We Have No Idea How Healthy Young People Actually Are
By Dr. Bobbie Kumar
If you ask someone in their 20s or 30s when the last time they went to the doctor was, you’ll get quite a range of answers, with perhaps the most common being “I don’t know.” Yet, if you ask them if they consider themselves to be healthy, they will almost certainly say yes. This is hardly surprising — the younger you are, the more invincible you feel. However, recently published data exposes this chasm, and in practice, we see exactly how and why it plays out.
As of 2018, around 80 percent of millennials in the U.S. rated their general health condition as excellent or good, according to Statista. However, 41% felt only somewhat informed about their health. Young adults deserve to know how healthy they are … and so do their physicians.
As a family physician, I would have been lucky to see young adults for their routine, annual physical. If I did, it typically went something like this: registration, vital signs, an array of questionnaires regarding their general health history, mental wellness, as well as screening for the risk of developing chronic medical conditions. Lastly, while I may order immunizations or routine bloodwork to provide additional insight into their health, the “annual” wellness physical is essentially deemed complete. I’m certain that this is considered both standard and accepted practice by primary care physicians across the country.
And since we’re being honest here, I can also say that it is highly unlikely that any diagnostic testing I may have ordered would have amounted to substantive insights. Because after all, most of these patients truly do not possess health concerns that are problematic for the immediate future. They are truly otherwise healthy. And because of that, this will also likely be the only time that I connect with them for the next 364 days, barring any acute illnesses that arise between now and then.
The embarrassing truth is: I get it. For this demographic, engaging with your care team can be an utter hassle. It’s time-consuming, perhaps even confusing and primarily focused on prevention of chronic illnesses that may not even affect them for years to come…if at all.. To be frank — the encounter they are likely to have with us in their eyes lacks value and ignores what they find to be of the utmost importance to them at this moment in time: to be the best version of themselves.
Preventative care visits in their current structure and cadence only provide us with a snapshot in time of one’s health. Physicians in traditional primary care settings spend (if we’re lucky) 30 minutes with a patient and hope that this encounter will tell us enough pertinent information to provide our patients with valid and focused guidance on all aspects of wellness for the entire year moving forward. Medically speaking though, optimal wellness extends far beyond the scope of what we can visibly see or measure in routine blood work and vital signs at any one particular visit. And it’s exactly why we fall short with the younger populations.
The current healthcare system has conditioned young adults to engage in their health reactively. There’s a widespread perception that one should only seek care “if you’re sick,” or that doctors are best equipped to manage acute episodes. There’s also a major shortage of primary care providers, with only 220,000 available to see 325 million people in the US. So when we find out that neither patients nor physicians feel adequately informed about their health, the reality is: what else would we expect?
We must face this hard truth: that if we want future generations to live their best and healthiest lives, then individuals have to engage with their care team much earlier than they’re doing right now. Our approach should be more than just preventative — it should be proactive.
Millennials and the oldest members of Gen Z aren’t given the tools to support adequate investment in proactive health, and more or less face minefields when they do. To get appropriate or necessary care, they’re forced to take time off of work — time they can’t afford with mounting expenses, student loans and rising costs of living. They visit urgent care clinics because they are accessible and convenient (…and who really wants to wait 6 weeks to see a primary care doctor, anyway?) But then they are relegated to navigate a complex insurance landscape with absolutely no support, if they’re even lucky to be eligible for insurance. So they fall through the cracks.
That’s not to say young adults don’t have an interest in their health: just look at the demographics of Instagram and TikTok health and wellness followers. Or those who are trying out the latest apps and adorning themselves in the newest wearables. Young, healthy adults are craving solutions that support holistic, longitudinal care. They want to live longer, look better, and feel great for as long as possible. Yet under the current paradigm, physicians are limited in their ability to achieve this effectively, and young adults aren’t ready for a long-term relationship with a primary care doctor that takes care of their grandparents as well.
