Thursday, March 31, 2016

What does a new model of primary care look like?

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Part of a series.

Here is a model for the delivery of primary care which offers certain rights balanced by responsibilities for patient, provider and insurer alike.

First the rights of each party. As a patient, you deserve a high level of care in a satisfying manner without frustrations. The insurer and your employer want to see the total cost of health care come down. The physician wants the satisfaction of offering outstanding care, a reasonable income, and a reasonable home life.

If those are the “rights” then here are the “responsibilities” in a well-functioning system. The PCP has the responsibility of providing thorough care of patients. Thorough care includes being available on reasonable notice, with timing dependent on acuity. The patient visit should be long enough to fully assess and treat the problems, including underlying emotional anxiety and stress. The doctor must allocate sufficient time to listen and think. If there is a need for a specialist, the PCP should personally call and explain the reason for the referral and seek a prompt appointment. After the specialist visit, the PCP may need to reinforce and interpret the specialist’s recommendations for the patient. When the patient’s illness requires multiple specialists, the PCP needs to accept the role of coordinator of care (probably with assistance from an office team member) to ensure that each specialist is cognizant of the other’s recommendations and that tests and prescriptions are neither duplicative nor will they lead to adverse interactions.

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