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Urgent Care or
Primary Care
How Young People Prioritize Convenient Healthcare

by Mason La Fleur

You wake up in the morning and find yourself with a runny nose, cough, congestion, and chills. After realizing how you took your good health for granted, you decide to call your primary care physician, only to be put on hold and transferred twice. Finally, you are able to talk to a real person, they can’t book an appointment for you for another 3 days. This is a story that is all too familiar to us, and especially to younger people like millennials and generation z.

Why are younger people choosing urgent care centers over primary care physicians?

As of late, more and more young people are choosing to do away with their primary care physicians. Instead, they put their trust in urgent care centers, which on average cost less out of pocket, and take less time to schedule. According to a Washington Post article, 45% of people aged 18-29 did not have a primary care physician, compared to 28% of those aged 30-49. For many, it’s about the convenience of urgent care centers. Like many other aspects of their fast-moving lives, millennials and gen z want healthcare to be delivered to them in a timely, and low-cost manner. That means no sitting in waiting rooms, filling out paperwork, and other tasks you must do when going to your primary care physician.

Primary care physicians are also more costly, with most visits costing around $175 with insurance, and nearly double without, according to the Mira research team. On the other hand, urgent care costs sit between $150 and $200, whether the patient is insured or not. Many factors in the price for primary care physician visits include location, duration of the appointment, and insurance status. For example, the average cost of a primary care physician visit in New York is around $150, while in Denver the same visit costs nearly $200. In addition, patients are usually charged a $15-30 copay if their doctor is out of network, meaning they don’t accept the patient’s health insurance. However, there are some advantages to a primary care doctor. Building and maintaining a relationship with your doctor over a long period of time can lead to a higher quality of care, compared to the a la carte style service you get with urgent care centers.

Convenience is key

Disease and illness don’t stop at the end of the workday, so patients need a place to go after 5 p.m. to get treatment, while also not breaking the bank. Many urgent care centers are open until 9 or 10 p.m., and it’s not uncommon to find them open 24 hours a day. On the contrary, primary care physicians usually operate from 9-5, and on Friday it’s common for their practices to close early. If a patient is able to schedule an appointment with their physician, it’s likely that they’ll have to reschedule their day in order to meet with their physician, rather than the physician trying to close that gap. Younger people have shown how much convenience matters to them by consciously making the decision to visit urgent care centers more often, and avoiding jumping through hoops to meet with their primary care physician.

What can primary care physicians do?

The future is unclear for primary care physicians, as well as most smaller medicinal practices. One solution would be to increase their use of technology to accommodate younger patients. Adding virtual check-in and allowing for paperwork to be done via phone or computer would decrease the amount of time spent in a waiting room, and increase convenience. Another solution would be to allow for walk-in appointments, and for their patients to cut the 3-5 day waiting period when their appointment can be done in 20 minutes.

While primary care physicians have been a key part of medicine in the past, if they don’t evolve to meet the younger generation's needs, they will become obsolete. In this world, time is everything, and if primary care physicians aren’t able to keep up, they will be left behind.

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Mason La Fleur is a senior at Grand Valley State University studying Health Communications. He serves as the Event Coordinator of the GVSU Health Communication Club, is a member of GVSU Students for Choice, and the GVSU Beekeeping club. Upon graduation, he plans to pursue a Master's in Health Administration with the career goal of working in a healthcare facility. In his free time, Mason enjoys reading, working out, spending time with friends, and watching movies. 

Summer Food Safety

Registered Dietitian Flavia Herzog Liebel provides guidelines for preparing and enjoying food outside during the summer months. This is an important video to watch as the grilling season begins.

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How Stress Physically Alters Your Genetic Code
and The Genetic Code of Your Children

by Nikita Amin

 

What is epigenetics?

