The Toughest Questions in Health Care: Can the Internet Replace Primary Care? with Dr. Priya Dixit-Patel and Melissa vanNeerden

According to the National Center for Health Statistics, from July to December of 2022, 58.5% of adults used the internet to look for health or medical information. But while most of us have done it, is it the right approach when you need medical attention?

For the sixth episode of our “The Toughest Questions in Health Care” series, we're asking the question, "Can the internet replace primary care?" ChristianaCare Physician Executive for Core and Primary Care Dr. Priya Dixit-Patel and ChristianaCare Virtual Primary Care Nurse Practitioner Melissa VanNeerden explain why the idea of a “medical home” that provides holistic support is a better approach to foster long-term well-being.  You’ll also hear how technological advances are making it easier to meet health needs in the ways that work best for individual patients.

Priyanka Dixit-Patel, MD is ChristianaCare Physician Executive for Core and Advanced Primary Care.  She is a family medicine physician who specializes in primary care, gynecology and women's health.

Melissa vanNeerden, AGNP is an experienced Adult-Geriatric Nurse Practitioner at ChristianaCare Virtual Primary Care.  She has been in practice since 2016 focusing on disease management and prevention.

Links

• ChristianaCare Primary Care
• ChristianaCare Center for Virtual Health 

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Transcript

Speaker 1: 0:01

Not everything is an algorithm. There is that art of medicine of being able to understand your patient.

Speaker 2: 0:09

You're listening to For the Love of Health, a podcast about delivering care and creating health, brought to you by Christiana Care. And now here are your hosts.

Speaker 3: 0:19

Hello everyone, I'm Megan McGerman.

Speaker 2: 0:21

And I'm Jason Tokarski. Welcome to another episode of For the Love of Health brought to you by Christiana Care.

Speaker 3: 0:26

According to the National Center for Health Statistics, from July to December of 2022, 58.5% of adults use the internet to look for health or medical information. So it's something we've certainly done, but is it the right approach when you need medical attention?

Speaker 2: 0:43

Which leads us to our sixth episode in our Toughest Questions in Healthcare series Can the Internet Replace Primary Care? Here to tackle that question are Dr Priya Dixit-Patel, physician Executive for Christiana Care Core and Advanced Primary Care, and Melissa Van Neerden, a Nurse Practitioner from Christiana Care Virtual Primary Care.

Speaker 3: 1:02

Priya and Melissa. Thank you both so much for your time today. Thank you for having us. Yes, thank you so much. Everybody Googles everything now, so why not Google medical information? Put it on Facebook, put it on Instagram there are so many ways you can get that immediate response. Why go to primary care instead?

Speaker 1: 1:22

It can be a very fast and easy way to and tempting way to, check your symptoms, but oftentimes information can be misleading, it could be non-applicable to the person looking it up, and so going to your PCP first makes more sense, because they know you, they know your family history, your personal history and they're able to actually give you a more likely diagnosis. In the context, if somebody searches chest pain, there could be many reasons for that. It could be acid reflux, it could be, you know, muscular, it could be heart disease, and your primary care doctor is in the best position to be able to really give you that guidance on what it likely is, what testing needs to be done.

Speaker 3: 2:07

And what could happen if you Google it and you think it's one thing but it's really the other and you never go to primary care and you're just relying on kind of the internet or your neighbors and your social platforms?

Speaker 1: 2:19

Yeah, that can lead to a lot of you know, worry, a lot of anxiety, and then you know if you're really worried about something that could be dangerous, leads you to go to the emergency room, which is not the best place to get your personal health addressed and a plan. They're there for urgencies, for emergent things, but not the long term. It's best to kind of develop a relationship with your primary care doctor that gets to know you and is able to give you a more personalized response rather than a general one. On Google.

Speaker 2: 2:52

What is the best way to have in mind what your primary care provider is and what their relationship with you should be?

