Patient centered care – panel size

Several organizations are currently championing the patient centered medical home. Patient centered is an important concept. What do patients want and need?

My thoughts are based on many conversations with patients, friends and other physicians. I have no survey data, only impressions.

If you ask patients to describe the ideal physician, I believe access is a fundamental concept. They want to be able to see their physician at their convenience, not the physician’s convenience. They want their telephone calls answered. They want to be called about their lab tests and imaging studies. They want explanations about their diseases, medicine and testing. They want their physician to consult prudently, only sending patients to consultants who meet the same standards. Many want email access.

The family practice literature has a growing concern about “panel size.” Panel Size: How Many Patients Can One Doctor Manage? I believe they overestimate the number of patients a physician should follow, because they leave out phone visits. Patients want to talk to their physicians, not the nurse, not the medical secretary, and not even their partner. They want to talk to their physician on the day they call – hopefully at the patient’s convenience.

Our current reimbursement system destroys panel size, and thus destroys the patient centered practice. We have an ever decreasing number of residents choosing outpatient practice precisely because the compromises one must make are not acceptable.

When wonks try to understand the retainer medicine phenomenon, they always forget these issues. They forget that medical practice is concerned with one patient at a time. We want to provide the best possible service to each patient. Each patient deserves that. For those who object to retainer medicine, I hope they can at least understand that the appeal comes from a new model which provides a better experience for both physicians and patients. I believe that most of the objects are misplaced. I will comment more on that issue in future rants.