Wednesday, December 22, 2010

Family Medicine: Influential with Patients, Hospitals and Employers- Let's Talk!

"You are a scarce, valuable resource," I told my colleague about 20 years ago when he felt rejected by the local hospital when bumped out of the practice he had served since proudly joining the family physician who had delivered him and cared for his family.  He was inspired by the man who had served the community so well, eventually for over fifty years, and became a family doctor, just like his role model and mentor.  Now, he saw the practice, in the neighborhood where he grew up, that he inherited at his mentor's retirement and merged into the hospital network to help with recruitment and management, redirected away from his philosophy of care toward hospital corporate values.  What happened?  Why did they close the office and order him to take the patients and practice where another recently trained family physician had been placed in practice two years ago in another retired physician's office in another neighborhood?

Hospital administrators think differently than physicians.  Family physicians may even think differently than many other physicians.  We care about our patients and their well-being.  We haven't taken the time to verify our thought processes and our differences with hospital managers and other physicians.  We need to clarify our similarities and differences now, though.  We have to find our areas of mutual interest and mutual misalignment.  We have to agree to disagree on many issues because of differing philosophies and business models.  A creative tension between family physicians and hospital leadership benefits patients and the local economy.

Hospitals need to fill beds, CT scanners and cardiac cath labs.  Patients don't want to fill them unless there is a clear need.  If there are excessive medical resources such as CT scanners and cath labs, there will be a push to fill them by changing decision thresholds to use them.  The creative tension between family physicians and hospital leaders can serve to find a balance in use of resources.  As the family physician becomes a more scarce, valuable resource, their influence in hospitals is needed even if their presence is diminished.  We are one of the keys to decreasing re-admissions of patients.  We are key influencers of how our patients use health care resources, e.g. which hospital they relate to and where they go for physical therapy.  We are key translators of healthcare system intentions to our patients.  We are important communicators with small employers and some large employers in communities.  We are trusted.

Let's get some better communication going between family physicians, hospitals and employers.  It will better serve our patients and communities.


  1. I agree entirely. Instead of millions invested in a Future of Family Medicine that focused on family medicine, an atypical FM response, family medicine should have instead marketed a future for patients in need of FM docs. The marketing plan would have been "FM or For Me or For My Care" indicating that family physicians are first of all for their patients. The TransforMed floor devoted to FFM would be named TransforMyCare suitable for all FM docs and illustrating their key role. A primary activity would be supporting the value of family physicians in their locations, including FM docs facing growth of local hospital and specialty docs and being marginalized in the process.

    Bob Bowman

  2. I also wholeheartedly agree. Organized FM has been misguided in attempts to "save the specialty.". Rather if we clearly advocate for patients, since the product we deliver is superior in regard to patient oriented outcomes, we will do very well. After all, is not patient advocacy "why we are here?"

    Stand for the patients.

  3. Dr Bowman and Dr Melahn, Thank you for your comments. This is a challenging time for family physicians and our specialty. We've initiated the charge with the PCMH, which initially looked more like the "Payment" Centered Medical Home, but is evolving.
    I work with a group that is developing the Human Centered Health Home (HCHH) to get better focused on the work of the dyad: patient and physician, starting with a human to human focus. Several previous posts here address this.
    The internet makes for faster evolution of ideas and models to get patients connected where they can make their best health decisions, with a personal family physician. You both made helpful comments about where we are and where we should be headed. Thanks again.

  4. Pat, Once again I find myself in agreement with your viewpoint on these issues before us. I recently had an unusual post op complication. It was a late post op hemorrhage causing diplopia with no obvious external signs of hemorrhage. While we were convinced it would resolve, as time dragged on, we decided to gain some reassurance for the patient by getting a second opinion. After an MRI and then a CT scan, our diagnosis was confirmed. Based on the findings of those two studies, there was a sense that surgical evacuation of the hemorrhage might be indicated. We encouraged the patient to defer further surgery despite opinions to the contrary. In the end, the condition rapidly resolved without intervention. Now, in followup with the consultant, additional MRI and CT studies have been recommended to confirm complete resolution and ensure the hemorrhage was not related to an unknown "other problem", such as an orbital tumor. With the patient very happy with the result of her cataract/IOL procedure, thrilled with the resolution of this unusual complication, she now has to deal with the possibility of this other "unknown other problem." For me this goes back to the old adage, if you hear hoof beats, think horses...not zebras! We have the ability to help but also the ability bring unnecessary concerns into the lives of our patients. I opt for the more common sense approach. Less is often more!
    Have a blessed and meaningful Christmas!
    Your "old" old roommate, Alan