A Physicians View of Collaborative Medicine

A Physicians View of Collaborative Medicine

One of the biggest points of contention in the ongoing discussion of Primary Care is that the system of health care is flawed. As a result, Primary Care givers are suffering from burnout. The endless bureaucracy, decreasing physician pay, and increasing meaningful use requirements that spawn endless clicking on an already inefficient electronic medical record platform have become unbearable by most practicing physicians today.

Furthermore, all the talk about "mindfulness" only riles up more anger in Primary Care physicians, as they feel they’re being blamed for their own burnout. 

While there is a case for physicians taking personal responsibility for their own self-care skills (or sometimes lack thereof), we must acknowledge the flaws of our current medical system. The shift to a “value based system” is a bad idea; not only because it does not reflect the true value of the work being done, but also because the devaluation is causing physicians to be required to see more patients in less time (as if 15 minutes was not bad enough) putting the primary care practitioners at even more risk of burnout, depression, and suicide, and putting patients at risk for increasing medical errors.

This way of operating is clearly not sustainable: not for doctors, not for patients, and not for the system as a whole. Like the real estate market, our health care system is doomed to implode if nothing changes. However, the same questions persist: “If the system must change, how can we as patients, be at the source of this change?  How can we be responsible in creating a new paradigm for the practice of medicine?” How can we gain back some of the control of our healthcare? If we are not at the center, then who will be, and will they have our best interest in mind?

In most of the current models being reviewed and tested, Primary Care physicians assume the central responsibility for the patients’ health. Now, in the collaborative model, this central responsibility shifts to patient. The patient gathers and collects the health information. They receive advice from the other Primary Care workers such as the Optometrist, Nutritionist, Psychologist, Physical Therapist, Dentist, Spiritual Counselor, Pharmacist and Herbalist, General Nurses, Emergency Care Giver, and Primary Care Physician. Notice these resources are part of the Health Guardian’s team and provide primary care support. But in the collaborative model, the Health Guardian withholds control.

On introduction, it may seam like the bottleneck in health care has just shifted from one point (the Primary Care Physician) to another (the Health Guardian). I think an example of this will make the advantage and sustainability of this new model crystal clear.

Through our sampling, practitioner interviews, and patient reporting we found a rising demand for new methods to deal with the here and now, populations are already looking at improving general health of local communities. This is consistent with most communities in the US.

Amid a swell of patients in need of primary care, our investigators collected data on the number of patients with primary care needs, versus the number of primary care providers. The figures were staggering—we found between 37 and 40 practitioners in family medicine and another eight in pediatrics were responsible for up to 40,000 families in each region.

Using the new collaborative model there would be some 40,000 Health Guardians responsible for there own health, being supported by a team of typically 10 Primary Care providers. Activities such as scheduling, planning, budgeting, recording, gathering information, testing, collaborating, prescribing and teaching which is currently over 80% of a 40 general primary care physician’s activity could be transferred to the 40,000 Health Guardian, while still keeping the Primary Care Physician informed. That would be a hundredth of the workload they are being forced to deliver with current models.

When addressing lifestyle, diets, exercise, sleep, chronic diseases, and self-reliance it becomes clear that the patient should accept more responsibility as well. These forces are causing more and more individuals to seek minimal training and become their own Health Guardian using a collaborative model.

This newly empowered role is referred to as the Health Guardian.

That’s right, it’s all about decision power, resource control, and scheduling. It may not be obvious at first, but at the core, this model proposes a fundamental shift in communication, responsibility, and decision-making patterns.

During the last few centuries, the local physician assumed these roles. In this new, collaborative model, the central source of information, scheduling, and even care selection remains with the patient. This builds the patient’s self-reliance.

Instead of talking in generalities, let’s look at some of our specific findings. Through our and other sampling, practitioner interviews, and patient reporting we found a rising demand for new methods to deal with the here and now, the populations are already looking at improving general health of local communities. This is consistent with most communities in the US.

Amid a swell of patients in need of primary care, our investigators collected data on the number of patients with primary care needs, versus the number of providers. The figures were staggering—we found between 37 and 40 practitioners in family medicine and another eight in pediatrics were responsible for up to 40,000 patients in the region.

The conclusion was that your typical doctor, as a singular person, could not be solely responsible for your care without sharing that responsibility. That realization prompted conversations about innovation and how practitioners in in the US might take a different approach to patient care. Questions abounded: What are the needs of our patients? What does the community need from its provider base? How can the quality of care be improved?

Understanding the need for varying levels of care, depending on the patient and his or her health care requirements, administrators, and practitioners began developing a plan for providers to work to the top of their licenses. Those qualified to diagnose would diagnose. Those who could prescribe would prescribe. Those who could educate patients would take on that role.

Trying to ensure patients had scheduled annual mammograms or blood tests, that someone in the office called patients to share test results, that a patient had been in for a colonoscopy, or was managing his or her chronic condition(s) felt overwhelming. 

