The Medical Home

The crisis in primary care is getting worse. One solution being touted is "The Medical Home." Sounds comfy enough. But what is it?

In a 2008 position paper of the Association of American Medical Colleges, the medical home is introduced as "a concept or model of care delivery that includes

• an ongoing relationship between a provider and patient,
• around the clock access to medical consultation,
• respect for the patient/family's cultural and religous beliefs,
• and a comprehensive approach to care and coordination of care through providers and community services."

Wait a second! Isn't that what primary care physicians do now? 

The op-ed piece, The Crisis of Primary Care by Dr. Anne Brewster, offers you a physician's view of the practical problems of providing expert and compassionate care. This piece by Dr. Volpintesta, Homeless at our Medical Home, reinterates the problem from the physician's vantage and responds to the proposal to "create" the medical home.

I first heard about the medical home at a recent Grand Rounds at my hospital. By the time the speaker concluded, the internists were looking around at each other, mouthing, "Is he kidding?"

An internist asked the speaker, "And who is going to pay primary care internists (or family practitioners, or gynecologists, or whoever) to take the time needed to explain, consult and teach?"

Medicine may feel like a calling (not a job) for selfless, noble-minded, expert and compassionate physicians. But even those who are called have to pay their bills.

Until our medical system values physicians' ability to do all the things that don't require high-tech equipment (e.g., think, teach, comfort) but are essential to healing, we all are going to lose out in life-altering and life-threatening ways.

Comments

[Pat]

Enlightening as always.

Because I have been with my PCP for over 20 years, we have become friends and he has occasionally shared with me some of his frustrations with the system. This has helped me become a more compassionate, and patient, patient.

It has also highlighted my own frustrations with a system that serves many masters, none of whom are the key players involved: doctors and patients.

I saw how back-breaking malpractice insurance can be when my ob/gyn had to pay an additional $20,000 for one more month's insurance in order to perform my hysterectomy before he moved his practice to another state! I know he lost money on that deal.

And yet all the articles I've read indicate that the malpractice premiums are increasing at astronomical rates each year, even though the actual payouts for lawsuits are far lower. The only ones benefitting here are the insurance companies.

I have heard tales from many of my doctors about the inefficiencies of medical school and the failures of training to keep up with the times.

The medical home is a great idea, always was. But we need to make sure the system rewards the PCPs for choosing to be the medical jack of all trades and traffic cop, and that it gives them a more direct path to the expertise they need for the job.

I may regret saying this, but it seems the Medicare model...if it dramatically increased physician compensation and allocated sufficient per-patient time...could reduce much of the complication from the system, which would give doctors more time.

As for curbing malpractice premiums, it will take a miracle to pry loose the grip insurance lobbies have on our way of life. And how do we convince patients to be less quick to sue doctors for merely being human?

Regarding medical school reforms, there is a quote I'm paraphrasing: "Great ideas don't take hold because they are eventually accepted by the majority, they take hold because those who cling to the old ways eventually die out."

[Kairol Rosenthal]

As a young adult cancer patient and author, I spend a lot of time listening to survivors' complaints about our doctors. It is important to blow off steam. At the same time, we need to find solutions. Part of that solution is understanding how this broken system limits our doctors to care for us in the ways they ultimately should or would like to. Thanks for this excellent post. We need more writing targeted to survivors that elucidates the docs' side of the story.
http://everythingchangesbook.com/

[Wendy S. Harpham, M.D.]

Dear Pat,

Thank you for sharing these experiences and ideas. I'm wondering why you think the Medicare model would reduce the complication of the system. It puts non-medical people in charge of gatekeeping. And so far it has never encouraged the taking of more time with patients.

Dear Kairol,
Thank you. As in any relationship, the more physicians understand the patients' side, and the more patients understand the physicians' side, the better off everyone will be.

Pat and Kairol, my hope is that this blog can be one small way to help that happen.

With hope, Wendy