Three years ago, I would've written your post.
But my beliefs changed after my experience within the system during a catastrophic series of events followed by repeated minor catastrophes. This series of unfortunate events caused to me face the reality that some of the underlying assumptions I was making were wrong.
First, emergency does not = simply broken bones or auto accidents. A PCP isn't an issue depending on the emergency and depending upon how the body of the person experiencing the trauma works.
When my son first started running a fever at 5 days old, my intuition went into overdrive. I remember very distinctly shouting at my husband, "We do not need a f***ing naturopath. We need to go to the hospital. Get that pediatrician our midwife recommended on the phone now. We need to see him first."
Because we had no contacted this pediatrician prior to this event, when we were not able to get ahold of him, we were forced to see someone else. Someone while competent, much less competent, and much less in line with our philosophies.
Not having a doctor before this crisis caused real and permanent damage to my child. Had I had the doctor the midwife recommended who we eventually switched to several months later, we would've gotten much farther much faster with our diagnosis of my son.
Competence, continuity of care, and (even some) shared philosophy would have made a distinct difference.
Second, I hear you saying that you do not classify different chronic illnesses or other illnesses as necessarily needing hospitalization or what I will term "modern medicine." You believe there are other approaches, and you would go to the ends of the earth to get them. And you would exhaust them before turning to "modern medicine."
Again, I held this view, and I still do for many cases. I have used traditional medicine ever since I could choose my own care consultants. But after my experience, what I believe now is that it is not possible to predict every kind of situation that may arrise where your instincts tell you that you need modern medicine, and you need it now.
I also assumed that the traditional medicine doctors would know who was best and brightest in the modern medicine world. This has not panned out for me. In fact, the wonderful acupuncturist, chiropractor, with an emphasis in herbs and cranial work friend gave me the name for the pediatrician that I used in our first crisis. And the pediatrician was about average, but horrid.
The same thing happened when I got a recommendation when I moved from our osteopath (the one who referred me to our homeopath and a nutritionist/chiropractor): the pediatrician she referred me to is the one who assaulted my kid with the syringes of antibiotics. And a friend later told me that that ped was actually blatantly incompetent in many ways.
Third, it is very rarely my phsyicians who decide my child needs to be hospitalized. There have been numerous times when I have told my child's PCP that we will need to go into the hospital when they were hesitant to send me. And in fact, the ER docs now ask: what do you think? Do you want him hospitalized or would you like to manage this at home?
In fact, I find many doctors, especially when they do not know your child well lean more toward not putting them in the hospital, even when they clearly need to be there. I can't even count on one hand the number of times my child needed to be in the hospital and was either sent home or triaged down (rated as less critical) when he was in severe crisis.
And I will tell you that nearly every time, the child for whom they are making space for first is a child either without a PCP facing a situation that could have been avoided with good advice or a child for whom an office visit the next morning would have been sufficient.
For example, last time I was in the ER we waited 6 hours to see a doctor. During these six hours children with ear infections and colds were seen before my child who was decompensating, suspected of having an abcess on his bladder, and quite ill. Why is it that we waited that long? Because the triage nurse declared that since my son had never been in the ICU, he probably didn't have a metabolic disorder and "he doesn't look sick enough to have an abcess." And all of this because I couldn't get ahold of my PCP urologist...I got instead the student for another doctor.
Another time my child had a blood pressure of 186/136. We waited 12 hours in the waiting room even though we arrived by ambulance, and even though we believed he had had a seizure lasting 25 minutes. Why? Because the nurse triaging him said "people don't cry out when they are having seizures," and his blood pressure is probably just elevated from the crying" (it was fussing). AND because my PCP pediatrician at the time used hospitalists who do not work in the ER, so there was no one to call and hastle them to move us up.
I am not advocating that everyone get themselves a neurologist, nephrologist, urologist, cardiologist, etc before their child is born.
I'm advocating finding the smartest pediatrician (or PCP...depending if it's for an adult or child) you can possibly find in your area with priviledges to the best children's hospital in your area.
*Someone who knows what a medical home is and uses that model. (The medical home model is the idea that the parents are the primary care givers and the cotors are consultants. And your PCP is the organizer etc of care for your children...they know specialists and make sure they play well with others; they collect your medical records; they see you whenever possible, not foist you off on a colleage. It's continuity of care to the extreme.)
*Someone who knows that it is parents who live wtih the choices that parents and doctors make.
*Someone who believes it is a parents right to choose or not choose any procedure.
*Someone who ideally supports normal birthing and child raising practices.
*Someone who understands how the system works, how it doesn't work, and does there best to keep you in or out of the system as best fits your situation.
I'm going to end by expanding on my plumber analogy. To me, having a PCP before you need them is like having a good plumber before you need one. You don't need them to tell you nothing or something is wrong with your plumbing. You'll know when something is wrong. Often, you'll even know what is wrong. But if you do need one, and you don't have one, you can't always count on the other people you do know to be home to recommend one. You can't always count on their recommendations to be accurate or reliable. You can't count on that you can get ahold of someone you don't have a relationship. And when you really need one, you need them as soon as possible...and they need to know at least a little bit about your house and your plumbing. In this way, they cost you the least amount of time, money, and damage to your house. And the least amount of repair work to be done later.