Friday, June 20, 2014

The Family in Family Medicine: The Differential Diagnosis

Part of the fun of a "Families Only" practice is the analysis of information relating to the chief complaint, referred to by physicians as the differential diagnosis.  In the family context, I'm likely to think of the patient as being aligned or mis-aligned with their values, goals and dreams.  Here are two blog posts explaining two models of thought about the differential diagnosis in the family context.

Family oriented differential diagnosis

Family Oriented Differential Diagnosis with Biopsychosocial Model

Just add a direct Primary Care element and you're ready to go- more time to explore in depth issues with patients and discover wonderful possibilities.

More later.

Tuesday, June 17, 2014

Families Only Practice: Thirty Four Years Experience

I have 34 years experience with a "Families Only" practice.  It's been very fulfilling.  I've now combined the traditional practice with a Direct Primary Care Families Only track- referred to as a hybrid practice (traditional and DPC).

I'm speaking about this at the DPC National Summit June 20-21 (I speak on the 21st) in Washington, DC.

I've posted about 8 posts about the Families Only model and mentioned it from time to time on my BlogTalk Radio Show on the internet.  The first post was:  Family Fanatic :Families Only Practice in April, 2010 providing the setting in which I started that practice.

 Have fun using the search function in Dr Synonymous blog to find the Families Only posts.

Happy Hunting.

More later.

Friday, June 13, 2014

Honoring Patients and Doctors, NOT Centering One of Them

There's lots of concern about patient centering and patient engagement these days as confusion driven by healthcare transformation increases.

"Payment Centering" is a better way to translate patient centering. Much of what's happening in healthcare is due to the EHR or EMR, that in turn is about coding and billing.  It's ALL about billing, folks.

"Bonus engagement" is how many in "The System" feel about patient engagement.  The physician is so distracted by the EHR or EMR with its lists of quality initiatives, many of which lead to physician bonuses, that it's hard to relate to the patient's main problem.  "Non-Compliant" is every patient who doesn't align with the bonus potential for their physician.

As I've written before, Human Centering is one way around the PCMH, EMR, EHR, coding and billing traps.

A Human Patient and a Human Physician relate as Humans through Human connection and Honor each other.  

Honoring each other as Humans and trusting each other as Neighbors works better than putting either one in the center. Likewise having one of them bill the other one for every utterance or add extra problems beyond the reason for the session for the other one to solve are more dishonoring.  Honoring patients and doctors as Humans leans in the right direction for the future of health care.

How might it be done?  Direct Primary Care is one way to have the time to listen and Honor each other.  Independent practice may also contribute more opportunity to listen and Honor each other.

What do you think?