USA Today op-ed: Patients need to be involved with team based care

My most recent column was published this morning in USA Today: As health reform unfolds, involve the patients.

Regular readers of KevinMD.com are up to date with Accountable Care Organizations and Patient Centered Medical Homes, both of which are crucial parts of the Affordable Care Act.

However, patient input has largely not been sought, and without their acceptance, these reforms are bound to fail:

The success of team-based initiatives, however, will rely on the patients themselves. And here’s the problem: Their input has largely not been sought.

Last year, the American Academy of Family Physicians released results from the first practices that were transformed into the team-based “medical homes.” Despite findings showing better quality of care, patients were unhappy with the change. Physician-columnist Pauline Chen noted in the New York Times that many patients felt “displaced as they saw the old one-to-one doctor-patient interactions replaced with … one-to-four relationships involving not only the doctor but also a whole host of other providers.”

According to Terry McGeeney, a primary care physician who led the medical home project, “The Achilles heel of all of this is a lack of patient understanding and engagement.” Indeed, someone forgot to inform patients how their health care would change.

Enjoy the piece.

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  • http://secondbasedispatch.com Jackie Fox

    Thank you for speaking up on patients’ behalf. We need to jump in too. As I’ve seen more than one person say, sooner or later we’re all patients.

  • pcp

    The results of the AAFP’s National Demonstration Project were disastrous.

    Patient satisfaction decreased, quality of care increased by a statistically insignificant figure, and practices experienced serious financial stress, despite enormous amounts of free support. Exactly what one would expect from a model of patient care that values administrative and bureaucratic goals more highly than the physician-patient interaction.

    After spending over $8 million on this experiment, the AAFP has shoved the results under the carpet and refuses to acknowledge the problems that were uncovered during the two year process.

    Intellectually disgraceful.

    • Leo Holm MD

      The “Patient Centered Medical Home”- Centered Medical Home is the correct term for the model.

  • Marc Gorayeb, MD

    Patient input has not been sought for a reason: they would probably vigorously oppose the dilution of the physician-patient relationship, which is at the heart of Obamacare. How would YOU like to have the details of your medical or psychological problems shared openly by an ever-increasing number of ‘team’ members?

  • Ashley

    I’ve learned the hard way as a patient that your health care is up to you to manage, even if you have to do that by getting creative or doing something uncomfortable. I see doctors, pharmacists, and other health care professionals on my side. It’s the system as a whole that doesn’t have my interests at heart.

  • http://WWW.OHIOSURGERY.BLOGSPOT.COM buckeye surgeon

    I may be missing the point of the “piece” but if patients are saying they don’t like a complete restructuring of how patients and doctors interact (i.e., more of an emphasis on a “team approach”, fewer one -one one encounters) then why do you think that by simply “involving patients in the reform process” they will suddenly embrace a model that they have heretofore expressly rejected?

    If I go to Olive Garden and they tell that I have to go back into the kitchen and make my own giant bowl of pasta (as part of a “new paradigm” of restaurant management) and I decide I don’t like it, why would I change my mind just because the Olive Garden CEO invited me to join in the decision making process whereby the waiters and cooks were eliminated in order to ensure a more stream lined eating out approach?

    I mean what if you involve the patients in the process and they tell you that they don’t like the medical home approach? What if they don’t change their minds? Then what?

    • pcp

      Exactly.

      The “medical home” is anything but patient centered. It’s administrator-centered

    • Ellen M Martin

      Right on! A big difference is that the Olive Garden plays in a freer market than health care–if they demand you make you own pasta, you go to a different restaurant. Third-party payment systems push patients and physicians out of the control positions–we are no longer customers or clients, but at the mercy of bureaucrats, insurers and government who run the system and pay the bills.

  • http://N4Maddox.com Lory Maddox, RN

    As Terry McGeeney speaks of both patient understanding and engagement a dimension of patient understanding is health literacy. The assumption that average Americans have the knowledge and skills to understand the complexities of health care is most likely flawed. Health care and patient management can be complex requiring expertise across many fields, e.g., medicine, nursing, nutrition science and pharmacology. Until such time that we are a health literate nation, patient understanding should not be assumed, nor confused with patient centered care.

  • Tony RN

    I think the Doctors don’t get it. Working in a major teaching hospital I see first hand how Doc’s are trained. The lack of true caring for the outcome of the patient shows once they are in private practice. With the healthcare care reform I see nursing playing a bigger role then physician’s. Physician’s talk down to patient’s not to them, once the physician is done they leave the room. I have seen more confused looks on patients faces after the Doc has leaves. Then I get to spend the next hour explaining everything to the patient. I empower my patients to speak up and questions the all mighty Doc’s, since it’s their that is in question.

  • http://www.TransforMED.com Terry McGeeney

    Kevin, great job on the article in USA Today. As you noted, the National Demonstration Project (that was designed as a learning lab not a research project) taught us that the patient must be more engaged at every level. They often viewed practice change as negatitve if they were not engaged and educated. We learned a great deal from the NDP on how to transform practices and engage physicians and their staff which was the goal. We also developed lots of tools and resources to fill the gaps. We have not done a good job engaging the patient/conusumer or developing tools and resources to do so. We have had some success at the local level, but engaging the national organizations and getting the issue front and center on the national stage has been a real challenge. We desperately need them at the table. If not, it will be very difficult to insure the patient centered medical home is truly “patient centered” and the solutions to the challenges to healthcare in America may not have the best interests of the patient at the forefront.
    Terry

    • Homeless

      “They often viewed practice change as negatitve if they were not engaged and educated.”

      My former doctor practiced in a clinic that participated in the TransforMED Demonstation Project. The above sentence implies my negative experiences a result of not being engaged or educated.

      I am an e-patient because I have a zebra. I know my disease, I live with it everyday. I have worked with some wonderful specialists and have done extensive research on my disease. At the time I was going through the diagnostic process, I didn’t have a primary care physician with enough time to be engaged with my health. When I learn the PCMH, I was intrigued and looked forward to having a real relationship with my doctor, one where my needs were met and the staff was familiar with my uncommon disease.

      I had been a patient of Dr. X for 9 months when the clinic began the project. During the next 20 months of the project, I saw five different providers for a developing problem-one unrelated to the zebra. The communication was poor and things were missed. I felt I wasn’t a real person, just a chart. During that fifth visit, I was almost in tears, frightened by my worsening symptoms and frustrated to feel alone. The stranger that walked in the exam room, a physician assistant, could see I was upset. Her solution: come in next week because I hadn’t seen “my doctor” in over a year. I did get a phone call from Dr. X the next day. She didn’t inquire about my declining mental health but she did recommend I see a specialist. I was engaged and educated enough to seek the care of a psychologist on my own.

    • pcp

      From the TransforMED website:
      “The goal of the National Demonstration Project was to assess the usefulness and impact on quality of care and business performance of the Future of Family Medicine Report’s new model. The hypothesis was that the new model’s best practices would improve patient care, patient satisfaction, physician satisfaction and business performance.”

      Doesn’t sound like a “learning lab” to me.

      The hypothesis was proven to be incorrect. It should be rejected.

  • http://www.elliothospital.org Kathleen

    I am a nurse and a PhD psychologist. We can do all the process improvement diagrams and models that we want, measure all sorts of outcomes, but we haven’t spent enough time talking about human behavior–both patients and providers. We have come at this “improve care” issue as a “service industry” problem: redesign our systems and we will get a better product. No question that some of our systems need redesign! But the final “product” is also up to the patient. [We're not the Olive Garden.] We can examine, advise, prescribe, do tests, educate, etc. etc. In the provider-patient relationship, we have forgotten the relationship.