Why Preventive Visits Matter Even When You're Feeling Healthy

Why Seeing a Doctor When You're Healthy Matters

Interviewer: What if one of the healthiest things you could do this year was see a doctor when nothing is wrong? Now, I know that sounds backwards, but Dr. John Barrett, as a family medicine physician here at University of Utah Health, says that could actually be one of the most important appointments you ever make. Seeing the doctor when nothing's wrong.

So, John, let me ask you up front. I think you might be a little biased, though, on the value of primary care because you are a primary care physician. Am I right on that, or what? 

Dr. Barrett: Absolutely, I'm biased. Way biased.

The Power of Prevention

Interviewer: All right. But I am glad you're here because you're also the chair of the Department of Family and Preventive Medicine at University of Utah Health. You've been leading efforts that touch everything from urgent care to how virtual care and primary care, and specialty care work together. So you've got this big, huge view, I think, that's important to this conversation.

So why would seeing a doctor when you feel perfectly fine make such a difference? Why is that something I should even consider?

Dr. Barrett: The first thing I would say is let's reframe a little bit from "seeing a doctor." Now, if we look at that as a concept about engaging in your own healthcare with a professional, then I think we're in better shape with that question. Not making it quite so black and white. 

Interviewer: Right. It's like an advisor. It's somebody who can help. It's a consultant, if you will. It's a skilled tradesperson who might come over to your house, although house calls are dead. But you get what I'm saying. When you've got something wrong with your house, you would bring in a professional to help you with that, to advise you with that.

Dr. Barrett: Yeah. And even if there's nothing wrong with your house right now, you want to make sure that you're looking at those systems in an educated way. And the thing that we're working on in family medicine currently, and I'm excited about, is this concept.

Number one, you need access to a medical professional who has a great fund of knowledge, who is a pro. She knows what she's doing when it comes to all aspects of your health. That's why it's primary care, right? That's why you're not seeing a neurologist for your headaches all the time, etc., or specialists all the time. You are talking to someone who has a broad scope of professional education experience. But you need access to them, and that's a huge issue, a huge challenge.

So, number one, you need access to that person with that fund of knowledge. And number two, that person not only needs to know their stuff when it comes to the topic, but they also need to know how to navigate a complex and nuanced healthcare system.

A Relationship, Not Just a Visit

You've probably seen, if you haven't, you should look it up on YouTube, comparing the healthcare industry to the airline industry. I was looking at a ticket today. You go to delta.com, and it's pretty straightforward. You click, click, click, and you find what you need, and you've got . . . You may not like your options when they're charging you to carry on your small item, but you know what your options are. You know how this works.

In healthcare, it's absolutely crazy. And so having a trusted advocate within the health system who knows you . . . And this is where it comes back to the primary care professional. They know who you are, they know what your needs are, and they have talked to you about next steps with your needs.

Whether that's something as serious as a PET scan to look for ongoing problems with malignancy or whether it's something as simple as an X-ray of your ankle when there's no X-ray machine, when the X-ray machine is down at one of our clinics, which happens sometimes, that navigation of the system and knowing what to do next in partnership with you is absolutely key.

So, yeah, that's why I think everyone needs a relationship with a primary care professional.

Rethinking What "Seeing the Doctor" Means

Interviewer: I know one of the barriers for some people might be that you have a wellness visit, maybe, right? So maybe your insurance requires a wellness visit, or maybe it doesn't, and you're like, "Well, I should have an annual checkup, but nothing is really wrong. It's kind of a waste of time." The way you put it, having a relationship with a trusted advocate for your health that not only has the information, the knowledge, the perspective, knows how to navigate this system, that really reframes that as a success.

That's the best thing that could happen, is if you go in healthy and you have this conversation with this professional, and this professional says, "Everything is great. See you next year."

Health Care as Collaboration

Dr. Barrett: Yeah. And look, how many people do you know who have it all dialed in, who have their nutrition, their movement, if you want to call it exercise, whatever you want to call it, their physical activity, their stress managed? How many people do you know who are like that? And by the way, they know what all their screenings are for, things like high blood pressure and diabetes and high cholesterol, and various types of cancer?

