The transition to a patient-centered medical home model at the Open Door Family Medical Health Centers(www.opendoormedical.org) in Westchester County, New York, has been an incredible paradigm shift for patients and physicians alike. The Family Medicine Interest Group (FMIG) at New York Medical College got a look inside from Dr. Daren Wu, chief medical officer of Open Door.
The health centers' transition began before the recent concept of PCMH made it big. Dr. Wu said he felt stuck in a hamster wheel, adoring the breadth of the patient presentation in family medicine, but without enough time to discuss prevention, healthier lifestyle, and critical patient education. The centers' providers started working together to gradually adapt the many foundational underpinnings of what it takes to be a better primary care practice, Dr. Wu said, but they didn't know at the time that what they were creating was a medical home.
"All we knew was that to improve patient care, to improve patient satisfaction, and our own satisfaction as clinicians, we had to get off the hamster wheel of modern medical care," Dr. Wu said. "When the idea of a PCMH came rolling along, it was not so much an organizational need to work on a project to become one. Rather, it was recognition of what we had become."
What the practice had become was much more focused on quality, both in the clinical sense as well as patient perception of their own care. The focus was in doing a far better job of primary care, including prevention, chronic disease management, and care integration.
"Being a PCMH essentially resurrects the promise of what primary care held for all of us who entered into the field in the first place, only to find a darker reality," Dr. Wu said. "It has helped place what is important first and foremost -- patients -- and in the process is revitalizing the specialty."
PCMH is a customizable model, not a one-size-fits-all solution. However, the business aspects of a not-for-profit community health center like Open Door and a large for-profit private practice are more similar than most would think. They share a common culture of physician-driven team care that embraces care coordination and patient education as core values.
"The patient is involved in as many steps along the way as possible. It's not so much negotiating with the patient on a care plan, as some often describe it," said Dr. Wu. "Rather, I think it's quite basically a matter of just figuring out how to enlist the patient in his or her own care, and finding out what the patient can achieve and commit to."
Gabriela Sanchez, a third-year medical student at NYMC and president of the school's FMIG at the time of the presentation, said an increasing interest in primary care on her medical school campus is strengthening interest in the PCMH model. Medical students want and need to be exposed to the ways in which primary care physicians practice now, and how they will practice in the future.
"The idea of a medical home makes a lot of sense, and the data certainly back it up," said Elizabeth Doran, a third-year medical student at NYMC and vice president of the FMIG at the time of this presentation. "But I'm always thinking about whether [primary care] is a field in which I will be happy, or feel fulfilled and challenged, or, on the contrary, whether it will be completely overwhelming. Finding real life examples of places and people that are making it work certainly helps define the field a little bit better, and lends a bit of encouragement along the way.
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