Focus on Team Care May De-rail Patient Centered Medical Home Efforts

[tweetmeme source=”Healthmessaging” only_single=false]”Team care” has become a rallying cry for those who think that the Patient Centered Medical Home is bad for health care 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 that they do not 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.

  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?


2 responses to “Focus on Team Care May De-rail Patient Centered Medical Home Efforts

  1. Sometimes “teams” mean synergy, and the whole is greater than the sum of the parts. That’s the plus side. But, sometimes teams often lack leadership and a solid connecting point for accountability.

    Unfortunately, I’ve seen more of the latter than the former, and the odds are you’re right. -slj-

  2. Excellent post. On close examination, the PCMH is seen to be a randomly assembled collection of managerial and administrative chores that benefit neither the patient nor the physician (does any patient really want to be part of a group visit?). There is absolutely no evidence that this model of care improves patient health or results in significant financial savings.

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