a medical home

THE MEDICAL HOME- a perspective

I remember growing up in a small community in Ohio and feeling comforted by the fact that my mom was always home to greet me after school or to pick me up to take me to my special activity. Dad was consistently home for dinner. Life was routine. I felt secure and comfortable. That’s probably what most of us feel when we think of home: a place where we are comforted, where there is some sort of stability. That place where we can close our eyes and know where the refrigerator is. Home is the place where we know we belong.

When I became a doctor, I tried to give my patients that same feeling about my office. I understood that healthcare was about relationships, communication, and cooperation: the patient/doctor relationship, doctor/doctor communications, and doctor/nurse cooperation.

I chose not to employ a nurse practitioner because I want my patients to always know that I am there for them. I chose to make most of my own calls to colleagues because I feel that is the best means of communication. Patients who choose me as their doctor know how our office works because we are purposely transparent; no need to lock up the food in this office. We invite all our patients to come in sit down and get to know us.

Over four years ago, I divorced myself from the “care follows financing” healthcare delivery system that has overcome our industry. I started to work directly for my patients as a concierge physician in order to “practice my profession.” I retrofitted a better medical home. Since that time, my patients and I live in a comfort zone; knowing that 24/7, there is someone to answer the phone and it’s usually me.

You can imagine the sick feeling that overwhelmed me when I was asked by experts leading the government’s conversation in health care reform, “who was on my team?” Team? Had my cozy medical home suddenly become an orphanage of residents in need of a team (presumably of social workers and case managers)?

Those of us engaged in the practice of “direct care” have built a business around a medical home that belongs to our patients. Our model is built to provide care in a comfortable and consistent setting. It is not just the pictures on the walls that make our (medical) homes peaceful and personal. It’s the welcoming gestures and the mutual respect that comes with taking the time to really listen to our patients and to coordinate a strategy that offers them that better day.

It’s helpful that the reception area is not overflowing with waiting patients exchanging detached glances but rather there is great coffee, cheese and crackers, and plenty of great big comfy chairs that are not chained to the wall. No patient appreciates or deserves a cold chair, a chilling stare, or that awful closed glass window when they are anticipating bad news. Visions of the movie “Home Alone” do not conjure up an image of paper gowns or cold empty rooms. That’s why we use thick jersey spa gowns when we ask our patients to change into their exam attire.

And just like families, medical homes come in all sizes and shapes. Mostly they suit the needs of the professional and his or her patients. Most of the practices are limited in number in order to provide the time necessary to do our jobs. Sharing is an integral part of most every home and it’s a part of most direct practices. While charity is not common in government run institutions, it is a natural element in the lives of most professionals the world over.

Over 10% of the patients in my practice pay me nothing and they get precisely the same care as the patients who pay me. It’s a pleasure and a privilege to give back and know that I have the time to offer my expertise, my life is enhanced and the lives of my patients are improved as well. My patients donate time to 501C-3 organizations in exchange for my scholarship. Everyone wins.

An open door policy isn’t as brutal as people seem it think. It isn’t hard being available 24/7. Usually, it means a phone call from a friend in need: someone I know well. When asked, most Americans say that they want access to affordable health care, the knowledge that their doctor is available. It’s always nice to have a key to the front door, so to speak.

The passion that my colleagues and I have to preserve the medical home and the sanctity of the relationship(s) that we have with our patients is as real as our patients’ trust and love. The necessity to safeguard the professionalism that we have earned so that we can provide the discretionary judgment to assist our patients with decisions about life and death is indispensable to the conservation of the integrity of the science.

America was built around the principle of a supportive family. Over the years, reams have been written about the disintegration of the family unit as the root of much of our cultural chaos. I don’t really think it takes a community if the comforts of home are maintained with consistency.

Healthcare is not much different. The inability for a patient to have their own personal doctor, someone who knows him (or her) who will advocate for them is probably the greatest frustration suffered by Americans in need of care. I would hope that America would work hard to maintain the “old fashioned” medical home before we purposely turn mom and dad into matrons of an orphanage where no one has a place to call their own and everyone is served the same dull pabulum in place of a nutritious meatloaf every Monday.

Home sweet home is not an institution to be judged by the federal government. It is a place we go to belong, to reinvigorate, to strategize and build our lives. Medical homes belong to our patients and must never become government fashioned institutions. Dickens wrote fiction about a failed cultural era that dehumanized children and sanctioned disrespect and cruelty. We must not allow his historical perspective to become a 21st century American reality.