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Making the Medical Home a Healing Place
Submit responseThe healing skills Drs Churchill and Schenck identify are vital to implementing continuity care "personal care" and a "whole-person orientation", two of the original four principles of a medical home as described by Rogers (1) (the other two principles being team directed medical practice, and care that is coordinated and integrated). More recent iterations of the "medical home" concept, however, have moved from including re-imbursement as a piece of the "medical home" (2), to translating "medical home" almost exclusively into a re-imbursement concept. This article provides helpful documentation of the healing skills that must be foundational to any conceptualization of what it means to build a "medical home," and it provides a vital reminder to busy clinicians as to what needs to be the focus of our day to day clinical practice.
References
(1) Rogers JC. Assembling patient-centered medical homes--the care principles. Fam Med. 2007 Nov-Dec;39(10):697-9. PMID: 17987408
(2) Joint Principles of the Patient-Centered Medical Home (AAFP, ACP, AAP, AOA)http://www.acponline.org/advocacy/where_we_stand/medical_home/approve_jp.pdf (accessed 8 December 2008)
Conflict of Interest:
None declared
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Healing skills cannot thrive when doctors practice in a treadmill existence
Submit responseMany would readily agree with Churchill and Schenck’s findings, particularly those clinicians who routinely apply the relational (healing)skills described.
But, for practicing physicians, the skills they mentioned require time--and a frame of mind unhindered by the need to see a disproportionate number of patients. Sadly, for many primary care doctors particularly, insurers’ low remuneration rates and excessive administrative obligations have polluted the atmosphere for healing skills to survive. Keeping up with the science of medicine is difficult enough, but when the burden of administrative duties is added to the strain of financial survival, many physicians, although they profess to honor the relational skills described, will admit that they are deficient in applying them.
Ironically, new imaging techniques and new drugs, along with clinical guidelines which do improve patient care in one sense, also diminish the perception of the value of relationl (healing) skills.
The point is, unless physicians make an effort to limit the number of patients they see in a day, they will not have the desire or the equanimity necessary to practice in the “healing” mode described by the authors. Using mid-level providers may provide some relief initially, but many physicians who employ them still complain that as their practices get bigger so do the time constraints and patient demands. Many say their professionalism has turned into a treadmill existence. Any initial saving of time by PAs and NPs evaporates quickly as more patients enter a practice.
As a physician who strives to use the skills mentioned by the authors, I have found the only way to achieve the composure needed to practice as a “healer” is to limit the number of patients I see in a day, fifteen to twenty patients being my limit.
Perhaps, the skills the authors mentioned are not actually teachable. Maybe they are part of some medical students’ psychological make up and need to be assessed before they are admitted to medical schools. Another possibility is that after enduring the rigors of studying the basic sciences and the responsibilities of residency, many students’ healing skills and humanitarian impulses simply shrivel and shrink, like a de-enervated limb.
It will be interesting to see how the importance of these skills are rated by patients and how much they actually influence their clinical course.
Conflict of Interest:
None declared