Since the official launch of the Affordable Care Act in late 2013, millions of previously uninsured or underinsured Americans have selected plans affording them better access to health care. With all the controversy around the new legislation and questions surrounding the launch of the enrollment web site, little attention was paid to how the law would directly affect the millions of newly insured and their care providers. Now, across the nation, physicians and insurers are beginning to serve a patient population that looks, and in many ways behaves, different from the previous patient populations.
According to new data from PwC - a multinational professional services firm - it is estimated that by the end of June, there could be as many as 30 million newly-insured Americans, many of whom will be “less educated, more racially diverse, and more than twice as likely to speak a primary language other than English.” They will be young (median age 33) and many who report “feeling healthy” may not want to see a doctor, or may not understand the reason behind routine, preventative tests. Others who don’t “feel” healthy, may have only previously experienced medical care when a condition was bad enough to require emergency care. Either way, it’s highly likely that many of the newly insured will be seeing a primary care physician for the first time in a long time, which could mean an increase in previously undetected conditions or mental health issues.
As health systems work to increase preventative measures and reduce Emergency Department readmissions, and newly insured patients attempt to navigate the health care industry, the two sides intersect, creating a pool of questions for both patients and care providers alike. For patients, what do you need to share with a primary care doctor? What kind of tests should you expect? Should you even bother to see a primary care physician? And for health care providers, how do you create a relationship with these incredibly diverse populations? How do you get to know them and their health history?
While Penn Medicine has some programs that help vulnerable patients access the care they need, and others to help patients create and maintain health goals, resources are limited and these programs are not currently available to all patients, leaving some to navigate the system on their own.
To get a sense for what these new patients should expect, I recently sat in on an interview with Michael Cirigliano, MD
, associate professor of Medicine, and Dan Gorenstein, health reporter for the national radio show Marketplace, in which Dan played the part of Dr. Mike’s new patient.
To Move Forward, We Must Go Back
For Dr. Mike, the new patient experience is all about returning to a time before technology ran rampant in exam rooms. Technology, he says, is a good and brilliant thing. It helps diagnose and treat conditions better than ever before. The problem is the affect it’s having on the patient-doctor relationship. On the wall of the exam room is a print of Norman Rockwell’s famous painting “Visits a Country Doctor” (above). In the painting, a physician sits with his elbows on his knees and his hands clasped in front of him. He is speaking to a man, woman and small child. There is no computer in the room. He pays no attention to his desk, cluttered with papers, not even to take notes. He looks only at the family, direct and personal. This time spent forming a bond with a patient is, according to Dr. Mike, just as vital to health care as the latest tests and procedures.
“If we want to help patients, we need to take the time to get to know them,” Cirigliano explains. “Relationships built on trust in health care are becoming a thing of the past, and as we start seeing more and more new patients, particularly in these vulnerable populations, it’s becoming more important than ever that we go back to our roots, and get to know them.”
As Dr. Mike visits with his new patient, making a note here and there but never looking at the computer, he asks him about his family health history: Family history of cancer? Mental health problems? Major surgeries? He asks the patient about his personal life: Is he in a monogamous relationship? How often does he smoke and/or drink? Does he experience high-stress in the workplace? Does he take any medications daily? How about vitamins? After a brief physical in which Dr. Mike checks the patient’s lungs, head and neck, he declares our 39-year-old male the “perfect picture of health.” Still, he says, we need to run some tests.
“Tests?” the patient asks dubiously. “For someone who has just been declared the ‘perfect picture of health’? Do we have to?” Oh yes. For our new patient, Dr. Mike wants blood tests to check his thyroid, lipids (cholesterol), kidneys, blood count, and more. It sounds like a lot but as Ben Franklin said, “an ounce of prevention is worth a pound of cure.”
“I tell my patients ‘trust in God, but for everyone else, show me the data’,” he says. “I want to see the test results because I want to know that you don’t just feel okay, but that you are okay. Investing in preventative medicine is one of the best things we can do, first and foremost for our patients so that they don’t end up in the emergency room, but also for the health care industry. We have to spend a little bit now, so that we’re not spending a whole lot later.”