Bypassing traditional health care

 A recent issue of the Journal of the American Medical Association notes that primary care is diminishing. “In 2024, more than 1200 positions in family medicine, nearly 1000 in internal medicine, and more than 500 in pediatrics went unfilled.” At the same time, they add, we now have “an emerging direct-to-consumer health care market that bypasses traditional health care organizations.” One of these organizations—no surprise—is Amazon’s One Medical, which “integrates telehealth, primary care, and pharmacy services into its Prime membership,” as described on their web site. You either pay $9.00 a month, $99 a year with Prime membership, or $199 a year without Prime membership. “Telehealth” is virtual health care. You visit a health care person using your computer or phone. Here's an example of how you'd make an appointment.

A while back, my son mentioned having used this service, so I queried him about it, starting with asking him what prompted him to sign up with Amazon’s service. As he explained, his GP had retired, and he needed someone to refill a prescription. As he wrote, “I searched far and wide for a doctor (GP), and it was very difficult to find one. Appointment times were at least six months out. All I needed was a prescription, so I kept searching. I finally got a provider through Amazon medical. I actually dislike Amazon, but it was very easy to get an appointment with a nurse practitioner. And, she's awesome.” 

This nurse practitioner is now his go-to health care provider. She sent his prescription to his usual pharmacy and, when asked, referred him to a local gastroenterologist for a colonoscopy. Like conventional practices, telehealth companies ask for medical records if they’re needed. Visits are covered by your insurance.

I’m still a little mystified by the whole telehealth business. I searched the internet for such companies. There are plenty to choose from. I’m not sure if they all work like Amazon’s. One company, called Sesame, showed photos of their health care providers along with available appointment times, as shown in this photo. Looks easy!

When my GP retires, I’ll probably turn to a telehealth company.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Anemia

Anemia is defined as a low number of red blood cells. It shows up on your blood test as low hemoglobin, which is the main protein in your red blood cells that carries oxygen and delivers it throughout your body. If your hemoglobin is low enough, your tissues or organs may not get enough oxygen. Symptoms of anemia include tiredness, weakness, leg cramps, shortness of breath, pale skin, and cold hands and feet.

One study showed that anemia affects 12.5 percent of people over 60, and that the rate rises as you age. Another study, published in the Journal of the American Geriatric Society, showed that about one in five patients was anemic.

A friend of mine was hospitalized more than once with anemia, in her case caused by blood thinners that resulted in gastrointestinal bleeding. Transfusions were required. Other causes include hereditary conditions, vitamin B12 deficiency, lack of iron in your diet, bone marrow disorders, kidney failure, heart disease, and inflammatory bowel disease.

Remedies include over-the counter iron tablets—which often have unpleasant side effects—and intravenous iron infusions, which have been shown to be effective.

The World Health Organization defines 13 grams of hemoglobin per deciliter as normal for men and 12 for nonpregnant women. As luck would have it, I’d had a blood test prior to my spine surgery last year, so I looked up the results. Everything was normal (displayed in green) except my hemoglobin, which was high (displayed in red with warning sign). According to the Cleveland Clinic web site, above 16 is high for women. Mine was 16.1. Dehydration is one cause. That’s probably me. But other causes include kidney cancer and congenital heart disease. At any rate, I’m clearly not anemic and have none of the symptoms.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Best not to sleep for eight hours

I usually sleep about six or so hours a night, and it’s usually broken sleep. Lying awake for an hour or more in the middle of the night is no fun, but I don’t worry about it. Sometimes it’s even productive. I plan menus or think up book ideas. Sleep experts agree that eight hours of sleep is not optimal. Rather, it’s 6.5 to 7.4 hours. A study of 1.1 million people concluded that those who reported more than eight hours of sleep “experience increased mortality rates.” Scientists who have studied hunter-gatherer tribes in Bolivia, whose lifestyles remain the same as our forebears of two million years ago, found that they average less than 6.5 hours of sleep a night.

Nevertheless, the idea that you need eight hours of sleep persists. In 2024 there were more than 2,500 sleep-disorder centers in the U.S. accredited by the American Academy of Sleep Medicine. Aric Prather, the director of the behavioral-sleep-medicine research program at UC San Francisco says the wait time at his clinic is one year. “We have people coming into our insomnia clinic saying ‘I’m not sleeping eight hours’ when they’re 70 years of age. And the average sleep in that population is less than seven hours.” Making matters worse, fear of losing sleep causes sleep loss.

Thomas Wehr, age 83, once the chief of clinical psychobiology at the National Institute of Mental Health, says that humans aren’t necessarily meant to sleep in one long stretch but rather in two shorter ones. The night awakenings tend to happen as we’re exiting a REM (rapid eye movement) cycle, when our dreams are most intense. He says, “If you know you’re going to fall back asleep, and if you just relax and maybe think about your dreams, that helps a lot.” When I’m awake in the middle of the night, I don’t think about my dreams. I can’t remember them.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Undocumented caregivers

Dr. Louise Aronson, geriatrician and author of Elderhood, says, “Caregiving is hard work. More often than not, it’s tedious, awkwardly intimate, physically exhausting and emotionally challenging. Sometimes it is also dangerous or disgusting. It is women’s work and immigrants' work.” Most old people get care from their children, spouses, other relatives, or non-relatives. The remaining caregivers are paid, but not much. The median hourly wage for all care workers was $16.72 in 2023—lower than the wage for all other jobs with similar or low entry-level requirements.

The New England Journal of Medicine notes that “immigrants are a vital part of the U.S. health care system: at least one in five U.S. health care workers is foreign-born, including 29% of physicians, 17% of nurses, and 24% of direct care workers.” Of the 37% of foreign-born direct care workers who are non-citizens, nearly half may be undocumented. The Journal also reports a shortage of direct care workers, estimating that the shortage will grow to 860,000 by 2032, and that 8.9 million positions will need to be filled over the next decade to meet the demand.

Raids by ICE have made matters worse. As the Journal noted, “Just four days after the inauguration, 25 undocumented Filipino direct care workers were arrested in an ICE raid at a senior care facility in Chicago; at least eight have been deported.” In one case, a cancer patient, living alone at home, had fallen but wasn’t found for days because “his home health aide had stopped coming to work for fear of deportation.”

Non-immigrants are unlikely to fill the void. Direct care workers “are often subject to exploitative work practices, including wage theft. The physically demanding nature of direct care work, combined with low pay and high susceptibility to exploitation, makes these roles unattractive to U.S.-born and highly skilled foreign-born workers.”

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.