Interviewer: I'm guessing that's a small percentage of people. Based on your experience, would you say that's a small percentage of people? I mean, we've got other things in our lives to worry about.

Dr. Barrett: That's the thing, is life gets in the way of all that when we feel fine physically. Although I would argue, and we could talk about that if you want, that if we actually took a few minutes to sort of do a self-assessment, we would discover that, "You know what? I could use some help with that." Whatever that thing is.

But if you have that relationship, that connection to a primary care system . . . And again, I would argue that you're better off coming to, and my bias is going to absolutely show through, a health system like the University of Utah. I happen to be biased for the University of Utah in this geographical region for lots of reasons.

Interviewer: Fair.

Access and Navigation Matter

Dr. Barrett: There are other health systems that do a fine job as long as they are providing you with that service. And one of the things that we're doing . . . We have our clinical folks, our operations team. They are fantastic. I'd love to call them out if I can. Can I do that? 

Interviewer: Yeah, absolutely.

Dr. Barrett: We've got a couple of physicians who head up that team. One is Dr. Bernadette Kiraly, and Dr. Kiraly is the division chief for family medicine. And she's got tons of experience. She's fantastic, she's caring, she's knowledgeable, and she's looking at the future.

Then we have Dr. Matt Johnson, who is our vice chair for clinical operations. He has been the medical director at Westridge Clinic, and he has decades of lived experience with traditionally underserved populations, people who have difficulty accessing the system.

Both of those doctors think deeply about what's next and what we can do to provide more access and care coordination. That's the formal term, by the way, for that navigation of a health system that I was talking about. Care coordination. That's the word we use, care coordination. So Matt and Bernadette are doing this.

Holly Bynum is on that clinical operations team. Erin McCormack. They're folks with tons of experience in building systems, and that's how we are differentiating ourselves. We're leveraging our strengths in that area to make sure that people have access and that they have access to qualified professionals and people who know how to navigate the health system.

And there are so many nuances in that, depending on which way you want to go. Things about virtual, things about asynchronous, non-real-time interactions where you send messages back and forth. All kinds of stuff to talk about there.

Interviewer: Yeah, that's an interesting point. For somebody like me, going to the doctor meant going to the doctor, going to your health care professional. Now there are a lot of different ways you can reach out and access that expert, that advocate for your health.

Dr. Barrett: You've got your phone right there by you. In 10 minutes, you could be seeing one of our virtual urgent care clinicians for a problem.

How Primary Care Improves Long-Term Health

Interviewer: Yeah. Pretty incredible.

I want to talk about the benefits of having a relationship with this professional. I used to be one of those people who used to think going in when I was fine was a waste of time. "Why did I even do that? I just took time out of my day." For some people, they're not even insured, right? So they have to pay for the whole visit.

But I've seen some interesting statistics that say that people without a primary care provider actually end up in the ER more often. I've also seen statistics that say people who have a relationship with a primary care provider actually have better health outcomes in general because it is that personal relationship, almost an accountability. And I can speak to that myself.

When I know I have to go in and I have to think, "All right. What am I even going to talk about here? Because I feel fine," I usually come up with a couple of things that I do have questions about, or I actually realize I do have concerns that I've just never paid attention to because life is busy. So for me, that's all very helpful.

What are your thoughts on kind of that angle, and do you have anything additional to add or expand on?

The Quiet Power of Early Detection

Dr. Barrett: Not from a data standpoint, but I can tell you that if you look over the long term, that is absolutely true. Over the long term, if you have that trusted healthcare professional who's your go-to, all of the things that you talked about are going to be better.

An example would be the patient that I saw several weeks ago in urgent care. And they're there for something completely different. They're there for a sinus problem, which is a pretty common thing in urgent care because you don't feel good, you want to get in right away, and see what you need to help you feel better.

