This was just routine protocol in this highly progressive physician’s office practice in my hometown, priding itself on the latest and greatest medical care and technologies. So, the robot scheduler proceeded to provide me directions and in turn, I followed them. I made an appointment, they sent me my blood slips and in short order, I got an office visit.
But, I was thinking “where was Rita” the slightly overweight, curly haired grandmother of 11, who worked there for years doing the same task as the robot executing now and who used to bug me about buying her granddaughter’s Girl Scout cookies? Rita always fit me in when I was sick at the time I needed, to avoid missing too much work and because of these deeds, ultimately created my loyalty to the practice.
Dutifully, I got my bloods drawn anticipating my impending visit with the practice. On the day of the visit, a clipboard and a pleasant woman (not Rita) offering to take my insurance card and a copy of my license greeted me through the glass partition. I then proceeded to answer a 5- page paper questionnaire, which lucky for them, and me, all the boxes turned out to be marked “no”. The good news, based on the 5-page questionnaire, was that I was well, without issues, a documented non-alcoholic, non-smoker and non-illicit drug user in no apparent distress ( I already knew that though without needing to take the 5 page questionnaire).
I sat uneventfully in the waiting room, the usual 30 minutes quickly passing while reading expired magazines from a year ago. The medical assistant then called my name out and I was escorted down a corridor full of public service announcement posters, with silence and zero relationship bonding along the way. Posters for smoking cessation, weight loss, depression, family planning, obesity and domestic violence. Nothing happy, nothing positive or uplifting to make me want to be healthy let alone anything reinforcing my otherwise healthy lifestyle and habits. No social programs to help others, like adopting a child or supporting foster care or anything like that did I see hanging on the walls of this otherwise unobtrusive corridor of information. Nothing to adopt an unwanted shelter dog to be a great patient engagement walking buddy, or an ad for new sneakers to get me motivated to exercise. Nothing motivational, nothing reinforcing my healthy lifestyle I choose to electively live. I said to myself, it was a good thing that the poster session I just walked through came after the 5-page questionnaire, else I might have been depressed just looking at the wall of “doom”. Basically, nothing reinforcing me or any new ideas for healthy living anywhere cheering me on and saying “keep up the great work and get socially active to help others” or anything like that. It’s supposed to be healthcare right? Supporting health?
In any event, we came to the end of the corridor where the first next thing needed was to record my weight, the usual dreaded scale routine for most. The medical assistant asked if I would agree to get my weight checked and I said “of course, no issues here, scales don’t scare me only needles and isn’t it a requirement for my visit not an elective process?”, trying to make a joke and be my usual friendly self to engage in a polite conversation. She didn’t laugh. She said many times people don’t like to be reminded they are overweight and refuse to be weighed. Really? Then how can you coach someone to lose weight just by looking at them? Really? So, I stepped onto the scale where she requested my shoes off, most external attire and anything else that could affect my weight. (Too bad I couldn’t remove the pint of Ben and Jerry’s from the night before). The assistant got slightly agitated because I stepped on the scale with my sneakers on, so she insisted, “we need an exact weight”. So I took off the sneakers, was reweighed but lost no additional weight on the digital scale. Guess my sneakers weren’t the culprits after all. Weight reflective of my perfect BMI of 19 measured by a gorgeous new digital scale, the highest-grade technology could offer.
I then entered the exam room, again depressing posters of smokers dying of lung cancer, people being battered, overweight people needing hypnosis and of course the dreaded eye chart, which anyone with minimal vision probably could pass the chart, given I was only 5 feet away from it for the most part. Anyway, despite the depressing posters of gloom, I noticed the progressive medical office with all of the electronics such as digital blood pressure cuffs and the top of the line EHR staring me in the face. The assistant took my pressure, stuck the thermometer in my ear, checked my reflexes and then took the clipboard and started to input the 5-page questionnaire with my answers. I asked her if all of the vitals automatically populated into the EHR and she said “no we have to manually enter it”. Ok, so technology is not quite working but at least they can enter the data to be reflective of my office visit. It took her all of 5 minutes for the most part as she entered the data from the various sources with all answers reflective of a person caring for their health. Labs all normal, perfect cholesterol, nothing wrong with me, she said. She sat there and reviewed the answers I supplied one by one and marked them in the computer as we spoke. At the end, she frowned a bit and said “ there seems to be nothing wrong with you. You are not on any medications, you aren’t depressed, you don’t have any aches or complaints and you eat healthy and exercise daily”. I said, “then that’s a good thing, right?”. She said, “can I have your exercise watch so I can download the data and you forgot to fill in what gym you go to for your exercise regimens?”
I replied “I don’t use an exercise watch and I don’t belong to a gym”. The nurse looked surprised given my otherwise obvious state of physical good health. She said” what do you do for exercise and how do you record it?” I said, “I try to do a daily run in the morning to give my dog exercise, depending on the weather around the block near my house, not fast just at pace and then I walk my adopted rescue dog daily in the evening because he needs to exercise. So, his exercise routine turned into my exercise routine. It’s simple, free and I have a companion who never fails me and forces me to exercise for the next 15 years or so. Besides, I saved his life. He was hours away from being euthanized so I did a good social deed as well. And the distance is about an 8 block radius which takes about an hour at most depending on who we meet along the way to chat up and talk neighbor talk”.
