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When was the last time you went to the doctor? And I'm not talking about running into urgent care for some antibiotics or the 30 seconds you chatted with the nurse before getting your COVID vaccine. When was the last time you saw a health care provider for some legit primary care—like a physical exam or cancer screening? If your answer is along the lines of “Wow, rude of you to ask. Also, no comment,” you're in good company. A lot of us put off going to the doctor during the last 14 months. In fact, a lot of us put off going to the doctor well before that, too. (In case you think I'm here to preach at you for your health hiatus: I also do not currently have a primary care provider, and my last physical was...much more than a pandemic ago. I'm writing this article as much for me as I am for you.)
Factors like cost, access, insurance status, and stigma often keep people out of doctor's offices. It's not that going to the doctor isn't a priority, but an issue of “competing priorities,” as primary care and HIV physician Oni Blackstock, founder and executive director of Health Justice, told VICE. “Many times clinic hours are 9-5, and if people have jobs that don't provide paid sick leave, or they would be losing income if they had to come to an appointment during work hours,” it's just not surprising why you'd put it off, she explained. Caring for kids or older parents is another hurdle: “People end up often putting other people or family members' well being ahead of their own—particularly women or people in caregiving roles,” she said.While routine visits and cancer screenings dropped significantly (and understandably) during the pandemic, it's not the only reason people avoid going to the doctor. Pre-COVID, just 56 percent of people in their 20s in the U.S. had a primary care provider, according to a 2019 paper published in JAMA Internal Medicine. And even once you find a go-to doctor, changing jobs, states, or insurance companies can send you back to square one.
Now that the pressure is on to “get back in there,” it can make you even more anxious about how long it's been and what might be waiting for you when you go. Has something been festering in my body all this time? Will I need a dozen invasive tests? Will I get news that I'm not mentally or financially prepared to deal with? It's a lot. As a person with health anxiety, I often want to avoid the doctor’s office for all of these reasons. But as a health journalist, I know that primary care is legitimately useful and important. So, let's talk about why primary care is not actually a scam, and how to make your triumphant return to the doctor's office as seamless and stress-free as possible.
Maybe you, like many of us, are not feeling awesome about the current state of your health (unless you actually used the last 14 months to get in the best shape of your life, in which case… you should be studied). Maybe you're worried the doctor will shame you for gaining weight (or just your weight in general), or give you serious side-eye when you mention your last check-up was in 2017. “I have definitely noticed some anxiety returning to the primary care doctor's office, and even when I see my patients, they're very apologetic,” family medicine physician Andrea Anderson told VICE. “There's definitely a sense of remorse, sometimes even shame, that they come with. But I really want to encourage people that I'm not here to judge you. I'm happy to see you. I'm glad you came in.”
First, let go of any embarrassment you might feel about how long it's been.
I know this can be hard to believe, especially if you've dealt with a judge-y doctor in the past, but a good primary care provider isn't going to be fazed by this—they're going to be focused on what they can do to support you starting today.
It can be easy to focus on all the negative things that might await you at the doctor's office, like concerning lab results or a life-altering diagnosis—which, of course, is likely to make you put it off. Clinical psychologist Jessica Stern told VICE there's another way: “Think about how this potential doctor's appointment might make you feel a sense of relief, or might help you achieve something you want to do in your life.” Blackstock echoed this strategy: “What would be a great thing about going to the doctor? What might be something you'd want to talk to the doctor about? What might be really helpful for you?” You know, is there some rogue symptom you've been Googling that you're convinced is cancer and you might be really relieved to hear is not actually cancer? Helpful! This reminded me that many of us have an expert or two who we willingly and enthusiastically turn to for some sort of betterment—whether that's a personal trainer, a therapist, a dermatologist, a career coach, whatever. These are still vulnerable and intimidating interactions (especially at first), but there's also an anticipated gain that compels you to go—like that you'll probably leave with some relief or progress, or at least strategies and tools to help you get there. What if we could look at primary care the same way? Instead of seeing it just as a favor you're begrudgingly doing for Future You, try viewing it as an opportunity to actively problem solve and help you navigate your health issues more effectively.
Think of literally any good things that could come out of this appointment.
For instance, maybe this doctor can help you troubleshoot that headache or stomach pain you've been dealing with. Maybe they can write you the prescription you need—and even set you up with six months of refills so you don't need to waste money on co-pays just to request a new piece of paper. Or maybe you'll just finally find a trusted medical professional who you vibe with. That's a pretty big potential win.
Both Anderson and Blackstock emphasized that primary care isn't about any one visit. It's about establishing that baseline and rapport with a provider who can be your ally—someone who knows you and your health history so they can be there when things get real. “It's not a matter of ‘I'm going to see you once and when you come back you better be healthier,’” said Anderson. “I want the patient to be in charge of their own health, and I want to work with them to support them in that endeavor.” I always thought I was being strategic by cutting out the middleman and just seeing a slew of specialists, but there are definitely benefits of having a primary care provider who sees the whole picture of your health, and can help you when you don't know where to start. “Many times people will say, ‘Oh well I came into urgent care for that ear infection that I had.’ Or ‘I saw my dermatologist for my eczema.’ And those are great people that you saw, I'm sure, but they weren't looking at the whole person, because that wasn't their goal of that visit,” Anderson said. “They were treating you for the thing you came in for. So it's really important to have a primary care visit every one to two years at least where that person is asking: ‘Are your vaccines up to date? Are your screenings up to date? How's your stress level? Tell me about your job? What's the family situation?’” Anderson also counsels her patients on issues that can be social determinants of health, like housing, food access, childcare, and other stressors—something a specialist might not ask about.
