By the end of my first day back to the office, I had over 100 documents to review and about 50 phone calls to make. The next day was only a little less hectic. Finally, over the weekend, I had a chance to sit and reflect, journalling through my thoughts. As I did so, I realized how big this project is and how the patient-centered medical home extends so far beyond me and so far beyond the walls of Green Spring Internal Medicine. There are certain features of patient-centered care that we would not possibly be able to achieve on our own; thus, we are going to have to tap into community resources. Most of all, we are going to have to involve patients in the process.
As thoughts flowed, I sketched a diagram of what the PCMH would look like. It was a daisy! This struck me as neat, because in my doodles and sketches in my journals throughout the years, I have often sketched daisies. It was a "eureka" moment for me, to think of our PCMH like this! In a rare artistic burst, I put this together later in the week to show exactly what I mean.
... and furthermore, a friend pointed out to me at church last Sunday, as I was sharing the story with her, that I was wearing daisy earrings. At that moment, even though it might seem so little, I felt the warmth of heavenly affirmation. I have to admit that I have relied upon God moments like this over the past 5 kind of scary years, the reminders that He is in it. It gives me a bit more bravery.
I thought about how we, Green Spring Internal Medicine, would be a home with a number of rooms in it: patient focus groups, care coordination, a nurse practitioner, medical assistants, community educators, nutrition, maybe even a psychologist, all overseen by me but all taking part in an ongoing team dialog and team effort focused on what it means to be patient-centered and what it means to be a medical home.
Hopefully, we will become a beautiful home, much like this beautiful row home I photographed while walking through Philadelphia last week.
Our medical home will exist in a medical neighborhood. What I like so much about the row home concept of the medical neighborhood is that rowhomes are attached to other homes in their community. Through care coordination and health information exchange, it will be possible for transitions between medical settings to become much more seamless for patients.
As in other neighborhoods, I am sure there will be a certain amount of "keeping up with the Joneses." In addition, some medical neighbors may need to be encouraged to get up to speed and fix the broken windows. There is increased safety and strength resulting from joining forces, and many lasting relationships are fostered by neighborliness. It is interesting to think of how these ties will form between entities who will invest in patient-centered care.
Hopefully the end result will be a much more relational than informational approach to healthcare. Research shows that certain patient populations especially value "affective" or more emotionally-connected interactions with health providers, as opposed to the traditional information-giving. With the internet, it is now more common for patients to come in full of information they've read on the web about issues affecting their health or the diseases that afflict them. Patients with rare diseases often know a lot more of the details than I do. An empowered patient has more charge over her/his health destiny; thus, the role of the health provider changes from analyst/director to compassionate coach. The word "compassion" has Latin roots. "Com" means "with". The Latin "passio" means "suffering". For many, staying in good health involves suffering. For others who are affected by chronic illness, there is a daily cross to bear. By putting a better model in place, a model that lessens the hassles of healthcare delivery, we are able to relieve unnecessary pain.
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