She said, “That’s it?” I said, “That’s it”. She frowned because I probably didn’t fit into her pattern of patient profiling or else she thought I was lying, couldn’t tell and didn’t want to ask. Then, it hit me – an epiphany.
I realized that I don’t fit in the norm of healthcare services today or at least they don’t fit my needs as a healthy person not needing anything except prevention and reinforcement to keep doing a great job. Yet, I am paying and professionally servicing those in need of healthcare and paying the same premiums probably as someone who utilizes far more services than I ever will. I also realized that the healthcare gadgets just weren’t what I needed and felt uncomfortable using them, but pressured to try them because everyone was doing it. When I used them, I felt that someone was watching me, which indirectly was true for all practical purposes. I also realized going to the gym sometimes turned into a social fest defeating the reason why I joined. Everyone looked so put together and I showed up in my college tee shirt and old shorts. Not too sexy but I wasn’t there for the sexy look in any event. I felt out of place at times. So both suggestions by the assistant while are probably the normal suggestions that payers would want to reinforce didn’t work for my lifestyle and me yet no alternative was offered to me. Luckily, I am smart enough to create my own, which I have, and reaping the benefits of good health today. I also came to realize that in order to be and live healthy, you need to practice routines that fit into your life and lifestyle not be pigeon holed into the norm of how others practice their healthcare. Healthcare needs to service and individualize its offering and solutions based on state of health – healthy or otherwise in order to be sustainable.
For example, I love dogs so I adopted my rescue dog who turned into the best motivator and exercise buddy ever, faithfully motivating me (or should I say reminding me) that unless I provide enough stimulation and exercise for him, he will tear up carpets, shoes and any belonging in the house, not to mention the bathroom issue, which in turn creates more work for me. So, he forces me to get up and walk. The best reminder ever and far better than a little beeper telling me I didn’t walk enough. Reflecting on the medical assistant’s interaction with me, I came to realize that the best exercise anyone could have, is routine effortless exercise that fits into your lifestyle and something you don’t notice and enjoy. That is the only way to change the trajectory of health in the United States. Let health become part of our lives and routines – whatever that may be.
Besides, when I travel, there is not always a gym, but walking can be done anywhere with or without my die-hard four-legged companion. And with all of the technology motivators gifted and offered to me, I actually did try them for a bit, but shut them off or conveniently forgot them when I knew I was going out for an event or was just plain not interested in being motivated. In essence, I created my own work around using intrusive technologies that just didn’t work for me like they do for others.
Because they were not true internal personal motivators, just reminders to make me feel guilty I should be doing something I wasn’t or had planned to do that day.
“Well”, the medical assistant stated, ” You are the first patient in two weeks who has a normal BMI. I haven’t seen a person with a normal body weight in the last two weeks but everybody wants me to review their monitoring devices to attest to their exercise efforts to ensure their healthy lifestyle habits. The insurance companies want us to reinforce using the reminders for patients to get motivated to improve their health. But, I can’t find a box that says walk the dog in the computer so let me add it. By the way do you suffer from toe fungus or any infectious issues, you didn’t mark that box?”. That question slightly agitated me and I quite politely quipped, “No, thankfully, not. I rarely wear my sneakers without socks and never subscribed to the stiletto prescription for shoes”. I felt the final question approaching as my time was almost up. “So, why are you here today?”, asked the medical assistant. “Well, you actually called me, I didn’t call specifically needing an appointment for anything. I needed to be seen to stay in your practice”. She then replied, “yes that is our policy”. Well, you are all up to date on your vaccines and annual tests based on your age group, so is there anything we can do for you at this time?” I said, “no thank you”. The assistant left the room and in short order the nurse practitioner entered, reviewed all of the data inputted by the assistant, shook my hand and told me to have a great day and asked if I had any further questions. I had just one question. I asked’ “can you recommend anything I should be doing besides what I have been doing so far to keep staying healthy? Do you have any healthy lifestyle things, I can and should be doing that I am not right now?”. She replied, “ we generally don’t see healthy patients much anymore, there is always something wrong with someone at the end of the visit, you are unusual at best”. I replied, “ I guess that is a good thing today then, right being unusually healthy? So, do I get any free coupons for healthy living food restaurants or anything like free exercise socks or something, like they do at the dentist’s office when I get my teeth cleaned? They generally give me a new toothbrush there and a tube of toothpaste, which I use when I travel. Do you have anything given my good state of health? Any freebies you offer to those of us healthy not needing any further healthcare services?” She said, “unfortunately no, but it must be nice to know you are fit and healthy and that should make you feel great”. I said, “yes of course” with a smirk of jeepers give me a break attitude. The practitioner then said, “ So is there anything else I can do for you today?”
I replied, “It would be great if you had a few happy posters on the wall encouraging others to keep up the great work besides all the doom and gloom on the walls”. She said, “ these are reminders for patients to stop what they are doing that is adversely affecting their health, but you can add your thoughts to the suggestion box”. I said, “thank you”. She said again, “so do you need anything else today?” I replied, “I guess not unless you can help me with my $4,962.00 dollar deductible and my $75.00 copay for today’s visit I need to meet and pay to reinforce that I am healthy, which I already knew.
And we wonder why healthcare sustainability needs to be revisited. We wonder why we are not healthier today than we were years before, we wonder why there is no longer loyalty built into the healthcare system and we wonder why everyone thinks “one size will fit all” into the scheme of curing our healthcare dilemma. Go figure.
