Boston, MA — Being alone is an increasingly important dynamic in healthcare. One that – thanks to changes in medical and communications technology, our connections to family, and even the way we work – is becoming increasingly prevalent.
Where we find out
What are you afraid of late at night? For many of us it’s a cough that just won’t go away, a mole that looks a little suspicious, a headache that feels too sharp. We sit in the glow of a screen and look for answers.
Almost 40% of us are using increasingly sophisticated online self-diagnosis tools to try to crack our own medical puzzles. Sometimes that WebMD Symptom Checker reports that the range of possible diagnoses is somewhere between indigestion and intestinal cancer. But other times the answers are much more specific and our self-searchers feel that cold trickle of fear and just like that: they know.
Advances in both home medical testing and electronic medical records are making it possible to get much more clinical information on our own, too. A home blood test can reveal anything from high cholesterol to HIV with no more than an email or electronic recording. Physician offices are signing patients up for digital portals that automatically deliver test results right to their inbox.
How the practice is changing
It’s not just patients who find themselves alone. It’s their doctors, too. Almost 50% of doctors report symptoms of burnout — emotional exhaustion, low sense of accomplishment, detachment. One reason is they’re working increasingly on their own.
A primary care physician recently talked to us about how his day-to-day connections with colleagues had changed over the years. When he first joined he practice, he would talk with his fellow doctors over coffee in the morning and again over lunch. They’d consult across cases and talk about changes in long-time patients. Today, he starts at 7AM. In the course of a typical day, he won’t see more than one of his colleagues and generally just in passing in the hallway. They don’t collaborate like they once did. They can’t. They don’t have time. Instead, they’ve nearly doubled the number of patients they see in order to keep up with changes in reimbursement from major payers.
As the medical home model pushes each professional to work only at the top of their skill set, this sense of solo practice will become greater and greater. There will be more opportunities to give care, but less connectivity between them.
That sense of working alone is fueled by the patient relationship as well. Today’s new doctors spend an average of 8 minutes with patients. For Dr. Pauline Chen, her relationships with patients were among the most fulfilling parts of her career, but for the new generation they aren’t even an option. One young resident said to her, “My generation is different because we can’t have the same relationships with patients as you did. We just don’t have the time.”
Who’s there with us
Did you know that married cancer patients live longer than single people who have the disease? It turns out that the support that marriage provides makes a big difference. A study, published in The Journal of Clinical Oncology, found that single patients were 53% less likely to receive appropriate therapy than married patients. Help from a spouse made it easier for those patients to regularly take their medications and keep up with chemotherapy and radiation treatments. Single cancer patients also were 17% more likely to have late-stage cancer at the time of diagnosis. Maybe all that nagging to go see the doctor really does make a difference. The biggest finding was in ultimate outcomes: Married patients were 20 percent less likely to die of their disease than single patients.
Shifting demographics are changing how many people have access to that essential support. From 1950 and 2011, according to calculations by the University of Maryland sociologist Philip Cohen, the marriage rate fell from 90 marriages a year per 1,000 unmarried women to just 31, a stunning 66% decline. Although most Americans will be married at some point in their lives, barely half are married right now. Older, more wealthy people are the most likely to be married – and also those already most likely to have access to the best care.
If you look beyond that core union to other historically close familial relationships, the problem becomes even more staggering. In China, for example, fewer and fewer young people have been respecting the tradition of Filial Piety, the ancient Chinese ethic of young people showing care and respect to their parents and older relatives. So much so, that parents can – and do – now sue their children for lack of care and support.
What we can do
How would we change what we create as an industry if we thought about that segment of people who are finding out, who are working, who are fighting on their own? A few ideas from conversations around these hallways:
- Be transparent about how important getting help and support really is
- Foster opportunities for doctors to collaborate
- Point to ways that people can connect with others in a similar situation who might need support, too
- Help care teams see the total impact they’re making
- Create more opportunities to hear from “people like you” and understand their journeys
What are your ideas?