By Will Lindner

I seated myself at the breakfast table, spread open the newspaper, sat back in my chair, and …. "ouch!" What was that? Something had stabbed me in the back.

I inspected the spindles on the back of the chair, looking for some untoward knob or culprit of some kind. Finding nothing, I deduced that the offending object must be on my back, instead. And sure enough, twisting my arm behind me, I located a bump on my spine. My hypochondriacal proclivities revved into gear, but I played the waiting game for several days, only to find that the growth became steadily larger and more sensitive, until contact with virtually anything was painful.

So one morning I called my doctor's office, and they fit me into their schedule that afternoon. The verdict: a cyst caused by sebum (a fluid that moisturizes the skin) that gets trapped below the surface and accumulates. Sometimes the condition resolves itself and sometimes the cyst must be lanced; my doctor decided this one was not yet "ripe" for lancing, so I should treat it with heat and see what happened.

Over the next 10 days the thing grew to the size (it seemed) of a door knob and became deeply red and infected. So I called again and they got me in that day. My doctor was out of town, so I saw one of his partners – a familiar face because he treats my wife and daughter, and we've been utilizing their practice for 10 years. This visit was no fun; he had to lance the beast in several places and squeeze out puss and blood, and the anesthetic was overmatched. He gave me permission to holler like a stuck pig, and I took him up on it.

The next day I returned to have the bandage replaced, and when I called again a week later they got me in at 11 a.m., repeated the procedure (much easier this time), renewed my antibiotic prescription, and sent me packing with a smaller bandage.

Four visits. Every time I called, they got me in quickly. Every time the examination-room door opened and the doctor walked in (either one of the two), he greeted me warmly, listened patiently, and attended to me with skill. I felt blessed, as I always have with this medical practice, to be in their care.

But I'm not dumb enough to think this is the norm for our medical system. Chatting with a carpenter in my home recently, it turned out he hadn't had a prostate exam (he's in his 50s), didn't have a doctor, and hadn't been able to get an appointment anywhere.

Boy, is he not alone. Primary care practices all over the state are overwhelmed, and most aren't taking – cannot take – new patients. My doctor told me during one of my visits that he loves his work – when he's doing his work. The exam room is a kind of sanctuary for him; when he leaves it, that "other" world, with all the conflicting demands and pressures that surround a medical practice, imposes its relentless realities.

A survey, "Voices of Vermont's Family Doctors," released last month by Cornelius Hogan, Deborah Richter and Terry Doran, contained telling quotes from dozens of primary care physicians. A family doctor with 15 years experience hurriedly wrote, "I see patients 8 to 4 and do paperwork from 4 to 11 p.m., and seeing fewer overall patients . . . because of calls, paperwork, etc. Offices need to hire extra help (for paperwork). Then docs need to make more money to pay them. So they need to see more patients, so they have less time for each one."

We have created a rat race for the doctors whose calmly considered diagnoses, gleaned in part from spending time with us, is most important to our care. For primary care doctors are the portal to everything else – the labs, hospitals, and specialists – we ultimately may need.

At least they should be the portal, but they can't be if folks can't get in to see them. According to Hunt Blair at the Bi State Primary Care Association, five of the eight primary care practices and health centers in central Vermont are booked solid. If my carpenter friend contracted prostate cancer he wouldn't know it until it was perhaps fatally late, and the cost-shifting that covered whatever expenses remained after he went bankrupt would constitute a financial drain on all of us.

Which happens every day. The Rutland Regional Hospital recently expanded its emergency room and added an Urgent Care Center, and demand for services instantly swamped the facilities. In Bennington County primary care practices are so chronically overbooked that they're basically not even a resource unless you've been a patient for years.

With pressures like these, who would choose to become a family doctor? Specialists earn twice what family doctors make, according to the New England Journal of Medicine (a factor for medical students, who might owe nearly a quarter of a million dollars by the time they graduate). While Congress, in the notorious Medicare Bill, declined to empower the government to negotiate lower pharmaceutical prices for senior citizens, the insurance companies have no compunction about exercising their heft to reduce recompense to family doctors.

And the Bush administration just submitted a budget proposal that reduces already inadequate Medicaid reimbursements for physicians. Brilliant.

Vermont has seen an increase in Federally Qualified Health Centers, a program that subsidizes these facilities and in turn requires them to provide primary care and accept Medicaid patients. That's a good thing, because practically every other message we are sending our family doctors is that we don't value them or respect their needs. That's why one doctor answered the Hogan-Richter-Doran survey thusly:

"I left medicine 2-1/2 years ago; have gone to law school. I graduate in the spring. Let me know if I can help."



Will Lindner is a former editorial page editor of the Times Argus.