Collaborative Medicine

Written by PathologyPrevention
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One of the biggest points of contention in the ongoing discussion of Primary Care is that the system of healthcare 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 healthcare 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 seem like the bottleneck in healthcare 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 and implications 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 their and their family’s health. They would be supported by a team of typically 10 Primary Care providers. Overhead activities such as scheduling, planning, budgeting, recording, gathering information, testing, collaborating, prescribing and teaching, which is currently over 80% of the primary care physician’s activity, could be transferred to the 40,000 Health Guardians, 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.


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