Imagine you have a cold. Well, you think it’s a cold, but you’re not sure. Instead of calling your doctor—which could mean a long wait for a quick, impersonal visit—you consult Amazon’s Alexa. With its vast index of medical records, Amazon’s cloud computing algorithm quickly compares your symptoms with those of millions of other people and returns the most likely diagnosis. And then you’re on your way.
This is hypothetical, but it’s a future that’s not far off, said Timothy Hoff, professor of management, healthcare systems, and health policy in the D’Amore-McKim School of Business at Northeastern University. A “perfect storm” of primary care physician shortages in the United States, a national push toward quantifiable outcomes, advances in technology, and the “corporatization of healthcare” has created a ripe environment for retail thinking to transform healthcare, he said.
“What we’re seeing now is this tug-of-war between a physician-centric healthcare model and a corporate healthcare model,” Hoff said. His new book, Next in Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health, examines this very issue.
Hoff interviewed 40 patients and 40 doctors to gain insight into the current state of doctor-patient relationships. He found frustrated patients who felt they had to wait too long to see their doctors and felt rushed when they finally did get an in-person appointment. He also found doctors who were overwhelmed by an ever-increasing volume of patients and paperwork, both.
The best doctor-patient experiences, Hoff found, had a measure of “relational excellence.”
“These were person-to-person experiences. They weren’t transactional. It was doctors who knew their patients and patients who knew their doctors,” Hoff said.
These experiences were the exception, not the norm, for most of the patients and doctors Hoff interviewed. What he saw more often were patients who had lowered their expectations of what a doctor’s visit would be like, who felt betrayed and discouraged.
With the bar set fairly low for in-person interaction, something like a walk-in clinic—where you won’t know the doctor but you’ll at least get fairly quick service—becomes more appealing, Hoff said.
“Companies such as CVS and Walgreens are true retailers who happen to do healthcare,” he said. “They’re starting to buy up health insurance companies and funnel those patients into their system.”
Indeed, in December CVS announced its intent to buy insurance giant Aetna.
“Then you have Apple, Amazon, Google, and Walmart—these brands that have clout—using technology to automate healthcare, looking for ways to use artificial intelligence to replace professionals,” Hoff said.
Just last week, Atul Gawande, a surgeon, writer, and public health researcher, was tapped to head an as-yet unnamed healthcare venture backed by investor Warren Buffett, Amazon chief executive officer Jeff Bezos, and JPMorgan Chase CEO Jamie Dimon.
“Then you have Apple, Amazon, Google, and Walmart—these brands that have clout—using technology to automate healthcare, looking for ways to use artificial intelligence to replace professionals.”
These shifts in healthcare do bring some benefit, Hoff said. People need better access to primary care, especially for more straightforward procedures such as immunizations and annual physicals. Putting walk-in clinics inside pharmacy chains is a way to lower cost barriers and create easier access. For a certain set of “low-level services” such as immunizations and annual exams, “retailing” healthcare can deliver similar quality for less money.
But it also puts too much responsibility on the patient to decide when a symptom is relatively benign and when it requires more advanced in-person medical care, Hoff said. Something such as depression, which can manifest itself in different ways for different people, may not be accurately diagnosed by someone working in a walk-in clinic who doesn’t have a personal relationship with the patient walking in.
“It makes healthcare feel like fast food,” Hoff said. “Is that how we want to think about it?”
Treating healthcare like a retail operation, he added, creates opportunities for brands to advertise treatments or services to patients, even when they’re not necessary.
“Who has your best interest in mind here? A physician still has to take the Hippocratic Oath,” Hoff said, referring to the promise physicians make to uphold ethical standards, “and CVS doesn’t.”