I'm looking at their face, and I see a lesion on their forehead. I see a suspicious-looking something on their forehead. I said, "How long have you had this?" "Well, a few years." "Well, is it getting bigger? Is it the same?" "Oh, it kind of gets bigger." And I look at it and I say, "Does it tend to scale? Does it get kind of flaky and bleed?" "Oh, yeah." "Okay. I want you to go to the dermatologist, and here's how you do that." See, that navigation of the health system, that care coordination. "Here's the number you call to get into the same-day dermatology clinic."

That person got into the dermatology clinic. Sure enough, it was a relatively benign cancer lesion. They're done. But if they hadn't had that done, bad things might have happened.

This person is seeing a trusted healthcare professional, happens to . . . Happenstance, right? Happenstance that this is sitting there and easy to see.

The same thing is true with blood pressure. I see people who have elevated blood pressure and say, "Hey, did you know your blood pressure was high?" "Well, somebody told me." Almost invariably, somebody says, "Yeah, they told me it was kind of high." I say, "Well, listen, you need to really act on this, and here's what you need to do." And again, helping folks navigate. So the person generally feels fine, but doesn't realize something is going on.

The Cost of Skipping Primary Care

Interviewer: Right. I think that story is a great illustration of had somebody gone in every year, that thing could have been caught earlier. And it turns out it wasn't a major issue, but how many other things?

For some people, it could be blood sugar. They have elevated blood sugar, and they're at the prediabetes level. You can do stuff if you catch that early, but you could also feel fine when you have that elevated blood sugar. It's not until it kind of gets out of control that it becomes a real issue.

Dr. Barrett: That it becomes an issue, absolutely. And when you talk about going to the emergency department, if folks have a place to turn when they have something they think might be serious, some of those people are going to be able to get in to see or talk to their primary care professional, and maybe they can take care of it without the person going to the emergency department.

Not always. Sometimes the emergency room is a great resource if we need it. So is urgent care. But we have the capability more and more, and that's one of the things we concern ourselves with. We're trying to make sure that we have the capability to talk to you, to interact with you, to communicate with you when you need it.

Breaking Barriers to Consistent Care

Interviewer: I'm going to say there's probably somebody listening . . . and this is a personal experience for me too. A barrier and a frustration to having a consistent primary care provider for me? Clinics can be busy. You might not always be able to see the same person. For me, somebody retired. I've had people who are at one clinic, and then they move to another clinic. So it's always felt like I'm starting over.

But if the healthiest step is seeing someone when you feel fine, how can patients best navigate that to keep that continuity going when providers sometimes can kind of come and go for whatever reason?

Dr. Barrett: Let me ask you a question about what happened when that person retired. Did that clinic, did that doctor's team reach out to you about setting you up with someone else or somehow coordinating things for you in the meantime?

Interviewer: I cannot remember for sure. My recollection is no, but I would not swear to that.

Dr. Barrett: Well, that's what we're supposed to do. That's what we build out. So the key is that you have this relationship with the team of healthcare professionals. You've got the quarterback of the team or the coach of the team, which tends to be a clinician, whether that's a physician or whether it's a nurse practitioner or a PA. And then you've got the rest of the team, who are trained professionals, nurses, medical assistants, even your front desk personnel, care coordination personnel, and care navigation specialists. They are all going to work to get you what you need and get messages to that clinician's team that will reach out to you.

I did this three times yesterday. I saw patients in urgent care at Redwood, and they needed their primary care clinician to follow up with them. These three patients. And I just simply sent messages to that team, and I knew that team would reach out.

Who Can Be Your Primary Care Provider?

Interviewer: I will say I'm glad to hear you talk about this in terms of a team, or I even think of it in terms of a system now, right? So that was a barrier for me. I had a hard time having a consistent provider.

And I just kind of came to the conclusion that if you go into MyChart, which is where I can look at all my medical providers, I have a physician associate, I have my MD, I have a nurse practitioner, all of which I've seen at one point.

