Thursday, January 3, 2013

Patient Centered Medical Home is not the only solution.

I used to think the Patient Centered Medical Home represented the essence of the new, improved vision of healthcare.  Currently, patients are frustrated, and many are getting lost in the cracks of the system.  Physicians, pressed for time and underpaid, are becoming more and more disillusioned than they are inspired.  

But maybe this is not the solution.  It is exceedingly difficult to define what patients need within the confines of a broken system.  Is a Patient Centered Medical Home truly for the patient?  Or is it for the doctors and the system?  Doctors want good care for their patients, and with the PCMH we can be assured, at least in theory, that patients will be connected to the caregiver they need when they need it, whether it be a family doctor, a home health nurse, or a specialist.   But who controls the information?  The data is stored in a central “location”, virtual or real, where it can be accessed by these providers to ensure the continuity that we all want.

This may work for some people, but for others it could create more hassle and headache.  If a working mom wakes up one morning and she needs a doctor, where can she go that will be what is convenient for her, not for her doctors?  What happens when she calls her regular doctor to make an appointment, but the first available appointment is weeks, even months from now.  There may be some slots saved for walk-ins, but she is guaranteed to wait. She could go to a “traditional” urgent care, and hope she does not have to wait for hours in a waiting room full of sick people, to be seen by someone she has never met.  And there is always the ER.

Maybe, just maybe, we need a new model.  "The best, most efficient (health) care is provided by teams of health professionals in the patient-centered medical home led by physicians, not independent practice by a single health professional”.  This is a quote from the AAFP.  But what if the PCMH is lead by the patient- as the name inherently implies.  Patients should have the right to organize their health care in a way that best suits their needs.  I think we will all look forward to finding a workable solution.

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