105. My Semi-annual Primary Care Team Visit

Fixing United States Health Care - Letters to the File

Part I. The Hot Mess

Part II. The Solution

by

T Michael White MD FACP

www.fixingushealthcare.com

The Realization of Universal Access to ABC-STEEEP

(Affordable, Basic, Compassionate - Safe, Timely, Efficient, Effective, Equitable/Just, Patient-Centered Care)

******

105. My Semi-annual Primary Care Team Visit

“Disciplining yourself to do what you know is right and important, although difficult,

is the highroad to pride, self-esteem, and personal satisfaction.”

Margaret Thatcher

The WhiteHouse on the Belleair Bluff

Sunday, November 16, 2025

Dr. Mike,

A letter to the file…

You are now a full-fledged, registered (card carrying) USHCS client/patient.

Telling yourself the truth, at the moment, your health is stable in an unavoidable,

cursed, unsatisfactory age and gender kind of way. In the near by and by, you have a semi-annual visit with your Primary Care Team coming up. All good.

Chatbot Osler sends you an email, “Czar Dr. Mike, please contact me, so we may

prepare you for an efficient semi-annual Primary Care Team visit.” At your convenience, you check in with Chatbot Osler, and this transpires:

Warmest salutations are extended;

• You agree on semi-annual Primary Care Team visit appointment date;

• Q: Since our last encounter, have you had medical care outside My (Unique and Very

• Personal) United States Health Care that I am unaware of? A: none.

• Prior to your visit, your Primary Care Team requests:

  • You have the following fasting blood work: CBC, Chemistry Panel, Lipid Panel,

    Hgb A1C, PSA.

  • You your vital signs (pulse, temp, pulse-ox , blood pressure, weight) at your

    pharmacy kiosk.

• You make a list (so all bases are covered) of topics you and your Primary Care Team

  must review:

  • Benign prostatic hypertrophy/nocturia ꟷ stable

  • Coronary artery disease:

    • Angina ꟷ stable

    • Lipids ꟷ stable

  • Gastroesophageal reflux disease/heartburn ꟷ stable

  • Osteoarthritis (neck, low back, hips) ꟷ stable

  • Skin cancer (actinic keratosis; basal cell; squamous cell) ꟷ stable

  • Sleep apnea/C-Pap ꟷ stable

  • Your medication list is comprehensively reviewed for accuracy, duplication and

    education opportunities.

• Chatbot Osler queries you regarding any concerns you desire to be discussed.

  • “Chatbot Osler, the vision in my right eye is deteriorating. I have trouble driving

    at night (sparkling oncoming headlights). If I close my right eye, my vision clears.

    I think I may have a cataract developing in my right eye.”

Prior to your visit, Chatbot Osler sends you a note. Your vital signs and blood work look good. Please bring your glasses to your Primary Care Team visit.”

At your visit, you underwent vision screening (pressures normal). Your nurse

practitioner examined you thoroughly and then went over each of your stable problems and your new (vision) concern. Your Primary Care Internist/Geriatrician reviewed your visit, and you left with the following plan:

• Maintain good (diet, exercise and sleep) habits;

• Maintain your current medications;

• Update COVID, influenza and RSV immunizations at pharmacy;

• See dermatologist annually;

• See urologist annually;

• Measure vital signs at your pharmacy kiosk at least quarterly;

• Schedule your biennial cardiac stress test prior to your next semi-annual visit.

• Referral to participating ophthalmologist (of mutual choice) with cataract surgery

  expertise regarding deteriorating vision (possible cataract).

• Review communication methods with Primary Care team (that are working well).

• Return to Primary Care Team in six months for next semi-annual visit and contact

  Chatbot Osler as necessary for intercurrent concerns.

Dr. Mike, you again have to admit that as an academic and clinical physician; a health

care administrator; and a LIOM-C (certified legend in own mind), you are impressed. This all made sense and went very well. With assistance (Chatbot Osler), you are investing significant time and effort in pre-visit prework that is making your care comprehensive and efficient for both you and for the fine ‘Better Angels’ that are caring for you so well.”

Respectfully submitted with fondest personal regards,

Dr. Mike

P. S. Chatbot Osler arranged your ophthalmology appointment and assisted you prepare for your visit. After an efficient comprehensive evaluation, cataract surgery was performed. You have recovered well. Stable, you have been instructed to follow-up annually with a participating optometrist.

You may leave an anonymous comment without username and email ꟷ please do. Please share your wisdom, insights and perceptions (your reality) about what I have right, wrong and/or omitted. I will be delighted to hear from you as this draft and subsequent chapters will be significantly enhanced.

Dr. Mike

Letters to the File ꟷ Part II

101. Introduction to Part II ꟷ The Solution

102. The United States Health Care System ꟷ Enabling Legislation

103. The United States Health Care System ꟷ View From Space

104. My (Unique and Very Personal) United States Health Care ꟷ Getting Started

105. My Semi-annual Primary Care Team Visit

(more to follow)

www.fixingushealthcare.com