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Annals of Family Medicine — Table of Contents (September/October 2006, 4 [Supplement])

It's been a whils since I've made a substantive entry about family medicine.  Here goes:

I've been very busy lately with a project I can't discuss at all.  It's very exciting and rather all-consuming and for those of you who have been follwing this weblog (if there are any of you left!) .. I can say that it's an opportunity for me to help provide something to healthcare that I've been whining about for a long time.  I'm doing my best to walk-the-walk rather than just talk-the-talk.

This may explain the paucity of posts lately.  As Dave has suggested recently, blogging has matured, and so has medical blogging.  Back in 1999 and 2000, there were a handful of medical bloggers (literally!) and we all had a bit of a role in educating each other and the world about what is is that physicians do, think, read, etc.  This was – from my view – a primary purpose of medical blooging: to enhance the transparency of our profession.

But there's lots of that now.  Hundreds (thousands?) of medlical bloggers are posting daily and – frankly – I don't think the Internet needs me anymore.  Hmm .. that sounded rather egocentric! .. oh well.

So I'll continue to post as a I can .. and hope to spring interesting and compelling observations on occasion .. but I doubt I'll be back to daily blogging again unless I find myself with fewer jobs or a renewed sense of mission for the blog.

This week in the office was (as usual?) psychiatry week.  Lots of psychosocial problems interwoven with my patients' health problems.  Them man with the heart attack last week is certain that stress is the primary factor that caused the event.  I don't disagree.  His hypertension and hyperlipidemia were "at goal" thanks to my prescriptions of a statin and antihypertensive …yet my prescriptions for counseling, weight loss and exercise were never implemented and this event was — as he put it "my 9/11."  Time to heed the issues he had set aside for too long.

The first intervention turned out to be a family meeting for 2.5 hours yesterday in the office.  Stress reduction was the primary focus, but it was clear form our conversations that he and his wife have fogotten to be friends recently.  I found myself teaching a "how to talk so spouse will listen." workshop. 

It's a long process to learn new skills and un-learn old habits.

Longtime readers have no doubt recognized the paucity of posts in recent weeks.  It's been quite busy.  yeh .. again .. no excuse. 

These are rough notes .. taken during the conference.

Right now I'm sitting at the STFM plenary session that is being given by Joe Scherger.  Joe's a good speaker.  He's suggesting that we are (mis)educating our residents .. and that family medicine is failing because the model of care that we are attempting to fit-into is an acute care model .. while the values and goals that are taught in family medicine don't fit into 15 minute visits.

He suggests that the future of family medicine depends on our embracement of the concepts outlined in the book Lean Thinking …

Hmm ..

Here are the core functions Joe suggests we provide:

• We manage relationships
• We manage Knowledge
• We manage resources

ok .. still follow?  .. I'm trying too ..

So we need to redesign what we do.

principle:  care is based on continuous healing relationships

implementation of principle: we provide care in a "personal medical home" 

Huh?  This means we provide care beyond the office visit. 
patients will have continuous access to healthcare
patients will have their medical records
patients will have access to all medical information

patients don't come to use for information ..they come to us for CARE .. as they have access to information.

IT in healthcare – the three legs of the stool.

Knowledge management
Patient Information – EHR, etc
Communications – digital connection between patients and providers.

"The young can't imagine life without online access"

— slide of an image with computers for the homeless (not to self – get image from Ruchard Usatine)

— Chronic care model .. http://www.improvingchroniccare.org

• Provide patient centered care

NEW VISION of family medicine

• Responsibility for a population
• Manage the needs and demands with acontinuous process
• etc (I type too slow)
• 50% more caring interactions
• 10 – 12 unhurried visits per day
• interactive practice website
• 40% of patient needs handled online or by phone

—

Concierge care?

Yikes

Joe is talking about the conflict of how concierge care has created a problem .. and wonders out loud if we can ALL provide concierge care.  Hmm .. the Concierge care organization has change their name to the Association for Innovative Practice Design.

He descibes Allen Dappen's practice .. and then describes Greenfield Health .. as well as Kaiser's new HealtConnect project.

It seems that this is the right thing to do ..

He mentions a book by David Lawrence

Financial models for the New Model

shift from phone to e-mail .. among other things ..

—

Change principles:

• strong leadership
• focus on teaching and learning methods
• use mentoring and targeted interventions

getting to quality driven practice  Chuck

Winding down with Wise words from Dee Hock :

The substance is enduring – the form is ephemeral.  the substance is who we are as family physicians .. the form is how we work.  Preserve substance – modify form —

How we are currently working is archaic.  We need to change the way we work.  Shift from focused, episodic are to a model of continuous care.