Tom Murphy
April 16, 2019 at 11:37
pm
Lisa Love hasn’t seen her doctor of 25 years
since she discovered telemedicine.
Love tried virtual visits last summer for help
with a skin irritation and returned for another minor problem. She doesn’t feel
a pressing need to seek care the old-fashioned way, especially since she also
gets free health screenings at work.
No more waiting for the doctor’s office to open.
Convenience rules in health care now, where patients can use technology or
growing options such as walk-in clinics and urgent care centers to get help
whenever they need it.
A survey last year found that about a quarter of
U.S. adults don’t have a regular doctor. Some such as Love wonder how much they
still need one.
“Telemedicine probably can’t do everything … but
for most of the things I might ever have, I’m pretty sure they can take care of
it,” the Twin Falls, Idaho, resident said.
Health care experts say the changing, fragmented
nature of care is precisely why people still need someone who looks out for
their overall health, which is the traditional role of primary care physicians
such as family doctors and internists.
They know patients’ medical histories, and
they’re trained to spot problems that may be developing instead of just
addressing symptoms that prompted the patient’s visit. They also can make sure
medications don’t conflict with regular prescriptions, and they can help make
sense of the information patients dig up with a Google search.
But the nature of primary care is changing as
patients branch off to drugstore clinics and urgent care centers. Practices are
slowly shifting to more of a team-based approach that focuses on keeping
patients healthy and reserves visits with a doctor for the more serious cases.
“The idea that the primary care physician is the
one-size-fits-all solution … that’s going to change pretty dramatically,” said
Sam Glick, an executive with the research firm Oliver Wyman.
This evolution began years ago when drugstores
started providing flu shots and opening clinics that handle minor issues such
as ear infections or pink eye. The two largest chains, CVS Health and
Walgreens, now run about 1,500 clinics combined.
More recently, employers have started adding
worksite clinics, and thousands of urgent care centers have opened around the
country to treat emergencies that aren’t life-threatening. Then there’s
telemedicine, which patients can use to connect to a doctor in minutes without
leaving their home or office.
Love said she’s hooked on virtual visits. They
only cost $42, or less than half the price of an office visit under her
insurance plan.
“I like technology and I like new things and I
like saving money,” Love said. “It was worth it to me to try it.”
About 25 percent of adults don’t have a regular
doctor, the nonprofit Kaiser Family Foundation found last year. That jumps to
45 percent for those under age 30.
On top of all the competition for patients, the
field also is fighting a shortage of doctors as medical school students opt for
higher-paying specialties.
Primary care practices have adjusted by adding
physician assistants or nurse practitioners to handle annual physicals and
other routine care.
They’re also creating teams that help them take
a broader look at patient health. Those teams might include mental health
specialists who screen for depression and health coaches who can improve diet
and exercise.
The idea is to keep patients healthy instead of
waiting to treat them after they become sick.
“We want to do as much outside the walls of the
clinic as we can,” said Stanford University’s Dr. Megan Mahoney, noting that
this push depends on insurers expanding what they will cover.
Doctors also are continuing to focus more on
coordinating care for people with complex health needs.
Bryant Campbell’s care team includes a primary
care doctor, a pharmacist and specialists to help manage his chronic liver
condition and rheumatoid arthritis. The Portland, Ore., man said his team
members talk frequently to avoid problems such as duplicate tests, and their
approach gives him more confidence.
“I sometimes think as patients we feel isolated
in our health care, and this team-based approach helps a patient be as involved
as you need or want to be,” he said.
Doctors say the expanded scope of their
practices is changing how they interact with patients. Dr. Russell Phillips frequently
responds to email or cellphone questions from his patients. He also refers them
to clinics for minor issues such as urinary tract infections.
The Harvard Medical School professor says
primary care is evolving into more of a flowing, virtual relationship where
patients have more frequent but briefer contact with their doctor’s office
instead of just office visits maybe twice a year.
“Getting medical care is such a complex activity
that people really need somebody who can advise, guide and coordinate for
them,” Phillips said. “People still really want a relationship with someone who
can do that.”
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