Change Your Primary Care Mindset--the Patient

“Change my mind? I’m as much a stick-in-the-mud as you are, Curmudge. The only time you change your mind is when you forget what was in it. Of course, that happens every 15 minutes.”

“You know very well, Jaded Julie, that primary care is changing. It’s no longer the solo-practice doctor with his combination nurse/bookkeeper. Over the years physicians have developed a variety of efficient team-based practice models. These have become the basis for what is now called the Patient-Centered Medical Home.“

“So I guess everyone has to change the way they think about primary care—the caregivers and even the patients. Change implies going from a condition to a different—hopefully better—condition. Modern health care is focused on the patient, so let’s start by considering what the patient will be changing from and then what he or she will change to.”

“In the recent past, Julie, a patient with an acute problem would call a doctor’s office for an appointment and then hope the appointment date arrived before the problem resolved itself, possibly to return again. At the appointed time, the patient would show up at the office of the doctor who might or might not know the patient well. Prior to seeing the doc, a nurse might check the patient’s b.p. and temperature and ask about current medications.”

“I think I know what’s next, Curmudge. The patient would wait—seemingly forever—in a chilly exam room. With luck, the nurse might pop in to say, ‘He’s running late.’ Ultimately the doc would hurry in, his white coattails flapping behind him. After a quick history and physical, the physician would make his diagnosis, scribble a prescription, and hurry on to the next patient, white coattails still flapping. In this extreme example the physician is not typical, and it’s evident that he had not read the books by Studer or Beeson that we discussed in recent weeks. If the patient needed to see a specialist, she might even have to pick up the phone book and turn to the yellow pages after she got home. And if the problem recurred, the patient would be tempted to go to the nearest hospital’s emergency department or a store-front urgent care clinic.”

“You make it sound pretty grim, Julie, but it’s something that does occur occasionally. Fortunately, the patient can now receive personalized care in a more efficient clinic or become affiliated with a medical home. Her mind as well as her experience will change. Let’s talk about how a medical home will change the patient’s mindset.”

“In the medical home, Curmudge, the patient will have one primary care physician who knows her well, and he or she will be the leader of the patient’s care team. And here’s a big difference; the patient will be a member of her team as an active participant in her own care and decision making. She must realize that her care is provided not by an individual but by a system comprised of a multidisciplinary team responsible for delivering and continuously improving care for her and the other members of an identified patient population (1). The patient must recognize that members of the team other than the physician may be the most appropriate to resolve some of her health care issues. And that some of these issues will be handled by telephone or e-mail without her needing to come to the clinic.”

“As we said back on September 10 when we introduced the medical home concept, the patient will no longer have to face the whole health care delivery system alone. That certainly sounds beneficial, but some patients could see it as a limitation. These patients might not want any limit on their choice of primary care providers or specialists, but they will need to alter this mindset to participate in a medical home. ‘Medical homes are likely to have a ‘soft gatekeeper’ function (2).’ ‘The medical home will help patients decide when to see a specialist and select a specialist that will both serve the patient’s clinical needs and coordinate with the medical home physician.’ ‘The medical home will identify redundant tests and services before they occur and counsel patients to avoid redundant services.’”

“On September 10 we also mentioned the medical home’s coordination of care for those patients with chronic conditions. What’s not to like about a system that improves the patient’s quality of life? By the way, Curmudge, I have always wondered whether old age should be considered a chromic condition. You should certainly know a lot about that.”

“Well, Julie, it depends on your mindset. I believe that old age is a chronic condition only if one allows it to be. Eventually, of course, old age is most certainly terminal. By the way, next time we’ll discuss the role—and the mindset—of the physician in the medical home team.”

Affinity’s Kaizen Curmudgeon

(1)http://www.transformed.com/components.cfm
(2)http://www.hschange.org/CONTENT/1030/?PRINT=1