Tuesday, August 17, 2010

Medical Homes

There has been quite a bit of talk lately in health care circles about something called Medical Homes.

The American College of Physicians expands the term somewhat and defines it as follows:

“A Patient-Centered Medical Home is a team-based model of care led by a personal physician who provides continuous and coordinated care throughout a patient's lifetime to maximize health outcomes.”

The idea is to remedy the general absence within the health care system of provision for the management of care. Such management would be the responsibility of the personal physician as leader of the Medical Home team. The notion has seemed sensible to me but recent personal experience has raised in my mind some questions about it.

Like many men my age, I have prostate cancer. Various recent studies have posed the question of whether the approach to the treatment of that disease has been too aggressive, considering the expense and side effects and that many senior men with the disease die from something else before the prostate cancer becomes a problem.

Thus, once the disease is diagnosed, the issue of what, if anything, to do about it is not always clear and therefore becomes a matter of judgment.

I have an able and conscientious primary care physician who, as best I can tell, is knowledgeable about her field of medicine and exercises thoughtful and sober judgment in the care and treatment of her patients. But she has been of no help in decision making about my prostate cancer, other than to listen to my reasoning about it and agreeing that it seems logical.

When you think about it, that is about all she can and ought to do. Neither she nor the group to which she belongs has the time or resources to study such matters in the depth required to come up with evidence-based guidelines for use in advising their patients.

Only institutions like hospitals can do that.

So I think the Medical Home concept is a good one, but that it needs to be institution-based.

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