Monday Oct 22, 2018
Millennials Don't Have PCPs; Here's Why They Should
Do young, healthy patients need primary care physicians (PCPs)?
It's a question that spurred a social media debate(twitter.com) on the heels of a recent Kaiser Family Foundation study(www.washingtonpost.com) that found nearly half of 18- to 29-year-olds say they don't have a primary care physician.
The trend isn't surprising. Millennial patients value convenience and connectivity over relationships.(www.managedhealthcareexecutive.com) They would rather get immediate care from an app or a retail clinic than wait to see a physician.
But relegating primary care physicians to chronic care management isn't the answer to our nation's health care woes.
Instead, primary care delivery needs to evolve to meet the needs of modern patients. It's why I'm proud to work for an innovative primary care organization called One Medical. The cornerstone of our model is designing a cutting-edge primary care system with the patient at the center.
As a result, easy access points -- including in-person and virtual care -- are a fundamental tenet. We value team-based care that includes nurse practitioners and physician assistants. We utilize technology to actually improve care delivery, not hinder it. A patient can do a video visit about their cold in real time or get treated for a urinary tract infection by reporting their symptoms asynchronously on our app. They can fill out an online questionnaire about an upcoming international trip, then walk into our office to get their travel vaccines. They can get a same-day appointment (including evening and weekend hours in some locations) to have their sudden ear pain evaluated.
Nonetheless, the main cornerstone of how we deliver high-quality care long term is the relationship patients have with their PCP.
Many of our patients are young and don't have chronic conditions. But we keep them engaged in their health to maintain wellness. We also proactively educate patients about the range of services we offer.
Studies have shown that comprehensive primary care has the potential to reduce health care costs(www.annfammed.org) -- through care coordination, curbing unnecessary/wasteful tests, and decreasing both ER utilization and hospital stays. Most importantly, primary care improves patient health outcomes, including mortality.(www.healthaffairs.org)
But how is any of this translated to younger, healthier patients? We are already witnessing the consequences of younger, healthier patients lacking a PCP through the usage of urgent cares or retail health centers for acute, episodic care. Unfortunately, retail health centers actually increase health care spending,(www.healthaffairs.org) likely attributed to overutilization in a still-traditional face-to-face setting.
And urgent cares are not necessarily known for their high-value care.(jamanetwork.com) Half of all patients who seek treatment for basic colds in an acute care setting get unnecessary antibiotics, compared with only 17 percent who are seen in an outpatient doctor's office. Not only is this approach costly, but unnecessary antibiotic use has several potential harms.
Cost is not the only lens we should view health care through -- quality and outcomes matter. And that's the main reason millennials deserve a PCP, too.
After all, it's a PCP who can support a patient through behavioral change, like decreasing alcohol use. It's a PCP who can link a patient's insomnia to their underlying anxiety disorder or detect and address their risk of diabetes. It's a PCP who can have a thoughtful conversation with a patient about why they don't need an MRI for their headache.
Continuous care also matters in piecing through episode care. I recently met a new patient who had multiple, one-time visits at different urgent cares for fevers and sore throats. Through testing in our office, we found out he actually had HIV.
In acute settings, I've seen high blood pressure dismissed due to a patient "being sick." When they later established care with me, I diagnosed their hypertension and started multiple interventions.
Last week at the AAFP Family Medicine Experience in New Orleans, I met family physicians who deliver babies in rural communities, serve as team physicians for college athletes, and are at the forefront of battling the opioid crisis. Our scope may be different, but we share a commonality in our commitment to patients.
What differentiates primary care is not just what we do for patients -- it's our philosophy of care. Primary care is not just about ordering vaccines and screening for cancer. The primary care philosophy is to care for every patient. We are adaptable. We evaluate evidence and avoid unnecessary tests, but engage in shared decision-making and respect patient autonomy. We believe research should include a breadth of clinical patients. Health care delivery should continually evolve while keeping patients at the center.
Through this approach, we can make a real impact on the health care system as well as on individual patients. And that includes the young, healthy ones, too.
Natasha Bhuyan, M.D., is a board-certified family physician in Phoenix. You can follow her on Twitter @NatashaBhuyan.(twitter.com)
Posted at 04:29PM Oct 22, 2018 by Natasha Bhuyan, M.D.