DPC, PHR, EMR, SoME and a couple other abbreviations

Watching the beginning of a training video for hospital administrators a couple of days ago made my head swim (and I can’t find the link on-line). It began with a gentleman walking his dog. Both he and his pet sustain minor injuries. They are sitting in the living room and his wife counsels her husband to see his doctor for an evaluation while she takes the dog to the vet. She calls the veterinarian office and is greeted with a real person who tells her to bring the dog right in. As she leaves her husband calls his doctors office and I’m already cringing at what I know will follow. Three minutes into the film (where it stops unless you want to buy), the gentleman is still on hold and has repeated his story to two different people. Meanwhile, the dog has already been seen by the veterinarian. This is getting better but it has been my personal experience and I hear frequent complaints from my patients. Fortunately they are less about my office than they used to be, so I think we are making progress. Rare the doctor’s office that has a real person answer the phone. It is discouraging to think that our pets get quicker, more empathetic care than we do.

Most of my Saturday was spent in the VA ER with a friend. It’s always interesting to be on the other side of the examining table. What I observed was the usual mix of caring and apparent disinterested staff. The individual I was with was in such pain he could not sit down. So for thirty minutes he stood, in obvious sight-line of three staff members. There was only one other patient in the waiting room at the time but it still took thirty minutes to get him processed and into the back. Once in the back, same scenario. No physician walked into the room for thirty minutes, it took another thirty to get him any relief. As I sat there being witness to this care, he said to me “Is this what a US single payer system would look like?” My thought was, “Gee, other countries do single payers well but can the US?” My French friends rave about their healthcare. My patients from Canada talk about how easy it is to get in to see their family doctor.

Lately I’m leaning more to changing how we reimburse primary care, rather than a radical change to a government-run payer system. The DPC system that David Chase discusses in Forbes makes sense to me.  As mentioned in previous posts, this is concierge medicine without the concierge price. For me it would be a win-win. I could see my patients for a reasonable monthly fee (which could be paid for by employers or patients) and in return they get more time with me and better preventive care. Add PHR (Personal Health Records), EMR (Electronic Medical Records) and social media to the equation and you have an opportunity for patients to become true partners in their care ( see the link to 6 things patients want from social media here).

Now if I can just convince my employer! 

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