5 Years Post-COVID: Has Debate and Personalized Health Care Eroded?
Five years ago, the COVID-19 pandemic dramatically altered everything, including the healthcare landscape. I felt it was important to share my insights as a seasoned physician since the pandemic's ongoing repercussions are impacting the essence of what I value for each of you—personalized choice and care wrapped with respect for individual choice, even if it does not align with your own.
Just the other day, a long-time patient of mine—someone I’ve cared for over several years—was denied the ability to have their ADHD prescription filled across state lines. This was a new restriction in their state.
I’ve noticed that, in recent years, multiple states have introduced legislation to block Schedule II medications from being prescribed across state borders. These new regulations seem to replace the flexibility that telemedicine temporarily gained during the COVID-19 pandemic.
Schedule II medications include substances with a high potential for abuse, such as opioids. The opioid crisis and its devastating toll are well-known. I’ve seen firsthand the tragic consequences. Years ago, I had a young pregnant patient I inherited to attend to her pregnancy. She was on methadone, and I spent the nine months of her pregnancy weaning her off. Tragically, after giving birth, another provider prescribed methadone to her at a dose equal to her prior peak usage. Now opioid-naïve, her body couldn’t handle it—she stopped breathing and died.
I share this story because I am not naïve to the dangers of these medications. Yet, I’ve also witnessed the pendulum swing to extremes over my career.
When I first became a doctor in California, we were required by the state medical board to undergo additional training in pain management and opioid prescribing. The message was clear: no patient should be denied pain relief. We were trained to manage pain aggressively, and the use of potent opioids like OxyContin, fentanyl patches, and methadone was not only normalized but encouraged. As a young physician, I followed these protocols exactly—after all, the state medical board knew better than I did, right?
Fast forward to today: Patients walk into emergency rooms with obvious fractures and are sent home with five pain pills barely stronger than Tylenol. I know this because I’ve cared for those patients, too. Physicians now fear prescribing opioids even when appropriate and perhaps necessary for their comfort.
Like politics and religion, medicine is subject to ideological shifts—often guided more by fear than science, as witnessed during the pandemic. In this case, it’s the fear of either failing to treat a patient’s unseen pain or unintentionally fostering addiction that could lead to harm.
However, the broader concern is this: Is healthcare shifting toward a model dictated by compliance and risk management rather than individual patient needs and disease-reversal?
I understand that policies—especially on hot-button topics like vaccinations—are designed to protect society as a whole, sometimes at the expense of personal choice. But when it comes to something as individualized as ongoing patient care, is it justifiable to impose arbitrary restrictions that disrupt continuity when a patient-physician relationship has been established? Does it truly matter whether my patient's prescribing doctor is in-state or out-of-state, both likely virtual appointments?
As a physician, I worry that there is less and less favorable debate across medicine and all areas. It's necessary to talk since one-size-fits-all does not exist, nor is it productive to shut others down if they do not align. This behavior across all the boards led to further divide during the pandemic, which I saw firsthand daily with patients. Favorable debate is becoming rare, and it's up to each of us to bring it back. It requires the one listening to find the common ground and bring it to the table before criticizing. Ultimately, everyone during the pandemic wanted to feel heard and do everything possible to be safe. What connected all my patients fundamentally was far more similar than what divided them.
Regulations and oversight are necessary in a society. I appreciate how regulations often protect the masses over the individual. Unfortunately, too much regulation unintentionally erodes patient-centered care in medicine. It discourages nuanced personalized care, leading to decisions based on fear of non-compliance by providers rather than personalized care, like how pain is treated today as a result of the opioid crisis.
Yet, just like we hold our constitutional principles as the guidepost to creating new laws, I hope the same unalienable right of protecting personalized choice and care for an individual is equally protected from erosion when new regulations are instilled. I hope that the lessons of the pandemic never occur again. Alienating others for their personal healthcare choice should never be a part of medicine again, just like the erosion of our constitutional rights.
Technology has expanded healthcare access and made what was once impossible possible. Yet, legal barriers and inflexible mandates can unintentionally erode the benefits that innovation was meant to bring. So, how do we balance protecting the individual and the broader population?
A New Model: 'Physician Pods'
This dilemma is one reason I brought up in a recent newsletter advocating for a concept I call “Physician Pods.” It’s a model similar to my current practice but on a national scale. It involves a newly designed national insurance coverage solely for catastrophic and urgent care. Covering the patient-physician ongoing, more multi-disciplined care is directly paid to the physician pod of your choice. Instead of paying astronomical insurance payments that many rarely use, the money goes to your physician pod provider at half the costs, whose sole goal is to care for 98% of your patient needs like I do today. The goal is to shift personal responsibility back to the patient rather than placing the burden on the system. It also requires physician training to take a 180-degree curve from specialized care models to ones that teach doctors again about whole-body medicine. Most diseases are interconnected and do not require specialized care if you understand the connectivity of the body.
Under this model:
• Patients choose their physicians; physicians can release patients if the relationship also isn’t working. Each physician pod is limited to 350 patients. It eliminates many complaints by patients and physicians alike and requires routine 1hr appointments every 4 months.
• It is not traditional insurance-dependent care. While some argue that choice already exists within insurance networks, this is far different—it’s a cash-based model that removes many third-party intermediaries and barriers to choose the best physician for you regardless of location. It utilizes our technological advances, yet there are local areas where patients can draw their labs, do their body composition scans, VO2 max testing, and other modalities, yet the results are automatically directed to their physician pod provider. The infrastructure of these offices is part of the pooled monies say of 5-10 other physician pod providers. This would reduce the cost on patients and the system and even create a nationwide catastrophic care model that aligns under an umbrella national system with true interconnectivity between every hospital and care facility. The information drawn from those visits is again directed back to the physician pod provider to guide the other providers to the accurate details and needs of that patient, reducing medical error, miscommunication, and record keeping.
• The physician-patient relationship returns to its original form. Care becomes more personal and patient-driven instead of being dictated by insurers and bureaucracies. The model is created out of what works from a humanity perspective first—do I connect with my doctor, and does my doctor connect to me and make not simply a 'physician pod' but a community within. This would erase state borders and regulations that unintentionally harm personalized care and place the ownership back to the patient as the CEO of themself.
• A broader network of well-rounded physicians is needed. They would be trained in primary and functional care, reducing overreliance on specialists and pharmaceuticals to reverse-engineer their patients' diseases rather than manage them.
Ultimately, this approach would help align broad healthcare policies with individual needs. And I know it can work because I’m already implementing it. The key? Intentional patients and providers are not required but are a necessity. This would require financial incentives built into the physician pod models to encourage physicians to expand their knowledge base and help their patients avoid disease but thrive as humans while also incentivizing patients with reduced costs via the national healthcare catastrophic umbrella not being utilized as often.
Preserving Personalization in Medicine
I share my thoughts and ideas as a reminder of what I have learned from the pandemic and how we can avoid making the same mistakes from our recent past. More than ever, I stand for patient empowerment and personal choice that puts our humanity, dignity, and individualism as the guiding measuring stick to any new regulations put into place. And, individually, we practice favorable debate principles with our fellow humans moving forward in all areas as well.
Would you trust a physician pod over the current healthcare system? Why or why not? Drop your thoughts below.
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Grateful to be your physician guide.
Kevin Hoffarth MD, IFCMP
BioFIT Medicine