Walking through an ideal care journey, a care provider might see a patient for a new concern, a cough, for example. First, the care provider manages the symptoms, but recommendations for additional diagnostic testing might determine a diagnosis of chronic obstructive pulmonary disease (COPD). If that’s the case, the provider then helps the patient set up a consultation with Team D’s Collaborative Care Nurse, a different provider, for inhaler training, and the patient is then scheduled to come back for follow-up with the team. Nurses and PAs, too, help to manage both in-person and virtual visits on the phone, via e-mail, or through the patient portal.

The vision is to be a family of medical professionals. People are cared for because we all are communicating. They should know that we talk every day, that we share an office, that the team is updated about what’s going on if he hasn’t seen them personally. That is our hope for our patients.

A longtime patient with diabetes lost his wife, who had been acting as his primary caregiver. At the man’s next appointment, he met with a care giver, who asked him questions about how his wife’s death might impact his diet or how and when he was taking his medication.

We could not do this using the old model, now we can focuses on patients with COPD and diabetes, do the groundwork for breathing, medicines, taking their blood sugars, and finds out how they are doing after follow-up. This allows patients to manage some of these chronic conditions without feeling alone. Our model gives us more opportunities for contact, and the relationships help provide better care.

In addition to creating action plans for patients in need of chronic disease management, team members work through registries to make sure those who have not been seen recently are contacted and encouraged to come to the office for follow-up. This includes setting up Medicare wellness physicals and providing training on completing advanced care directives, among other tasks. The team approach we have keeps things on track.”

This model generates better health outcomes, and we have data to back that up. We have better outcomes with diabetics, better screening rates, better care because our patients engage with the team.

With this mindset, PathologyPrevention™ promotes a collaborative medical model, which gives healthcare providers and patients back their autonomy, joy, power, and freedom. We’ve envisioned a model that involves primary care providers, emergency providers, dentists, nutritionists, psychologists, religious counselors, sports therapists and complementary or alternative therapies such as acupuncture, naturopathy, and chiropractic practices coming together in a holistic collaborative and participatory environment. 

We feel this is the best way for you the patent to increase your own self-reliance capabilities, while collaborating with medical professionals to form an information hub centered on you, your past, and future, while addressing and preventing long-term chronic illnesses.

In health care, teams that collaborate effectively can enhance the quality of care for individual patients. By being prudent stewards and delivering care efficiently, teams also have the potential to expand access to care. Such teams are defined by their dedication to providing patient-centered care, protecting the integrity of the patient-physician relationship, sharing mutual respect and trust, communicating effectively, sharing accountability and responsibility, and upholding common ethical values as team members.

An effective team requires the vision and direction of an effective leader. In medicine, this means having a clinical leader who will ensure that the team as a whole functions effectively and facilitates decision-making. In the past, Physicians were uniquely situated to serve as clinical leaders.

However, as the size and scope of primary care expanded, and the focus of care shifts to preventative care, the leadership role is better served by the individual seeking preventative medicine. This individual requires additional training, but still is better suited than existing members of the primary care team. This new leadership role wit the additional training is called the Health Guardian.

By virtue of their diverse training, experience, and knowledge, Health Guardians have a distinctive appreciation of the breadth of health issues and treatments that enables them to synthesize the diverse professional perspectives and recommendations of the team into an appropriate, coherent plan of care for the patient.

As leaders within health care teams, Health Guardians individually should:

(a) Model ethical leadership by:

  1. Understanding the range of their own and other team members' skills and expertise and roles in the patient's care
  2. Clearly articulating individual responsibilities and accountability
  3. Encouraging insights from other members and being open to adopting them and
  4. Mastering broad teamwork skills

(b) Promote core team values of honesty, discipline, creativity, humility and curiosity and commitment to continuous improvement.

(c) Help clarify expectations to support systematic, transparent decision making.

(d) Encourage open discussion of ethical and clinical concerns and foster a team culture in which each member’s opinion is heard and considered and team members share accountability for decisions and outcomes.

(e) Communicate appropriately with the patient and family and respect their unique relationship as members of the team.

As leaders within health care team, Health Guardians individually and collectively should:

(f) Advocate for the resources and support health care teams need to collaborate effectively in providing high-quality care for the patients they serve, including education about the principles of effective teamwork and training to build teamwork skills.

(g) Encourage identification and constructively address barriers to effective collaboration.

(h) Promote the development and use of team policies and procedures, such as conflict resolution plans within teams that might adversely affect patient care.

This model of medical practice, leveraging collaborative treatments and being directed by the Health Guardian, is a primary care style sometimes called the Medical Home Team (MHT) model. It’s a standard devised with the patient at the center of a collaborative approach that ensures continuity of care from a group of professionals, who share information and workload with the Health Guardian information in a way that’s most efficient for those under their care.

This patient-centered approach considers the synchronized wellness of the whole person. This synchronization is the responsibility of the Health Guardian.

Comments powered by CComment