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My Story

Rdruz

All worrisome things always happen at night. Most of my physician colleagues would agree that deep at 3 to 4 am is the "witch hour", a time for percolating maladies to coalesce and erupt. This was my thought as a severe, throbbing pain struck in my lower abdomen, waking me up. My palms turned sweaty, and my heart raced as I felt a large, firm mass on the lower right side of my belly. Was it an appendicitis? Did it rupture? An ovarian tumor? A cancerous mass in my colon? I felt nauseated and dizzy. My brain fogged. The clock ticked at 4 am. I was due to be up in 2 hours to get my children off to school, and to get to my office for my patients. I summoned every last bit of my rational, medical mind to calm down, to stay detached as thoughts raced through my mind. I contemplated going to the emergency room but knew I would be stuck there for hours, and ruin my entire day. I was also in between my medical insurance carriers (read "no insurance"), and the thought of getting slapped with a bill to cover thousands in tests was horrifying. I made an educated guess, deeming my situation non-emergent. Next day, an abdominal sonogram and a doctor's visit disclosed a new uterine fibroid, a benign condition. I was safe.

There are many similar stories. Over the years, my professional experiences convinced me that many patients have no way to address their sense of urgency, no one to turn to get medical advice rapidly, resulting in delayed or poor care, or aggressive and expensive over-diagnosis and treatment. According to the Centers for Disease Control, approximately 130 million Americans visit emergency rooms annually. Over 70% of these visits are due to non-emergent conditions. Perception of urgency, lack of access to care, and insurance coverage are the main factors leading to overutilization. The cost of such care exceeded $5 billion in 2013. On the other hand, some patients, especially women, misjudge their symptoms, and face other barriers, often leading to neglect of potentially life-threatening conditions. As one of my patients said recently, “There simply has to be a better way.”

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