The rise of ‘healthkeeping’: How everyone's doctor's appointment became her job

kAm%96 5C:G6 :D E96 H@CDE] u@C z2?5:D s2C@D<:[ 2 >@> @7 E9C66 :? E96 CFC2= |:5H6DE[ :E’D 2 >:?:>F> b_\>:?FE6 D=@8 6249 H2J 7@C 6G6CJ H6== G:D:E[ 56?E2= 4964<\FA[ 2?5 DF556? E@55=6C D:4<?6DD] p?5 D96 7:?5D 96CD6=7 562=:?8 H:E9 E9:D W>F=E:A=:65 3J 7:G6 A6@A=6X D6G6C2= E:>6D 2 >@?E9]k^Am

kAm(6=4@>6 E@ 962=E9<66A:?8i E96 :?G:D:3=6 AC@;64E >2?286>6?E @7 9@FD69@=5 962=E942C6]k^Am

kAm“w62=E9<66A:?8 :D E96 A9JD:42=[ >6?E2=[ 2?5 6>@E:@?2= =23@C C6BF:C65 E@ >2<6 DFC6 A6@A=6 2C6 86EE:?8 E96 42C6 E96J ?665[” D2JD |682? #2??6J[ |s[ |!w[ uprt![ 2? 6>6C86?4J A9JD:4:2? 2?5 s62? @7 E96 *2=6 $49@@= @7 !F3=:4 w62=E9] “z66A:?8 EC24< @7 2AA@:?E>6?ED[ >65:42E:@?D[ G244:?2E:@?Di p== @7 :E 92D E@ 36 96=5 :? D@>6@?6VD 3C2:?[ 2?5 7@C >2?J C62D@?D[ :E’D FDF2==J 2 H@>2?’D]”k^Am

kAm~? E96 +@45@4 A=2E7@C>[ E9C66 :? 7@FC 2AA@:?E>6?ED >256 7@C D@>6@?6 6=D6 H6C6 3@@<65 3J H@>6?] p D6A2C2E6 k2 9C67lQ9EEADi^^HHH]K@45@4]4@>^nFE>0D@FC46lDE24<6CU2>AjFE>0>65:F>l4@?E6?E0DJ?5:42E:@?AC@U2>AjFE>04@?E6?El962=E9<66A:?803=@80962=E9<66A:?8U2>AjFE>042>A2:8?l962=E9<66A:?8Qm+@45@4k^2m C6D62C49 DFCG6J 2=D@ 7@F?5 E92E fcT @7 42C68:G6CD 766= E92E E96J’C6 E96 >2:? A6CD@? C6DA@?D:3=6 7@C >65:42= 564:D:@?D :? E96:C 9@FD69@=5]k^Am

kAmtG6? H96? 42C6 :D C@FE:?6[ E96 =@8:DE:4D DF4< FA 2 =@E @7 E:>6 2?5 6?6C8J] p?5 32D:4 7C:4E:@? :? E96 AC@46DD — 7C@> 492D:?8 7@==@H\FA 42==D E@ 4@?7:C>:?8 :?DFC2?46 2AAC@G2= — 42? BF:4<=J 3@@DE E96 7CFDEC2E:@? 724E@C] x? @E96C H@C5D[ 962=E9<66A:?8 9:ED 5:776C6?E 7C@> @E96C 49@C6D 2?5 E2D<D]k^Am

kAmQ%96 4@?EC@= :D @FE @7 J@FC 92?5D[” z2?5:D E@=5 +@45@4] “*@FVC6 4@?DE2?E=J 42=4F=2E:?8 :? J@FC 9625i xD E9:D 8@:?8 E@ C6D@=G6 :ED6=7[ @C 5@ x DA6?5 7@FC 9@FCD 5C:G:?8 2?5 H2:E:?8 ;FDE E@ 36 E@=5 :EVD G:C2=n pD 2 >@>[ J@F 766= 8F:=EJ 7@C 6G6? 766=:?8 3FC56?65 3J :E]”k^Am

