The speaker at this morning's Grand Rounds invited us to stop her with questions or comments at any point and so I did.
She was an expert from a nationally recognized healthcare think tank and her topic was the "Patient Centered Medical Home" and she had just finished mentioning that the concept came out of Pediatrics, and that in her opinion the defining characteristics of this model were the availability of a database to follow populations with special problems and teams of advanced practice nurses to do patient education. I disagreed.
The field of Pediatrics did not invent or discover the patient-centered medical home. Rather, our leaders described what we already did and gave it a name. Its underpinnings are not about "processes" but about a culture and a shared set of beliefs about where the obligations of the patient's primary care physician begin and end. At its center, the pediatric medical home is a place where physicians, nurses and other team members take responsibility for the whole child and her family. What the consultant says, what the surgeon recommends, what the school needs, whether the medications from two specialists are compatible, what the insurance company will or will not do, how mom and dad and the siblings are coping - it's all our concern. Not because a federal program has offered to compensate us according to some new and innovative formula, but because it's our job.
Not that I am opposed to innovative compensation mechanisms that promote this work. I have no illusions. In the world of child healthcare we can afford to do this precisely because most of our patients don't need it. As the population ages, however, and more and more baby boomers find themselves caught in the maze of contemporary medicine, ricocheting between the endocrinologist, the cardiologist and a variety of other specialists, our colleagues in adult primary care will need to find imaginative ways of keeping up with the care coordination needs of these individuals.
This will not be free, but it will be much, much less expensive in financial and non financial ways than the (current) alternative. Welcome home.
Welcome to SECOND OPINION. Visit us if you are interested in the world of healthcare quality and the hard work of eliminating harm from our healthcare system. We'll talk about Pediatric healthcare (my first love) and surprising and innovative efforts from many quarters to reinfuse Medicine with the kind of Humanism and patient-centeredness that are the enduring legacy of our profession. My aim is to be relevant, practical, philosophical, occasionally outrageous but always worth the read!
Internist New York City
ReplyDeleteThis is another blog with an incredible amount of information . I recently started to compile this kind of information to write a website about the subject and many of your suggestion will make their way to it. Thanks for the nice website!