Speaker 4: 3:00

So a primary care provider should be the person that you trust medically, that knows you the best, to be able to give you guidance, support and help. So somebody in primary care will see you for routine screenings to ensure that you're healthy, that your blood pressure is good, that your blood sugars are good, that your height and weight are good, and if they're not, we'll be there to help guide along the way, ideas and sometimes even medications and lab work to follow up on. They're also there for when you're not feeling well. You can reach out to them if you have a fever, or if you're growing up this morning, or even if there's a bug going through your family's household and you haven't gotten it yet. They may be there for some advisement as well.

Speaker 1: 3:51

We want you to think of your primary care provider as your medical home, which is basically a care delivery model where a group, a team of caregivers help a patient through education, through community resources, through care management to allow for access when needed and that continuity of care. We want to be able to connect the patient to all the things that they need in order to continue on their good health journey.

Speaker 3: 4:18

So if you are the medical home. Are you the medical home for everything? Say that person who was Googling chest pain. Should they call you? Or should they just say found a good cardiologist on the internet? I'm just going to go right there.

Speaker 1: 4:31

I think it's always good to connect with your PCP. We want to think about patients and primary care physicians as being partners, and so one should communicate with the other and so, before going ahead and referring to a specialist, to discuss again with your primary care doctor about what your symptoms are. There could be testing, there could be evaluation that the primary care physician can do. Not everything is an algorithm that the primary care physician can do. Not everything is an algorithm. There is that art of medicine of being able to understand your patient. You know, through that long-term relationship that you build, which I think you know is the most special part of being a PCP is that you get to know that patient in the best moments and the hardest moments, and you know, you understand their physical, their mental health, their social determinants of health, and to be able to really piece that together and come up with a plan that will work for that individual patient. I think it's really the reason why patients should invest in spending time with their primary care physician.

Speaker 3: 5:34

You mentioned mental health, so your primary care physician could connect you to those resources as well.

Speaker 1: 5:39

Absolutely. Yeah, we actually provide, you know, a lot of mental health support. I think through COVID we were able to really have a front seat view of all of the hardships that our patients, that our families, that our colleagues, you know, were going through in that challenge and that really brought an openness for people to talk about it. It's part of our evaluation and our patients feel very comfortable to share that.

Speaker 1: 6:06

Sometimes, you know, I'm using the chest pain diagnosis, but sometimes, after a patient has had like extensive evaluation for the heart, for the lung, you know, for GI issues, we sort of have that conversation. Like you know, I'm so glad to tell you we've evaluated this and everything's okay. Can we talk a little bit about what else it could be? Are you worried about something? You know it could be related to anxiety, and I think that that really allows for patients to trust the process and their provider to be able to say, okay, they are looking out for me and looking at me as a whole and not just one symptom, one body system. It's me as a whole. The holistic approach to taking care of patients is, I think, something that appeals to all of us when we come into primary care.

Speaker 2: 6:56

So we're talking about primary care in terms of relationships and, as much as we do treatment. What are some suggestions you would have to help somebody pick the right primary care provider for them?

Speaker 4: 7:08

There are multiple options and really it's up to preference of the patient. Really, what are you looking for? To preference of the patient, really, what are you looking for? Are you somebody that wants to physically go into a location and see a specific person or group of people, or are you somebody that would prefer to stay at home? Or maybe you're in your office and can close the door and have some privacy and use that location as a place to receive your healthcare? And both are options. Also, I think it's important that you have a good, trusting relationship with your healthcare provider, and that may take more than one time to find the right person, but it's really important you feel heard and listened to and you have a trust with that provider so that you're able to get your healthcare needs met and you feel comfortable opening up to somebody.

Speaker 3: 8:00

Let's dive deeper into what Christiana Care is doing to make that Google-able stuff easier to talk to you about. How have you seen change, especially since COVID, that maybe someone, instead of looking up a symptom, is now able to text you guys?

Speaker 1: 8:18

I think the virtual platform has really allowed for us to stretch our abilities to provide more care and more acute care. Now, patients don't have to leave work. They can, you know, step into their car and discuss something that maybe they would have delayed, you know, for many months in the past. I think the virtual capability has really allowed for us to take care of more patients in a more timely way.

