An ingrown toenail is not a lung transplant

Here’s a quick review of health care delivery basics:

Primary care – Stuff you can get handled with your primary care provider in your neighborhood. Example: ingrown toenail.

Secondary care – Stuff your primary care provider refers to a secondary provider specialist down the road. Example: colonoscopy.

Tertiary care – Complex stuff you need to deal with at a big-city hospital. Example: lung transplant.

Simple. Right?

Here’s the problem: In modern medicine we’re holding primary care hostage to a tertiary care delivery model.

If you’re getting a lung transplant you need a 5-story hospital with helipad, a medical team, insurance coding/billing software (you actually need insurance to cover the $500,000+ bill) and all sorts of special machines and complicated equipment. If you’re getting a colonoscopy, you need one person to shove a tube up your butt in a simple office with a few staff. If you’ve got an ingrown toenail you need one primary care provider in one tiny exam room with a pair of scissors.

When we force ingrown toenails and buttholes to subsidize 5-story hospitals, helipads, medical teams, and insurance systems, we create incredible inefficiency and expense. In fact, all that crap is not only unnecessary, it just gets in the way and makes your $100 toenail or $1000 colonoscopy cost hundreds and thousands more!

When we force primary care to pay for the infrastructure of tertiary care medicine, we end up with assembly-line medicine in which patients are forced through 7-minute visits. Both high volume and price gouging are required to pay for the unnecessary helipads and hospitals for your ingrown toenail.

I’m a family doctor and I’ve been delivering primary care to my community for decades. I’ve removed ingrown toenails and metastatic lung cancer. I’ve cared for psychiatric patients and complex neurologic conditions. In fact, I can deliver care for 99% of what ails my patients right in the comfort of my 280-square-foot office. Just two chairs. One exam table. And no staff.

All I really need is my brain. And my brain tells me we must stop allowing buttholes to design primary care delivery in America.

Pamela Wible, M.D., is the founder of the Ideal Medical Care Movement. She is the author of Physician Suicide Letters — Answered and Pet Goats and Pap Smears. Watch her TEDMED talk, Why physicians kill themselves. She hosts medical student and physician retreats to help her colleagues heal from grief and reclaim their lives and careers.