Well, the Affordable Care Act has already kicked in, and the law of unintended consequences is running amok. Beware not only if you are on Medicare or Medicaid, because most private plans take their guidance from the government, the biggest healthcare payer. Guess what?  You are going to have to learn how to avoid the doctor, monitor yourself, diagnose yourself on the internet, and save any visit to the physician for a real emergency.

Here’s what happened to one woman (me), who went to the doctor for an annual visit soon after some changes kicked in with the new year. I have mitral valve prolapse (benign abnormality), so on the advice of my doctor, I go every couple of years to the cardiologist to have it checked. When I do, I usually get a contrast treadmill test, which is the standard of care for diagnosing heart disease in women, and an echocardiogram, which is the standard of care for diagnosing abnormal valve actions.

In the past, all  that took place on the same day. This year, however, because of changes in the insurance policies of the federal government, I only  had a quick chat with the doctor, who then put his arm around my shoulder and walked me to the appointment desk, where I had to make three more appointments — one for each test and one to discuss the results. (Can you say “time suck?”)

I took time off work four times, waited in the doctor’s office four times, traveled four times, and waited four weeks for results. When I finally got the treadmill test, it was without the contrast, too. It was the test that works better on men. One long-time treadmill tech finally explained it to me.

According to the new regulations, the doctor can’t get paid for your visit if you have a test the same day. And the insurance will not reimburse for two tests given on the same day. Moreover, you don’t get a contrast treadmill anymore, except as a followup to a standard treadmill. If  they had discovered anything wrong, I would have had to make another appointment to have the treadmill with the contrast. How does this save anyone any money? Is it supposed to prevent waste and fraud?  The staff has to submit four or five different claims. The office has to squeeze in the same patient load, spread over more time.  More gowns, more techs, more claims processors. The doctor can’t make a timely diagnosis. And I waste time and gas.

I tell this to you because it’s a lesson: time to stop going to the doctor, because it is going to be more about him than about you in the future — what he will be reimbursed for, how willing he is to see certain patients who don’t get better according to his “outcomes-based” payment system, and how many more records he has to keep with his new electronic health record. One doctor friend of mine says the typical fifteen minutes with a patients now consists of five minutes talking to the patient and ten minutes typing into the computer.

This same doctor says his colleagues are leaving the profession as quickly as they can, or turning to concierge medicine, where you will have to pay a lump sum annually to be a patient. In advance. If you can’t afford that, you’re going to get short shrift. Medicine in the future will take place on your smartphone and YOU will be the doctor.

Here are a few apps that help with preventative care and self-diagnosis:

1) Medicine Finder (over the counter)

2) WebMD

3) Glucose Buddy

4) Pilltracker

5) Runkeeper

6) Withings