By Lauren Bock, ADVANCE HEALTH COLUMNIST
Top 10 most common patient comments and questions regarding lifestyle changes:
10. “What am I supposed to do if I can’t have screen time within two hours of going to bed?”
9. “I’ve tried to meditate, but it doesn’t work for me. I can’t turn my brain off.”
8. “I need to lose 50 pounds.”
7. “I don’t want to take a statin.”
6. “I don’t like tofu.”
5. “I don’t have time to exercise.”
4. “I’m tired all of the time.”
3. “I try to make changes but they don’t last.”
2. “What am I supposed to eat?”
1. “I need a new PCP, who do you recommend?”
Sound familiar? These comments continually to echo in my life from friends, family, patients— and myself. While there’s much to unpack in the top 10, today we’ll focus on number 1.
My husband recently brought home a souvenir from a work trip to Guatemala: two weeks of diarrhea. While losing 10 lbs. was appreciated, the journey to his diagnosis was more challenging than it should have been.
After the initial chills, aches, and intense stomach cramps subsided, the residual post-meal diarrhea became quite the nuisance. The earliest Primary Care Physician appointment was in two weeks, so he decided to hold out, assuming the condition would resolve on its own.
By day 10, he opted to go to urgent care, only to be told to lay off the coffee and feast on dry toast and bananas. They refused to order a stool kit, and told my him to go to the emergency room instead if the diarrhea persisted.
Fortunately, our insurance covers emergency room visits, but my husband’s symptoms weren’t exactly life threatening, and the thought of spending hours of his day lying on an ER gurney was less than appealing.
The VA finally pulled through and offered him a phone-only tele-visit to order his stool kit, by which time the probiotics had kicked in and he was finally feeling better—10 pounds lighter and 15 days later.
Given time, many acute health issues will resolve on their own. Sniffles: 5-7 days. Low back strain: a few weeks. But what about the issues that worsen without appropriate treatment? A simple urinary tract infection that doesn’t flush out with heaps of water and pure cranberry juice can become a costly hospital-admission kidney infection for Grandma Jane.
Having access to care, and, importantly, care that you trust, are significant issues. Many folks ask me for PCP recommendations—because they don’t have one, or because they don’t feel their current PCP really listens to them or takes the time to hear their concerns. This often leads to what’s referred to as PCP-hopping.
Having practiced primary care and internal medicine for 14 years, I see both sides of this dynamic coin. Time is precious for everyone. A five-minute appointment for the sniffles and a 15 minute time-slot for a complex 65 year old with diabetes, heart disease and gout will leave both patients and providers exhausted.
In my experience, problems practically fix themselves when patients feel heard. By some estimates, 70 percent of office visits are stress-related. Ever notice that your back pain flares when you’re fighting a work deadline? Or you can’t sleep when you’re arguing with your spouse? Subsequently, the poor sleep will compromise your immune system, bringing on a nasty cold that sets you back further.
It is difficult, if not impossible, to adequately address a patient with 15 chronic health conditions in a single office visit every six months. Important details are not discussed, and gold-standard care is rarely delivered.
Access to healthcare is no new issue in the U.S. or abroad. I was trained 20+ years ago in medical school that the PCP is the ultimate gate-keeper. The all-knowing. The trusted confidant. The first step before accessing specialty medicine.
Today, Google, ChatGPT and WebMD often replace the PCP and patients are bypassing primary care to jump straight to the specialists. Trust in healthcare is down. Access is down. Time is a limited resource. Why wait 2+ weeks to see my PCP when I really just need to see the specialist? I get it, and at times am guilty of this mindset myself.
And with the nationwide shortage of physicians expected to be as high as 86,000 ten years from now, the access problem is only going to get worse.
The PCP-patient partnership was the reason I chose to stay in Internal Medicine for many years. The relationship was special, and I reflect back on time spent with patients fondly. Unfortunately, for many providers, years of skipped lunches and extended office hours leads to tired, burned out providers who leave the field prematurely, worsening the provider deficit.
Without a solid PCP coach, the team tends to fall apart. The PCP gatekeeper is there for a reason: Someone to oversee the big picture. Someone to put the puzzle pieces together. Someone to root for the home team.
As a military spouse, I changed practices 10 times in 18 years. With each move, it would take months or sometimes years to create my village of providers that I trusted with my own patients. Finding your own village of providers can feel like a full-time job. Inevitably, providers will move on or retire, leaving their patients to scramble to find the next provider, hoping to find “a good one.”
But there’s an alternative.
Over the last four years, I spent my days running a Lifestyle Medicine clinic with an emphasis on shared medical appointments—essentially group therapy. Lifestyle Medicine can be a time-intensive specialty, as providers place a premium on understanding their patients’ complexities. I can’t help someone navigate lifestyle changes without knowing their story: home, work, family, relationships, prior successes, and prior failures. With all of this for context, we can build momentum for change, especially in the company of others.
None of us are alone in our challenges, but our challenges can feel isolating. Loneliness is the new smoking, haven’t you heard? Shared medical appointments can bring folks together to navigate their diseases with support and understanding. Elders share wisdom, hipsters share the latest health-apps, and providers share their knowledge.
While group appointments aren’t the cure-all for today’s PCP shortage, creatively using our resources is good for the goose and the gander. Shared medical appointments aren’t a new concept, but resistance remains. If there is one thing I learned in medicine, it’s that change is hard, both for individuals and organizations.
As we look to optimize our limited resources with an open mind and curiosity, here’s hoping we provide greater access to care going forward, and avoid a three-week delay for a Giardia diagnosis.
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Lauren Bock is a certified Physician’s Assistant. From 2021 until 2025, she led a Preventative Cardiology program with Virginia Cardiology Consultants and Oracle Heart and Vascular. She has since become the first PA in the Fredericksburg area to be board-certified in Lifestyle Medicine. You can contact her at her lifestyle medicine practice Be Well.
Family member is a 'derm doc'. Has to keep up with 60 hrs Continuing Med Ed and ABD/American Board of Dermatology continuing certification. What's been popping up in these trainings are: Robots.
Robots and advanced AI systems are already performing skin cancer screenings, with commercial deployment expanding globally. Rather than replacing doctors, these technologies automate the scanning process and provide instant risk assessments to assist medical professionals.
Recent breakthroughs and clinical deployments highlight how this technology is becoming the new standard of care:
Autonomous Full-Body Imaging: Platforms like the French-built SWAN robot by SquareMind use robotic arms to capture standardized, high-detail images across your entire skin surface in minutes. The AI then maps every spot on your body, tracking changes across visits.
Instant AI Point-of-Care Devices: Handheld devices like DermaSensor utilize artificial intelligence and spectroscopy to analyze cellular structures in seconds. The device is currently commercially available in the U.S. and provides real-time risk assessments.
Global Pilot Programs: The UK's NHS has actively piloted AI tools in over 20 hospitals. By evaluating clinical images, these algorithms can clear nearly half of patients on the spot, cutting down waiting times from months to mere days.
Diagnostic Accuracy: Clinical studies have demonstrated that when AI is used to aid practitioners, detection performance rivals or even EXCEEDS that of expert dermatologists in specific settings.
I'm intrigued by the concept of shared medical appointments, which I hadn't heard of before. I'd love to read more about how they work!