himespau 

Not directly bike-related, but it is a Boston specific question, so I hope it's ok that I put it here.

As the title says, what do you do when you need acute, but not emergency medical treatment?

I'm in Boston for my first post-college job. When I was in college and you had a medical problem that wasn't an emergency, you called up the health center and they got you an appointment for the next day or two. Before that, in my small hometown, if you got sick or hurt or whatever but didn't need to go to the ER, you called up the family doctor and he got you in within the next week or so. Sometimes within that day or the next.

So here I am in Boston, and just injured my back while moving my apartment. Called up my primary care doctor to see about getting an appointment and was told she has about a 6 month wait (earliest appointment is March 2012). I was like WTF? and said that wasn't going to work and wasn't acceptable as a general practice.

I don't see the point in going to the ER and tying up resources that should be directed to emergencies (or waiting in triage for 6-8 hours) for what feels like I sprained the ligaments that support my illial/sacral joint (based on range of motion ability and where pain occurred when I did that much worse before). With enough prescription Motrin that my wife had left over from when she had our baby 7 months ago, I'm able to manage the pain and am more or less mobile (though unable to pick up our 19 lb baby and getting dressed takes a while). So pain management isn't an immediate problem (until the Motrin 800 runs out), I'd like treatment for the underlying condition.

So Bostonians, where do you go when you're sick/injured in a non-emergency way like this and can't get in to see your primary care doctor for 6 months? Or is my primary care doctor just screwed up and I need to find a new one?

JandersUF

I am employed in the health care field in Boston... but don't construe this as actually medical advice. More of hypothetical discussion.

(1) You need a new primary care. Have you ever seen them before? A six month wait for an acute visit is totally unacceptable. NOW... if they are just listed on your HMO card as your doc, and you've never seen them... they aren't really your PCP, and maybe they do have a 6 mo wait for new patient visits. In that case, you need to find a different PCP and establish care with them, so when you do have problems you don't have to wait forever. What part of town do you live in? You can very likely find someone with a shorter wait.

(2) I am an ER guy. We see back pain all the time. If you don't mind paying your ER co-pay, someone will be happy to see you... but you are correct, you might wait forever (some places have much shorter waits)... and we won't do much more than re-fill your IBUPROFEN. If you are lucky you might get a quick referral to a PCP or ortho/back doc from the ED, but that does require a bit of luck.

(3) Simple rest, anti-inflammatories, and mild stretching is generally enough for acute back pain to go away. Otherwise, PT might help. Depending on your insurance, you MAY be able to go get PT without A PCP referral. End around the system that way. Same with massage therapy, if covered.

(4) Ibuprofen is over-the-counter. While one cannot recommend long-term ibuprofen without MD supervision, using 400mg OTC Ibuprofen 3 times a day will give you relief. You could even take 600 or 800mg using the over-the-counter pills, though that is more likely to upset the old stomach, and technically is Rx strength.

(5) If you get weakness, numbness, bowel or bladder dysfunction, etc you should ignore everything else and go to an ER pronto.

Anyway, the best thing for you to do, I would think, is to call around and find someone taking new patients more quickly!

himespau 

Turns out I just had a crappy receptionist. The third time I called the PCP's office (I'd been there twice before for checkups) I got one who finally admitted that I didn't have to just see my PCP because I was her patient and the fact that I was willing to see anyone in the practice got me in later that day. They agreed that it was unacceptable that I'd taken 4800 mg of ibuprofen in the last day (2xMotrin 600 4 times in a bit more than a day) and switched me to aleve with some muscle relaxants as needed. Going to go to physical therapist to try and get rid of the underlying issue (I've had back problems for over 10 years - and am only 32). No neurological issues this time as far as I could tell going in (or the resident I saw could detect), so I guess the moral is that I need to be more persistent until I get the appointment.

Thanks for the advice.

sherbornpeddler

I've been going to the same Doc for 25 years and reception and appointments are increasingly a barrier. My Doc once said if I needed to get through, mention chest pain. Docs are crushed with insurance plans and minutes per patient instead of bed side manner listening about what ails you. My Doc, when time allows, asks about my family, stress, ups and downs and stuff that really effects health beyond slap on a prescription and refer to a specialist. He is a good Doc but the system is grooved to prescriptions and specialists; NEXT!

Remember, everyone wants to do a good job. Take a deep breath, don't cry wolf and persist. The people are good; the system.....is difficult. I hate taking meds, wait too long and my spouse worries too much but the system does require the optimistic, patient, well meaning active types to advocate for themselves.