About a month ago, one of our patients, a man in his mid-40s, came to the clinic for an in-person visit for the first time in more than 12 months. For the past few years, he’s struggled with sky-high blood pressure and always seemed to be teetering on the edge of a major stroke. But this time his blood pressure was perfect.
The difference? Since he couldn’t get care in the clinic during the pandemic, he bought a blood pressure machine and used it often. With near daily feedback, he realized how important it was to take his medication on time, and that certain foods affected his blood pressure. He was also more motivated to make changes because, if he suffered a sudden health problem, he didn’t want to go to the hospital and risk getting Covid or finding out that there weren’t enough doctors to care for him.
As doctors who believe that people are ultimately responsible for their own health and need greater agency in directing their own care, we’ve long bemoaned the lack of progress, entrenched paternalism, and learned helplessness that has pervaded the health care system for years. The pandemic has turned that upside down.
For the first time, we’re seeing a glimpse of a new kind of patient: one who has the potential to upend the way health care works and could lead to improved care for decades to come. Here’s what that might mean:
Better connection between daily behavior and health
Nearly half of deaths each year are attributable to individuals’ behaviors, such as smoking, poor nutrition, lack of exercise, and excess alcohol consumption. Early in the pandemic, little was known about treatment or prevention of Covid-19.
If people wanted to avoid catching the virus, they had to rely on themselves and their habits. Many people became more vigilant about protecting themselves — washing hands, social distancing, staying away from others while sick, and the like. We’ve known for years that hand washing and wearing masks limit the spread of airborne diseases, such as the flu, but it wasn’t until this crisis that many people actually changed their behaviors to do so. It’s no coincidence that in the year the world adopted masks, flu transmission was interrupted with a 100-fold decline in cases. Imagine what other diseases we could prevent — lung cancer, liver cirrhosis, type 2 diabetes, and more — if we all made more informed, mindful choices in our daily lives?
Better navigation of the health care system
Over the course of the past year, nearly all of us have had the experience of struggling to find a Covid-19 test or vaccine for ourselves or our loved ones. In the early months of the pandemic, Americans were forced to open the black box that is our health care system. People searched for testing sites, booked appointments, and checked into virtual waiting rooms.
At the same time, health became a community effort: People turned to each other for help to make sense of the medical system. Group chats exploded when testing site availability opened up. People found creative ways to pick up no-show appointments. Others took on more formal roles, such as contact tracers or volunteers at vaccination sites. In effect, people began to take more responsibility for the health of their communities.
There’s still a lot of progress to be made in establishing a better understanding of U.S. health care. Not everyone was able to learn these critical skills due to lack of connectivity or digital literacy, which left many out of testing and vaccines. But as we’ve seen with our own patients, there’s a newfound desire and motivation to learn.
Better understanding of medical science
Overnight, the novel virus commanded headlines. Many people read about Covid-19 every day, or heard about it on the news, and it quickly became the central focus of our lives. What were the latest case numbers? The latest signs and symptoms to look out for? Progress on the development of new treatments and vaccines?
For the first time, basic language from biostatistics, such as specificity, sensitivity, and pre-test probabilities, found its way into normal conversation. With concerns about false positives or negatives, the world began to understand that not every medical test is perfect.
Once test and vaccine development were underway, people read about the FDA device- and drug-approval process, clinical trials, and the limitations of those studies. Digesting medical science became a normal part of our patients’ preparation for appointments, a skill that will help them well beyond the pandemic. That analytical lens, for example, can be applied to other health care topics, such as the limitation and role of mammograms in breast cancer screening and the importance of vaccines and primary prevention.
More ownership of health
For health care providers and their patients, organizing medical information is vital for effective care.
During the pandemic, virtual and in-person appointments were scarce, with resources diverted to hospitals and emergencies. For many people, seeing their regular providers became difficult and, if they did manage to get in, they had to make sure it was a comprehensive visit. They needed to have lists of questions ready, or lab tests ordered and performed before the visit.
People also increased self-care. Many of our patients bought medical equipment, such as blood pressure machines and pulse oximeters, and subscribed to meditation or remote monitoring apps on their smartphones. During the pandemic, health app downloads increased by 25%. While there is a risk of taking this too far — people diagnosing or treating themselves without appropriate access to medical expertise — this is a welcome shift.
Vocal advocates for change
The pandemic intensified the deep and longstanding failures of the U.S. health care system. For years, care in America has been inaccessible, inequitable, and failing in primary care and mental health for many people. Covid-19 illuminated these issues for many Americans for the first time.
Many were appalled to learn that the Black, Latino, and Native American communities were two to three times more likely to die of Covid-19 than white Americans — but the same is also true for deaths during pregnancy and infancy in these communities in non-pandemic years. There were also worse outcomes for individuals living in poverty and rural communities and for older adults.
Health care in the U.S. won’t get better if people don’t demand it, as they did during the pandemic. When headlines reported people being charged more than $1,000 for one Covid-19 test, people demanded refunds. When vaccines weren’t reaching homebound older adults, people insisted that health care workers go to their homes to deliver them. Most recently, people pressured the Biden administration to choose saving lives in India over protecting patents. As doctors, we hope that our patients and people across the country continue to demand better from policymakers, health systems, and providers so these inequities will be addressed on the national level.
Although the five shifts above are moves in the right direction, they don’t mean that the system has been transformed. Not everyone was equally engaged or activated during the pandemic. Many of the people who were not impacted by these shifts are from vulnerable communities that the current system already fails too often — individuals without internet connectivity or digital literacy, living in poverty, and facing systemic and individual racism. For many of these individuals, the failures of the health system made their health problems worse — not better. The future of care must be inclusive and be explicitly designed to empower people, not overburden them.
The pandemic has given all of us a glimpse of more engaged and activated patients. If our country hopes to build a future of health care that is truly patient-centered for all, it’s incumbent on all of us to make the most of this moment.
Shantanu Nundy is a primary physician, chief medical officer at Accolade, and author of “Care After Covid: What the Pandemic Revealed is Broken in Healthcare and How to Reinvent It” (McGraw-Hill Education, May 2021). Felicia Hsu is a resident physician at UCLA Internal Medicine and author of a forthcoming memoir about her journey as a new physician through the Covid-19 surge and as a daughter through her father’s life-altering cancer diagnosis.
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