I am a primary care doctor who runs our chronic disease and preventive care initiatives at Massachusetts General Hospital, and in these waning days of the pandemic my clinic often feels like a family reunion that has gone really well. I get to catch up with people I have known for almost a decade — many of whom I haven’t seen in well over a year — and make a difference in their lives. But those reunions aren’t always happy: Every other week for the last two months, I have diagnosed one of my patients with cancer. That has never happened before in my 10-year career.
As headlines abound about the grand reopening of our country, we’re all making plans. Long-overdue vacations are now on the calendar and the rental car apocalypse has arrived. Many are reuniting with family they haven’t seen in more than a year and videos of people hugging again are going viral. One big thing seems to be missing from everyone’s list: getting back to the doctor’s office. I want to offer some general advice about your own reemergence into society: Don’t delay your health care any further.
The pattern in each of my cancer cases was the same: Patients did not reach out with highly concerning signs and symptoms like unintentional weight loss, months of persistent diarrhea, or severe fatigue, or chose to delay a screening test like a CT scan or a colonoscopy because they were afraid of covid-19. If you are sitting on a new or mysterious symptom — especially one you’ve ignored throughout the pandemic — or have delayed a recommended screening test, the time to act is now. We never reversed the catastrophic messaging from the early days of the pandemic that health-care settings were unsafe or too overwhelmed to provide non-covid care. The messaging to stay away from health-care settings was incorrect and circumstances have changed: Health-care providers are open and ready to care for you safely and effectively. Your chance of getting covid at the doctor’s office is probably far lower than almost anywhere else you might go.
Meanwhile, those with chronic diseases such as diabetes or high blood pressure need to reestablish routine care, even if they feel like nothing has changed with their health. Thousands of patients with chronic health conditions were lost to follow-up during the pandemic and they are not yet banging down our doors to reconnect. I run a series of programs that keep score on how well we care for more than 190,000 primary-care patients in eastern Massachusetts. During the pandemic, our overall rate of disease control declined by 17.4 percent for patients with diabetes (defined by a well-controlled blood sugar checked within six months) and by 18.1 percent for patients with high blood pressure (defined by a well-controlled blood pressure checked within six months). Initially, we explained away this decline by the fact that we were forced to close our doors by the state of Massachusetts. However, we have been fully open and available to our patients for months and our rates of chronic disease control remain 7 percent below pre-pandemic levels for diabetes and a whopping 12 percent below pre-pandemic levels for hypertension. Our total volume of primary-care patient visits year-to date, including all telehealth, is still 19 percent lower than it was in 2019. This is despite an extensive media campaign, thousands of email messages and many outreach calls to our patients. I would have expected a nationwide surge in outpatient visits to make up for the many thousands of routine immunizations and screening studies that were missed or delayed during the pandemic, but that surge has not yet emerged.
Primary-care physicians are also well-equipped to help their patients grapple with many of the concerns that have arisen during the pandemic’s long months of isolation and anxiety. Numerous surveys performed over the past 12 months should raise a high degree of concern about a rising tide of depression, anxiety, alcohol and opiate use. Multiple studies have found that symptoms of depression across the population are three- to sevenfold higher than pre-pandemic. An estimated 81,000 people died of drug overdose in 2020, the highest number on record. Similar alarm bells are ringing about alcohol use.
Many are struggling, but help is available. It starts by taking the most difficult step: coming forward and sharing what you are going through. Primary-care doctors are very comfortable managing most cases of depression and anxiety. We have medications that help reduce cravings for alcohol and opiates. Increasing numbers of health systems have built substance use disorders teams led by specially trained addiction medicine physicians, recovery coaches, psychologists and nurses who can help with alcohol or opiate use without stigma or judgment.
Telemedicine is booming during the pandemic, but it’s leaving people behind
There are still far too many barriers to accessing high-quality, affordable health care for all people in the United States. Fortunately, the relief packages and emergency measures passed during the pandemic offer some glimmers of hope. The Biden administration dramatically increased eligibility to purchase health insurance on the exchanges by opening a special enrollment period through Aug. 15, 2021, accessible through healthcare.gov and the Marketplace Call Center at 1-800-318-2596. Simultaneously, many health systems are actively growing their primary care patient base, though finding a primary care doctor in the United States remains much harder than it needs to be.
Getting care isn’t just on patients, of course. I have no doubt that the decline in chronic disease control and prevention has disproportionately impacted patients of color, patients with limited English proficiency and patients with limited insurance. Health systems will have to respond by dedicating resources like community health workers and navigators to better support these communities.
Even now, I still have some days where my schedule is only half full. It haunts me that I am diagnosing more cancer than usual while watching appointment slots go unfilled. Together, these two facts should be a reminder that there’s reason to both seek out care and to expect that it will be waiting for you when you go looking for it. If you are afraid of what your symptoms might portend, avoiding the potential financial impact of seeking health care or simply overwhelmed by the return to work or school, I would urge you to keep it simple: Reach out to your doctor’s office or your local clinic and get in to see someone as soon as you can.