What You Should “Pack” if You Are a Nomadic Healthcare User

 

Are you a nomadic healthcare user?

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no·mad noun \ˈnō-ˌmad, British also ˈnä-\
1
: a member of a people who have no fixed residence but move from place to place usually seasonally and within a well-defined territory
2
: an individual who roams about
— nomad adjective
— no·mad·ism noun

Origin of NOMAD

Latin nomad-, nomas member of a wandering pastoral people, from Greek, from nemein
First Known Use: 1579

Synonyms: drifter, gadabout, gypsy, knockabout,maunderer, rambler, roamer, rover, stroller, vagabond,wanderer, wayfarer, bird of passage

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*Modified from Merriam Webster online

 

A nomadic healthcare user – if there is such a term – is an individual who gets his healthcare from multiple places (different clinics/states/cities/etc). There are various reasons for this type of healthcare utilization that I have come across since I started practicing as a primary care internist.

Some reasons are obviously geographical:

  • a move (to another city or state)
  • travelling for long periods of time after retirement (ex: RV’ing )
  • Wintering in other states

Other reasons are less obvious, but frequent, and still occur despite living in the same location:

  • a job change (new insurance)
  • doctors changing or closing practices
  • an employer changing insurance, thus forcing a change in PCP due to cost (My pet peeve. This seems rarely cited as a contributing factor to fragmented healthcare/increased healthcare costs and can occur each year for some patients!)
  • using the healthcare system “prn” (only as needed, calling up doctor’s offices as needed, going to the first local doc that has an appointment available)
  • “doctor shopping” (going from doctor to doctor, searching for one that you agree with)
  • second, third, and fourth opinions.

In the U.S., particularly in bigger cities, an individual’s healthcare can be quite fragmented due to all of these factors.

The result:

  • Expensive care (primarily through repeated tests and scans that have already been done)
  • Confusion among patients and their doctors
  • Over- or under-immunizing

If you find yourself in any of the above “nomadic” situations, there are some things you can do to keep as much continuity as possible in your healthcare. If you need to switch primary care doctors, get records from the last one. It may cost you money, but it can be invaluable to the next doc and perhaps to the healthcare system as a whole by reducing redundancy of testing. They are your own records and you should have them. They may not be retrievable if the clinic went out of business.

Let’s say there was a fire in your doctor’s office and all the documents disappeared, the computer system was inaccessible, and you came to see me for the first time. These are the records that I would hope you have:

  • Complete immunization record
  • Labs from the last 2 years
  • Medication list (exact dosages and frequency)
  • Allergy list (reactions)
  • Primary care notes from the last 2 years
  • The last colonoscopy report + pathology report (if there was a polyp)
  • MRI and CT reports within the past 5 years
  • Specialist notes from the past 2 years (this one is more optional)

 As a side note, it would be curious to see how the “medical home” concept fits into some of this nomadic behavior. They seem antithetical by definition .

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