The Medical Home--Introduction

“Hey, Jaded Julie, let’s invent a model for personalized primary care.”

“We’re too late, Curmudge. It’s already been invented.”

“Let’s do it anyway. With your innate chutzpah and my propensity to pilfer paragraphs from publications (with proper citations), we can’t lose.”

“I’m with you Curmudge, and I’ll bring along my inborn audacity. Presumably, we’ll start by considering the patient’s needs, as the folks at the Mayo Clinic say, ‘The needs of the patient come first.’”

“That’s it, Julie. And one of the patient’s biggest needs is to be able to get into the office at a time that reflects the patient’s condition. If she is acutely ill, she wants to hear, ‘Come on over right now.’ If she is scheduling an annual physical, ‘sometime next month’ should be acceptable.”

“And just like when you were a child, Curmudge, you were certainly more at ease knowing everyone in the office and being able to spend whatever time was necessary with the doctor. I bet that’s still true, even for a senior citizen (actually, an old relic) like you.”

“Time with the doctor is a difficult issue, Julie, especially if the goal of our model clinic is personalized care. Fortunately, not every patient needs to see the doctor at every encounter with the clinic. We’ll discuss that more after we complete our list of basic criteria.”

“Coordination of care is another requirement to build into our model. It seemed to me that traditionally, after the primary care doc made a referral to a specialist, the patient-doctor relationship went from patient-primary care to patient-specialist. Sometimes the primary care doc might find himself/herself left out of the loop. The specialist might neglect to send a report; and if he did, the overworked primary care doc might not find time to read it.”

“Patient involvement in her own care is important, but she shouldn’t have to deal with the whole health care delivery system all by herself. That’s where our model clinic’s coordination of care capabilities can really help the patient.”

“Curmudge, a person with a chronic health condition cannot help but be involved in his/her own care. The newspapers remind us almost every day of the expense of these conditions and of the importance of controlling them by doing the right things at the right times. Our model clinic can help these people by monitoring their condition and reminding them when it is time for a specific test or exam.”

“Here’s another personalized care issue, Julie. In a big clinic or one connected to a hospital, a patient might have to go to different locations for different tests and procedures. It’s easy for the patient to feel ‘herded,’ and that’s what we want to avoid. Some place that I read about—perhaps Geisinger—assigns a guide to each patient. This would be a perfect duty for a volunteer with an outgoing personality.”

“Great idea, as long as the volunteer isn’t a curmudgeon. It would be better if everything could be done in the clinic exam room. This would include patient registration, nurse time, time with the physician, and scheduling the next appointment. Of course, this would require careful coordination.”

“I would call it choreography; but under any name, it’s a great idea. We’re already doing this in our pulmonary area. So Julie, we’ve put together our list of basic requirements, and we’ll talk in more detail about these in subsequent weeks. Do you think we should give our model clinic a name?”

“Of course. Let’s call it The Jaded Julie Primary Care Clinic.”

“(Now you know what I meant when I spoke of chutzpah.) Even though the name is not new, I think we should call it The Medical Home.”

Affinity’s Kaizen Curmudgeon