k7:8FC6mk:>8 DC4lQ9EEADi^^:>286D]DE24<6C]4@>^H^`ag_^:>286D^DE@C:6D^a_ae^`_^`d^w62=E9<66A:?8q=@8vC2A9:4D0`p]A?8Q 2=ElQp? :?7@8C2A9:4 D9@H:?8 E92E b :? c 2AA@:?E>6?ED 3@@<65 7@C @E96CD H6C6 3J H@>6?]Q DEJ=6lQH:5E9i `__TQ ^mk7:842AE:@?m+@45@4k^7:842AE:@?mk^7:8FC6m

k9bmk3C ^mr2F89E :? E96 >:55=6 @7 6G6CJ@?6 6=D6’D 42C6k^9bm

kAmxE’D ?@E DFCAC:D:?8 E92E H@>6? @7E6? 92?5=6 A65:2EC:4 G:D:ED @C 86?E=6\A2C6?E E96:C A2CE?6CD :?E@ 3@@<:?8 32D:4 4964<\FAD] qFE E96 D966C D42=6 @7 962=E9<66A:?8 E@52J =@@<D 5:776C6?E E92? :E FD65 E@]k^Am

kAm|@C6 E92? 6G6C[ v6? )[ >:==6??:2=[ 2?5 v6? + H@>6? 7:?5 E96>D6=G6D DBF66K65 :? E96 QD2?5H:49 86?6C2E:@?[Q >2?28:?8 E96 4@>A=6I[ @G6C=2AA:?8 >65:42= ?665D @7 J@F?8 49:=5C6? 2?5 28:?8 A2C6?ED 2E @?46]k^Am

kAm|@C6 E92? 92=7 WdaTX @7 H@>6? :? 2 D6A2C2E6 +@45@4 DFCG6J D2:5 E96J >2?286 42C6 7@C @E96CD[ 2?5 ahT D2:5 E96J >2?286 42C6 7@C E9C66 @C >@C6 A6@A=6] xEVD ?@ H@?56C E92E bfT @7 962=E9<66A6CD D2J >2?28:?8 @E96CD’ 962=E942C6 E2<6D D:8?:7:42?E E:>6[ 2?5 @?6\E9:C5 @7 A6@A=6 766= @G6CH96=>65 3J 42C:?8 7@C >@C6 E92? @?6 A6CD@?]k^Am

kAmw62=E9<66A:?8 @A6C2E6D 24C@DD E9C66 DA246D] u:CDE :D 42C:?8 7@C 49:=5C6?[ H96C6 A2C6?E2= =62G6 A@=:4:6D 2?5 3C@256C D@4:6E2= ?@C>D ?@E\D@\DF3E=J A@D:E:@? >@E96CD 2D E96 5672F=E 962=E9 >2?286C 7C@> 52J @?6] %9:D 6DE23=:D96D 2 =2DE:?8 EC2;64E@CJ :? H9:49 D49@@= ?FCD6D 5:2= >@> 7:CDE[ A65:2EC:4 A@CE2=D E6IE 96C 7=F D9@E C6>:?56CD[ 2?5 fdT @7 >@E96CD 2EE6?5 A65:2EC:4 DA64:2=EJ G:D:ED 4@>A2C65 E@ ;FDE ccT @7 72E96CD[ 244@C5:?8 E@ E96 k2 9C67lQ9EEADi^^2>H2\5@4]@C8^H9@\D9@HD\FA\E@\E96\2AA@:?E>6?E\86?56C\82AD\:?\A65:2EC:4\962=E942C6\:?G@=G6>6?E^Qmp>6C:42? |65:42= (@>6?’D pDD@4:2E:@?k^2m]k^Am

