Health Care You Do Not See


Within a mile from my home in one direction, there are two pharmacies and a primary care office.  In another direction, there’s a multi-specialty physician practice, complete with lab and pharmacy.  And in a third direction, an urgent care center.  Widen the circle another mile, and there are more physician offices, a plethora of other health care professionals, another urgent care, a retail clinic, and an imaging center.  Add a couple more miles and hospitals – plural – to start show up.

I’m not sure that’s a good thing.

Admittedly, not everyone has so many options.  If you live in a rural area or a disadvantaged neighborhood, there may not be so many choices.  Chances are, though, even in those places, whenever you find retail activity, some portion of it is probably healthcare-related.

Retail clinics helped blur the lines between retail and healthcare, and early moves by retail giants like Walmart or Kroger to incorporate first pharmacy, then primary care, into their stores made getting care easier for millions.  All in all, probably a good thing.

Still, though, you know when you’ve gone from shopping for home goods or groceries to getting your healthcare.  You know because there’s more waiting.  You know because there are more forms to fill out.  You know because you don’t know what will happen to you. 

And you definitely know when you are getting health care services.  You get an injection, you take a pill, you have an image taken, your body is invaded by a tube or a scalpel.  That’s why we go, isn’t it?  We go because we fear something may be wrong and we want someone to do something about it.  Advising us to make lifestyle changes is all well and good, although usually not effective; we want some concrete treatment.

And you know because you don’t (usually) call your doctor by his/her first name, but use the honorific, even when he/she addresses you more familiarly.    

We’ve made places of care very visible, persons who give that care very distinct, and the care itself obvious.  At those prices, it’s not too surprising.  We spend over twice on healthcare as on education (although you don’t see many rich teachers) and four times as much as on the military, so you’d expect to see evidence of all that spending — and we do.

It may be that what we’ve built is not what we want.

A few years ago Steven Downs took my breath away with his call to “build health into the OS” of our daily lives.  “It would mean” he said, “building a culture where people don’t have to think consciously about being healthy, but rather being healthy is a natural consequence of going about your day.”  He and Thomas Goetz continue this work at Building H.

That work is important, and necessary, but not sufficient.  We’ll always need a healthcare system, we’ll always need some form of care, and we’ll always need some help with those.  The question is, how visible do they have to be?  How obvious does it have to be when we are getting “care” and from whom we are getting it?

For example, not that long ago, to measure your blood pressure, a blood pressure monitor had to be attached to your arm to take a reading.  It might have been taken at your doctor’s office by a nurse, at the pharmacy using a self-service machine, or by a family member at home.  Now, though, your smartwatch can measure it for you. 

Your smartwatch might also track your heartbeat, detect irregular heartbeats, monitor your blood oxygen, gauge your stress levels, or track your sleep.   Many expect blood sugar monitoring for diabetics via smartwatch will come soon.

That’s care built into the OS of our lives.

Yes, it’s a marvel that we can do cardiac caths and heart bypasses to fix hearts, that we can use radiation and chemotherapy to attack cancer, that we have lasers to improve vision.   Yes, it’s the right idea to aim for precision medicine.   Yes, our various healthcare advances are (generally) resulting in less collateral damage to our bodies (although not to our wallets), but they’re not making our health care less obtrusive and less obvious. 

For example, many cite the pandemic as bolstering the use of telehealth visits (although its persistent effect remains to be seen).  It was great: see your doctor (or, at least, a doctor) without having to go to an office, without having to wait with all those sick people!  But, for the most part, you still had to schedule an appointment, you still had to use a specific application, and you still were talking with a doctor.

Imagine, instead, your personal A.I. assistant acts as your healthcare concierge and as your first line of “care,” helping you deal with most common issues and triaging you quickly to either more specialized experts or in-person care.  There’s no bright line between asking for help with groceries and with colds.  You expect quick, expert advice, and you get it.

That’s care built into the OS of our lives. 

My favorite example of “invisible care,” though, remains the use of nanobots and/or synthetically engineered microorganisms at work inside your body.  They could deliver targeted medication to just the right place in just the right amount, repair damaged tissues, spot and address potential issues long before any symptoms manifest.  They’d work tirelessly, unobtrusively, fixing things “at the source code level.

Healthcare designers are working to make the healthcare experience more retail-like, with prettier buildings, nicer layouts, better amenities.   Resource and cost pressures are driving more care to “extenders” like nurse practitioners and physician assistants.  Digital health is becoming a thing, with more of the speed and convenience we’ve become accustomed to elsewhere.   Again, all are important, but we may be missing the forest for the trees. 

For those who want to reform our healthcare system, how do we “hide” it into our everyday lives?   How do we make care not just more effective but also more unobtrusive?  How do we build our healthcare, as well as our health, into the “OS” of our daily lives?  Let’s not build ever more elaborate healthcare institutions and practices; let’s design ever more subtle approaches. 

The best healthcare system, it may turn out, is one in which we don’t even realize we’re getting care. 

Kim Bellard is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

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  1. I wonder who will shoulder the ultimate medical and medicolegal responsibility in this fragmented, invisible non-model. Thoughts?