We sat down with a group of providers to discuss the current state of healthcare, their hopes and hang-ups, and what they’ve learned from their patients over the years and compiled those stories to create the Heart of Healthcare. In this guest blog post, Dr. Elizabeth Flynn, a pediatrician at Manassas Pediatrics, reflects on how healthcare has changed over her career.
In talking with my colleague, Dr. Anita Flower, for The Break Room podcast, we reflected on how the practice has changed in our 40+ combined years at Manassas Pediatrics. When I recently celebrated my twentieth anniversary as a pediatrician, my mind wandered back to the beginning. I asked myself, “What has changed in medicine?”
In a nutshell: tons!
Electronic health records, revised best practices, the impact of the internet, fewer and fewer teens smoking cigarettes. Most of the changes have been positive, though some negative, and oftentimes a mixture of both. The two biggest issues, in my opinion, are the reduction of the primary care relationship and the skyrocketing rates of adolescent depression. And I think there might be a link between the two.
Patients are seeing primary care providers less often. That’s a fact. When I talk to my friends who are pediatricians, I ask them, “Are you seeing fewer patients too? And are the patients you are seeing a little sicker?” The answer is always yes. Patients are waiting longer to receive care for various reasons — the out-of-pocket cost, the hassle of scheduling a visit, or not understanding the future value of their health. Primary care and wellness visits are replaced with emergency departments and minute clinics. The problem, as I see it, is patients treating what may seem like minor problems at these facilities when in fact these symptoms should be discussed with their primary care provider.
I don’t want to seem like I am disparaging urgent care centers, which certainly serve a valuable purpose. As far as efficiency and transparent pricing go, they’re doing a great job, and many practices could learn from their model. However, a lot of this convenience comes at the expense of the relationship between primary care providers and their patients. When a patient sees three different clinicians at three separate locations, they miss out on primary care’s coordination and thorough knowledge of the patient’s history and personality needed to place all symptoms into perspective. That’s one advantage that primary care providers offer: the ability to fill in the blanks and see the full scope of a patient’s story. And we risk losing that tremendous benefit when we lose sight of the primary care relationship.
This patient relationship and understanding are especially pronounced when it comes to mental health. Within the past five to eight years, I’ve seen more frequent cases of the telltale chronic headache and tummy ache that signal something else hurts, something emotional and psychological. Ask any pediatrician and they’ll tell you they recognized this alarming upswing in childhood mental illness far before any analysts graphed it on charts or any cultural critics blogged opinion pieces. To help my patients, I often ask myself, “What has changed?” and, if we are to fix this epidemic, “What needs to change?”
Parents often ask whether social media is to blame. I tell them, “I don’t think so, I know so.” There is plenty of evidence to suggest overuse is tied to feelings of inadequacy, failure, and poor self-esteem, not to mention the potential for cyberbullying. But perhaps it’s more accurate to view social media an “accomplice” rather than the “culprit.” Despite all of those studies that support the relationship between negative mental health and excessive screen time, I think in some ways it’s a scapegoat for the deeper problem, which is the decay of the primary care relationship.
I mentioned headaches and upset stomachs earlier as textbook symptoms of childhood depression. If those were diagnosed and treated separately by various urgent-care clinicians, the patient may find short-term relief, but without treating the deeper, underlying issues that are causing the symptoms. Were a long-time patient to see their primary care provider instead, I firmly believe that they would receive a more accurate, more compassionate, more helpful diagnosis, one based on an ongoing and trusting relationship.
A primary care provider not only sees the larger picture, but also has a network of specialists to assist in a coordinated treatment plan that serves the patient’s overall — not just immediate — health concerns. For instance, as a Privia provider, my electronic health record (EHR) contains an in-built referral network of high-quality providers that I can trust with my patients’ health concerns. I’ve built an excellent list of psychiatrists, psychologists, and therapists in my area so that I know my patients are taken care of. This EHR makes it so much easier to document concerns. Before, we had to print questionnaires, hand them to the patient, and enter the information manually. That was cumbersome and hard to remember to do. Now, we have a simple tab that acts as a reminder to have the patient complete the questionnaires.
The primary care shortage, social media, EHRs, mental illness awareness … Together these loose threads weave together to illustrate many of the ways medicine has changed since I began. One of the most incredible parts of my job is the amount of change I see. Not just in the field of medicine or the state of healthcare, but in the lives of my patients. I’ve watched babies mature into teenagers then come back as adults with babies of their own. That’s what happens when you’re in this practice for as long as I have been. When I noticed this, I had a bit of an epiphany. The children we care for today are tomorrow’s parents. I can’t imagine what the world or medicine will look like 20 years from now, but if we support children and empower parents, we’re working to solve not only today’s issues, but the unforeseen problems that will arise in the future, too.
Elizabeth Flynn, MD, is a pediatrician at Manassas Pediatrics. The views and opinions expressed are those of the author and do not represent the views of Privia Medical Group™ or any other entity. Listen to her and Dr. Anita Flower discuss the world of medicine on our podcast, The Break Room!