Just the other day one of the medicine residents presented a case to me, and mentioned that in looking through the patient's chart he noticed that the patient had undergone a prostate biopsy 1 month prior to this visit, with a follow-up appointment in urology scheduled next month. The result of the biopsy was positive for cancer, but that had not been communicated to the patient. His first instinct, he ...

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Integral to the very concept of the patient-centered medical home is the need for a very real, very concrete, one-on-one relationship between the patient and his or her primary care provider. No matter who this is, the patient needs to know who their internist, or gynecologist, or pediatrician, or nurse practitioner, or other primary care provider is. Nothing can replace this, and everything else about the patient-centered medical home is designed ...

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Even in its purest form, in the most perfect patient-centered medical home we can create, patients will sometimes need to move beyond the confines of primary care. Each of us in primary care has a point that we choose not to venture beyond, into the realm of subspecialty medicine where we lack the experience and tools and support to fully implement complete care for patients with these particular problems. It may be ...

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What does access to care look like in a patient-centered medical home? To answer this we first have to see what access looks like now, under our current system. What happens now? A patient wakes up in the morning with abdominal pain, cannot reach us, and so turns to the computer and types "abdominal pain" into Google. He or she is rewarded with multiple catastrophic and deadly diagnoses, most of which they assume ...

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So what exactly do we want a patient-centered medical record to look like? What is the point of a patient's medical record? Historically it has served many functions. Perhaps the time has come to reassess what it needs to be, what it can and should be. If a healthcare provider from one or two generations ago were to look into a patient's chart today, would they recognize what they saw? Would they ...

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Here are just a few of the mouse clicks, key strokes, and computer screens I need to make or navigate to get through my day: Control-Alt-Delete. User Name. Password. Double click on the icon to load the electronic health record (EHR). User Name again. Password again. Schedule. In-basket. Results. Patient Calls. Rx Requests. And that is just to get started. Before I finish my first cup of coffee. Every patient interaction that needs ...

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Having gotten all of the members of our team on board, how do we get them to actually get together? We've all got busy days, all have lots of jobs to do, pulled in multiple different directions. The time needed to be thoughtful and really invest in the patient's care is missing from our day. We need to make room for it, to get together, to really apply ourselves to ...

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How do we get the many disparate members of our healthcare team together to provide better care in a patient-centered medical home? Doctors (attendings and residents), nurse practitioners, nurses, medical assistants, phlebotomists, registrars, medical secretaries, social workers, community care organizers, pharmacists ... the list goes on and on. As it is right now, everyone is so busy trying to do their own job, to keep up with all of their paperwork, to ...

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One of the greatest challenges when it comes time to affect major change in any system is figuring out who the stakeholders are, who has a vested interest in seeing a project rise or fall. Without knowing who all the players are from the word go, there is almost no way to move things forward. But recognizing that we can't keep everyone happy is also a big part of this process. So ...

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Creating a patient-centered medical home within our existing system seems, at times, like a Herculean task. Getting all the pieces in place so that we can make the needed changes sometimes seems too vast to get it all right. We find ourselves asking: Why bother? Is our healthcare system that broken? Is the way we take care of patients now failing, satisfactory, or outstanding? If we just continue on the path ...

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