Beware of the health-care ‘rabbit hole’ | Expert Opinion

A friend recently shared with me her frustration trying to navigate a health scare involving her daughter, a college student in her early 20s.

The young woman, who had always been healthy, began to experience fatigue, decreased motivation, along with menstrual and bowel irregularity over a period of weeks. She visited a number of care centers — student health, urgent care — that were focused on management of common health emergencies. She was told to consult various specialists; perhaps a gastroenterologist, endocrinologist, or psychiatrist would be helpful.

The young woman’s symptoms persisted, while she and her mother felt increasingly frustrated and lost. They were unsure what to do next.

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After listening to my friend’s story and acknowledging her worry, my first question was, “Does your daughter have a primary-care clinician?” She stared at me for a second or two, surprised by my simple question, and then replied, “No, she does not.”

As my friend learned, navigating our health-care system on your own can be a topsy-turvy experience, much like the world described in the children’s fantasy tale, Alice’s Adventures in Wonderland. In Lewis Caroll’s classic tale, Alice is a curious young girl who discovers a rabbit and follows him down a rabbit hole. There she finds wonder and excitement beyond anything she has imagined. But Alice is also a cautionary tale, as things rarely follow the rules she is used to, which leads to many unexpected frustrations.

Finding a path through the health-care system is also far from straightforward for many people. Test results can be ambiguous, each specialty visit may lead to greater uncertainty, and answers are elusive. And unlike in Alice’s case, it usually does not turn out to be only a strange dream. The health-care “rabbit hole” is very real, may delay proper diagnosis and appropriate treatment, and be quite costly, especially for those with high-deductible insurance plans. There is, however, a strategic way to avoid it.

A trusted primary-care clinician can serve as both a diagnostician and a guide to avoiding the worst pitfalls of the health-care rabbit hole. These doctors and advanced practice clinicians are expert problem solvers; they are also health system’s wayfinders, who know the most expedient way to reach your destination.

In my friend’s case, I arranged a visit with a family physician colleague who has committed to working closely with her daughter as they try to understand how best to address her symptoms and concerns. The primary-care physician has already relieved a lot of stress by providing reassurance that she does not have some of the diseases she feared most, and by taking a long-term interest in her health.

Accessing your primary-care clinician on short notice is not easy these days. This can lead to temptation to rely on the advice of friends, websites, or artificial intelligence chatbots, visit urgent-care clinics, or self-refer to specialists. Keep in mind that many primary-care practices now work as care teams that provide guidance leading up to and following an office visit — mostly through the patient portal — to maintain forward progress toward resolving your concerns.

Many medical venues appeal to our consumer-driven desire for quick, convenient service that can be accessed independently whenever the need arises. On-demand telemedicine, urgent care, in-store clinics, and online resources often make sense when the issue is simple and straightforward, and you are short on time. These options work best to supplement rather than replace a relationship with a primary-care clinician, who may take a little more time to connect with. Remember, in Lewis Carroll’s tale, Alice is lured into the precarious rabbit hole by a rabbit who was in a hurry because he was running late.

Jeffrey Millstein is an internist and regional medical director for Penn Primary Care.