Ep. 255: Jason Guardino and Karen San | How Turning 18 Can Break Your Relationship With Healthcare

Episode 255: One of healthcare's biggest blind spots? When patients turn 18. It's the moment they age out of pediatrics and fall headfirst into a system designed to prioritize older, sicker adults. Physicians, stretched thin, reserve energy for complex cases, giving young adults shorter visits and less attention. That means early signs of medical trouble, like anxiety or preventive needs, go missed.

Jason Guardino and Karen San, care experience experts at The Permanente Medical Group, are addressing this massive and often invisible problem head-on. The Permanente Medical Group found that younger patients in their twenties and thirties consistently gave lower satisfaction scores than both pediatric and senior patients.

"They didn't feel listened to and they felt dismissed," Jason says. "They felt like there was a lack of compassion during that [medical] visit." That sentiment, combined with rising anxiety, digital misinformation from things like social media, and a national shortage of mental health professionals, creates a high-stakes problem few health systems are equipped to solve.

When doctors unintentionally triage young adults as low risk, this puts younger patients' health at risk, "If you don't slow down and focus on providing a great experience, you can miss something that could be potentially very dangerous for this patient," Jason explains.

Fixing this gap means rethinking how we treat both patients and providers, from doctors to nurses to clinicians. To drive change, The Permanente Medical Group is listening—literally. Through live feedback tools and real-time digital prompts, they're surfacing patient pain points. That data is changing how care teams engage with young adults and helping leaders understand the double bind facing providers: everyone needs high quality care, despite limited time and resources.

Guests: Jason Guardino, Chief Experience Officer and Gastroenterologist, The Permanente Medical Group, and Karen San, Senior Director of Care Experience, The Permanente Medical Group

Host: Rob Markey, Partner, Bain & Company

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Time-Stamped Quotes

• 00:01:00 – Why young adults often feel overlooked in adult care
• 00:02:30 – The Net Promoter Score drop for post-pediatric, 18-year-old patients
• 00:04:00 – Pediatric expectations compared to the reality of adult care
• 00:06:00 – How provider triage creates blind spots
• 00:08:00 – Understanding complaints from young patients
• 00:09:30 – Social media and how people's anxiety levels impact care
• 00:10:30 – The mental health burden on primary care
• 00:12:00 – Listening at scale, with real-time feedback
• 00:13:30 – What patient ratings can reveal, data-wise
• 00:15:00 – Why compassion still beats automation

Notable Quotes

• 00:00:05 "We don't set [children up] well for when they make a transition into adult medicine. There's an opportunity to strengthen our care delivery model to meet those expectations and the ever-changing patient expectations."
• 00:00:07 "If you don't slow down and focus on providing a great experience, you can miss something that could be potentially very dangerous for this patient. Even if they're in the minority, I always say, if something happens a few percent of the time, somebody has to be in that small percentage of time—that [means] an injury can happen."
• 00:00:08 "The system stressors disproportionately affect our younger members because the providers are using this as a kind of survival tactic. They're saving their energy for the more complex patients with more comorbidities. And so it's not affecting our older population the same way it is our younger."
• 00:00:09 "We have found that the younger population [does] have heightened anxiety. And that's fueled by a number of things. Covid-19 affected their perception of health. Social media is affecting how they define what good looks like. And so they're looking to primary care providers, who may not be experts in mental healthcare, to provide that mental healthcare. And that also creates a friction point that we need to solve for."
• 00:00:11 "We did a pilot of 5 of our 21 medical centers for several months. And then, in December of 2023, we launched it throughout the entire medical group—so, 21 medical centers and all of our patients. So we're about a year and four months into this, and right now, we're sitting at about 2.5 million results. We have about 1.5 million—what we call 'caring moments'—[where] patients write about their clinicians and the staff. And as we say, it's an expression of gratitude, appreciation, and love—like something we've never had before."

Resources

Check out Episode 197 of Customer Confidential, where we interviewed Jason Guardino back in 2022 on the importance of compassion in healthcare: https://www.netpromotersystem.com/insights/compassion-in-healthcare-podcast/