Speaker 4: 8:46

It's okay to throw a question up there like what is this on my skin? And we can actually have you take a picture of it and attach that as well. Or, hey, I have this form that needs to get filled out. Can you fill it out and attach it as a PDF? So it's very bi-directional in the communication and we may say, hey, this requires us to actually talk more about it, let's get a visit going, and whether that goes to being in person in an office or we just talk more through that portal messaging, we do also have another type of texting platform called Twistle, which is literally like on your phone. It's HIPAA compliant as well as the portal Same kind of concept as well. So I know for the virtual practice, they actually have two options New and exciting to the healthcare world, and for those that like digital access to their care, we have something called the Wow app, which really stands for Working on Wellness.

Speaker 4: 9:38

This is currently only in pilot and it is with our ChristianaCare virtual primary care practice at this moment. The goal is, once it releases out of pilot, that it will be available for any of our primary care patients using one of our offices for care, whether it's brick and mortar or virtual. The purpose of this app is to help you be more in tune with your personal healthcare needs. It will give you guidance on if you're due for an immunization or a screening or blood work. It will offer you help if you are, for instance, with use of tobacco products or something. It'll ask you to reach out if you want to quit and get help with that.

Speaker 4: 10:21

It also works for care planning as a patient. Whether you're perfectly healthy or whether you have conditions that require chronic treatment. Each of us have a desire, at least over the course of a year, of what do we think is the most important things for us to ensure our health, our safety, our well-being. We call this care planning and this is also part of our Working on Wellness or WOW app that you can actually update those goals and measures and that way you can see over the course of the year how you've progressed and improved and or maybe checked a couple things off and hit the goals and targets. So exciting and it's working very well in our virtual practice setting right now and I'm excited when it launches officially for all of our ChristianaCare primary care patients.

Speaker 1: 11:08

Yeah, I'm really looking forward to that rolling out to all of the primary care offices. And then I think the possibilities with remote patient monitoring are also really exciting. That we can look at our patients that have uncontrolled hypertension and be able to kind of monitor that and make decisions in between office visits. It really allows for us to become highly efficient with our clinicians to be able to provide great care.

Speaker 3: 11:36

So how often should you be seeing your primary care provider?

Speaker 1: 11:39

So how often should you be seeing your primary care provider? Well, for some patients that you know don't have any chronic diseases, major health issues under the age of 50, you know they could see their PCPs every three years. And for patients older than 50, a more appropriate touch point may be an annual checkup. For someone that does have an illness like diabetes, hypertension, heart disease, you know we want to see you every three to six months, depending on how well controlled your health conditions are. And then there are some patients that need, you know, more frequent visits. When you have that long-term relationship with your PCP, they can help gauge what the frequency should be in seeing their patients.

Speaker 1: 12:21

I ask everyone, I ask our clinicians and our patients, to really think about those other modalities of contact. We're also used to like that in-office, in-person visit as feeling like okay, I saw my doctor, but you have the ability to use portal messages, twistle. You have the ability to contact a nurse in the medical home. You have the ability to work with case management, our care VO team. There's so many people that are advocating for the patients that are on your team. That are all touch points that can provide good, sound advice, that can get information back to your PCP, and so it really becomes a much stronger way to support our patients.

Speaker 4: 13:07

And we do know that patients that have a medically based home with a primary care provider will. In general, when we look at the studies, they show that they have higher satisfaction rates within the healthcare system. So that could be their primary care provider, specialists, anybody that they're seeing for care. It also shows that there's lower cost of care as a result and better outcomes.

Speaker 2: 13:31

It's Probably just that instant gratification of Google that makes it a little bit different, but it's not that much more to send a message and wait for somebody who knows you and has your history to provide an answer to a concern or a question that you have.

Speaker 1: 13:46

Exactly, exactly. If you looked at which patients were Googling, more probably are ones that aren't seeing their PCPs or maybe don't have that. You know that long-term relationship and so they rely on that and I think there are some you know reputable sites our Christiana Care site, cdc those might be better places to start if you absolutely have to look. Maybe better places to start looking for some answers. But again, like you said, the ideal place is to reach out to your home practice to get the information that is appropriate for you.