kAm$64@?5 4@>6D A2CE?6C 962=E9] +@45@4 A=2E7@C> 52E2 D9@HD E92E H@>6? 3@@< 2 H9@AA:?8 gaT @7 2== >65:42= 2AA@:?E>6?ED >256 7@C >6?] xE’D 2 >6?E2= =@25 E9:?8[ E@@] (@>6? E6?5 E@ 5@ >@C6 @7 E96 :?G:D:3=6 7FEFC6 >6?E2= A=2??:?8 <?@H? 2D AC@DA64E:G6 >6>@CJi E96 2?E:4:A2E:?8 2?5 A=2??:?8 @7 >65:42= 42C6[ =:<6 3@@<:?8 4964<\FAD >@?E9D :? 25G2?46] pD ~<=29@>2 $E2E6 &?:G6CD:EJ C6D62C496C 2?5 pDD@4:2E6 !C@76DD@C @7 !DJ49@=@8J {F4:2 r:4:@==2[ !9s[ 92D 7@F?5 :? 96C C6D62C49[ >6? C6A@CE C646:G:?8 72C >@C6 @7 E9:D 4@8?:E:G6 A=2??:?8 DFAA@CE 7C@> 76>2=6 A2CE?6CD E92? E96J C6EFC?] “u66=:?8 =:<6 J@F 2C6 2=@?6 :? C6>6>36C:?8 2?5 A=2??:?8 7@C E96 9@FD69@=5[” sC] r:4:@==2 6IA=2:?D[ “:D H92E 5C:G6D 5:DEC6DD[ 7CFDEC2E:@?[ 2?5 3FC?@FE]”k^Am

kAmp?5 E9:C5 :D 6=56C42C6] k2 9C67lQ9EEADi^^HHH]22CA]@C8^4@?E6?E^52>^22CA^AA:^E@A:4D^=EDD^72>:=J\42C68:G:?8^42C68:G:?8\:?\FD\a_ad]5@:]`_]aec`h\a7AA:]__bfb]__`]A57Qmpp#! C6A@CEDk^2m H@>6? 4@>AC:D6 e`T @7 F?A2:5 42C68:G6CD 7@C @=56C 25F=ED[ ;F88=:?8 E96 4@>A=6I 42C6 ?665D @7 28:?8 A2C6?ED 2=@?8D:56 E96:C @H? 9@FD69@=5D]k^Am

kAm“x @?46 962C5 2 E6CC:3=6 6IAC6DD:@? E92E J@FC 36DE 6=56C42C6 :?DFC2?46 :D 92G:?8 2 52F89E6C[” D2JD {F4J |4qC:56[ |s[ 2 w2CG2C5\EC2:?65 AC:>2CJ 42C6 5@4E@C 2?5 2FE9@C @7 E96 3@@< k2 9C67lQ9EEADi^^HHH]36J@?5E96AC6D4C:AE:@?3@@<]4@>^Qmq6J@?5 E96 !C6D4C:AE:@?k^2m] “xE’D 4C:?86H@CE9J[ 3FE :E’D ECF6]”k^Am

k7:8FC6mk:>8 DC4lQ9EEADi^^:>286D]DE24<6C]4@>^H^`ag_^:>286D^DE@C:6D^a_ae^`_^`d^w62=E9<66A:?8q=@8vC2A9:4D0ap]A?8Q 2=ElQp? :?7@8C2A9:4 D9@H:?8 E96 >@C6 E92? 92=7 @7 H@>6? >2?2865 42C6 7@C @E96CD]Q DEJ=6lQH:5E9i `__TQ ^mk7:842AE:@?m+@45@4k^7:842AE:@?mk^7:8FC6m

k9bmk3C ^m%96 D64@?5 ;@3 J@F ?6G6C 2AA=:65 7@Ck^9bm

kAmw62=E942C6 E649 H2D DFAA@D65 E@ >2<6 E9:?8D 62D:6C[ 3FE 5:D4@??64E65 DJDE6>D @7E6? 5@ E96 6I24E @AA@D:E6] yF88=:?8 D6A2C2E6 A2E:6?E A@CE2=D @C H2:E:?8 @? 9@=5 E@ D4965F=6 2AA@:?E>6?ED @C 562= H:E9 :?DFC2?46 42? >2<6 962=E9<66A:?8 766= =:<6 2? F?A2:5 D64@?5 D9:7E]k^Am

