The Patient’s Medical Home and Me

Last week, after I posted my blog on my concerns regarding “Primary Care Pediatrics”, Shereen Miller responded thoughtfully, asking, “Who is the quarterback of each person’s health care?…Should someone be in charge, connecting all the dots…”

This question is immediately answered for me by the Patient’s Medical Home, as described by the College of Family Physicians of Canada in their position paper A Vision for Canada: Family Practice: The Patient’s Medical Home. (http://www.cfpc.ca/uploadedFiles/Resources/Resource_Items/PMH_A_Vision_for_Canada.pdf)

This paper defines the Patient’s Medical Home as “a family practice defined by its patients as the place they feel most comfortable – most at home – to present and discuss their personal and family health and medical concerns. It is the central hub for the timely provision and coordination of a comprehensive menu of health and medical services patients need. ” Does this not sound exactly like the service Shereen is seeking, as a patient?

As a specialist physician providing mental health care, I also like the idea of a family physician trained to coordinate my patient’s personal health care so that my team can attend to mental health concerns. All too often, it is necessary for the multidisciplinary mental health team to attempt to piece together a patient’s health status ourselves, without the longitudinal view of a personal  family physician who has monitored someone’s health over many years.

While the introduction of primary care models in the past decade in Ontario has given more patients access to a hub for their primary care, there is not yet a system in place for specialists like me to easily plug into the central team. To some extent, this is because many specialists are in hospitals, physically and virtually disconnected from patients’ family physicians. I can see the value of better connections between specialists like me, who are experts with difficult to manage chronic illnesses, and family physicians and their teams. Right now in Ontario, many family physicians’ teams have the services of allied health professionals, e.g. social workers, pharmacists, nurses, directly on the team but this collaboration does not yet completely extend to specialist physicians such as psychiatrists, internists or pediatricians. Some of the large university family health teams do have these “shared care” services but, as far as I know, none of the community-based family physician groups have access to specialists as I have described above.

In my view, such a system offers tremendous advantages to patients. First of all, because of the ready access, collaboration regarding which patients’ conditions need a consultation versus therapy could be undertaken quickly, eliminating some of the time usually spent waiting. Another consideration mentioned by Shereen was the notion that the doctor is not always required in a patient’s assessment and diagnosis. Certainly psychiatrists are very used to working with allied health professionals – I have worked on multidisciplinary teams since my residency and, like all of my psychiatric colleagues, team-based care for patients with psychiatric conditions has the best outcomes. This system eliminates another layer of inefficiency, allowing patients better, quicker access to specialty care.

I have been sold on the idea of the Patient’s Medical Home since I first read about it and heard it described. To extend this care to include specialists requires some changes to our current funding models, but different funding and not more funding is required.

Having said this, I am sure there are disadvantages to the model I have begun to describe.   I would like to hear about them to see if they can be overcome. I am also taking the advice from my readers by examining some of the models in place in other countries to see how they would refine this concept of specialty care being a “room” in a Patient’s Medical Home.

It is important for all of us to consider how the developments in primary care can more fully exploited for every patient’s benefit. How would this work for you?

One thought on “The Patient’s Medical Home and Me

  1. Dr. Bec: I like the model. I think there are two issues that remain unresolved for me. The first is how other “health-care professionals or ‘alternative’ medicine might be incorporated. For example when my first child was born I was a patient of a midwifery practice that was fully integrated into an OBGyn practice where, as long as I remained a low risk person I was treated by midwives and if the pregnancy or delivery had some surprises, there were docs to step-in in an integrated practice. Which brings me to my second question: Why not set up a health-care system that is more focused on wellness. I family practices were aimed at managing wellness then physicians could step in when pathology required it. I was fortunate and the midwives handled my pregnancy, my delivery and my post-partum care in the Well-woman practicce. Maybe we need to map the orles of family docs slightly differently too?

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