Three years ago, I suffered a debilitating core injury while playing hockey. Barely able to walk, I made my way to the local urgent care center for an evaluation. Diagnosed with a severe muscle strain, I was quickly prescribed physical therapy and sent on my way, with orders to follow-up with my PCP should things get worse.
Fast-forward two-and-a-half years: having been bounced around from harried PCP to orthopedics to general surgeon and back to physical therapy, I had seen little to no improvement in my symptoms. Finally, and because of a recent move, I found a PCP who had made the provider-patient relationship an imperative in his care center.
For the first time in a long while, I felt like someone actually listened to my symptoms, and soon after, I saw results. Starting with a conservative approach to stave off costly and invasive surgeries, he asked me to undergo a physical therapy regimen for a number of weeks before other options were considered. Once we knew physical therapy wouldn’t solve the problem, he quickly set in motion a plan to formally confirm and fix the diagnosis he suspected all along: a sports hernia. An MRI followed, which revealed (to our surprise) not one, but two hernias, both of which would require surgical repair. A specialist referral was ordered and surgery scheduled and executed.
Quality Programs, Computers, and Paperwork — Oh, My!
By now, we’re all-too-familiar with the ubiquitous government and commercial quality programs implemented to slash costs and improve the quality of care we deliver to our patients on a daily basis. Designed with the best intentions, these programs are sorely lacking where it matters most: making space for providers and their staff to improve interactions with their patients.
Mile-long task lists, managed to satisfy program requirements have filled the time in which providers used to connect with their patients. A common complaint amongst modern-day providers is that computers have come between provider-patient relationship — both literally, in the exam room, and metaphorically, as practices must rely on them more and more to run day-to-day operations. In short, the delivery of healthcare has become an onerous and highly impersonal job.
Other competing interests — filling schedules, driving revenue, administrative paperwork — have cropped up and conspire to steal valuable patient time, and rob a provider’s ability to develop meaningful relationships.
Patient Centered Medical Homes (PCMH) try to get the balance right, by spelling out the key piece of the program in the name and definition itself. According to the advocacy organization Patient-Centered Primary Care Collaborative (PCPCC):
“The medical home is best described as a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety. It has become a widely accepted model for how primary care should be organized and delivered throughout the healthcare system, and is a philosophy of health care delivery that encourages providers and care teams to meet patients where they are, from the most simple to the most complex conditions. It is a place where patients are treated with respect, dignity, and compassion, and enable strong and trusting relationships with providers and staff. Above all, the medical home is not a final destination instead, it is a model for achieving primary care excellence so that care is received in the right place, at the right time, and in the manner that best suits a patient’s needs.”
Notice that nowhere in the description of the Patient Centered Medical Home model are computers mentioned — that’s because they’re a means to an end in documenting an encounter, but they’re not (and shouldn’t be) a critical component of healthcare delivery. Neither should a practice’s business needs factor into patient time.
What We SHOULD Focus on: The Patient’s Needs
Instead, we should refocus on the patient, and ask these questions of ourselves, as new initiatives are rolled out, and old ones are re-evaluated:
- What are the patient’s wants and needs from me, as their provider?
- How do I accommodate these needs?
- How can I carve out time, by streamlining quality and incentive operations, so I can truly listen to my patients?
The benefits to building a practice around these questions are clear: a deeper, more trusting provider-patient relationship means more engaged and healthier patients. And, by designing practice operations with these questions in mind — which privilege the provider’s time, too — we can also improve provider satisfaction and engagement.
After nearly three years of pain, my strained muscle issue was resolved — from PT to surgery — in less than six months. I credit the speedy recovery entirely to my PCP’s ability to organize his day around his patient’s needs, and not the needs of his practice. By cutting out the noise of operations and meeting quality program requirements, he was able to focus on why he chose medicine in the first place: the patient.