As some of you know, this time last week I was having vial after vial of blood drawn after rushing to make an appointment with my doctor regarding a sudden sharp pain in my abdomen.
I went in under the assumption that either I had some lingering effects of the flu I’d had over the weekend, or that my colon was inflamed like it had been a few years back.
However, the quality of care I received was sub-par to say the least, so I want to take the opportunity to break down the various care systems that are available and when patients in my situation with a known history of chronic illness should utilize each option.
So on the most basic level, we have our Primary Care Physicians, Nurse Practitioners and Specialists and I’ll break these down first under the category of “doctors”.
Doctors – Primary/Specialty
In most insurance cases in the US, we have to seek out a primary care doctor as the first point of contact. This person serves as the base of our care and refers us to any specialists we may need to see.
I’ve been seeing my current Primary Care Physician since around September, and although she is incredibly friendly, we are not a good patient – doctor match. Yes, she serves the basic purpose of addressing my existing health concerns and referring me to my specialists but when it comes to base care, the quality simply isn’t there.
For example, over a month ago, I saw her in regards to getting my spine checked out. This is something my previous doctor was ready to send in a referral for after my neck physical therapy didn’t prove to be successful – so to me, asking to see a specialist now isn’t out of line. However, after a brief physical exam she decided she’d send in for a Scoliosis test and we’d follow up after that was completed… it’s been over a month and they haven’t even bothered to schedule the test. She also took my base concern of this perhaps being the initial “trauma” of my migraines and brushed it off to it being a coincidence.
Now, my primary care office serves as a “walk in urgent care” as well. While experiencing the severe abdominal pain, it made sense to see if an appointment was available with them rather than paying extra for urgent care… the Nurse Practitioner had a same day opening.
My medical history was almost entirely disregarded during this visit. My personal concerns and questions related to previous stomach pains were disregarded. Mind you, I worked with my regular doctor on stomach issues (potential IBS) during the Fall so it is documented in their system. But I was met with the initial accusation that I had been binging and purging and that’s why I was in pain. I was 116 lbs because I’d had the flu and eaten chicken noodle soup for 3 days straight. And then, my colon related concerns were tossed out the window and I was told I most likely had a gallbladder or liver issue. So, she did blood work and sent in for an abdominal scan and scheduled a follow up with my regular doctors for two weeks out.
Do you know what it’s like to not google symptoms and gallbladder/liver conditions in order to keep panic at a minimal? It’s hell.
That was Monday the 18th. I received a call for the scan today, Monday the 25th. I’d already gone to urgent care to do it myself, but the lack of urgency of my primary care office is horrifying.
In addressing the first issue of the scoliosis test, it brings me to the importance of our Specialists.
At the end of the day, my neurologist who has been my most consistent doctor over the last 6 years knows my medical journey better than anyone. In most cases a specialist only sees you for a short time and once the issue is resolved you stop seeing them, but with chronic migraines I consider my neurologist my main doctor.
My doctors are all in the same network, but the communication between them is less than ideal and to believe that they work side by side on all my medical issues to come to a real solution.
Therefore, my concerns regarding my spine and wanting to dig deeper on that connection to my migraines, should have been taken straight to my neurologist. We can scream for integrated and whole body approaches to healing all we want, but with chronic issues, it’s important for us to decide who is going to take that whole body approach.
Although the same can’t be said for my stomach pain, the underlying issue may be something that primarily gets dealt with with my neurologist and incorporated into my care plan.
A step up from your regular doctors office, is your local Urgent Care Center. We have a variety of urgent care’s in my area, most of which are smaller than a regular doctors office.
Urgent Care is the place to go when you can’t get in to your regular doctors to address a cold, the flu, or other aches and pains. Now, even though my doctors office advertises “urgent care services” I think it isn’t the right place to go when you have – literally – more URGENT issues.
You’ve been vomiting nonstop? Urgent care. Blood where it isn’t supposed to be? Urgent care. Stomach pains in any area? Urgent care. Breaks and sprains or minor cuts? Urgent care.
I prefer urgent care over the emergency room when it comes to treating a migraine, why? Urgent care doctors aren’t rushed. Urgent care doctors want to get a real medical history from you and they want to treat you adequately. They’re more patient with you and take the time to explain what options exist and what possible issue may be present if it isn’t simply a migraine.
On Wednesday, my abdominal pain hadn’t improved, I no longer could poop, and suddenly the pain shifted to the right of my belly button. In my mind this signals appendix so it was without question that even though I hadn’t been called in for the tests, I’d be going to urgent care to have this addressed immediately. (My urgent care is also the imaging and diagnostics center for my primary care network so the order for the abdominal scan would already be in their system)
The second I explained my pain to the lady at the front desk, I was taken back to a private room and bumped up on the list – abdominal pain especially in that area can be cause for greater concern. I can happily report that I’d moved up to 118 pounds, and the nurses were very prompt in getting my vitals and an explanation for the doctor.
