Wednesday, October 12, 2016

Family Medicine: Paradigm Lost

The new narrative in health care is here.  The alphabet soup of the next era is here.  Technology wins, patients lose.  
I remember the dream.  The dream of living in a small community and caring for its people as their Family Physician. The dream of helping people to be healthy.  The dream of knowing people, science and medicine at the same time in a useful way.  The dream of helping people to know that they matter. 
Then Family Medicine showed up:  "Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences."...American  Academy of Family Physicians.
It was billed as a relationship based specialty.  It delivered.  Over and over.
Then things changed.  It didn't secure its borders and its core.  It devolved with the so-called Patient Centered Medical Home (which could be called the Payment Centered Medical Home).  
It turned away from patients in favor of "Bonus- Based Medicine", aligning with misguided "quality" initiatives run through Electronic Medical Records.  It drooled over "Meaningful Use" bonuses.  It turned into a group of data entry clerks, far removed from thoughts of The Principles of Medical Ethics.  Patient Autonomy be damned.  Employers, insurers and Statins became more important than patients.
Family Medicine went on the defensive and stayed there (with the rest of medicine when the Affordable Care Act pushed medicine passively over a cliff).  
It was "The Counter Culture", a hope for the people to have good health care, pushing against the technology and subspecialty driven approaches that now are bankrupting our nation.
Family Medicine:  Is it time for a Hospice consult?

Or is it time for Direct Family Medicine?  The Family Medicine version of Direct Primary Care?  The New Counter Culture?
It's time to get a paradigm that's on the offensive.  There is only one of them:  The Direct Primary Care Movement.  

1 comment:

  1. Yes. I wish Washington would listen to you......Doug