Generational Shifts in Chronic Care Perceptions

The clock is ticking. You don’t hear it—you don’t even have the little digital box in your bedroom anymore. Your phone is all you need. But still, you can feel the minutes passing. If you don’t get back to sleep soon, there’s no point.

But your mind keeps racing. There’s that meeting at 10, and the report due by the end of the day. And you still need to schedule that doctor’s appointment, the one you keep putting off because you know exactly how it will go. The doctor rushes in, barely looks at you, asks a few questions, then walks out the door. The nurse comes back 10 minutes later with a piece of paper you take to the pharmacy, where the guy in a lab coat behind the counter explains that your insurance won’t cover the medication, but there’s this coupon to help bring the cost down.

Across America, millions of young adults are repeating the exact same cycle, silently battling a debilitating chronic condition while feeling like the forces are conspiring against them. Forget about being old and ornery—for Americans living with a lifelong disease, it’s the younger generation with an axe to grind. From trouble obtaining meds to difficulty booking specialist appointments, people under 50 feel like their condition is undertreated and the healthcare system is overcomplicated, according to a national survey by HealthCentral Corporation.

Whether they’re battling depression or diabetes, younger Americans are sick and tired of feeling sick and tired. Here’s what it’s like being young and chronic in America today, from barriers to treatment to challenges with diagnosis—and how the healthcare system can better help young people successfully manage their conditions.

A Growing Crisis

Among those with chronic illnesses, younger Americans are nearly three times more likely to be diagnosed with a mental health condition than older Americans; in fact, mental disorders account for one out of every two (53%) young adults with a chronic condition, according to the HealthCentral Corporation survey. The most prevalent condition? Anxiety, followed closely by depression.

It’s a trend Audrey Kteily, Ph.D., the clinical director and owner of Texas-based Coppell Family Therapy, knows well. “Many people under 50 grew up in an era where insurance was guaranteed by their parents’ corporate jobs and retirement funds were held in pensions,” says Kteily. “These anchors are often no longer in place, which leaves this younger group with fewer choices regarding their healthcare management. They are also challenged by school loans, lack of jobs, and the American dream of owning a home slipping away from them.” The rising numbers for depression and anxiety are troubling, she says, but not surprising.

HealthCentral Corporation’s findings echo those of other large surveys. Blue Cross Blue Shield Association’s 2019 Health of Millennials Report found that one in three millennials suffer from a behavioral health condition with a 43% increase in major depression among 20- and 30-somethings and 17% increase in substance use disorders since 2014.

There are many reasons for the rise in mental health challenges. “Feeling disconnected, with little structure to lean on and an uncertain future, makes anxiety and depression likely outcomes,” says Kteily.

A New Model of Care

Younger populations are more stressed out than ever, but they’re also more likely to experience difficulty accessing follow-up treatments, diagnostic tests, and medication for their chronic conditions. While 67% of people in their 60s and 76% of those 70+ say they have no difficulty accessing treatment, only 32% of younger adults agreed in the HealthCentral Corporation survey. Equally problematic: A full 25% of the younger population—the group with the highest mental health care challenges—have difficulty obtaining psychological counseling and referrals to specialists.

What’s more, according to the HealthCentral survey, 18- to 49-year-olds are three to four times more likely to have difficulty accessing diagnostic tests than older populations (for example, 25% experience difficulty obtaining blood work, compared to only 7% for those 50 to 59 and 3% for those 60 to 69). This pattern is evident across all follow-up diagnostics, as well as ease of obtaining prescription medications. Younger Americans are also two to three times more likely to report difficulty purchasing brand name meds, expensive drugs, and/or pain medication, compared with those over 60, the survey found.

Some of this comes down to economics. But other frustrations expressed by younger adults may have as much to do with a generational shift in expectations about the convenience and speed of medical care. In place of traditional healthcare models, where a patient sees a primary care physician for annual well-visits and specialists for acute or chronic conditions, scheduling appointments months in advance, today’s younger patients prefer walk-in clinics, telehealth, and Zoom calls—appointments than can be scheduled virtually, instantly, and are geared to meet the needs of faster-paced lifestyles.

But while this new model for receiving healthcare services offers some key benefits, it comes with trade-offs as well.

A Weaker Support Network

It’s 8:30 p.m. on a Thursday night, and your back is killing you. You could wait until morning to call your primary care doctor but waiting seems pointless when you can simply log onto a website, sign-in, and wait for a text letting you know the walk-in care clinic doctor is ready for you to drive over. True, the doctor you see looks barely out of med school and as disinterested in your symptoms as he is in your name. But he’s available now to write a prescription and make your pain disappear.

Insta-care has its appeal, but HealthCentral Corporation’s survey suggests that under the surface, this ER-style approach to treatment is leaving younger generations dissatisfied with their provider experience. It’s possible that in the absence of an established interpersonal relationship between patient and doctor, a relationship that when successful can span decades, the physician-patient exchange becomes more transactional and less caring.

Megan Conoley, M.D., a Dallas-based internal medicine specialist, sees these changing attitudes toward care on a daily basis. “Younger Americans have grown up in a vastly different technology world where everything is faster,” she says. Meanwhile, they’re at a point in their work and family lives where time constraints add more pressure than ever. “Most people prefer a single point of contact for something as sensitive as health, but the balance of convenience may outweigh this and, with a rapidly shifting healthcare system, the expectation of a single POC is likely less for younger than older patients,” she adds.

The problem: “Fragmented care can be passable for healthy people but when you start adding chronic conditions, that changes,” Dr. Conoley says. “It is well-documented that continuity of care has a significant positive impact on health outcomes. Fragmented care impacts the trust that is built between doctor and patient, which is key to important patient disclosures.” Solutions, she says, include medical groups expanding office hours, offering more technology to assist with convenience of scheduling, and providing access to test results after hours. The idea that the younger generation will mold themselves to the traditional system is proving false; so it’s up to the system to reconceive care in a way that relates better to the next generation.

Losing the Connection

That outdated system may be one reason that 25% of younger survey respondents skip out on seeing their doctors. Other reasons include two in 10 who have felt shamed by their healthcare provider, while another 14% stay away because they don’t trust the medical system. A whopping 71% believe their chronic condition has negatively affected their personal finances, while 50% say their financial status has prevented them from obtaining the quality care they need—a rate significantly higher than older populations.

It’s also a matter of perception, says Dr. Conoley. “Younger people don’t have as clear of a view of their own mortality,” she notes. “They have fewer chronic conditions and therefore not as much insight into the impact of good or poor health—and it’s hard to delegate funds to something that seems less urgent or less important than other financial priorities.”

That leaves younger adults with chronic conditions vulnerable to disease advancing at a rate far greater than it might with proper medication and treatment; it is opens the possibility of lower quality or inconsistency in care.

Kteily believes it’s incumbent on the medical community to find a way to reach and work with young and chronic Americans. “Practitioners who are able to bend towards this demographic would do well to connect with them,” she says. But the issue is bigger than just one group, she maintains: It’s not only doctors that need to change, per se—it’s the system. “Young adults need to know how to look for and access resources, and they need helpers who care enough to show them.”