 102-degree fever, sudden onset of body aches, chills, sweats, and “a killer sore throat.” She is vaccinated against influenza but had a flu assay-positive case in December 2022. She wondered if she could catch the flu again.
My toddler grandchildren attend daycare and pre-school and bring home febrile viral illnesses in abundance almost weekly. Bacterial Streptococcal infections and respiratory syncytial virus are epidemics locally along with flu and high risk of COVID, per the CDC and not our Florida Department of Public Health. Her COVID home antigen test was negative, so after taking some Tylenol and throat lozenges, she called her family physician. She was told to “go to urgent care. We don’t see sick people in the office.”
At the beginning of the SARS-2 coronavirus pandemic, most physicians were unvaccinated and unprotected against COVID-19, and we followed the advice of the CDC in referring patients to COVID-19 test sites for testing. We conducted phone calls with patients and telehealth visits. With five COVID vaccines, and an abundance of at-home quick tests available locally, most of us are now seeing sick patients in our offices again as long as we know their COVID test status.
In my practice, pre-COVID and pre-concierge medicine, we always adjusted our schedules to include patients with acute febrile illness and not in respiratory distress. I knew most of these illnesses were caused by viruses and required nothing more than fluids, Tylenol, cough syrup, and tincture of time. Most had multiple medical and metabolic conditions exacerbated by the infection. The purpose of the visit was to make sure the other conditions, exacerbated by the viral infection, didn’t exacerbate. To accommodate our sick patients, we started the day earlier, worked through lunch at times, and stayed late if need be.
When my daughter called me from the urgent care center facing a 90-minute wait, she asked me what she should do. I suggested she wait it out, see the physician, and when she felt better, find another doctor.
I understand the reason for not bringing an acute COVID patient into the office. For everything else, there is no excuse for only seeing “well” patients. Our job is to keep our patients healthy. What value are we if we don’t see them when they are ill?