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Dr. John Seibel, HealthInsight New Mexico has not set their biography yet

Are We Providing Patient-Centered Care?

Providers and Patients

There are many definitions of "patient-centered care" or "shared decision making" floating around. But most agree that it ideally includes certain aspects such as:

  • Consideration of the patient's preferences and needs
  • Integration of care through the teamwork of all providers involved
  • Respect for the non-medical needs of the patient and family
  • The patient's physical comfort
  • Free flow of communication among the patient, family members and medical team members

When I first heard of patient-centered care, I was somewhat perplexed. It reminded me of my own situation when I was 12 years old and had just been found to have a chronic medical condition. Our family internist sat down with me and my parents and explained that this was a problem that I would have for the rest of my life. He told us that there would be ups and downs, but that it was manageable. He went over the treatment options and asked what we thought would work for us. I have always considered that situation to be an example of patient-centered care.

Since then, there have been two big changes. The first change is the formation of care teams working together for the benefit of the patient and family. This has been a great help, but at times someone tries to force members of the care team on the patient. When that happens, we start to negate the positive effect of the team. The patient's perspective always needs to be considered. The second change is the free flow of information found online. Half of patients, both old and young, have already looked up their provider's credentials on the Internet before their first visit. Sometimes the patient will get false or dangerous information about either their provider or their ailment. This information must not be brushed aside, rather explained why it is not correct or appropriate for their condition. Then the patient should be directed to good, evidence-based care websites for more information. The Internet can be an ally in the patient care, almost like a team member when used correctly.

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Corporate Medicine and Quality

doctorJust this week I received a call from a pediatrician that he and one of his partners are closing their office and retiring early. Their third partner is quitting and going to work for a corporation. I keep hearing about small practices that are closing. Most all of these are physicians and independent nurse practitioners: non-proceduralists that cite well-meaning rules and regulations that are driving up the costs of running small practices. The small practices are literally being driven out of business.

We all agree that we would like to see a way to measure quality and to find alternative payment forms, but at what cost?  The cost of all of the reporting is becoming so expensive and so time consuming that small primary care practices cannot afford to stay open. Many of these primary care providers are looking for positions that do not involve patient care; some are starting boutique practices; and others are going into corporate medicine.

When was the last time you tried to get a new primary care physician?  If you can find one taking patients, you are fortunate if you only have to wait three months. You may have to wait even longer to see a specialist: five to six months. Then, you need to find one that will take your insurance. Many hospitals and corporations try very hard to find enough physicians to adequately serve their populations. They are also faced with a frequent turnover of physicians working for them. It may be that forcing physicians into large group practices may be the better way to go if we really want to measure outcomes. But will patients like it?  And if they don’t, will it have a negative effect on the individual’s health?

As leaders in health care quality improvement, we have many questions: Will we need to add many more parameters to measure quality? Will quality measures include the patient's point of view? When a patient becomes ill, how long will he need to wait to see his personal physician? Will he need to see the next provider in the queue? Or should he just go to urgent care or the emergency department?  As corporations struggle to try to personalize patient care, more and more obstacles are put in their path. And the cost becomes more expensive.
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Doctors are Lazy

Doctor with Patient

I just read an article in Medical Economics by William M. Gilkison, MD, an older physician, entitled, "Opinion: Doctors are lazy". He pointed out that patients complain to him that physicians have very little contact with them during exams: they come in for five minutes and leave. Some physicians even tell patients that they can only discuss one problem at each visit. Certainly, if the physician was the patient, he or she would not tolerate being treated in this manner. What if he or she had diabetes with a comorbidity such as high blood pressure, high cholesterol, heart disease or depression?

Practicing good medicine dictates that all medical problems should be addressed at the visit and it will take more than five minutes. Years ago I might have agreed with the author, but now I'm not so sure. Over time, as more and more physicians became employed by hospitals, insurance companies and large groups, they began to feel pressured to see more and more patients. Then, as they all began using electronic health records (EHRs), they found that they needed to collect more data for others – insurances and government (including the Physician Quality Reporting System - PQRS, meaningful use, and prescriptions by computer only). It seemed that every time they turned around, there seemed to be more time-consuming tasks that they were expected to do.

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Health Care Changes: The Concerns of Physicians in Today’s Environment

As a quality improvement organization, HealthInsight and its contractors and partners are committed to improving health care and the delivery of that care. Sometimes it may be hard to understand why not all providers are excited about the changes taking place. I recently attended the American Medical Association's annual meeting in Chicago. Here are some of the concerns I heard from physicians:

Some providers are resistant to ICD-10, electronic health records (EHRs), e-prescribing and meaningful use. Many of the physicians did see value in the changes mentioned, although to be sure, they saw the least value in ICD-10. Physicians definitely see value in EHRs, but they do not like the manner in which they feel they are being forced to use them. Most physicians saw EHRs as improving communication and in making documentation clearer, and as a tool to improve communication between doctors and patients. However, they are very upset the government did not take early steps to be sure that EHRs could easily communicate with each other, government and insurance companies.

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To Improve Overall Health, We Must Look at Preventive Care

Exercise

For those of us who have been working in quality improvement for some time, it is difficult to constantly hear that health care in the U.S. is much more costly than it is elsewhere. Even worse, we are told that it is not as good. Our recent HealthInsight Board retreat made us think more about this subject and the validity of it. Much of it depends on what you call health care.

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An Inside Look at a Model Medical Delivery System

Doctor With Patient

One year ago I was diagnosed with a heart murmur. It was evaluated and I was told that I had a congenital bicuspid aortic heart valve – nothing to worry about for another 20 years. In December it was reevaluated as I just did not feel well. This reevaluation did not show much change. I was scheduled to give a talk to endocrine fellows at the Mayo Clinic in Rochester, Minn., and I decided to go through the clinic for an evaluation.

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