Aficionados of my blog posts will know that we long ago established that I’m old. Some would say archaic (Joseph children, I am looking at you!), but I think that is harsh. Be that as it may, back when I was in medical school and residency, I was taught to meet the patient where they are. This meant, as I recall, to understand what circumstances my patients found themselves in and respond to their needs with the specific situation in mind. For example, if an adolescent has been struggling with a neglectful parent for much of her life, it is completely understandable that she will have trust issues when first encountering a caregiver or authority figure. If the clinician properly anticipates the patient’s needs and appreciates where they are in their journey, everyone will have a better outcome.
In the last few years, however, “meet the patient where they are” has taken on another dimension. The United States healthcare system has now seemingly acknowledged that while it might be convenient for us (physicians and hospital administrators) to have the patient travel to our buildings and sit in our waiting rooms, it is not always what our patients and customers want or indeed can accept. Who woulda thunk it? Wait. Don’t answer that. It was a rhetorical question. (Hang on. Let me answer this rhetorical question! In March of 2021, Nordic’s CEO Jim Costanzo wrote that “[d]ecentralizing care provides the opportunity to offer consumers a multi-channel and multi-location experience, improving engagement through convenience.” So, there you go. It was thunked before.)
While the pandemic has made convenience and remote options expected choices for all aspects of our lives, we have been moving in this direction for many years now. We realize that many people cannot take a half-day off from work to meet with their physician for a 30-minute office visit or leave their children unattended while they get an involved imaging study. We read academic articles noting that “cultural competence” can move the needle on getting people the care that they need.
Bring the care people need to where they are. Case in point: former UK Health Secretary Sajid Javid announced in February that “walk-in MRIs will be available in shopping centres as part of [the] war on cancer and pandemic backlogs” in the United Kingdom. These diagnostic hubs will be located at football stadiums and community organizations, as well as attached to hospitals. Clearly, if people won’t or can’t come to the imaging center, bring the imaging center to them. Further, make it as easy as possible, so appointments are optional. Drop-in possibilities make it easy to do the right thing, and that should be the goal for screening tests like mammograms and other cancer prevention tools.
Taking this one step further is startup company Fabric Health. As noted in an article about the group, “[o]n a recent weekend at a laundromat in North Philadelphia, while people waited for their clothes to dry they could choose to also get a cancer screening, have their blood pressure checked, or sign up for health insurance.” Fabric Health works with health insurance companies whose enrollees may be struggling to understand or take advantage of their benefits. If a patient can access chronic care services, they may be able to avoid much more expensive visits such as to the emergency room or the intensive care unit. This can impact an insurance company’s quality metrics as well as their bottom line.
For well over a decade, the Black Barbershop Health Outreach Program (BBHOP) has attempted to meet their community where they are. They note that African Americans have a disproportionately higher incidence of chronic diseases such as diabetes mellitus and hypertension. The group started offering free blood pressure measurements as people waited to get their hair cut. They progressed to identifying local physicians and clinics who would be willing to see patients referred by the BBHOP members. They now have mobile phone apps that can help folks find care, record and monitor weight and blood pressure, and even check symptoms to learn if they need to seek care for a specific problem. Their program works and should be replicated by other populations.
Meeting the patient where they are is the right thing to do. Convenient and accessible care is the way forward. When operationalized in a culturally competent way, people are much more likely to get their preventive care and deal with their chronic conditions before they transform into much more serious problems. We need both small startups and established large healthcare systems to think nationally and act locally to get their customers/patients/neighbors the care they need and deserve.