This presents physicians and the greater health ecosystem with a fundamental conundrum: how do we engage with people who won’t engage with us? Part of the solution involves meeting patients where they are physically, mentally, and emotionally. Young adults don’t think about their (presumably) far-off-in-the-distance comorbidities or demise; rather, they think about how they can be the best versions of themselves right now. They think about sleep, fitness, mindfulness, appearance, and nutrition in conjunction with their clinical health.
The desire for short-term performance can be harnessed to the advantage of the patient-provider relationship, using popular tools that we already have within our reach: smartphones, smartwatches, and other forms of wearables that measure things like steps, heart rate, EKG, sleep patterns, and nutrition logs. Fitting these non-clinical pieces into the broader ecosystem will help drive proactive care. The best way to achieve this is to have physicians and care teams embrace tech-forward initiatives that protect and promote people’s vision of health. By doing this, we also increase the ability to ward off comorbid conditions that may affect them later in life because we are capturing patients in a meaningful way..
For example, the COVID-19 pandemic raised the importance of optimal management of chronic underlying (and often undetected) health conditions. An enormous risk factor for poor outcomes from COVID was obesity, which poor sleep, fitness, nutrition, heredity, neurohormonal dysfunction, and stress levels all contribute to. Targeted care plans based on real-time, valid, personalized health information can and should be used to determine how to best approach achieving health goals pragmatically.
The ability to leverage data from wearables and remote patient monitoring devices could capture valuable information to help guide care plan decision-making that is both robust and relevant. Advocacy should be pushing to have services such as this covered by insurance in order to financially support the additional overhead that care teams now must undertake.
While obtaining this data is just one piece of the puzzle, being able to digest and interpret that data into meaningful value for the care team is also a challenge. Physicians should be partnering with companies that can provide actionable insights. For example, if your resting heart rate is in the high 90’s or low 100’s day to day, what are the contributing factors to that? Are there some unhealthy habits we can work on? Or is it situational anxiety vs. excess caffeine vs. an intrinsic cardiac anomaly? Truly, how do we know unless we have interpretable data to support our decision-making?
Companies like Alertive, one of our recently acquired former portfolio startups, focused on automated but accurate remote patient monitoring. Their offering captures health measurements and offers data insights that can then be utilized to effectively treat the patients from their home.
Finally, changing the relationship between provider, patient, and technology means radically breaking down the construct of care delivery teams and expanding the use of the remote workforce. Primary care providers carry patient panels in excess of 3,000 patients. One physician to provide comprehensive care to each of those patients requires not just tech and tools but personnel to better guide health decisions. Imagine pairing each doctor visit with a personal health advisor who provides high-touch, concierge-level assistance in achieving your goals.
The administrative burden that physicians face is truly cumbersome. To fully manage patients the way they deserve, we need to capture the key indicators that drive their health outcomes as it pertains to their lifestyle and life events. Not only would this require a shift in how we staff our care teams, but also broaden our reach, enhance the patient-provider relationship, and integrate disciplines that currently exist in silos: primary care, specialists, surgeons, nutritionists, therapists.With a strong push to having robust care teams to support all these efforts, it won’t just be an up-and-coming trend, it’ll become the way.
Young adults want to stay well. I’ll even go as far to say that they want to be cared for, but until we as care providers give them a reason to allow us to guide their health journey, they will continue to go it alone until something doesn’t feel right and perhaps even too late. Let’s use our talents supported by technologies and tools to meet them where they’re at to ensure they’re not just absent of illness, but present in wellness.
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Dr. Bobbie Kumar is a board certified family physician and Director of Clinical Innovation at Inflect Health as well as Director of Clinical Innovation at Vituity, leading many of Vituity’s transformative programs including telemedicine, care navigation and health technology next-generation prototype programs. Dr. Kumar works clinically as a telemedicine physician, serving patients nationwide. She received her MBA from Auburn University and currently serves as a key opinion leader for Philips Healthcare’s COPD Insider for her work on redefining care delivery through patient care navigation for at-risk patients.
