I was recently fired by my primary care doctor. He was my PCP for 7 years. According to his protocol, I had a physical every year until three years ago. I rarely go to the doctor unless an ailment seriously impedes my ability to function. I saw my PCP in 2002 to have stitches removed after a bicycling accident. the day of the appointment, I fell on the sidewalk and sprained both wrists. The PCP looked at me and said, "Why so clumsy?" I thought he might want to find the answer to that question, but the conversation stopped there.

In 2003, I had terrible insomnia, and having exhausted every OTC and natural remedy, I went to see PCP. I told him I was also suffering from a horrible agitated depression and racing thoughts along with the insomnia. He didn't ask for much in the way of details and prescribed Lexapro. Three months later I was back, still not sleeping, feeling worse. He increased the Lexapro. Three months later, back again. The PCP said, "You're supposed to be getting better, not worse. Twenty mg of Lexapro is the maximum effective dose. Give it more time." This went on for well over a year. After 18 months, I was suicidal, so I took it upon myself to see a psychiatrist.

The pdoc diagnosed me with Bipolar disorder. For the next two years, the pdoc worked on getting the right combo of meds. When I went to the PCP for a minor illness, he was visibly annoyed when I said I was taking lithium. He was offended that I had taken it upon myself to see a specialist.

In September of 2007, I went in after having a sore throat for three months. The PCP told me there was nothing wrong with me. He told me I needed to lose weight and exercise. I said I was too tired. He said it was because my lithium wasn't at a therapeutic level. I told him that lithium was prescribed as an anti-manic agent for me, not an anti-depressant (I take two of those). He said the other reason I was tired and depressed was because I was obese (5'2" 175) and sedentary.

The truth is, I was NOT depressed. I was tired for the same reason I wasn't exercising: 70-hour work weeks, including weekends. He never asked about my schedule or my job or my home life or my sleep. There was no time. My 15 minutes were up.

Two days later, the secretary called and said I had to get a physical. I said I was too busy at that time, but I could do it in three months. She was adamant. She insisted I come in for blood work and a physical exam. I told her not now. I pointed out that I had had four blood draws (for lithium level) with full panel in the past 14 months. My blood pressure was great, adn I've never had a cholesterol problem--never.

I explained that I had seen the gyno only six months back, and she had done a fairly thorough exam and recent history along with the annual pelvic. I had two mammograms and a breast sonogram w/in the last 4 months. I had been to the dentist twice in the past year, plus the psychiatrist every eight weeks. I was hardly neglecting my health. Since it would be almost impossible for me to take time off from work for a physical, I said I would be happy to go to Quest on a Saturday and have a blood draw, with results going to the PCP. Nope. No go. I also explained that although I hadn't yet met my deductible for the year, by January a physical would be affordable for me. Finally, the secretary got very irritated and abruptly finished the call. I SWEAR I was not rude.

A week later, I got a letter from the PCP saying, in effect, I was fired as a patient because I would not have a physical. Or maybe they think I'm difficult. At least I was the polite person in this scenario.

If this is what doctors demand from patients these days, I don't want to go at all. Ever. I don't care how sick I am. It's too intimidating. I don't feel like I did anything wrong, but apparently I did.

What do I do now? Just go to a critical care "doc in the box" business if I get sick? I can't face the prospect of looking for a new PCP. What's the point of hiring a doctor to see you for only 20 minutes a year? Are patients just a commodity?