In genetics, one of the foremost concepts is that evolution takes time to occur.  Natural selection acts across multiple generations in order to cement a certain heritable trait as an evolved, acquired one that aids survival.  However, the relatively new field of epigenetics studies the changes in genetic code based on the life events of the parental generation then inherited by the offspring generation.  One of the most common ways that this plays a role in our everyday lives is epigenetic stress: oxidative damage and overexpression of stress hormones can cause long-term changes to how our DNA expresses itself.  These changes can then be passed onto biological offspring, impacting their development.

 

Epigenetics, as a term was first coined in the 1940s, and was originally used to refer to the method in which the genotype (genetic code) manifests into a phenotype (physical attribute).  The field of study now instead pertains to the modifications to the genetic code other than those that directly act on the primary DNA sequence.  There are many ways in which gene function is affected by epigenetic modifications; the most well understood methods are DNA methylation, histone modifications, and histone exchange.

 

DNA methylation is a form of gene expression regulation.  Enzymes called DNA methyltransferases are able to transfer methyl groups, a highly reactive organic compound commonly found in methylating agents, to specific regulatory spots in the DNA.  By doing this, the DNA is able to stop certain genes from being expressed without entirely eliminating that chunk of genetic code.  Similarly, histones can also be methylated to repress gene expression.  The difference between the two is that histones are a more localized process, meaning it is easily reversible, whereas DNA methylation results in a more stable, long-term change that results in a semi-permanent repression.  The methylation is often referred to as “methylated tags”, derived from how these methyl groups can be visualized as tags attached to the original DNA sequence.  Tags can show up in many different parts of our genome, impacting a wide range of biological and biochemical processes.  This regulatory process is entirely neutral at its core; it can be helpful or harmful based on its source, purpose, and effect on the body.

 

For example, DNA and histone methylation are essential for the body to be able to develop specific cell types for distinct organs to develop.  Without these methyl tags, the body would be unable to differentiate specific organs with their specialized functions.  These are not the acquired methyl tags that have been cause for concern in recent years; those specifically refer to heritable gene silencing.

 

How does epigenetics impact me?

Epigenetic changes are acquired by all organisms depending on a variety of life events and factors, the most broad and common category being stress.  Epigenetic stress has recently gained attention for the way in which it can impact the bodily functions of people exposed to high levels of stress. 

 

The mechanism of how our body is changed by this stress is through gene silencing, which is heritable.  Gene silencing is regulatory, and as previously mentioned, can happen in a variety of ways.  It is a method in which parts of the genetic code are stopped from being expressed (“silenced”).  This, in effect, usually means that a set of specialized proteins are not produced, resulting in a loss of function. 

 

A good way to better understand epigenetics is by looking at identical twins.  Identical twins inherit the same exact set of chromosomes, yet twins never end up looking or acting the same way.  This is due to how environmental factors and experiences can add tags, changing gene expression, impacting the overall development of each twin in different ways.  The genetic code is most likely to attain these epigenetic modifications earlier on in life, when the body is still developing and more of the genetic code is being activated.

 

Why children benefit from low-stress environments

Any alterations to genetic code can also be passed down to future children.  This is an even more significant impact because while these changes impact the day-to-day lives of adults, methylated DNA tags play an even bigger role in the development of a fetus.  If a certain gene is methylated from conception, its impact on the biological makeup of the person is much more significant because it impacts the organism beginning at fetal growth.  This is called genomic imprinting, and is the process in which methylated tags are passed down from parent to offspring.  By being inactivated early on, epigenetic changes can have a larger effect on the biology of a child than it had on its parent.

 

These new insights into epigenetics have highlighted the biological significance of low-stress environments, especially for young children.  While some of these epigenetic changes are temporary, with removable tags, there are cases in which the change to our genetic expression is permanent.  Epigenetics provides evidence of how nurture is just as relevant as nature is in how a child develops, and how a young child’s birth circumstances can drastically change their future.

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Nikita Amin is a third year undergraduate student at the University of Virginia double majoring in Biology and English.  She hopes to go into the biological research sciences, and is passionate about making the academia she is passionate about more accessible.  This is one of her main focuses as a Senior Contributor at Today's Patient, writing articles that make scientific news more readily available to the general public.

June 2022   page 4