Instead of stressing about the possible takeaways of the visit, focus on establishing a connection.
“Your primary care doctor is your advocate,” Anderson said. “They're there to help you navigate the system and help you to get to a better state of health.”
If your health care avoidance stems from past bad experiences with providers who shamed or stigmatized you, you should know that your experience is valid and infuriating, but it doesn't mean that you have to settle for that going forward. I won't pretend that finding a provider who is nearby, in-network, and taking new patients is a simple task, because it's not. But if you have options, it’s really worth doing your research to find someone you're more likely to connect with. You want someone who you'll feel comfortable talking to about how many drinks you actually have in a given week, the drugs you dabble in, how your poop's looking these days, and the kind of sex you're having. You should feel safe, heard, and empowered with them. To find that kind of provider, Blackstock suggested looking at online review sites like Zocdoc, which can be helpful “in terms of understanding a provider's bedside manner, how patient they are, do they keep people waiting, whatever it is.” She also stressed word of mouth recommendations from friends and family. If you have health coverage through your job, it can even be helpful to ask your coworkers for recommendations since they probably have the same insurance you do.
You’re allowed to find a primary care provider you actually like.
If you're uninsured or underinsured, your options will likely be more limited, but you still deserve quality, validating care. You can find affordable primary care at a federally qualified health center (find one in your area here) or at some Planned Parenthood locations. It's also worth noting that some membership-based primary care practices like One Medical offer financial assistance if you qualify. One more tip for vetting potential providers: Actually call up the office to ask any questions that might help you feel more prepared. For instance, do they definitely take your insurance plan? Do they do bloodwork on site or send you to a lab? If you might need labs, should you prepare in any specific way (like skipping breakfast)? Will they use your correct pronouns? Do they have an online patient portal? All that good stuff.
If you have the flexibility, schedule your appointment for a low-stress, low-stakes time. “Maybe not scheduling it before you have to go back into work,” Stern suggested. “Or giving yourself enough buffer time to take a walk after an appointment if it was overwhelming to you. Or maybe at the end of the week so you don't have the burden of the work week after you.” It can also help to make a day of it. Hype yourself up a little bit if you need to. Plan to treat yourself afterward—whatever that means to you. “Maybe you tell a friend, ‘Come with me. Let's go out to lunch afterwards—outdoor seating or something,’” said Anderson.
If possible, be strategic about when you schedule your appointment.
While we're on the subject of scheduling, try to pace yourself. "It might feel like this pressure to schedule all of your doctor's appointments all at once," said Stern. Unless you absolutely have to, give yourself a couple of weeks between each check-up to give yourself a break.
“I can't stress enough how important this is,” said Anderson. “It's always good for the doctor to hear all the questions at the beginning of the visit so that you can work together to see how much time there is, how many you're able to deal with during that visit, [or if] you need a follow-up visit.” I can verify from experience that it sets an entirely different tone when you can sit down with your provider at the start of the visit and talk through your main concerns… while still fully clothed. You should feel like an active, informed participant at your check-up. Some primary care providers will start appointments with a quick chat about your concerns and health goals—particularly if you're a new patient—but if you want to make sure that's the case, call the office ahead of time to request that.
Make a list of your top questions and concerns to bring up at the beginning of your appointment.
Stern suggested downloading a podcast you've been excited about to listen to on the way or in the waiting room. She also suggested identifying a safe and supportive person you can call if you get overwhelmed before or after the appointment. “And I really stress the 'safe and supportive person' because sometimes there are people that we reflexively call up in our life that are actually not so helpful or make us more stressed,” she said.
Have some stress-management strategies handy.
If the office allows, you can bring your support person to the appointment, which might help you relax, or give you some peace of mind because you’ll know they’ll be taking notes for you.
If you feel some type of way about this visit, it could be helpful to tell your provider at the beginning of the appointment. Maybe it's that you're in recovery for an eating disorder, or that you have a history of sexual assault—anything that you'd like them to be particularly sensitive to. Stern suggested this helpful script: “Hey just wanted to give you some context about why this appointment is a little bit nerve-racking for me…”“That way, the person sitting in the office with you knows a little bit about what this appointment means to you and where it fits into your life,” said Stern.
It also can't hurt to prepare an elevator pitch on your medical history or hang-ups.
Whatever your reason is for avoiding the doctor all this time, just know that it’s valid, and that you are deserving of care. Your health care hiatus doesn't determine what you do from here on out. So, who cares if it's been a minute since your last check-up? “I think that we should count our successes just as much as we count the things that we're still working on. So the fact that you're going into your primary care office is a success,” said Anderson. “You were able to make an appointment. You were able to find a primary care doctor that you connect with. You made it through a 14-month deadly pandemic. That's a success. That's great. You came in and you're here. I count that as a success.” Casey Gueren is the author of It's Probably Nothing: The Stress-Less Guide to Dealing with Health Anxiety, Wellness Fads, and Overhyped Headlines, coming September 2021.