Let’s build the medical home, and remember who it’s for

As the nation prepares for a new administration, it’s time to rebuild our crumbling health care system. In a statement on the AAFP Web site, President-Elect Barack Obama has pledged to “encourage and provide appropriate payment for providers who implement the medical home model…” Physician-directed inter-disciplinary teams, disease management and care coordination, quality assurance, and health IT systems, he states, “will help to improve care for those with chronic conditions.”¹

There’s much to applaud in that statement. Yet I worry that a critical element is often overlooked in discussions of this concept—namely, our patients, the people for whom we’re building medical homes.

Written standards governing patient access and detailed plans for patient care do not equal a trusting physician-patient relationship, any more than an interactive Web site can substitute for a caring clinician who connects with his or her patients. Amid the multiplicity of measures alleged to judge medical “home-ness,” let’s not settle for attributes that are easy to determine and miss those that are truly important.

A medical home should nurture the spirit, not merely provide refuge from the rain. To do that, we need to see patients as whole individuals, not just a sum of their chronic conditions. Too little attention is paid to mental health as an underlying mediator of wellness; too few dollars are allocated to incentives for integration of physical and mental well-being.

While we certainly need to do a better job treating heart disease and diabetes, a system that values smoking cessation and other lifestyle interventions would diminish the morbidity and mortality of these scourges. It’s time to challenge the old sickness model of medicine and move to a system that rewards health promotion, disease prevention, and population-based care.

Finally, we need to build a medical home for everyone—“black, white, Hispanic, Asian, Native American; Democrat and Republican; young and old; rich and poor; gay and straight; disabled or not.”² As Barack Obama said in a recent speech, shouldn’t everyone have “the same kind of health insurance that members of Congress get for themselves?”²

As the nation prepares for a new administration, it’s time to rebuild our crumbling health care system. In a statement on the AAFP Web site, President-Elect Barack Obama has pledged to “encourage and provide appropriate payment for providers who implement the medical home model…” Physician-directed inter-disciplinary teams, disease management and care coordination, quality assurance, and health IT systems, he states, “will help to improve care for those with chronic conditions.”¹

There’s much to applaud in that statement. Yet I worry that a critical element is often overlooked in discussions of this concept—namely, our patients, the people for whom we’re building medical homes.

Written standards governing patient access and detailed plans for patient care do not equal a trusting physician-patient relationship, any more than an interactive Web site can substitute for a caring clinician who connects with his or her patients. Amid the multiplicity of measures alleged to judge medical “home-ness,” let’s not settle for attributes that are easy to determine and miss those that are truly important.

A medical home should nurture the spirit, not merely provide refuge from the rain. To do that, we need to see patients as whole individuals, not just a sum of their chronic conditions. Too little attention is paid to mental health as an underlying mediator of wellness; too few dollars are allocated to incentives for integration of physical and mental well-being.

While we certainly need to do a better job treating heart disease and diabetes, a system that values smoking cessation and other lifestyle interventions would diminish the morbidity and mortality of these scourges. It’s time to challenge the old sickness model of medicine and move to a system that rewards health promotion, disease prevention, and population-based care.

Finally, we need to build a medical home for everyone—“black, white, Hispanic, Asian, Native American; Democrat and Republican; young and old; rich and poor; gay and straight; disabled or not.”² As Barack Obama said in a recent speech, shouldn’t everyone have “the same kind of health insurance that members of Congress get for themselves?”²

As the nation prepares for a new administration, it’s time to rebuild our crumbling health care system. In a statement on the AAFP Web site, President-Elect Barack Obama has pledged to “encourage and provide appropriate payment for providers who implement the medical home model…” Physician-directed inter-disciplinary teams, disease management and care coordination, quality assurance, and health IT systems, he states, “will help to improve care for those with chronic conditions.”¹

There’s much to applaud in that statement. Yet I worry that a critical element is often overlooked in discussions of this concept—namely, our patients, the people for whom we’re building medical homes.

Written standards governing patient access and detailed plans for patient care do not equal a trusting physician-patient relationship, any more than an interactive Web site can substitute for a caring clinician who connects with his or her patients. Amid the multiplicity of measures alleged to judge medical “home-ness,” let’s not settle for attributes that are easy to determine and miss those that are truly important.

A medical home should nurture the spirit, not merely provide refuge from the rain. To do that, we need to see patients as whole individuals, not just a sum of their chronic conditions. Too little attention is paid to mental health as an underlying mediator of wellness; too few dollars are allocated to incentives for integration of physical and mental well-being.

While we certainly need to do a better job treating heart disease and diabetes, a system that values smoking cessation and other lifestyle interventions would diminish the morbidity and mortality of these scourges. It’s time to challenge the old sickness model of medicine and move to a system that rewards health promotion, disease prevention, and population-based care.

Finally, we need to build a medical home for everyone—“black, white, Hispanic, Asian, Native American; Democrat and Republican; young and old; rich and poor; gay and straight; disabled or not.”² As Barack Obama said in a recent speech, shouldn’t everyone have “the same kind of health insurance that members of Congress get for themselves?”²