Let’s admit it, doctors play almost no role in patient’s wellness today.
I recently made an appointment for a “wellness check-up” — an annual physical exam with a primary care physician (PCP). According to the healthcare industry, I’m in relatively good health and considered ‘low-risk’: I’m in my 30s, I don’t have hypertension, diabetes, heart disease or any major or minor health condition and I don’t take any medications. In fact, the only official diagnosis I’ve ever received was a self-resolving ‘jumpers’ knee’ (patellar tendinitis) as a teenager. As a physician, I know that I’ve been pretty blessed, and I should savor this clean bill of health as long as I possibly can.
However, I don’t feel “well”. I’m 5’10” with a BMI just under 30. I work a lot (arguably too much, but I really enjoy it, so it feels like a choice), I don’t exercise enough and I’m constantly cycling through trendy diets to try and lose weight. My stress level is manageable and I sleep ok, but I don’t think I’ve ever woken up refreshed and stress free like the actors in mattress commercials. Like many adults of the cell phone era, my mind is always racing and I find it difficult to sit idle. I have no time for hobbies (unless this blog counts), and yet I’m constantly on my phone checking the news or social media. In other words, I feel like I’m a mess and far from “well”.
And yet, the PCP appointment I scheduled was the first time I was going to see a doctor in years — and I was only doing it because my employer would withhold a meaningful amount of money from my paycheck if I didn’t. Why so long since my last appointment? You might suspect I’m the oft-cited paradox of doctors making the worst patients — however, it’s the opposite. I’m someone who deliberately seeks help from experts, and as a physician, I’m no expert in wellness. I’ve had years of training in diagnosing illness and treating sick people, but almost no training on how to make people who aren’t acutely sick feel well or healthy.
Needless to say, I had pretty low expectations for the value of my “wellness check-up”, and my new doctor didn’t disappoint. After my blood had been drawn, he reviewed my vitals, solicited a greatly abbreviated review of systems and performed a cursory physical exam. Although I know diligent doctors who are more thorough during this new patient intake, the brisk version I received is not uncommon for a relatively young, healthy patient who is not likely to raise any red flags. I could tell our visit was drawing to a close, and I decided I shouldn’t put the entire burden on him. So I asked what I could or should be doing to improve my health, to which he replied “drop a few pounds, but otherwise, keep it up”. And I was on my way, literally none the wiser.
As a healthcare industry veteran, I can’t help but think about how much lip service we all (insurers, health systems, employers, government, etc.) pay to wellness and prevention… and “keep it up” is the best advice I got from the single point of contact I’m likely to have with the health system all year (if I’m lucky). It’s abundantly clear that what traditional healthcare sees as wellness falls incredibly far below the expectation of anyone living in today’s stress-filled world. Of course it’s critical to get appropriately timed screenings like Pap smears, colonoscopies, mammograms, prostate exams, etc. but preventive screenings are far from sufficient for achieving meaningful wellness.
As an aspiring self-improvement junkie, I’ve learned there are so many universal things we could all be doing to greatly improve our daily wellness — relatively simple things like understanding basic nutrition, practicing mindful eating habits and proper sleep hygiene, or dedicating daily time for meditation. Even more fascinating is the latest research on behavior and habit change (more in future blogs). Unfortunately, traditional healthcare providers simply do not have the proper training, time, resources or incentives to educate patients on topics like these. Instead, they’ve been relegated to the internet or their employers/insurers. The problem is, patients don’t listen to or trust those sources for health information nearly as much as they do their doctor. If you don’t believe me, imagine you received two voicemails saying that you had an important message from your insurance company or your doctor. Which one would you respond to first? From industry benchmarks, I know that patients are about 4 times more likely to take calls from the latter than the former.
Before I receive angry comments from my physician colleagues, let me be clear that I’m not suggesting simply stuffing nutrition, fitness, psychology, sleep and other topics to an already bloated medical school curriculum. It’s barely tenable as it is (a topic for another day). I’m suggesting that we challenge our assumptions about the scope, responsibility and opportunity for primary care, and consider how we can better leverage the sacred and intimate physician-patient relationship to motivate and support our patients to improve their holistic well-being (both sick and healthy patients alike). How can we complement the knowledge and skills of a PCP with other wellness experts? What should be our role in curating the wasteland of internet content in the world? What role can technology play to help us increase personalization without creating additional work for the care team? How do we incorporate the power of cutting edge behavioral science? Most importantly, how can we do better for the majority of our patients who aren’t acutely ill and engage them in covering the full spectrum of their needs?
