The Rebel's Guide to Primary Care
Unconventional tactics to maximize your annual physical plus 5 revealing questions to ask when vetting your PCP
A weigh-in. A blood pressure check. An offer for a shingles vaccine. Zero discussion about menopause or new research on LDL cholesterol — both apparently "out of scope."
Welcome to the American primary care experience, where what you actually care about rarely makes the agenda.
Last week's annual physical left me with nothing but a CGM prescription (small victory) and a stark reminder of how broken the system is. When I joined One Medical a decade ago, I was a frequent traveler between New York, LA and Miami. Back then, having offices everywhere with seamless digital records felt revolutionary.
These days, as someone who rarely gets sick and proactively seeks out progressive modalities (that are almost always out-of-pocket), less so. I went into my wellness exam prepared but with appropriately low expectations — and the system delivered exactly what it's designed for: the bare minimum.
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The 5-question vetting script to find a great PCP
Exact phrases to keep your visit coded as preventive
A Pre-Visit Checklist so you walk in with clarity
An In-Visit Strategy Guide to get what you came for
A Follow-Up Tracker to close the loop on labs, referrals, and care
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The Primary Care Paradox
Your PCP is supposed to be your healthcare quarterback, but they're operating in a system designed for volume, not value — with on average 2500 patients per doctor and appointments lasting approximately 17.5 minutes (yes, really). Blame insurance not your doctor — who is equally constrained within this system — for making it feel like a drive-thru.
To change your annual wellness visit from an insurance-approved check-list into a real-time review that gives you answers, try these pro-moves:
Send a pre-visit brief. Complete the health history in advance and attach a one-pager with your supplements, extra health data (DEXA scans, CGM trends), discussion points, and prescription requests. Email it 48 hours ahead of time.
Request labs in advance. Insist your routine bloodwork be drawn pre-appointment. Discuss lab results and action items during your visit for insights.
Schedule strategically. Pick an early morning slot if you plan to arrive fasted and do bloodwork. Also, the doctor will be “fresher.” When time runs out, ask for a follow-up to continue the conversation.
Know when to walk. If your PCP consistently runs late, interrupts or gaslights you — they're not your person. Like all bad relationships, move on.
Language Matters
Here’s a game-changing secret. It’s all in how you frame the visit.
The system distinguishes between "preventive visits" (covered) and "problem-focused visits" (billable). The moment you mention a specific concern, you've triggered a billing code.
Instead of: “I have fatigue and brain fog. I think it’s a thyroid issue,”