Why patients are wary of the primary care medical home

Say the words, “Patient-centered medical home,” and you’re bound to get a variety of opinions.

On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money.

And that’s not good news for its advocates, who are pinning primary care’s last hopes on the model.

Medical homes hit the mainstream media recently, with Pauline Chen focusing one of her recent, weekly New York Times columns to the issue.  She discussed the results of a demonstration project, showing some positive results:

… the researchers found that the vast majority of doctors’ offices could successfully incorporate most of the changes into their practice, and early signs of the model’s success were promising. Quality of care and preventive health ratings revealed small improvements. Office staff became more streamlined, efficient and satisfied. Most notably, physicians were more content than ever before with their work, despite still having to deal with an unchanged fee-for-service or managed care reimbursement system. The doctors’ enthusiasm persisted even after the study closed, with many maintaining contact with one another through a listserv and twice-yearly self-organized meetings.

But patients themselves were not completely satisfied, and that mirrors some of the comments here on the blog.  The biggest complaint I’ve heard was that patients were not treated by a single provider, but instead by a team.  That may improve access and chronic disease management, but bucks the traditional model where a single physician was paired with a patient.

Indeed, as Dr. Chen notes,

… many patients reported feeling disoriented. Some felt displaced as they saw the old one-to-one doctor-patient interactions replaced with one-to-three or one-to-four relationships involving not only the doctor but also a whole host of other providers. As offices switched from paper-based to electronic medical records, other patients reacted to the distracted clinicians who seemed more focused on learning the new computer system than on listening to them. Satisfaction fell because, like my friend, few patients were cognizant of, much less involved in, the changes going on around them.

Transforming a practice into a medical home is a huge undertaking, with fundamental changes in how patients are seen.  Doctors in these practices are going to have their hands full, both making the transition, and, in some cases, adopting new electronic medical records as well.

Patients need to be informed every step of the way, so they can better understand how the medical home can potentially improve their care.  Absent that, and it’s no wonder why they’re going to react negatively to such drastic change.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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