How Can We Reach the Patients We Don’t See Regularly?

\r\nHe has published in several medical journals, including recent research on use disparities in telehealth visits & effective community outreach interventions to encourage COVID vaccination. His weekly MedPage Today column, \u201cBuilding the Patient-Centered Medical Home,\u201d focuses on improving patient care.<\/p>“,”affiliation”:””,”credential”:”MD”,”url_identifier”:”fp4223″,”avatar_url”:”https:\/\/assets.medpagetoday.net\/media\/images\/author\/Pelzman_330px.png”,”avatar_alt_text”:”Fred Pelzman”,”twitter”:””,”links”:null,”has_author_page”:1,”byline”:”Contributing Writer, MedPage Today”,”full_name”:”Fred Pelzman”,”title”:”Contributing Writer, MedPage Today, “,”url”:”https:\/\/www.medpagetoday.com\/people\/fp4223\/fred-pelzman”,”bluesky”:””}]”/>

Let me tell you about two “new” patients I saw recently.

One was a new patient who came to see me at the request of their newly found significant other, someone in their late 50s, who reported to me that the last time they’d seen a doctor was their discharge from the military just about 30 years ago.

The other one was a patient of mine who came to see me for their annual physical examination, who apologized and said, “Sorry I missed my annual checkup last year — and maybe the year before?” When I looked back, the last time that they’d been in to see me was about 7-1/2 years ago.

Both of these patients were actually doing okay — some minor ailments; some healthcare hiccups and bumps along their roads; some high blood pressure, cholesterol, and impaired glucose tolerance that were creeping towards a place where all of those needed to be paid attention to. Both of them also were long overdue for some healthcare maintenance updates: quite a number of vaccines; colon cancer; breast cancer; and cervical cancer screenings. Maybe they were drinking a little too much alcohol, smoking a few too many cigars, and not getting any regular meaningful exercise.

The Regulars and the Not-So-Regulars

I started to think about how potentially different these two may have been from people who see us regularly, people who come to see us for their annual physical exam like clockwork once a year, a check under the hood to make sure everything’s going okay, or even those patients with multiple chronic medical problems who see us quarterly or even more often.

The person who’d seen me as a truly new patient was just there because their new significant other had yelled at them that they needed to see a doctor, and had in fact been puttering along living their life pretty well — working, raising a family, qualifying for life insurance, not having any major interactions with the healthcare system, and in fact had probably dodged quite a few bullets (not the military kind, but the healthcare kind).

My patient who thought they had just missed an annual physical or two, on reflection, realized they’d been busier than they thought, not taking care of themselves, focusing on their work, traveling all over the country and indeed the world, doing some incredible things and making a big difference in the lives of the people they touch through their work.

I began to reflect on whether I, and by extension we — the healthcare system at large — had failed to provide these patients the healthcare they needed, and whether we could do better. What if, each time we see someone, we make darn sure we find a way that their healthcare continues in the time between when they walk out our door, when they get their lab results back, when they see the subspecialist for evaluation of a particular symptom, and the next time they come in for healthcare, whenever that time may be?

How Do We Reach Everyone?

Right now, many electronic medical records are set up to remind patients that they are due for an annual visit, birthday reminders that gently nudge them toward scheduling an appointment, and reminders on the portal about age-specific screenings they are due for, as well as disease-specific testing that may benefit them. But what if they aren’t already engaged with the healthcare system? What if they are just out there free-range in the world living their lives?

Sure, we’d love to be taking care of all of them. We’d love to capture every patient, every member of society, and make sure they can overcome the hurdles that stand in their way to the best healthcare and health they can get. We’d love to keep them engaged in healthy behaviors and offer them opportunities to make good, healthy changes. We want to make sure they’re keeping up with all their vaccines and cancer screenings, and provide them with resources to address all of the social determinants of health that may be negatively impacting them.

But since there are only so many of us, and so many of our patients lack access to primary care and decent (or any) insurance, maybe one of the answers is to find ways that technology, connectivity, and social safety nets can provide these things to patients even when they’re not engaged with us. Then, when something needs our attention, when somebody needs treatment or surgery or to make some changes, it can quickly and safely connect them to us.

A Personal Healthcare Assistant

Just as everyone seems to be building themselves artificial intelligence (AI)-based personal assistants — a bot or agent to read their emails, summarize their meetings, and create task lists for them at work — maybe we as a society should build a parallel healthcare assistant for everybody.

Something that could present people, even when they’re not our patients, with evidence-based guidelines, scientifically backed recommendations, a place to ask healthcare questions and get good answers, connections to resources, coaching and counseling and education, grounded in truth that (hopefully) we can all agree on.

I imagine that a system like this is a long way off — that in our current fee-for-service environment it’s much better to pay attention to those we have already captured, those that are coming in to see us, those that are on our schedule for today. But as a society we have a responsibility to try and get and keep our patients, and indeed every member of every community, as healthy as can be.

If we set everyone out on the right road, from before conception to end of life, on a healthcare pathway that provides them with the best advice and guides them to the care they need when they need it, we might just end up with a healthier society and one that doesn’t waste trillions of dollars a year on unnecessary healthcare costs and expensive treatments for things that could have been prevented in the first place.

At the end of the visits with those two patients I described above, nothing big and bad turned up, but they both had some catching up to do, some changes to make, and some serious life choices if they really wanted to get themselves to be their healthiest selves. If we can arm all of our patients with all of the information and care they need, I bet we’d all be able to live healthier and longer lives.

And maybe, just maybe, save society some serious money as a bonus.

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