From Primary Care to Portable Care

With all of the focus last year on health insurance costs and coverage, it strikes me that we may not be paying enough attention to how people actually get their health care.  Change is a constant in so many things . . . including the world of primary care.  It’s not just about a visit to your family doctor anymore.

When I talk to my millennial sons, they rarely mention visiting a conventional doctor’s office.  I hear instead about flu shots at CVS’s Minute Clinic, consultations through the Amwell app on their smartphones, and Saturday visits to the urgent care clinic for that thing they’re worried about (just not worried enough to take time off from work during the week).

They’re not alone in seeking out new and different options that leverage 21 st century technology and our increasingly “on demand” culture.  Walk-in clinics are popping up across the country. Telehealth apps enable virtual appointments and conversations with medical professionals, and confidential messaging systems let you communicate with your doctor’s office in between appointments.  Even an old healthcare standard – the house call – is making a comeback, with services like Remedy in Austin, Texas, that will send a licensed medical professional to your home or office.  And if you absolutely have to go to the hospital, you might choose an Uber or Lyft over an ambulance.  All of this is on top of the slew of portable, wearable devices that can monitor your body’s condition and countless websites – some more reliable than others – that stock descriptions of symptoms and dispense treatment advice. (Check out AARP’s online health tools including our Symptom Checker, Care Provider Locator, Drug Interaction Checker and more.  But, note that all visitors to – or really, any health-oriented website -- should seek expert medical care and consult their own physicians for any specific health issues.)

Better and more convenient access is a wonderful development, particularly since a primary care physician shortage is looming.  But these solutions aren’t without their drawbacks.

You can’t believe everything you read on the internet, and some of the free advice available may do more harm than good.   And one of the most powerful benefits of seeing a primary care physician regularly is the continuity of care you receive.  A primary care doctor gets to know you and understands your medical history, lifestyle, and risk factors – and how they may have changed over time.  He or she can help you adopt healthy behaviors, “connect the dots” of disparate symptoms or test results, catch signs of bigger problems early on, and guide you through the sprawling healthcare industry.  These new access points—urgent care, apps, websites— tend to serve as just-in-time doctors, answering immediate questions and treating one-time health issues.  Convenient, yes, but also targeted and selective.  What is lost is the benefit of having someone keep an eye on the bigger picture.

Additionally, many of these services and options may not be available outside of cities and larger towns.  Just as traditional healthcare is more difficult to access in small towns and sparsely-populated areas, these alternatives are also scarce.   Even new telehealth options, which offer tremendous promise, can be limited by poor broadband access.

So as usual, technology and innovation bring us more options and convenience, with a degree of unforeseen risk.  I can’t (and wouldn’t!) tell you how to manage your healthcare day-to-day, but I am happy to report that someone has likely created a solution that fits your needs.

Nancy LeaMond is AARP chief advocacy and engagement officer. She leads the organization’s Communities, State and National Group, including government relations, advocacy and public education for AARP’s social change agenda. LeaMond also has responsibility for AARP’s state operation, which includes offices in all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands.

You can follow her on Twitter @NancyLeaMond.

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