What is an ideal medical practice?

We are the cutting edge of office practice innovation in the US.  There are  many who would wear that mantle, but the clothes don't fit.

The cutting edge does not define primary care as a branch in a carefully designed hospital based system flow chart.

The cutting edge does not define primary care as a thousand details calling for endless analysis of minutia to justify every act, every stroke of the pen.

The cutting edge does not define primary care as grateful recipients of vendor technology to achieve 'meaningful use.'

The cutting edge does not define primary care as the practice capable of running fastest on the hamster wheel while spouting off about guideline adherence for a handful of clinical conditions.

We are the foundation of effective primary care.  Our patients are more likely to say:

• I can get care when and how I need it
• I have a PCP who knows me as a person
• My PCP cares for the bulk of my health care needs
• My PCP coordinates any care I need in the health system

The shape, size, financial arrangement, team configuration are means to the end.  We vary in shape, size, financial arrangement, team configuration to better serve our patients in vital and professional practice.

(Please also consider reading my comment below)

Comments

[L Gordon Moore]

My post came off a bit arrogant and chest-beating, but my intent was to remind small practice innovators that we do matter and we can contribute.

Many of us have been able to take innovations in care delivery and run far with them because we practice without the rate limitations and constraints of systems. This is our freedom but is also a limitation.

One of the limitations we face is that as independents we have limits to what we can accomplish. We may achieve brilliance in our individual offices but lack the resources to extend care into things I would love to do.

I heard John Oldham from the UK talk about his general practice. Because of his ability to do good work he was given greater responsibility and funding to accomplish even more within his region. He and his team created a multidisciplinary process of outreach that included mental health nursing, social work, and more that helped his large patient population achieve unprecedented results.

I'm jealous of those resources, of that team, of that process excellence. With our foundation firmly rooted in effective primary care in our microsystem we have the perfect platform upon which to build. This is where we need resources adequate to the work. If we had the resources to achieve Oldham's level of population care we would simultaneously solve the primary care shortage while improving quality and bending the cost curve.
Gordon