The urgent care doctor did a more in depth physical exam, listened to my concerns and opted to do more blood work to compare to Monday’s tests. He was able to pull up the blood work from Monday and quickly assure me that the liver enzyme levels were normal. After getting my scan completed, he was able to assure me that my liver and gallbladder were completely healthy and there was no cause for concern. He did note that my colon looked irritated (as I expected) and since I responded positively to the GI cocktail, he sent me on my way with a script to reduce stomach acid production and instructions to follow up with my regular doctor.
He also took the time to answer follow up questions I had, which included my original concern of “could this be IBS” to which he explained how that diagnosis comes about – you rule everything out first and it’s a diagnosis of elimination – and then said where my symptoms did and didn’t align with it.
That took about 3 some hours. That 3 some hours should have occurred on Monday instead of the 48 hours of total panic where I was under the impression I was going to need a new organ…
Emergency Room Care
The final option for receiving medical care is to go to the emergency room.
This is typically the most costly option, but can be the most effective option as any tests needed or medications are in house and can be accessed almost immediately.
I’ve been in the ER for a migraine more times than I’d like to admit. I’ve had urgent care centers tell me they can’t treat my pain and refer me elsewhere right off the bat.
Migraines are an emergency. When the pain gets to that level of severity that is beyond tolerable, and it’s been there for days and hasn’t responded to regular treatment… it’s time to see a doctor. When your migraine suddenly changes in nature or presents itself differently… it’s time to see a doctor. And often in these cases, we need immediate help so we wind up in the “emergency” category.
There are also cases where urgent care facilities are not open at the time you need care or there aren’t urgent care facilities, or your insurance doesn’t cover urgent care, therefore, immediate care falls to the emergency department.
Emergency rooms are an obstacle course. Bright lights. Loud noises. Non-private rooms. Throw in a migraine – you’re in for a rocky ride.
Often, doctors and nurses don’t want migraine patients in the ER. They don’t see it as an immediate issue or may treat patients as drug seekers. It’s important to have an advocate with you and to be equipped with your medical history to avoid this.
There are two go-to migraine treatments, it’s best to already be familiar with them and to know which one may work for you based on previous experience – toradol, steroids and nausea medicine can help break the pain while compazine, nausea medicine and benadryl will break the pain and put you to sleep. The doctor may also want to hook you up to an IV if you are dehydrated.
Being in the an emergency room for a migraine takes a back seat to every life threatening injury or case that will fly through the doors. You may have to wait hours to be seen. Your doctor may be pulled away and put into surgery. Your nurse may forget about you. You are not the priority because your migraine may hurt worse than the person who’s leg has been chopped off, but they can bleed to death, you cannot.
In my opinion, the emergency room is the last resort for chronic illnesses and conditions like migraine. Doctors here are assuming worst case scenario and for chronic patients we know we don’t have a brain tumor and aren’t having a stroke (even though hemiplegic migraine may mimic one), so we should truly strive to avoid the emergency room.
There are certain steps we can take with our neurologists to have emergency kits at home to use when our abortives have failed us. The best thing we can do if we have to go to the emergency room is be our own advocate and stand our ground when it comes to our needs. And most importantly, if you’re going to the emergency room for something that isn’t migraine while experiencing a migraine attack bring an advocate for you so that they don’t brush your other concerns off as migraine.
We are fortunate, especially those of us living in more urban areas, as we have tremendous amounts of options when it comes to receiving quality care in the time frame we need. But from my own experience, the care we receive at each location is different and it is different for a reason.
We may never have a perfect care team, but we can know that in no situation should be accused of having an eating disorder and sent into panic mode with an unclear speculation as to what’s causing our pain. Especially when it will take over a week to even have follow up for the pain you want addressed in that moment.
If you think it’s urgent, go to urgent care. If you go to your doctors office and don’t like what they said, go to urgent care for a second opinion. Urgent care is urgent. Doctors offices are not. Emergency care is extra extra urgent.
Know how each office can serve you, and if an office no longer serves you, start the search for new office.
I wish they held interviews or had real reviews when it came to doctors, but they don’t so it is up to the patients to seek optimal care.
I’m happy to report that my follow up appointment for this abdominal pain has been moved up, and hopefully I can get some real answers. Once I have that appointment I will be looking for a new doctor that better understands my needs. My stomach is still in a tremendous amount of pain, but I don’t have to fear the worst.