My First Experience with Direct Primary Care

by Will Grice (@wgrice03)

It started early on Friday morning…3:30am specifically. My digestive system had a message for me: “We really need to get something out now, and it can’t wait. There’s something in here that doesn’t need to be here.” By the time I had gotten from my bed to the bathroom, that unmistakable feeling of your body letting you know “this is urgent” had morphed into excruciating pain that buckled my knees and collapsed me onto the floor. My intestines felt like they were on fire (I don’t mean that in the figurative sense). The pain eventually consumed my whole body and as sweat poured out of me from head to toe, I thought to myself, “Is this really how I’m going out?”

Eventually I was able to get to the toilet. Relief didn’t come immediately, but within a few minutes I was able to evacuate my bowels. That brought instantaneous and complete relief. After finishing in the bathroom, I walked back into my bedroom and fell into the bed relieved and expecting to wake back up in a few hours and get ready for work.

When the alarm went off, I began my normal routine. I went back to the bathroom thankful to have made it out of there alive just hours earlier, turned the shower on and began scrolling through Twitter as I waited on the water to warm up. After my shower I began brushing my teeth, but it was becoming apparent quickly that a normal day was a no go. My stomach was still upset. The pain was nothing like earlier, but it was still there. I was very weak. I decided I had to make the call (text) to work to let them know I would not be in. Then I did what any other man would have done, I went back to sleep and waited for it to get better on its own. Of course, it did not. Without going into graphic detail, I still had movement in my bowels and it was very apparent that this wasn’t an average stomach bug. Still, in my stubbornness I decided to give it til the next day.

Saturday came, I slept late, and made it to Salty Nut Brewery a few minutes late to record our weekly podcast. I was pale. My stomach was still doing ungodly things. I felt like death warmed over. Just a few days earlier I had signed up with Dove Family Health. They are subscription based primary care, but are distinct from concierge services in a few ways. One, they are much cheaper. Their service only costs $70 per month. Two, they offer direct access to your care provider. If you call, you won’t get office staff who communicate to the care provider for you. You get the actual person. Three, they don’t take or charge your insurance. With most concierge services, the benefit you get for your monthly fee is same day service, but you still have to pay your copay and they still charge your insurance for each visit.

My care provider at Dove is Crystal Gaskins, CRNP. I had lost the sheet of paper with their after hours number, but remembered her saying she usually checks emails on the weekend. As I struggled through our podcast interview, I decided to send an email describing my symptoms hoping that she could at least offer a rough diagnosis, give some advice, and have medicine ready for me to pick up when the office opened on Monday. Something in my email set off alarm bells, though, and my phone was ringing maybe 20 minutes after I sent the email.

Crystal started talking. I had a hard time hearing her. I eventually said,

“Where are you? It sounds like there’s a lot going on in the background. Are you at Panoply?”

Crystal responded, “Oh no, me and my husband are at Buena Vista eating. How soon can you meet me at the office?”

“Well,” I said, “it’s about a 10-15 minute drive from where I’m at…”

She interrupted me, “Great, I’ll meet you there in 20 minutes.”

Forget same day service, this was instant weekend service. Granted, she did think my condition might be pretty serious. Initially she wanted me to go to the ER, but after talking a little more and getting a few more details she said she’d meet me at the office first. I arrived at Dove’s Huntsville office and Crystal was waiting on me, her husband relaxing on the couch in the lobby. I apologized for interrupting their meal, but Crystal said, “It’s just food. You’re sick!” Whats more, I believe she was actually sincere! It wasn’t one of those situations where she said, “Oh, don’t worry about it,” but was secretly still thinking about the fajitas she left sitting on the table.

Crystal did an exam, asked a lot more questions, and consulted with Dr. Goss in Rainsville who eventually ended up on speakerphone. David (Dr. Goss’s husband) was in the background saying, “It could be the lettuce! Ask him about the lettuce!” It turned out, David was right. I had apparently eaten some contaminated romaine lettuce from Yuma, AZ. Crystal explained her diagnosis to me, explained my options, and was there to do whatever needed to be done to get me through the bout with E. coli. She was nothing short of amazing! Not only was she that amazing in the office, she kept texting me throughout the rest of the weekend to make sure I was ok. She even saw me first thing this morning for a checkup. Thankfully I am better today. Not well completely but very much on my way.

Now, sit back for a moment and think about all the things that seem odd in my story.

  • I talked to my care provider on a Saturday…and she took it upon herself to call me
  • I didn’t have to go to urgent care because it was outside the normal hours for my primary care office
  • Four people disrupted their Saturday to take care of me
  • My provider texted me throughout the weekend to check on me
  • I saw my provider first thing Monday morning and didn’t have to wait for them to work me in
  • I walked out both Saturday and today without having to stop on my way out and give them money. It was all included in my subscription.

More than that, I have a real relationship with my primary care provider. She knows me. She took time with me. She explained everything in the sort of detail I needed. She answered all my questions. There are many great physicians out there who truly care about their patients, who wish they could take that kind of time with each one. However, to make their office financially solvent, they have to pack their schedules and give their patients only a few brief minutes. What I experienced this weekend was something wholly different.

When I heard about the theory of direct primary care, I got really excited because it seemed like exactly what is needed in this country to get health care costs under control and improve the patient experience. After experiencing it first had this weekend, I am absolutely convinced it is the revolutionary wave we have been needing for so long.

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