Last year I had to find a new primary care doctor. Did you? I ask because it seems like I talk to a lot of friends who are changing doctors for a range of reasons -- from the Affordable Care Act to insurance companies restructuring their in-network/out-of-network directories to the simple fact that many doctors are retiring or leaving the profession. And at the same time--because I work in the healthcare field -- I talk to a lot of doctors who tell me their patient community is shifting.
Until last year, I had the same doctor for 35 years. He was a gem. Naturally -- after 35 years together -- he knew my name, he knew my kids' names, and even my grandchildren's names. We had a collegial relationship in addition to our doctor-patient bond, and so we would often have the chance to greet one another at local social gatherings and even far-flung medical conferences. My experience was not typical, I know, and in these months since his retirement I have come to recognize now how spoiled I was, because not only was my doctor a wonderful guy, but his practice had been focused on health promotion and disease prevention for decades. In essence, he had been delivering personalized health care for 30 years and I didn't fully appreciate how different this was from the standard of care being practiced elsewhere.
So there I was last year, 68-years-old and thankfully in good health, and I set about the task of finding someone new to be my primary care physician. I thought the transition would be an easy one for me to navigate. After all, I confess I consider myself an "insider," having focused my career on healthcare research, physician education, and clinical delivery. This would be a cinch. I made some calls. I set up some appointments.
The first stop on my learning curve was to recognize that there was very little likelihood I was going to find "a" doctor (singular), who would manage all my needs in my later years the way my previous doctor had managed all my needs in my younger years. Because as I interviewed doctors, I recognized that I was also interviewing the healthcare systems in which they practiced. What I need -- I came to recognize -- is a medical team. I am well and fit now, yes. I intend to stay well and fit for as long as possible, no doubt. But what if...
I decided I needed to develop a medical team to cover both prevention and disease management concerns that might arise in the future.
Knowing that I may be seeing more than one provider going forward caused me to examine my thoughts about electronic medical records. I was already an advocate for centralizing information and making it more easily available, but now it was personal. While my previous doctor seemed to have near-magical powers of recall about my history of illnesses and injuries (but, in truth, he was an early adopter EMR technology, so maybe there was slightly less magic going on than I let myself believe...), my new team would need to have this information at their fingertips.
Electronic medical records allow a patient to "own" their healthcare information -- not only health history, but laboratory tests, results of examinations, and treatment plans. This information should be available no matter what doctor or medical service provider a person visits. In a sense, these records are a narrative of our life's history, and having such a history readily available for review can potentially open the door to communicating with our health providers in a way that was never possible before. Picture a conversation with a provider in which you mention a past illness or concern and the provider does not have to shuffle the pages of a thick folder, looking for the relevant notes and findings -- an act that interrupts the discussion and perhaps even gets it off track. I believe electronic medical records will make it possible for providers and patients to spend more time looking one another in the eye, and what could be better than having your physician not only be fully informed about your history, but also be fully present and engaged at your appointment?
Next revelation: Under the present reimbursement system for Medicare and likewise under many health insurance plans, I will be expected to pay more of my healthcare costs for specific elective services. Fortunately, many prevention-focused services are reasonably priced, and these costs are decidedly less onerous than co-pays on disease-treatment procedures. I see preventive services as an investment in my "life insurance."
And finally, in my search for my new healthcare team, I recognized that there are many new opportunities for me to "own" much more of my health. Devices like Fitbit and Jawbone allow fitness and sleep information to be recorded automatically. Is it too much information? For some people it may be. But consider me guilty: I like too much information, especially when it comes to my health. I also found a Bluetooth-enabled home blood pressure machine that can transmit my readings to my Microsoft HealthVault account. An electronic scale records information about my weight and body composition. And while all this data may be more than many of you need or want, I find it allows me to connect directly with my new doctors. I can share health information I am collecting about myself -- diet, activity level, lifestyle monitoring -- with my electronic medical record.
This is a new era in health care. The house call is long gone, but has it been replaced with the "email call"? We are witnessing the creation of a system that will allow us to develop a virtual personal healthcare team to meet our healthcare needs. And with such a team, we will be better able to manage our health in partnership with our doctors and other healthcare providers who can provide a continuity of care that improves the success of both prevention and treatment.
At the start of my search for a new doctor, I was disheartened. I didn't want to lose the connection I had had with my doctor for more than 30 years. But as I gained a deeper understanding of what the future looks like, I became more optimistic and energized. I would have more responsibility in designing my healthcare team and that is empowering. The system is evolving to support the development of a balance between health care and disease care. And more than ever, my health future is in my hands.