Saturday, July 16, 2011

Invitation for Practicing Primary Care Physicians

Health care is currently experiencing tremendous turbulence. The old ways of doing things are about to give way to new ideas and new models, or perhaps just refurbished old models, and at the heart of it all is primary care. The old hope of care management has been rebranded to advocacy for care coordination, because the term coordination sounds more benign and better aligned with the increasingly vocal patient engagement movement.  After all, empowered patients do not wish to be managed, but they do expect that someone will coordinate their informed decisions and preferred courses of treatment. Unlike management, which implies a paternalistic approach to patient care, coordination implies efficiency with no loss of freedom of choice. From a public relations perspective, this is a brilliant change of messaging content.

Care coordination is also the main ingredient in patient-centered care, by far the most overused buzz word of health care transformation. Other than individualized coordination, patient-centered care should be delivered by care teams, guided by population based medical evidence and measured by aggregated, process and outcome, population based statistics. The main vehicle to facilitate such change is the Patient Centered Medical Home construct as defined by the numerous NCQA accreditation requirements. Since Medical Homes require care teams of various capabilities, engaging in the coordinated sport of health care delivery, it is recommended that primary care physicians operate in large systems and facilities, where qualified team members are readily available, and a steady paycheck is guaranteed for the team doctor.

Medical Homes require state of the art computer technology to facilitate coordination, evidence based protocol enforcement and statistically meaningful measurement of compliance and outcomes. Health care computer technology adoption is being encouraged by the federal government through the well-publicized Meaningful Use series of incentives and penalties. The equally well-publicized complexity and prohibitive costs of health care computerization imply that large system are much better suited for widespread deployment, thus freeing their physicians, who have already been relieved of financial uncertainty, to better concentrate on the labor of managing the provision of health care. The quintessential problem of physicians being too busy seeing patients and having no time to deal with administrative, financial and technology demands, is thus resolved.

If you are reading this, and are experiencing an uncontrollable urge to through the computer against the wall right about now, you obviously are able to find a few minutes in your busy schedule to surf the web, read blogs, forums and maybe browse the news pages. Perhaps once in a while you even post a short comment here and there, most likely anonymous. Perhaps you are a social media maven, tending to your own blog or facebook/twitter presence. Most likely this is not the case because maintaining a web presence is pretty hard work. One thing is certain though; you most definitely have at least one opinion regarding the turmoil of our health care system and the particular circumstances surrounding your chosen profession.

So if you feel the need to express your thoughts, once a day, once a month, once a year, once in a blue moon, or when it can be contained no more, I would like to offer you a safe and easy way to do just that. Although this page’s title implies technology, you can see that much of the content is actually geared to the plight of primary care in small, private settings, which has been my personal passion for many years. This little blog has been my home for well over a year now, and I would like to invite you to make it your home too.

Anytime you feel the need to write, on any health care related subject, just type it up (or use your dictation tool) and email it to me. It could be a long essay or a short note, and it does not have to be Shakespearean prose either. All materials will be promptly posted, unedited, uncut, with no judgment and no commentary, anonymously if you so desire. You will not reach millions of readers, but you will reach quite a few influential folks active in the health care field, and I will do my best to spread the word. This is an open invitation, with no strings attached, no expiration date, no exclusions, no rules, no guidelines, no protocols, and with a simple goal of providing an outlet for the voice of practicing primary care physicians who have been largely silent and “too busy seeing patients” for way too long. I view it as a service.

Feel free to forward and share with others. The first such post from an anonymous MD, who was the inspiration for this service, will appear here on Monday, July 18.

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