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“Team Care” In The Patient-Centered “Medical Home?”

“Team care” has become a rallying cry for those who think the patient-centered medical home is bad for healthcare reform. Comments on a recent blog post in the New York Times provide a good example of this. When patients get sick, as the argument goes, they want to see their doctor — not some nurse or PA who they don’t know. I agree.

There are a whole bunch of things wrong with all the current focus on team care in the patient-centered medical home.

They include:

  1. Team care is not patient-centered careat least not for those patients who want to see their doctor and not nurse, PA, etc. By definition patient centered care respects, and where possible, honors the patient’s wishes, beliefs, expectations, etc.
  2. Team care is not one of the founding joint principles of the patient-centered medical home agreed to the American Academy of Family Physicians and other professional groups. In fact it is counter-intuitive to the first of these founding principles. That is that “each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.”
  3. Team care is seen by many patients and physicians as a way to cut cost — not improve the quality of care.
  4. Team care is not conducive to good provider-patient communications. Each person that comes between the patient and physicians complicates the communications process and will lead to increased risk of medical errors. Just look at the provider communication problems in hospitals associated with “handing off” a patient from one provider to another.
  5. Team care and expert patients often do not get along. Many people who have effectively lived with and managed their chronic conditions don’t want to “match wits ” with someone (non-physician) that probably does not know as much as they do in terms of living with their condition.

I have nothing against nurses, nurse practitioners or physician assistants. I just prefer to discuss my person health with my physician of many years. Other people may be quite happy working with physician extenders. The point is it should be my choice who I see for care and not the choice of the physician, physician group, insurance company, government or anyone else.

For some consumers, the term “medical home” conjures up visions of nursing homes and end of life. The term “team care” also apparently carries a lot of unwanted baggage.

My advice to aspiring medical homes? Tread carefully when it comes to telling everyone that they are going to get “team care” in their new “medical home.”

What’s your opinion?

*This blog post was originally published at Mind The Gap*


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One Response to ““Team Care” In The Patient-Centered “Medical Home?””

  1. Robert says:

    The idea of “you” being able to see “your” doctor whenever you want to is all fine and good. Apparently, you are a very special person indeed.

    The fact is, there is not enough primary care physicians in the United States so that every resident in the United States can timely see “their” physician when they need to.

    The fact that in Massachusetts, which has already enacted the elements of National Health Care Reform, residents have the longest wait to see a primary care physician is extremely relevant.

    So, perhaps you are a very special person, but for the average American, they may need to get used to seeing a fine medical professional who is not “their” physician [A "physician extender" as you derogatorily name them in my view.] it they want to receive timely, high quality health care.

    Unless you have the power to mass-produce physicians, and while I don’t doubt you think you may be able to the fact is you can’t, in the very near future when many millions more Americans will have quality health insurance coverage, it will be much more difficult for the average American who does not a few extra thousand dollars a year to establish and maintain a relationship with a concierge physician to receive timely care from “their” physician.

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