My Ideal Healthcare Experience

Recently someone very dear to me had a disappointing experience. She saw a physician's assistant at group health who did several disparaging things...

• He criticized diagnosis made by her regular physician in front of her.
• He didn't listen to her concerns about shoulder pain and her previous history.
• His critical manner and disparaging comments made her feel as though she was crying wolf.

Needless to say she won't be seeing this physicians assistant again however hearing about the episode got me thinking to what an ideal health care would be so here it is...

My family would have a long-term relationship with a highly competent family practitioner. That family practitioner would see them selves as physician, trusted advisor and most importantly partner in helping manage all aspects of healthcare for my family. They would be comfortable with the level of knowledge and more complex questions that they receive from us as we learn about our own health online, willing to discuss what we have found and open to hearing us explore different options. Their guidance would be spring from evidence based best practices that are consistently communicated and applied across the discipline with tweaks as necessary that account for the individual characteristics of my family members. As a partner there would be other avenues of communication than having to schedule a visit, reducing the amount of visits necessary.

Implication

• A model of compensation that allows family physicians the flexibility to care for their patients in this fashion.

In the case of an emergency for one of my family members we would arrive to an ED that rarely had long lines/wait times and where the physicians on duty had easy access to their medical histories. Our family practitioner would automatically know about the episode and when necessary collaborate with hospital and ED physicians on the right plan of care. Again, the ED and hospital physicians would make heavy use of evidence based best practices with an understanding of the individual patient. This would all apply in the case of hospitalization sans emergency admit, i.e. giving birth...

Implications

• A model where healthcare coverage and/or urgent care clinics replace the overwhelming use of EDs as a surrogate for family medicine.
• A mechanism that allows easy ad-hoc collaboration between hospital and primary care physicians.
• An acute care setting reimbursement model that rewards hospitals and physicians that utilize evidence based care.

In the case where a member of my family has to grapple with a chronic illness or condition the family practitioner would recommend and collaborate with the right specialists to develop a plan that focused on the well being of the patient. Updates to the patent's history would be available to both physicians as needed and the family practitioner would have easy access to the treatment record as well. Again the baseline for the care plan would be evidence based best practices with changes that are necessary for the individual situation of the patient. Communication with the specialist would also not always need to occur via an encounter/visit and it would be easy for patient, family practitioner and specialist to have dialogue outside of the office setting.

Implication

• A reimbursement model for specialists that rewards the use of evidence based care.

Global Implications

• Medical schools would need to begin training physicians towards newer highly collaborative models of care where they collaborate both with other physicians and their patients.
• A industry mechanism for identifying, deploying and educating physicians about evidence based best practices.
• Medical history and updates need to flow seamlessly to and from all settings on demand. THERE IS ONLY ONE PATIENT RECORD PER PATIENT.
• Mechanisms for physician and patient collaboration need to be made available and easy to use outside of the office visit setting.
• Healthcare insurance is available to all Americans.

What does your ideal healthcare experience look like???