kAmw@==:6 |6492<[ 2 >@> @7 EH@ >:55=6 D49@@=6CD[ EC:6D E@ 86E 29625 3J D4965F=:?8 AC6G6?E:G6 42C6 >@?E9D :? 25G2?46[ 3FE 7:?5D C6D4965F=:?8 2 ?:89E>2C6] “x7 J@F ECJ 42==:?8 E96 @77:46[ J@F C2C6=J 86E 2 A6CD@? 2E E96 7C@?E 56D<[” D96 D2JD[ ?@E:?8 D96 72C AC676CD E@ 3@@< @?=:?6 H96? 2G2:=23=6] “*@F 86E C@FE65 E@ 2? 2FE@>2E65 42== 46?E6C E92E 766=D D6A2C2E6 7C@> E96 AC24E:46]”k^Am

kAm(9:=6 >2?J 962=E9<66A:?8 492==6?86D @7E6? DE2CE 2E E96 7C@?E 5@@C E@ 42C6[ E96J C2C6=J 6?5 E96C6]k^Am

kAm“!C:>2CJ 42C6 :D >62?E E@ 36 J@FC >65:42= 9@>6 E92E 4@==2E6D 2== J@FC :?7@C>2E:@? :? @?6 A=246[” D2JD sC] |4qC:56] qFE F?7@CEF?2E6=J[ D96 E@=5 +@45@4[ >@DE A6@A=6 DE:== 92G6 E@ 4@@C5:?2E6 E96:C @H? C64@C5D[ C676CC2=D[ :>28:?8 2?5 >@C6 3642FD6 6G6CJE9:?8 :D D:=@65] “%96 DJDE6> 7@C46D A6@A=6 E@ 24E 2D E96:C @H? 25>:?:DEC2E:G6 4@@C5:?2E@C] xE’D ?@E 962=E9J 2E 2==]”k^Am

k9bmq@EE@> @7 J@FC @H? E@\5@ =:DEk^9bm

kAm(96? 962=E9<66A:?8 62ED 2== E96 32?5H:5E9[ E96 7:CDE 2AA@:?E>6?ED E@ 72== @77 E96 42=6?52C 2C6 =2C86=J H@>6?’D @H?] x?5665[ +@45@4 C6D62C49 D9@HD E92E e`T @7 962=E9<66A6CD D2J E96J AFE D@>6@?6 6=D6’D 962=E9 7:CDE]k^Am

kAmz2?5:D C642==D D<:AA:?8 56?E2= G:D:ED H96? 96C <:5D H6C6 J@F?86C[ 6?5:?8 FA H:E9 2 42G:EJ E92E C6BF:C65 6G6? >@C6 E:>6 2?5 >@?6J E@ 7:I] (96? D96 5@6D D66 2 5@4E@C 7@C 2? 24FE6 :DDF6[ 7@==@H\FA 42C6 86ED 5C@AA65] “x’> ?@E 2=H2JD 8@:?8 324<[” D96 D2JD] “xE 5@6D?’E 766= =:<6 2 AC:@C:EJ]”k^Am

kAmw62=E9<66A:?8 DEC6DD @7E6? D9@HD FA :? E96 6I2> C@@> 2D 96252496D[ :?D@>?:2[ DE@>249 :DDF6D[ @C 9:89 3=@@5 AC6DDFC6] “}@E 2 52J 8@6D 3J :? >J AC24E:46 H96C6 x 5@?VE E2=< E@ 2 A2E:6?E[ FDF2==J 2 H@>2?[ H9@D6 A9JD:42= @C 6>@E:@?2= DJ>AE@>D DE6> 7C@> 42C68:G:?8 C6DA@?D:3:=:E:6D[” sC] |4qC:56 E@=5 +@45@4] “%96J 42? @G6CE2<6 2 A6CD@?VD 6?E:C6 =:76 2?5[ E96C67@C6[ 962=E9]”k^Am

k9bm$92C:?8 E96 H@C< @7 DE2J:?8 962=E9Jk^9bm

kAm%96 D@=FE:@? :D?VE >@C6 D6=7\42C6 @C 36EE6C E:>6 >2?286>6?E] xE C6BF:C6D DECF4EFC2= 7:I6D :? 9@H DJDE6>D DFAA@CE H9@=6\72>:=J 42C6] “%96C6 :D D@ >F49 H6 42? 5@ E@ C65F46 E92E 25>:?:DEC2E:G6 E2I E@ >2<6 :E 62D:6C 2?5 D:>A=6C[” D2JD sC] #2??6J[ “2?5 6?DFC6 E92E E96 24E @7 962=E9<66A:?8 5@6D ?@E :>A2:C E96 962=E9 @7 E9@D6 H9@ 2C6 5@:?8 E92E 6DD6?E:2= H@C<]”k^Am

