Tuesday, April 1, 2014

Measuring Quality in Direct Primary Care: Let Patients and Physicians Define it Together

One challenge with the DPC "solution" is the freedom enjoyed by the early adopters of the concept as they frame the potential for a dominant design.  There is still some radical innovation at the edges that should be allowed to play out before nailing down the center of DPC.  Honoring the sacred nature of the patient-physician relationship anchors the potential for personalized quality parameters that exceed some of the phony, but measurable, drivel currently being forced on family physicians and their patients (e.g.,statins for everyone who ever stayed at a Holiday Inn Express). 
While others, such as Harold Sox commented on the need for dyadic defined quality parameters in JAMA a couple years ago, complemented by more recent JAMA comments from Mayo Clinic echoing the same need,  Family Medicine has fallen behind in our responsibility to measure quality through dyad driven parameters, sometimes drooling over A1C's as Godly annointed quality truths while ignoring the beauty of the ongoing patient-physician relationship which has quality defining potential of radical proportions. 
Which is to say we should encourage presentation of DPC quality parameters that show the uniqueness of the model and its fans/ practitioners.  Human values manifested through pt-phys relationships into human outcomes could refresh some of the dullness of the EHR as well as patients and physicians.  This is what we do daily in Family Medicine and it's extremely satisfying.  With the time allowed in most DPC settings, it can continue, and improve.  Onward.

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