Helping patients practice self-care and embracing telehealth to build a new model.


 

The devastation of the coronavirus pandemic has disrupted our healthcare system—and our private medical practices—as nothing before in our lifetimes. The majority of our patients essentially disappeared as they self-isolated in their homes and, in millions of cases, lost their jobs and their health insurance.

Amidst this chaos, however, a nationwide survey points to significant behavioral changes in America that could guide us forward in creating a positive, new, post-COVID19 care model. These findings show that we could greatly benefit patients and doctors alike by changing our focus from treating diseases to actually creating health and wellbeing by helping our patients effectively practice self-care.

The survey of 2,000 adults commissioned by the Samueli Integrative Health Programs and conducted by The Harris Poll last month shows that a remarkable 80% say they will be more mindful of practicing self-care regularly once the pandemic is over. More than half (55%) say they are scared to get healthcare, and nearly two-thirds (64%) are more focused on their mental health now more than ever before. Findings show roughly one-third are engaging in each of these self-care practices: eating healthy foods, time outdoors, creative activities, prayer, and meaningful contact with friends and family.

Two other key findings send a clear message to clinicians to begin adapting to this new reality: nearly half (44%) say they want more guidance about how to practice self-care, and the vast majority (83%) say they have used technology to remain connected to the world.

 

How Can Physicians Incorporate Self-Care?

Smart medical practitioners will hear this message loud and clear: patients are not seeking more medical treatments to cure diseases. Instead, they are seeking more support from doctors in learning how to avoid diseases in the first place by taking better care of themselves. And they are also more willing than ever to receive that assistance by “seeing” their doctor via telehealth.

COVID-19 gives us an unprecedented chance to reframe and rebuild what healthcare should be. But we cannot make the same mistakes. The United States spends far more on healthcare than any other nation, yet our overall health and life expectancy lags behind much of the developed world. This is because we rely far too much on pills and procedures, rather than actually helping people achieve and improve their health through the non-pharmaceutical practices of self-care and behavior change and the social determinants of health.

We need to see COVID-19 as a wake-up call. We need to be treating the whole person and providing value-based care to prevent illness in the first place, not just trying to fix symptoms and cure diseases after the fact. More than 100 million Americans are already practicing various forms of evidence-based approaches seeking to find wellness, such as yoga, massage, acupuncture, nutritional counseling, mindfulness, and biofeedback processes. We need to be promoting these modalities and help patients make proper choices about food, movement, sleep, stress, and substance use.

There are ways we physicians can implement these approaches in our practices. For example, physicians can offer an integrative health visit using a tool such as the Department of Veterans Affairs’ Personal Health Inventory or the Healing Oriented Practices & Environments (HOPE) note. Both tools specifically address questions about self-care that are currently missing from most office visits and can help fill these gaps in communication.

Using tools like these will bring out the patient’s own engagement in their personal determinants of health. This allows for a deeper, richer, and more personally relevant conversation and helps physicians guide patients more effectively in self-care.

 

Seizing the Opportunity

COVID-19 is creating room for a new medical model, much of which will endure beyond the pandemic.

All good doctors know that patient education is crucial if we are to prevent chronic diseases, such as obesity, heart disease, diabetes, hypertension. If we really believe that, why not begin reaching out to our patients in a new proactive way, via telehealth or other means, without waiting for them to reach out to us?

But, how can primary care doctors do this?

One option is to look to the small but growing number of practitioners who are even opting to try to escape the straight-jacket of fee-for-service constraints by joining the “direct primary care” movement. Bypassing insurance altogether, they are charging a flat membership fee to provide care directly to uninsured or underinsured members of the community. Think of it as a medical concierge practice for the common person.

Regardless of how we do it, we have a once-in-a-lifetime moment to begin to reinvent primary care and truly address the whole patient in our work. I strongly hope that we do not let this unique crisis and opportunity go to waste.