By Donald McGee
I just attended a very useful meeting, where there is a consensus that maybe how we practice primary care, an ideal, is actually a failure in reality. To some, it could look like a big power trip for a physician to invite you into her or his “territory,” ask you to sit on the end of a hard examination table half-naked, and offer no recognition that you took a half day off and maybe a quarter of tank of gas for 6 minutes in her or his exalted presence.
You then get a prescription for some drug you barely understand, are told to lose weight, exercise, de-stress over your sixteen year old, and “see me” in 6 months for another 6 minute visit. Of course 6 months later, you have not lost weight, still are not fit, still arguing with your now sixteen and half year old-- so your medication dose is increased. Maybe you are told to see the diabetic educator.
And, if you get sick, your physician is not accessible, so you go to the ER where some unknown physician will run thousands of dollars of tests, and then have the effrontery to tell you to lose weight, exercise, and have a family counseling session “somewhere.” You might get antibiotics.
If, however, you REALLY do know something about DNA telomeres and endothelial health (you know, those heart attacks, strokes, cancer, dementia causing things) you might be less interested in prescriptions and more interested in how to really lose weight, maintain fitness, manage stress, and do those things that have to do with comprehensive prevention and wellness.
Prevention and wellness do not come in a pill (sorry statin industry). Primary care IS prevention and wellness. Does anyone else get this disconnect?
Many do now. And the answer is a paradigm change. See your physician for the annual check up exam, but after that, 90% of follow up visits can be by telephone or video visit app that includes your physician, but also those who (should) work with your physician in all things prevention and wellness: a nurse arranging immunizations and screenings (e.g. mammograms); a pharmacist on minimizing your dosages; a nutritionist who virtually is monitoring your food choices and weight through a mobile health app, and behavioral specialists who really can make a difference by integrating with other health apps. And, all this is in your “territory”: your home or workplace.
Afterall, this is where YOU make your choices having to do with how YOUR DNA works and how YOU maintain vascular health.
So, if your physician and supportive staff do not offer telephone and video visit encounters for most of your non-emergency needs for the year -- change physicians or get a new insurance payer. I am an “old” family and emergency physician, and trust me, most of your needs are better met with virtual care that focuses on the relationship you have with a physician that does not require you half-naked every time.
Your physician knows so much more than prescribing drugs--but in too many cases the broken office visit model cannot afford allocate the time you need for a thorough consultation. Virtual encounters can help change this relationship in your favor hopefully providing a bit more virtual face time with your trusted physician. Demand it.
If you're a healthcare provider, you can start offering modern telemedicine services to your own patients by getting set up with an inexpensive Truclinic account. For more information on Truclinic, please email: steve(at)wellness.com for a demo.