Although retired, I continue to monitor publications about healthcare in general, and pharmacy in particular. Most recently (1-26-2024) I encountered an article in Becker's Health IT and CIO Report in which it is reported that Amazon CEO Andy Jassy described modern healthcare (not the journal) as "just kinda nutty". I must confess that my knee-jerk reaction before I actually read the article was that this was going to be how making healthcare more like a business would make it better. I was wrong.
The focus of this brief article was about all the inconveniences our current healthcare systems impose on patients. He describes "making an appointment sometimes far in advance, driving to the physician's office, sitting in a series of waiting areas, seeing a clinician for a few minutes, then commuting to the pharmacy" as something he expects his grandchildren to hear about with disbelief, somewhat akin to my grandchildren hearing about life without cell phones.
He envisions a world in which the visits are virtual, prescriptions are automatically forwarded to a mail-order pharmacy, and the pharmacy sends the medication through the mail.
I understand his point; I experience that disconnect on a regular basis. No matter what happens, I cannot get relatively urgent care without paying through the nose for it or spending my time in a multiplicity of telephone calls begging to be notified and scheduled if there is an opening. It seems like office practices have a staff of persons dedicated to preventing one from speaking to the physician. Not to mention the joy of learning that someone in the pharmacy couldn't get my insurance right, or that the medication for my COPD was not available in the pharmacy and had to be acquired (and would therefore be delayed), even though I purchase it every month like clockwork.
I do find myself wondering, however, if it is practical to handle all healthcare this way. In my experience, there seems to be a certain amount of value in the "laying on of hands" that seems unlikely to be replaced entirely by virtual visits. For reasons that are hard to fathom, automated blood-pressure cuffs regularly overstate my blood pressure, but manually performed measurements report it as normal. Mail-order is fine for most chronic medications, but generally not for the antibiotics that are needed for immediate treatment.
Further, it seems that there would need to be a significant shift in the way that providers are compensated to keep those offices (or pharmacies) open for the times when in-person care is required.
I am not certain I know the answers for this, but agree that the way a patient experiences the healthcare system is "nutty". How should it work? What could we, as pharmacists, do to make it better? Does the model of having clinics staffed by nurse practitioners in retail pharmacies seem like a good answer to this need?
What do you think?
Dennis A. Tribble, PharmD, FASHP
datdoc@aol.com
Retired