I have spent 20 years of my career working in primary care, 12 of which were spent in a country with socialized health care and the past six years in a free clinic for those without insurance and limited access to care. Some of the reasons I have heard for not attending primary care visits are the same worldwide and some are related to potential or unknown costs.

What are a few of the most common reasons given for not seeing a primary care provider?

Unsure of the cost/cannot afford the copay or doctor visit

Prior to working in the U.S., I had never heard of this concern (varying amounts of charges, being unable to determine visit cost in advance or not being able to afford the cost) as a reason for not seeing a primary care provider. Without a doubt, those without insurance or under-insured have reported cost as the biggest obstacle for avoiding wellness visits. We are fortunate to have a free clinic serving all our surrounding counties which eliminates the cost factor.

If cost is a factor, seek out concierge or direct primary care providers where costs incurred may be much less and stated up front. With this approach, you pay for 24/7 direct access to a provider and have a very small monthly charge. You absolutely can inquire what an office visit costs and have an estimate of pricing. Another option is telehealth, which allows people to use their smartphone to get immediate consultation in their own homes. Although this will not replace the ideal doctor-patient setting, this technology allows people to be seen and treated without putting it off.

“I haven’t been to a doc in years, and only go if absolutely needed.”

Many times I hear this statement and the conversation sounds more of a self-assurance than a factual statement. Often people have simply delayed or put off a visit and when things can no longer be ignored, they will seek help. More worrisome in the long term is that many people already know the underlying cause or have had a prior diagnosis they have chosen to ignore, blood pressure and diabetes being the two main culprits. These conditions tend to not have any outward symptoms until they have gone untreated for years. Because of this, many individuals will ignore the treatment recommendations of their providers until symptoms occur (numbness, heart failure, vision problems). Unfortunately, by the time symptoms occur, the damage can be permanent. I strongly encourage individuals to become informed about their medical conditions and come into the office and speak with a medical provider. A decision to not take treatment recommendations should be an informed one in which the person understands the risks and benefits and then chooses the best option based upon professional advice vs. going off a belief that “as long as there are no symptoms, then no treatment is needed.” I often hear “I never knew how bad I felt – until I never felt that way.” Many underlying ailments alter our moods and physical health so slowly that change is difficult to detect.

White coat syndrome

Arriving at an unfamiliar place, meeting new people, not knowing what to expect and a sense of feeling out of control can all contribute to avoiding doctors’ offices. Once at the office, anxiety and panic can ensue. These are all external sources to increase our desire to leave or not attend. Sadly, these external influences often win and people may not follow through. Many times people’s internal anxiety contributes to negative thinking (“What if they find something?” or “What if I need to go back or see someone else?”).

In reality, the majority of wellness visits are just that: a well visit in which nothing abnormal is found. Everyone feels a certain sense of relief when leaving appointments, me included. For those visits in which something is found, most conditions, when caught early, can be treated to prevent long-term complications. Every provider I have worked with will verbalize what they are doing, what they are looking for and their findings as they work. Although initially a little anxiety provoking, subsequent visits will be much easier.

Familiarizing yourself with the office, attending with someone else to learn the flow and remembering you are in control of every aspect of an appointment will help to decrease any anxiety you may feel. Most times, it is possible to take a tour and ask questions. Even compiling a list of questions prior to making the first contact can help the dreaded diagnosis of white coat syndrome.

Inconvenient times

Most offices can accommodate a late or early schedule. Remember wellness checks are completed once a year. Telling the office your schedule and booking an appointment around this will allow you flexibility and decrease the likelihood to cancel. Book in advance and make it a routine to have your wellness physical at around the same time each year (around your birthday, at the new year, fall break).

The last doctor told me “No need to come back”

The doctor may have said there was no need to come back for that sore throat, but they didn’t mean to not come back ever. Taking the time to have a 30-minute checkup at least once a year can help quickly address any potential pressing problems, keep on track of any changes in existing complaints, and perform age-related wellness checks. In addition, take advantage of community screenings and local health fairs that offer free blood pressure, blood sugar, cholesterol and prostate checks and have these results forwarded to your primary care provider. Regardless of whether you “don’t get sick,” wellness checks should always be a priority.

Excuses still?

With the recent changes and approaches to health care, traditional appointments and medical centers are changing, making it more accessible and convenient than ever. People are taking charge of their health in multiple ways, including telehealth, pay up front services, direct access 24/7. In effect, this is having health care work for you when you want it. Most of the health ailments I have encountered have been undiagnosed for a period of time. However, these can be addressed by quickly working together as a team with your chosen medical provider.

I welcome speaking with anyone to help them overcome the obstacles that are preventing them from seeing a medical provider, as most can be overcome with support and information.

Take charge of your health and encourage others to take charge of theirs. More importantly, please make that appointment soon.

Paul Tyrer is the manager of the Southeast Indiana Health Center, 920 County Line Road, Batesville, which was established for residents of Franklin and Ripley counties who do not have health care coverage or insurance. Clinic hours are Tuesdays from 9-11:30 a.m. and 5-7:30 p.m. and Thursdays from 5-7:30 p.m. Office hours are 9-11:30 a.m. weekdays. Appointments are required: 812-932-4515. Info: www.seihc.org.

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