Wednesday, May 7, 2014

Direct Primary Care: Challenges and Pitfalls III

OK, We have a phone "schpiel" to present to potential new Direct Primary Care patients who call.  It takes about three weeks or five separate new patient calls for an individual staff member to get "calibrated" in our front office to the DPC patients.

Remember that we are a "niche" practice - "Families Only!"  I believe in Family Medicine!  I love it!  It works!  Families are amazing!  They know something about each other and their culture/identity.  It fits nicely into Family Medicine practice.

How does that translate into medical practice?  Perfectly.  How many people understand that?  Few.  The founders of the specialty stumbled onto "The Family" but didn't really understand the potential.  (I spoke with G. Gayle Stephens at length about this).  I digress because the "Families Only" approach has made my experience in Family Medicine so enjoyable and meaningful.  I hope that others try it and learn one of the secrets of the specialty.

Direct Family Medicine (DFM) is what I practice in a Direct Primary Care business environment.  Each new patient has to be "vetted" to clarify if we can continue, once they show up for their first.  As I mentioned before, I have a contract with government health plans such as Medicare and Medicaid that preclude me treating patients in different financial ways. No one can make a separate financial arrangement with me about those patients.  The "Pure DPC" physicians don't have to worry about this.  Many patients on these plans see DPC physicians and pay them their fees to get the personalized care and extra time.

We have a one page summary of Direct Family Medicine that we review with each patient- twice if possible because they are too busy with forms, etc. to grasp the details on the phone and at the initial visit.  Relationship-based, Continuous, Comprehensive care of the individual patient and their family who resides  in their home is the base/ anchor for my practice.  We offer care for prevention as well as acute illness/ injury, as well as chronic disease.  Physicals are part of the prevention strategy.  We use the MilCom patient history forms to organize the initial information about each patient, providing discussion starter information and a place to scribble notes.  (EMR aspects of this later).

After the initial visit, persons with multiple problems or chronic diseases are usually scheduled for one or more follow-up visits to "peel the onion" of chronic disease and hear their story.  The time available in DFM is generally more than in traditional practice.  They also are more likely to align with the prevention and health strategies than the traditional practice patient.  In the traditional part of my practice, it's more difficult to have people come in three weeks in a row to get through their whole story and sort out the diseases and medications and their impact on individual and family life, goals and dreams.  This is not a superficial undertaking.  Burrowing with someone into their living room their life and their DNA to clarify and develop differential diagnoses using the biopsychosocial model helps me to form the patient physician relationship and develop direction and mutually agreed to outcome goals.

If it was easy, it wouldn't be so much fun.

More later.

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