I have now transitioned from primary/care to a Lyme consultative practice.
I don't get to diagnose patients in the "general population."
The chief complaint of patients visiting a primary doctor is musculoskeletal in nature about 30% of the time. For some reason, the incidence of peripheral neuropathy is on the rise; I was surprised to read that "idiopathic." unknown cause, is found more often than diabetes. ( old joke: idiopathic means the patient is pathological and the the doctor is an idiot). OK, so how many of these patients and others have Lyme disease?
Then there is the growing population diagnosed with fibromyalgia: many treated with drugs that are supposed to help but only make things worse.
The really sick patients might see 40 doctors before visiting with an "LLMD" if they are lucky.
Many patients will be left disabled with "mystery diagnoses."
Of course if I am not there to diagnose a few, my former patients will suffer the fate of so many others. Perhaps when patients hear I have left primary care to treat Lyme disease it might communicate something.
HMOs and managed care allows for 6-8 minute visits with a primary care doctor and focused evaluations by specialists who never see the bigger picture. Even the more open minded physicians operate in a system which deprives them of the energy or time to look elsewhere.
This is all rather depressing so I will turn my attention elsewhere.