Tuesday, October 2, 2012

The Human Centered Health Home: Respect Revisited

I'd like to revisit and upgrade the Human Centered Health Home model of care, developed through the Center for Innovation in Family and Community Health (CIFCH) and years of practice and collaboration with others, especially Larry Bauer since our days at the Hershey Medical Center.

Here's the original first post about the HCHH:

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.

NOW, in October, 2012:  Respect is even more meaningful as we move ahead into healthcare transformation.  If the human dyad of patient and physician respect the context of their engagement and each other, that may be a good start.  Respect may allow enhanced communication and understanding of their relationship-based, shared endeavor.  It may enable a mutual honoring of the attributes of the other and the self in their shared roles.  The respect may lead to increased commitment to protect each other and their medical neighbors, even if it means standing up to the Medical Industrial Complex and its money sucking ways.


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