Stories from the front lines: delivering great care in a virtual team but would get no credit as a "medical home." Maybe the definition of "medical home" is bankrupt.

Just thought I'd share a little story that reminded me of why it sometimes makes sense to work this hard, because sometimes the system works.

A woman, pretty healthy, very active, a few medical problems, had a breast biopsy 2 years ago.  She had bleeding complications from the biopsy and had to be transfused, then had a bizarre transfusion reaction, but in the end the biopsy was benign (after 2 weeks and much drama in hospital).

Last year she had another vaguely abnormal mammo - obviously not anxious to jump to biopsy again.  Surgeon recommends MRI (reasonable). The patient stalls and stalls and stalls, afraid MRI will show something that needs biopsy again and she will be forced to make a tough decision.

She finally schedules the MRI.  Day of the MRI she asks the brilliant question of the safety of MRI with a St Jude heart valve (d'oh! I hate when I miss stuff like that, and I thank God for smart patients).  The MRI tech looks in her book, says it should be fine, patient decided to call the cardiologist. 

The cardiologist NP is one of the smartest and most caring people I know.  She called the radiologist, looked online, and investigated the serial number of the patient’s particular heart valve, found that it does contain some tungsten and would "probably be safe" in a less-than-3-tesla MRI, but after talking to the radiologist decided that the chance of artifact rendering the test useless was high and that "probably fine" wasn't good enough. 

Then she called the patient and they discussed the risks and benefits, then, then (this is where it gets good) she CALLED me to go over everything with me.   (Actually she stopped by her office is on the same block).  So I called that patient and now, get this, WE ARE ALL ON THE SAME PAGE! 

I’ll talk to the surgeon Monday, and its beautiful.  (No answer on the abnormal mammo yet).   But this is what happens if everyone wants what is best for the patient and is willing to pick up the phone and act on it.

The fact that this is so rare sort of bugs me, but for now I am basking in the moment that if we work together we can provide good care.

And I'm not even a NCQA certified PCMH.

Elizabeth Crowley, MD
Family Medicine
Cape May Courthouse NJ

Comments

[PookieMD]

I think the very effective care you described has nothing to do with the medical home concept. The medical home is a way for nurse practitioners to deliver care, while physicians "supervise" and "colloborate" on patients. I think the medical home will bring about the demise of primary care, as it will force physicians into a supervisory role, rather than that of a practitioner of medical arts. Most physicians want to practice medicine, not supervise medicine. (Including me.)