Three years after the World Health Organization declared the COVID-19 pandemic, we have widespread population immunity against the virus. But no one is immune to the absence of adequate preventative care, a glaring shortcoming that COVID put into stark relief. Health care institutions, policymakers, and even patients have learned the wrong lessons: that health is about damage control, not prevention.
The pandemic laid bare the importance of healthier lifestyles and the relevance of mental health to physical health. Skyrocketing rates of depression, alcohol and drug overuse, and death by overdose should have alerted us that we need a holistic approach to health care. What COVID should have taught us is that health includes mental and physical wellbeing; it is about more than test results, and it is a lifelong process — not a pitstop or PCR test.
Instead, the private sector is rolling out mental health apps and Zoom therapy. The medical establishment now classifies obesity as a disease, an ICD-10 code to treat with Ozempic, never mind that in the past 40 years, the U.S. obesity rate has gone from 15 percent in 1980 to 41.9 percent in 2020. The wellness industry continues to brandish anti-aging and weight loss products and services, profiting off modern medicine’s failure to meet the moment.
When I review these individual struggles and wrong turns, I realize that perhaps the most troubling lesson lost from our three-year COVID struggle is the failure to re-value primary care and its importance for all Americans.
In the United States, we have two primary care physicians per 1,000 people — and that number is misleading because rural areas and economically disadvantaged areas have far fewer. We’ve increasingly made primary care a privilege, accessible more for the well-to-do. By contrast, Norway, Sweden and Denmark — and even Russia — have four doctors for every 1,000 people. Our poor outcomes in obesity rates, opiate addiction, and falling life expectancy are placing us closer to developing nations than first-world economies. A 2021 modeling study from the Annals of Internal Medicine suggests that having more primary care physicians — more than 95,000 additional doctors — would make a measurable difference in life expectancy and health outcomes. Instead, we are moving in the opposite direction, with an expected shortage of up to 55,000 primary care doctors in the next 10 years. That is a serious issue for Americans’ daily health — and even more so in the face of the next pandemic.
All during the pandemic, primary care providers managed patients’ underlying conditions that put them at higher risk for severe COVID outcomes. We innovated to keep patients at home and out of hospitals. We set up telemedicine platforms and home-based blood pressure monitoring. We helped patients cope with grief and vulnerability. Now, like teachers who are confronting massive COVID learning and social-emotional losses in their classrooms, primary care doctors are struggling to manage their patients’ accumulated health problems due to neglected care and pandemic-related despair.
Primary care doctors understand that patients are more than their cholesterol and weight readings. We treat diabetes and cardiovascular disease and the person who inhabits these problems. We understand that blood sugar levels and blood pressure numbers are often driven by mood, stress, sleep and everyday mental health. We know that we cannot prescribe our way out of this current “chronic health” crisis — and that patients need trusted guidance, support and a sense of agency over their health. But here, the system is truly set up to fail.
As opposed to prioritizing the doctor-patient relationship and time with the doctor, the economic incentives from health care companies and private equity firms, which are increasingly buying up medical practices, are based on testing and referring. Problem-solving, addressing root causes — not simply managing symptoms — and triaging mental and physical health together are not seen as a profitable or desirable business “model.”
For decades, primary care doctors have been the family doctor — a trusted source of medical information, a coordinator of specialists, and the keeper of the patient’s whole health story. We are more than an annual, check-the-box visit, prescription renewals, and blood tests. Primary care physicians are the people who can help integrate physical and mental health for improved patient outcomes — indeed, our individual health and well-being depend on understanding the vital links between our health and humanity. We have always been the branch of medicine that saw our patients as people, rather than their illness, chronic condition or disease. I fear that we won’t be for long.
Or, put another way, where will patients turn for help when their Ozempic stops working or their prescription runs out?
Lucy McBride, M.D., is a practicing internist in Washington, with two decades of experience. She is a health care educator, mental health advocate and author of a weekly health newsletter, “Are You Okay?” Follow her on Twitter @drlucymcbride and her podcast, “Beyond the Prescription.”