Primary Care vs. Urgent Care: Know the Difference

Dear Diary,

Another day, another patient informing me that I’m their primary care provider.

Not in the legal, billable, continuity-of-care sense. No. In the “I haven’t seen a doctor since Y2K, but you look trustworthy enough to fix 30 years of damage in 8 minutes” sense.

It always starts the same way. They plop into the exam chair and casually respond to “Who is Primary” with:

“You’re my primary.”

I didn’t sign up for this, Diary. I work in urgent care. The sign says it. The paperwork says it. My borderline caffeine toxicity all say it. But somehow, I’ve been drafted as the de facto PCP for every “healthy” 60-year-old who looks 80 and has never heard of colonoscopies, cholesterol, or preventative care.

The Introduction

Patient: “I don’t really have health problems.”

Also Patient: Can’t walk 15 feet without wheezing like a harmonica.

Patient: “Never needed a doctor before.”

Also Patient: Smells like cigarettes and beer.

Patient: “You’re my primary.”

Also Patient: Thinks “primary care” means “the place that gives work notes and antibiotics.”

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The Lifestyle “History”

They’ve got no med list. No history. Not even a vague idea of what year they last had a blood pressure cuff strapped on.

Instead, their daily regimen goes something like this:

• One pack of cigarettes before lunch.
• One twelve-pack after work.
• Dinner is drive-thru, unless they’re “watching their weight,” in which case it’s some “healthy” frozen meal.
• Exercise consists of lifting a remote.
• Preventative care = putting Vicks on everything.

Age on ID: 54.
Age in appearance: 74.
Lungs: “pre-owned coal mine.”

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The Irony

What kills me is the pride. They lean back, arms crossed, and brag:

“Don’t take no meds. Don’t need ‘em. Haven’t seen a doctor in 20 years.”

As though the absence of medical documentation is proof of immortality.

Sir, you don’t not have hypertension because no one’s written it down. You just don’t know you have it. It’s like saying you don’t owe taxes because you never filed.

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The Counseling

I always try. I really do.

Me: “You need a primary care provider. Someone to track your labs, screenings, blood pressure—”

Patient: “That’s you.”

Me: “No… that’s not me. I work in urgent care.”

Patient: “But you’re here. And you’re nice. So you’re my primary.”

Me: deep, audible sigh

It’s like trying to explain to a toddler that the babysitter isn’t their mom.

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The Reality

But instead, I’m stuck in the middle. The urgent care oracle. The substitute teacher of medicine.

They don’t want a primary care provider — they want urgent care on demand, forever. No continuity, no screenings, no lectures about smoking. Just quick fixes, notes for work, and maybe an antibiotic to “nip it in the bud.”

The thing that gets me every time is the disconnect between what they say and what I see.

Patient: “Healthy as a horse.”
Me: You mean the kind of horse they put down in old Westerns?

Patient: “Never needed a doctor before.”
Me: You’ve definitely needed one. You just haven’t had one.

Patient: “I feel fine.”
Me: You’re literally out of breath from talking.

Patient: “I don’t take any meds.”
Me: Right, just nicotine, caffeine, and Miller Lite — the holy trinity.

Patient: “I don’t trust medicine.”
Me: And yet here you are, asking me for a Z-Pak like it’s holy water.

Patient: “I’m healthier than most people my age.”
Me: You look like you fought most people your age and lost.

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The Conclusion

And then comes the finale. After I’ve explained, counseled, begged them to establish care:

“Okay, well, thanks, Doc. See you next time.” (Yes, I’ve already explained I’m not a doctor multiple times at this point).

It’s like I’m some seasonal event. Right up there with pumpkin spice lattes and tax season. “Happy Z-Paktember, everybody!”

I didn’t go into urgent care to become the unofficial PCP for half the population. But apparently, here I am. Drafted against my will. Against medical logic. Against the entire structure of our healthcare system.

Because let’s be real — if you haven’t seen a primary healthcare provider in 20 years and you keep showing up here calling me “your primary,” maybe I am your primary. God help us all.

Love,

(Reluctant Primary Care Provider for the Undiagnosed Masses)