Friday, July 2, 2010

The Human Centered Health Home: Start with Respect

Aretha Franklin sings of one kind of R-E-S-P-E-C-T and Rodney Dangerfield joked about not getting another kind of respect, but the underpinnings of the patient-physician relationship is another kind of respect.  As transformation in health care moves forward,  we must continue to remember the respect that is the basis of our current interactions and future successes.

The Patient Centered Medical Home (PCMH) has been proposed by employers,  governments and organized medicine to help "bend the cost curve down" by shoring up a crumbling primary care base with more money and more tasks.  Proposals and demonstration projects so far make it look like the "Payment" Centered Medical Home instead of the "Patient' Centered one.  There is too much connection with the Medical Industrial Complex (MIC) for the PCMH to really get to the point about patient centered care.  It is a good start, but too bogged down with issues about the electronic health record, reimbursement, "quality", time management, cost, "meaningful use", power and control to leap into a future needed by patients.

Our Center for Innovation in Family and Community Health (CIFCH) proposes that we re-emphasize the human aspects of the patient and the physician to refresh the PCMH model into a more meaningful one that we like to refer to as the Human Centered Health Home (HCHH).  The human to human dyad of the patient- physician relationship allows "neighborly" discourse that protects the pair from some of the distractions and intensity of the MIC.  Their mutual respect allows a better understanding of the context of each other's lives, allowing a better focus on the work at hand.

Start with respect for each other, for the system in which we both function, for our teams, for our colleagues, for our families, for our information systems and so forth. In a context of human to human respect, our other roles of consumer, steward, teacher, leader, warrior, visionary and so forth can be allowed and understood. We spell it the same as Aretha Franklin, maybe even flashing back to hear "RE, RE, RE, RE, RE, RE, RE, RE Respect". Then hearing "Just a little bit. Just a little bit." If we only have a little bit of respect we might only get the "Payment" Centered Medical Home instead of the Human Centered Health Home that patients and Family Physicians both deserve.


  1. What a great point......we can't regulate or pay for true respect...and like any relationship it will take communication, and a foundation of caring to work.

  2. Well - you might not like my alternative but personally I think that we need to take the profit issue out of health care and put the "First do no harm" aspect back in. Since I don't see many family physicians now who understand health care as a calling, I think the only way to get there is a salaried workforce of some type. The moment you start adding fees for service inevitably someone starts inventing more ways to make a profit instead of remembering that "First do no harm" statement. My favorite story is of the lady with breast cancer with only 4 positive nodes. The Cancer Centers of America and the Karamanous Institute in Michigan insisted she should have a bone marrow transplant. Not only was there no evidence that this would make any difference in her prognosis, but within a year or so the data came out clearly indicating that more people died from this approach than were helped. A bone marrow transplant cost at least $75,000. There was no question in my mind that the goal of the institute and the Cancer Centers of America was profit, not people. But I was considered a heartless bastard for even suggesting that this was not only not a proven treatment but that the risk of dying from the transplant at that time was greater than the risk of dying from the breast cancer in the next 5 years. For all the humanity we bring to the table, we are currently grossly outnumbered by those who just want to make a profit...