kAm(@C<7=@H 492?86D 42? 492==6?86 5672F=E 2DDF>AE:@?D[ DF49 2D FA52E:?8 6=64EC@?:4 962=E9 C64@C5D D@ 3@E9 A2C6?ED^8F2C5:2?D 2C6 2FE@>2E:42==J =:DE65 7@C 2AA@:?E>6?E D4965F=:?8 2?5 A@CE2= >6DD28:?8]k^Am

kAm|@56C? 3@@<:?8 DJDE6>D WA@H6C65 3J @?=:?6 D6=7\D4965F=:?8 @C ac^f px A9@?6 2DD:DE2?EDX 6=:>:?2E6 2??@J:?8 A9@?6 E28 D@ 962=E9<66A6CD 42? D64FC6 42C6 H96?6G6C E96J 92G6 2 7C66 H:?5@H[ H96E96C E92E’D 2E d 2]>] 367@C6 E96 <:5D H2<6 FA @C =2E6 2E ?:89E H9:=6 D4C@==:?8 :? 365]k^Am

kAm$@>6E:>6D[ E9@F89[ 62D:?8 E96 3FC56? >2J 4@>6 5@H? E@ D:>A=J 7:?5:?8 2 AC@G:56C H9@ 86ED H92E J@F’C6 8@:?8 E9C@F89]k^Am

kAmp A2E:6?E C646?E=J D2H sC] |4qC:56 D66<:?8 96=A 7@C 49C@?:4 :?D@>?:2 4@FA=65 H:E9 2?I:6EJ] pD E96J E2=<65[ :E EFC?65 @FE D96 H2D @G6CH96=>65 3J 42C:?8 7@C 96C 6=56C=J 72E96Ci 766=:?8 D25 E92E D96 4@F=5?VE 5@ >@C6[ 2?8CJ 2E E96 4@?DE2?E 56>2?5D[ 2?5 E96? 8F:=EJ 7@C 766=:?8 2?8CJ]k^Am

kAmsC] |4qC:56 AF==65 @FE 96C AC6D4C:AE:@? A25[ HC@E6 5@H? 2 D:?8=6 A9C2D6[ E@C6 :E @77[ 2?5 92?565 :E @G6C] %96 EC62E>6?En $6=7\4@>A2DD:@?]k^Am

kAm%96 A2E:6?E :>>65:2E6=J 3FCDE :?E@ E62CD[ sC] |4qC:56 C642==D] }@E 7C@> D25?6DD[ 3FE 7C@> E96 C6=:67 @7 36:?8 G2=:52E65]k^Am

kAm“x E9:?< D96 ;FDE ?66565 D@>6@?6 E@ D2J[ ‘J@F 2C6 5@:?8 E96 36DE J@F 42? :? 2 DJDE6> E92E H2D?’E 3F:=E 7@C J@F[’” sC] |4qC:56 D2JD] $@>6E:>6D E96 36DE 42C6 H6 42? 8:G6 2 962=E9<66A6C :D D:>A=J 24<?@H=658:?8 E96 =@25]k^Am

kAmk2 9C67lQ9EEADi^^HHH]K@45@4]4@>^C6D@FC46D^3=@8^2CE:4=6^962=E9<66A:?8\H@>6?\3@@<:?8\962=E942C6\7@C\9@FD69@=5^Qmk6>m%9:D DE@CJk^6>mk^2mk6>m H2D AC@5F465 3Jk^6>m k2 9C67lQ9EEADi^^HHH]K@45@4]4@>^Qmk6>m+@45@4k^6>mk^2mk6>m 2?5 C6G:6H65 2?5 5:DEC:3FE65 3Jk^6>m k2 9C67lQ9EEADi^^9F3D]=2^"_b<=8$#_Q C6=lQ?@7@==@HQmk6>m$E24<6Ck^6>mk^2mk6>m]k^6>mk^Am