Speaker 2: 14:21

Obviously you believe, in all the different ways, the different touch points, that people can get a hold of you. What kind of success are you seeing from that? That you feel that it's that important and that worthwhile to have as part of your practice?

Speaker 1: 14:34

Yeah, like I said, the telehealth platform has really allowed for us to stretch our abilities to see more patients provide that acute access. One of my patients had actually called our office for an appointment. He shared that he had had a lingering shortness of breath after a COVID infection three or four weeks ago, was still having symptoms and felt, you know, he should get a chest x-ray and be evaluated. And we asked him to see one of our one of my colleagues on a virtual visit just to kind of get some more information. My colleague saw the patient and ordered some testing, got a wonderful detailed history, ordered some labs and when the lab work and the workup came back, my colleague stated that I think you should go see your PCP. Everything that I've ordered is reassuring, but I think there's just one other piece. And he actually reached out to me and said Priya, I need for you to get this patient in. And I was able to get the patient in.

Speaker 1: 15:34

We did an EKG in the office and the patient had new onset AFib. He was stable but again, this is something that we were able to bring to the front of the line. I was able to connect him to our cardiologist. He stayed out of the emergency room, and I think it just speaks to our ability to be able to pivot and take care of patients when they need us to. If we just stuck to the in-person visits, you know that would have been delayed.

Speaker 1: 16:02

He may have ended up in the emergency room, and this was really good coordinated care. I'm very proud of what we were able to do for the patient. Having the same electronic health record, I think is, of course, wonderful for all of us to take care of our patients, but also reassuring to the patients that whatever is happening, you know my doctor or the doctor that I'm seeing in a virtual visit. They all have access to my information and we'll share that with each other. That really speaks to a great deal of coordination behind the scenes. That is just very good for high quality care at a lower cost, which is something that we strive for.

Speaker 3: 16:42

If someone is listening to this and doesn't currently have a primary care provider, or it's been years since they've connected with their primary care provider. What should they do? How do they best get reconnected into our system? Is there a set of, maybe information or questions they should come to you with to make sure that they can get the full experience out of that connection?

Speaker 4: 17:05

The patient can always use ChristianaCare, the main website, christianacareorg, and that would connect them. They can search primary care providers and it will give them a full list, and we have locations in Maryland, new Jersey, delaware, pennsylvania, as well as our virtual practice. When a patient goes in to that office visit, or if it is a virtual visit that they're scheduling for, at least to have on hand with them any medical records that may be pertinent If they are dealing with a current situation, whether it's an acute illness or skin rash or something that's going on now versus something that they've been diagnosed with and being treated with in the past. If they have any specialists, it's good for us to know that, if they've done any recent lab works or if they have immunizations that they can share with us. All of that helps to really start that relationship off. So my recommendation would be, if you can't get it to the provider, at least have it with you at the time of that visit.

Speaker 1: 18:01

It's a long-term relationship. This is not going to be the only time, and so when you're first meeting, you want to have that ability to share pertinent past medical history, personal history, so that the primary care clinician can get an understanding, and also having that expectation that there's going to be more visits to address everything we wouldn't be able to address every single thing at that first visit but really to think about the long-term plan. You know how am I going to continue to bring things that I'm concerned about, maybe the top priority ones, at the first visit? It's a continuous evolving plan for optimal health.

Speaker 3: 18:40

So the toughest question for this episode can the internet replace primary care?

Speaker 1: 18:46

No.

Speaker 4: 18:48

It cannot replace primary care, but it can be a setting where primary care is obtained.

Speaker 3: 18:53

Fantastic. Priya and Melissa, thank you both so much. Thank you for having us.

Speaker 2: 18:57

We'll have more information on ChristianaCare Primary Care Services and the Center for Virtual Health in the show notes for this episode.

Speaker 3: 19:04

And don't forget to subscribe to, for the Love of Health, on Apple Podcasts or Spotify and follow ChristianaCare on social media.

Speaker 2: 19:11

We'll be back in two weeks with another great conversation.

Speaker 3: 19:14

Until then, thanks for joining us for the love of health.