So now, between those three, I know they have access to my health records. That way, if one of the team members moves away, I know that I still have my records and I still have contact with a couple of other team members. So I'm glad that you brought that up.

I do want to transition to what does count as primary care. Does it have to be an MD? Could it be a nurse practitioner, or physician associate, or somebody else?

Dr. Barrett: The key is two things. Number one is that the individual has training and experience to have a fund of knowledge that's going to be helpful to you. And that's not going to be everybody, right? You've got to have a certain level of credentials, and right now, I would say that's a nurse practitioner or a physician assistant, or a physician right now, as the sort of team lead.

The second part is that the individual is able to help navigate/care coordinate the health system for you. So as long as those things are true, you're in good shape, whatever that person's title is.

Now, we may get there where we have registered nurses doing more of this work. I think, actually, that would be advantageous to us. I know a lot of RNs are outstanding at doing this type of thing.

It's a matter of escalating the problem, if that makes sense. If you've got a sprained ankle, maybe that's not as serious as if you've had escalating, worsening abdominal pain for six months. That seems pretty obvious, right? So if you've had a bug bite, maybe that's not as serious as, "I've got headaches and I've got blurry vision."

How to Find the Right Primary Care Partner for You

Interviewer: Right. Your best contact, and then if more knowledge and expertise or specialty is needed, they are the people who can help make that happen. Again, navigating the system.

I want to wrap this up by talking about the very practical next steps. So if somebody listening doesn't have a primary care provider right now, that health advocate, what's the first step to start making this happen?

Dr. Barrett: Right now, the thing to do is go to the University of Utah's website and figure out which clinic they want to go to. Now, some people want to go to clinics near their homes. Other people want to go to clinics near their work. A select set of people want to go to a clinic where they have the first available appointment. That's totally understandable. But deciding geographically where you want to be can be very different access based on your location.

Go to the website, and you can either make an appointment online with a primary care clinician or call the phone number, and you'll talk to a human who can help plug you in. Probably, at worst, three to four weeks. At best, depending on the clinic, one or two weeks out.

In the near future, and when I say near future, I mean six months, maybe less, you're going to be able to make a virtual appointment for one of these intake-type visits with one of our clinicians who is virtual only, and they can get you plugged in. You can get this done within a couple of days with one of our virtual providers, and then you will be in our system. That's what we're aiming at, and that's what we're going to be doing here.

The Future of Primary Care

Interviewer: Dr. Barrett, thank you so much for your insight. I'll tell you, this has been kind of an eye-opening conversation for me. I'm seeing the healthcare system in kind of a completely different way, which is ironic because I've worked within the healthcare system for a long time. There's some really exciting stuff coming up. Are you excited about the future of healthcare?

Dr. Barrett: Oh, absolutely. I think the technology tools that are available to us are evolving and becoming better. I don't think you're going to see Dr. Robot any time soon, but I think that your clinician is going to be using these types of tools to communicate with you to make your experience better. Not only from a human standpoint, to make your experience better, that communication aspect, but also make your experience better as far as the science behind it.

We've seen these things in action. It's already helping us do our jobs. And frankly, the U.S. healthcare system is going to be short on clinicians in the future. But I think that the improved coordination of care and the use of technology are going to help us get better and better at what we do and help you be healthier and healthier for the long run.

Interviewer: Dr. Barrett, thank you very much. Our guest today could be a little biased towards primary care, but I think after this conversation, it's kind of hard to argue with you.

I mean, when it comes to this whole idea of rethinking what that visit is about, it's about having access to an expert about health who knows how to navigate the system, who might be able to see some things that you didn't even realize were wrong. You're like, "I'm fine," but then the provider is like, "Well, this actually could be an issue. Let's talk about this to make sure that it doesn't become an issue." And ultimately, keeping you healthier and saving you money.

This has just been a great conversation. Thank you, Dr. Barrett, for being here and helping us better understand why you should go to your doctor even when you're feeling fine.

Dr. Barrett: Absolutely a pleasure, Scot. Thank you.