It was fun to present MDM to our colleagues associated with MaineQualityCounts. They are doing great work and this work clearly resonated with frontline folks. For example, nurses working in the Community Care Teams found it compelling to think of their work as promoting / defending patient capacity. You can review the presentation here and the video here.
It is very clear that capacity that could be deployed to do meaning-making work (spend time with family, pursue interests, support loved ones, achieve goals) will compete favorably with patient capacity vs. work of being a patient that is disconnected from patient goals. In failing, the healthcare system will respond with more work or with disparaging comments about the patient or by firing the patient. This is going to come to a head as a wave of previously underserved people, many with chronic conditions and most with limited capacity for self-care, will encounter health care systems well-oiled to achieve disease-specific performance measures. The solution here is to implement minimally disruptive medicine. It is frustrating to me that we still do not know exactly how to do it, but research grants have been submitted and our team continues to explore best approaches. We need to do more, faster. Our patients deserve it.
That was an engaging and inspiring presentation, Dr. M. I was taking notes like crazy throughout – what you say makes eminent sense and should be embraced by all health care providers. Sadly, many have one eye on those algorithms and the other on lab test results that demand upping the intensity of treatment.
Thank you for making a difference in the way medicine works for both care providers and patients.
Agree. You have stated this so well: We have a “well oiled machine” that is geared to produce “outcomes” that matter to the machine…but not always to the human being affected by the machine. I believe it will all have to be “grass roots”: the “supply” side economics (what “we” sell) will not work. It will have to be what the “demand” side (what patients want) the effects reform. I am afraid that as long as we have anything other than single-payer, we won’t get there. I spent 3 hours today dealing with issues that would not have been necessary (and did not result in better care) simply because of multiple payers. Mark
It seems to me that if we take PCMH as a call to care being care centered on the patient, then we will by necessity be dragged into thinking much more carefully about MDM.
One disruption that I don’t see much writing about is the need for patients to “satisfy” their physicians, So often i see patients who engage in their care only because they don’t want to let me down or cause me to loose face.